Lokiru Paul : Life, death and humanity on a Covid-19 ward: ‘We thought we were ready. But we were overwhelmed’

GQ HYPE

By Giles Duley25 May 2020

Award-winning photographer Giles Duley spent a fortnight capturing the response to the coronavirus across three NHS hospitals. This is what he saw

For two weeks I’ve been documenting the response to Covid-19 by Imperial College Healthcare NHS Trust in three hospitals: Charing Cross, St Mary’s and Hammersmith. From A&E to the laboratories, admin staff to intensive care unit (ICU) nurses, the first ward to be switched to a Covid-19 cohort and heart surgery, I’ve seen the complex, multidiscipline response to this crisis by the NHS.

What strikes me most is the professionalism and calmness and, most importantly, the sense of being a team where every player is crucial. After one meeting a nurse pulls me aside and says, “Please make sure you document the work of the cleaners. They’ve been amazing,” after another, a junior doctor, asked me to make sure I focus on the nurses. Everybody is full of praise for their colleagues. Again and again I’m told, “I only got through this because of the support of my team.”

Staff at Charing Cross Hospital A&E. At the change of each shift the teams gather to share information. The response to Covid-19 is constantly evolving and staff need to be aware of new procedures and protocols, 11 May 2020

This project has particular meaning to me. Following an accident in 2011 – I stepped on an IED while out in Afghanistan working as a photographer – I spent a year in hospital, much of that time in wards of the hospitals I’m now documenting. Some of the staff I’m now working with were responsible for saving my life. Indeed, it was they who asked me to come and document the hospitals during this unprecedented time. It was the 46 days I spent in an ICU, much of that time on a ventilator, that left the most traumatic memories and returning was not an easy decision. The nightmares from that time have never left me.

Staff on the night shift at St Mary’s paediatric ICU (PICU) check a patient’s monitor, 8 May 2020

To enter an intensive care unit at night is to enter a place of ghosts. It is a place between life and death, where patients’ lives are maintained by machines and drugs that take over many of the body’s functions. The doctors and nurses, like modern-day alchemists, control the ventilators, drips, PICC lines, feeding tubes, medications and monitors that sustain life. It’s a process that doesn’t stop; even throughout the night a patient’s bloods and vital signs are recorded and analysed and adjustments are made. There is a constant whir of servos, bleeps and alarms; lights flash and monitors record the slightest change in vital signs.

Dr Sabeena Qureshi holds the hand of a ventilated patient in St Mary’s PICU, 8 May 2020

This work was hard enough before Covid-19 but now the task is a brutal physical battle for the ICU staff. Scrubs, gloves, apron, shoe covers, disposable apron, mask, visor, second gloves and then tape must all be donned before entering the unit. It’s unbearably hot and hard to breathe through the mask; even the simplest of tasks is exhausting. Like a Grand Prix driver, the staff are pushed to the limits of endurance while having to stay alert, as a moment of distraction could prove critical to a patient’s survival. As the PPE takes so long to remove it’s impossible to stop for a sip of water or to take a toilet break. The teams are working 12-hour shifts, often with only one break.

Emergency technical assistant João Carlos Ruivo Alves steps into the ‘red zone’ (for Covid-19-positive patients) at Charing Cross A&E, 11 May 2020

A Covid-19 intensive care unit is brutal: the stark environment, the physical strains, the knowledge that some patients won’t survive. Yet, despite all this, what I find in these units is the greatest of humanity. The staff go about their work with professionalism and focus. They are the strongest of teams, all supporting each other and, most movingly, they treat their patients with such compassion and dignity.

At Charing Cross Hospital A&E, staff nurse Mhelody M Castillo prepares a patient for a swab test that will determine if he is Covid-19-positive, 11 May 2020

As the doctors do their rounds, even though most patients are in induced comas and those conscious are barely responsive, they take their time and talk to their patients, hold their hands, comfort and encourage. The nurses, despite being under so much pressure, do the same, always explaining what they are doing, looking into the eyes of their patients as they inject drugs through the PICC lines or take more bloods.

