Fri. Nov 18th, 2022

Some of the images have had details blurred, in order to protect patient identity.
When I started getting fitted for my PPE next to the Covid ICU ward I realised what I was doing. What a privilege I have to see what really is happening and form my own conclusions. My first impressions were: this is real, the people looked ill, in danger and in doctors hands. Doctors and nurses were running around but also in contemplation. I saw one doctor just looking at a patient with his hands on his hips. I could almost hear him think.
I have seen lots in my 25 years as a photographer. Wars, famines, suffering and disease, but the atmosphere in the ward was something I had never experienced. Only nurses and doctors speaking medical terms with no chatting and no families or faces to be seen. All I could hear were machines bleeping and squeaking of peoples shoes walking in corridors. No moaning, crying, no emotion. If you looked at the patients, they seemed white like ghosts. I went to work. I went home that night and stayed up until 5am. Its a worry, as the people I photographed looked young and fit. The youngest and most poorly I photographed was 9 years older than me. Graeme Robertson, photographer.
Stretched to capacity, University College Hospital London put out the call for medical volunteers to help. Among those who took the plunge into the physically and emotionally draining world of the Covid-19 intensive care unit were the consultant endocrinologist Dr Helen Simpson, 52, and the fourth year University College London medical students, Seyi Adeleye and Theo Reback, both 21.
Seyi Aleleye | Fourth-year medical student
Thats what I signed up for as a medic, said Aleleye, who has found herself supporting exhausted nursing staff. And it has been a baptism of fire.
You sit there, repeating, ‘Youre OK. Youre safe. Youre at UCH’
Practical tasks, such as taking vital observations, drawing up drugs, assisting in turning patients, cleaning them, disposing of urine and faeces, allow her to lessen the load on over-burdened nurses.
On her third day, a patient deteriorated and their family came in. Aleleye knew the prognosis. It was hard to see. You keep it together while youre there. But coming out, I just stopped and had a little cry. Two days later, the patient died.

  • Seyi Aleleye cares for a patient on the Covid ward, and below, has a moment with her patient.

It wasnt until some time later she sat down and thought, I saw someone take their last breath. That is crazy. That is something Im still processing and will continue to process what that means.
The most emotional times are when staff facilitate FaceTime calls between a patient and their families. And you get to hear the families. One particular case was really hard because it was a younger patient, and they had a little child and hearing the child sing to their parent. That is hard.
Often the patients are asleep. You sit there, repeating, Youre OK. Youre safe. Youre at UCH. Some are conscious, but tubed so cannot speak. So its finding ways to communicate.
But on another day she witnessed a patient being extubated, now on their way to recovery, and who later managed to walk out of the hospital. And that made me cry as well, because you dont see as many of those, and to know they had been discharged was amazing.
Dr Helen Simpson | FRCP, PhD Consultant
Helen Simpson, in addition to her job as a consultant endocrinologist at UCH, is now volunteering to assist in ICU. These are the sickest, the ones where over 40% will die.
I can have two people, and I look at them and think, Well, its 50:50 odds. Essentially one will die and one wont. And I have never worked in an environment with 50% mortality rate before.
Theres a lot of death going on, and there are exhausted staff as well.
Youre basically non-stop once you hit the floor, she said. Working in full PPE which she has done at times for six hours without a break is very hot, sweaty and claustrophobic by the evening. Its tiring even talking as voices are muffled.

  • Helen Simpson has her best moment of the day when her patient smiles at her. It makes it all worth while

Shes been profoundly struck at how Covid-19 has highlighted societal inequalities. The patients she sees are frontline workers with no option but to work. Its the Uber driver, bus drivers, restaurant workers, delivery people, security guards. People think its old people dying. Everyone Im looking after is in their 50s and 60s.
I can have two people, and I look at them and think, ‘Well, its 50:50 odds.’ Essentially one will die and one wont. And I have never worked in an environment with 50% mortality rate before
Dr Helen Simpson
In ICU, you see what its doing to families. If your loved one is dying, and you get a 15-minute video call, and can only visit end-of-life, its really hard to see that burden of suffering.
She worries about the long-term toll on health workers, at the coal face now for a year, who will need time to recover and process. She is angry at rule flouters, and at some government decisions.

  • After a 8am-9pm shift Helen Simpson, exhausted, is delighted to take her PPE off.

But there are positives: the amazing team work, the speed at the hospitals adaptability. And when, in this almost inhuman world of ventilators and Cpap machines, she get the chance to see the person, not just the patient, such as one woman who was taken off the ventilator and placed on a breathing tube. And she was able to smile. Its a real boost, to see this person awake and smiling. You see the person that they are.

  • Helen Simpson near her home having a rest day.

She escapes by walking and cycling. I try to get out for the nature.
Theo Reback | Fourth-year medical student

  • Theo helps with proning a Covid-19 patient.

Theo Rebank found he was unprepared for the wide age range of those he is helping. One of the patients a woman in her later 20s really resonated to him. That was quite a shocking experience.
I will carry this experience with me into my future clinical career I will think back to a cold, wintery day in January 2021 when I suited up in full PPE and entered into a room full of a virus
Theo Reback

  • Theo Reback starts his shift. He changes in to his PPE.

Another tough moment is when families see loved ones on ventilators over video calling, he said. You can hear, the first time they see them, and it is an absolute shock.

  • Reback helps with proning a Covid-19 patient proning is the process of turning a patient with precise, safe motions from their back to their stomach to help get more oxygen into the blood.

He has witnessed much, more than most in their early 20s. One patient, on a ventilator, was on videocall with her family. It was heartbreaking to see her young son say, Hi mummy, I miss you. She could hear him but was unable to respond and could only open her eyes.

  • Theo Reback cares for Covid-19 patients.
  • Theo Reback has a break and takes his PPE off

One special moment was when another patient, on a ventilator for about 40 days, was woken up. He had a tracheostomy tube still in his throat. And I said his name, and asked if he could hear me. And he nodded. This was his first interaction with people. He was only able to nod. That was very special. It makes you feel like its all worth it.

  • Shift finished and Theo gets on the tube home.

I will carry this experience with me into my future clinical career, he said. When I feel outside my comfort zone whether that be on my first day as a foundation doctor or may be one day as a consultant, I will think back to a cold, wintery day in January 2021, when I suited up in full PPE and entered into a room full of a virus which I had spent the last 8 months doing everything possible to avoid, driven by a deep desire to do my part.