On the wards and in the intensive care units, the pandemic is as bad as it’s ever been. Jon Williamson, an anaesthetist, has been there with his camera
The vaccines have arrived, but the struggle continues for Covid patients like Geoff Woolf – and for the doctors, nurses and support staff who treat them.
I’m an anaesthetist at a London District General Hospital and, over the past year, I’ve been bringing my camera into work to capture my colleagues as they battle against this pandemic. It is, for everyone involved, a high-pressure situation. The stream of new patients never seems to relent, and it has been particularly ferocious over the past two months. Worse, in fact, than it was during the first wave of the virus last year.
If I had to pick out just one emotion from the swirl of sadness, tiredness and camaraderie, it would be determination. The systems are in place, people know what they’re doing, and they’re getting on with it.
Above, this is the effort that goes into proning a Covid patient; that is, turning them on to their front. Everyone in the team helps out – the nurse-in-charge and the intensive care consultant are shown closest to the camera – as a sheet is slid beneath the patient to first move them to the side of the bed, then on to one side of their body, then finally on to their front.
Here a doctor runs through a checklist for proning, making sure that everything has been done correctly. Meanwhile, the team prepares cushions to place under the patient – under their chest, pelvis and legs – for padding.
At the time of this photo, all the patients in our intensive care unit (ICU) are suffering from either Covid itself or Covid-related illnesses. And yet there is still a need for ICU care for patients with other illnesses. This presents a significant logistical challenge: with hospitals working together to try to keep patients separate, to find extra space and extra staff. This, of course, can only go on for so long before the entire network of hospitals reaches capacity.
A nurse listens into the daily briefing from a patient bay, while another nurse cares for a patient.
An ICU nurse prepares a bed for a new patient – the red sliding sheet is there to help move the patient over from their trolley. The bed has become available because its previous occupant passed away. Any bed space is immediately filled.
The NHS team is huge and wide-ranging – it’s not just clinical staff. Here a porter is seen with anaesthetists, helping to safely transfer an intubated Covid patient from the emergency department to the ICU, and to the bed that has become available.
A physiotherapist listens to a patient’s chest. Chest physio aims to remove mucus and secretions from the lungs by a variety of techniques, helping the lungs to expand and distribute oxygen more effectively.
An ICU professor does the ward round, checking the charts that explain a patient’s physiology, ventilation and drug infusions, among other information.
A whole new patient transfer service was set up in my region just to cope with the strain on the system from Covid-19. It has helped smaller hospitals offload patients into the larger centres that have had to massively increase their capacities.
Here a patient is being moved from an ICU bed and on to a trolley, ahead of being transferred to a different ICU at a neighbouring hospital. An anaesthetist at the patient’s head holds the breathing tube in place, which is itself connected to the ventilator by the red tube snaking across the room. At the far end of the scene, an ICU health worker holds the patient’s drug infusions.
The patient’s vital signs are checked and the necessary paperwork filled in for the transfer.
An anaesthetist checks the “transport ventilator”. A patient can become unstable when switched on to a new (and sometimes less sophisticated) ventilator; the whole process is, for many reasons, physiologically challenging for them. We try to select the “most well” of these very unwell patients for this sort of transfer.
There’s so much equipment required that it can be a tight fit to get out.
Meticulous planning goes into transferring a patient, especially an intubated one unwell with Covid-19. Due to this, we use special checklists and highly skilled individuals have training in transferring patients. Here they are set up in the back of an ambulance.
Two senior nurses involved in the ICU outreach team review the long list of particularly unwell patients on the wards. Patients receive further specialist input and, with ongoing clinical monitoring, can then be transferred to ICU if required.
An ICU nurse does the calculations for drug doses during her night shift.
A portable X-ray machine is positioned so that it lines up with the recording plate behind the patient. Later, a desk lamp illuminates ICU staff as they work. The main lights have been turned off to help patients maintain their day-night patterns.
An ICU nurse and helper sit opposite their patient bay during the night shift. This one bay contains two patients. We refer to it as “doubling up”; phrase unfamiliar to me before the pandemic.
After de-proning – that is, moving a patient from their front to their back – the anaesthetist suctions the breathing tube to make sure that it has not become blocked or kinked.
Transferring an intubated patient from ICU who needs to have a CT scan to check for blood clots on their lungs. Even this type of “intra-hospital” transfer – as opposed to the “inter-hospital” version shown earlier – requires a lot of planning and the involvement of specialist staff.
Elsewhere, a patient who had been intubated earlier in the day is seen through the window of their isolation room.
A mixed team of two anaesthetic registrars, an ICU nurse and a medical student prepare for “head turns” – when a proned patient’s head and arm position are changed to face the opposite side, to reduce the risk of pressure sores or nerve injuries.
An anaesthetic registrar and observing medical student check the patient’s new position so as to avoid pressure on the eyes and other key areas, as well as making sure that the breathing tube has not become obstructed.
Another anaesthetic registrar changes the oxygen levels on the patient’s ventilator after the repositioning.
Lifting up a patient by their shoulders, so that a head turn can be performed. It’s tricky moving the patient’s head, as the breathing tube needs to stay exactly in place, while the tubes supplying drugs and nutrient feed can also get pulled out if not careful.
An anaesthetic registrar pauses after completing the physical and often challenging procedure of head turning, the second time during this night shift. So far, the team has spent three hours of the night dedicated to this task.
Dr Jon Williamson is an anaesthetic registrar training in London, with an interest in photography, expedition medicine and medical education. His photography has been published by Photo London 2020, Tortoise, ITV, Channel 4, Channel 5, NBC and Sky. He continues to engage the public with ongoing photography and insights on his Instagram @drjdwilliamson. More of his work and updates can also be found on his website.
All photos and text © Jon Williamson