The night shift team in St Mary’s PICU discuss the treatment of a ventilated patient, 8 May 2020

One patient has been taken off the ventilator and is slowly waking from his induced coma. Confused and disorientated by the drugs still in his body and unable to speak because of a tracheostomy, he taps on his phone. No personal items are allowed in ICU – the staff must leave their mobiles and even ID cards outside – but the one exception is each patient has their phone with them. As no family members are allowed to visit, this is their only connection to the outside world and their loved ones. He taps the phone again and sister Amy Hunter picks it up. “You want to speak with your family?” Hunter asks. The patient’s eyes widen, pleading silently. Sister Hunter tries to unlock his phone but is unable. The patient is still too weak to do it himself, so the nurse places it back down beside him and squeezes his hand. “We’ll figure it out, I promise. Till then I’m here.”

The ICU night shift team at St Mary’s PICU dons PPE before entering the unit, 8 May 2020

“This pandemic felt like a huge wave that was going across the world and it was going to hit us like a tsunami. I think that time waiting was the most terrifying thing for me,” explains Dr Sabeena Qureshi. Normally, she is a consultant paediatric anaesthetist at St Mary’s Hospital, but as the Covid-19 spread, her ward was switched to an adult ICU.

Cleaners Rene Molinga and Raj Ramgi disinfect one of the bays in Charing Cross Hospital A&E, 11 May 2020

“In our network we were hearing of hospitals that were suddenly, overnight, overwhelmed by patients that were intubated and put on ventilators and we knew it was going to happen. We were ready, we were set up and then it didn’t hit for about a week and we thought, ‘Maybe it’s not going to happen?’ But that was the calm before the storm – literally the tide going out before the tsunami hit. And then it hit.

St Mary’s PICU, 8 May 2020

“Although we had been told by our counterparts in other countries ‘these patients are really sick’, I don’t think we really understood. Then the first patients came and we knew. We knew as doctors and nurses that whatever we did these patients were getting worse. We were overwhelmed by the number, how sick they were and that they all came in at the same time. We thought we were ready and then we realised we had no idea. I don’t think we realised quite how infectious the disease was and quite how devastating it was.

Jacinto Mendoza, a cleaner, with staff nurse Cora Cosmod at Charing Cross Hospital A&E, 11 May 2020

“It was amazing how the nurses coped, because they are the majority of the staff in ICU. It was a very coordinated effort. And although things were changing rapidly day by day, we were ready to adapt. In the morning our plan was maybe X-Y-Z; by the afternoon we’d be back to the start of the alphabet and off again, rewriting the book.”

At St Mary’s PICU, lead nurse Amy Hunter tries to unlock a patient’s phone so his family can speak to him for the first time since coming off a ventilator, 8 May 2020

This first wave did get close to overwhelming the NHS. This virus is complex, aggressive and still not fully understood. And, for the teams, they are dealing with the realisation that what started as a sprint is turning into a marathon. The analogy most used when describing it to me is the Aids epidemic; patients often present with confusing and unique symptoms.

Emergency technical assistant João Carlos Ruivo Alves taking bloods in the red zone of Charing Cross A&E, 11 May 2020

In the worst cases it seems to be the body’s own response to the virus that is proving fatal. The most serious cases are a puzzle that deeply challenges the clinical staff. I’ve documented frontline hospitals in warzones, Ebola outbreaks and worked with medical NGOs in other humanitarian crises and this virus is deeply worrying. This is not the flu. An uncontrolled second wave or a slight mutation of the virus could be catastrophic. As for the potential devastation it could cause in developing countries or packed refugee camps, it’s unimaginable.

Cleta Ng, a senior sister at Charing Cross Hospital A&E, takes a call about an incoming ambulance with a suspected Covid-19 patient, 11 May 2020

The majority of the staff I’ve met working on these wards are uncomfortable with the word “hero”. It is, of course, used with best intentions, but they are worried there is a danger we forget that the staff are human. Cleaners, porters, nurses, doctors, admin teams, lab technicians – all the staff have been under huge physical and emotional stress these past months and many will need support in the months ahead. They also need us to do our part in making sure they are not again faced with the level of pressure reached at the peak.

Politicians and media constantly use the analogy of this being a war and the NHS staff being at our frontline. I have witnessed war and I can tell you that this is the opposite. War is devoid of humanity. It is inhumane and cold. What I see in these hospitals is all that is good in humanity. The hospital staff, despite all their challenges and fears, go about their work with calmness, professionalism, compassion and dedication. They are the best of us and I feel humbled to have witnessed their work.

Lokiru Paul

Monday, 25 May 2020

Life, death and humanity on a Covid-19 ward: ‘We thought we were ready. But we were overwhelmed’

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