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'I cry a lot on the train home': London medics fight to save Covid patients

Tom Pilston, with Denis Campbell
·8-min read

As you approach the imposing tower of University College hospital on Euston Road in London, bathed in low winter sun, all seems normal. Except, possibly, the road itself is a little quieter, fewer cars, less traffic, less noise. It is only when you get inside and on to the wards that any semblance of “normal” disappears.

  • Staff on the acute medicine unit work in several layers of personal protective equipment, depending on their role.

That is not to say that the Covid-19 wards are frenzied or chaotic. Far from it. Figures in head-to-toe PPE are methodically going about their business without complaint and with compassion, hour after hour, to keep people alive. Sometimes succeeding, sometimes failing.

The sights and sounds of these wards stay with you long after you leave. The now-setting sun slants across London and into the wards, alighting on a nurse’s concerned eyes behind her visor and the face of an unconscious man on a ventilator, head to one side.

  • Nursing assistant Stuart Walker calls to a colleague on T8, an infectious diseases ward at University College Hospital.

The rhythmic bleeping of machines and monitors rises above the constant mask-muffled murmur of voices. Clinicians of all description often talk to their unconscious patients, a kind word or an apology for an uncomfortable procedure.

  • Acute medicine consultant Dr Ben Lovell talks to patient Jay William about his recovery.

Dr Ben Lovell: consultant in UCLH’s acute medical unit

“In 16 years as a doctor I’ve never seen things as intense as they are now. It’s just the sheer volume of patients coming in. We’re admitting three or four times as many patients a day as we’re used to doing but we’ve not been able to increase staffing because there are no spare staff. Every day we think we can’t have more patients coming in than we did today and then the next day it’s another 50% higher. That’s exhausting the resources we have and exhausting the people in the NHS who are trying to keep up. And some of us feel like we’re sinking.

“Some patients who come in are very sick, others need only a little bit of treatment. Those who are very unwell always have breathlessness. Some people have an oxygen saturation monitor at home and they come in and tell us their numbers. And those numbers can be very frightening. People say things like: ‘I have oxygen levels of 79%, what does it mean?’. It means you’re very sick and thank God you came in. But some people just come in and say: ‘I can’t breathe.’ Breathlessness is the most terrifying symptom a human being can experience because it feels like you are dying by degrees.

  • Dr Ben Lovell being helped into PPE before entering the secure part of the acute medicine unit.

“When you hear them say ‘I can’t breathe,’ you are calm. This is our training; we look after people like this all the time. The first thing you do is say ‘OK, you’re safe, we’re going to help you now.’ We check their oxygen levels and then start applying oxygen and then assess if they need to be looked after in the acute medical unit or in the ITU [intensive treatment unit]. But we never panic.

“What’s causing distress for staff is because we’ve never had to make these kind of intense prioritisation calls before. When you have 50 people, all with equal severity of illness, in front of you – which one do you do first?”

Most affecting of all are the prone human forms, unmoving in a precarious world somewhere between life and death. The image of a waiting room comes to mind, so easy to take a train in the wrong direction from here. But the staff – nurses, doctors, physiotherapists, nursing assistants, cleaners and porters – work unstintingly to get everyone out alive.

  • Anaesthesia associates Chris Leck and Alex Balynn and staff nurse Rebecca Lennon prepare a patient for proning.

It is an eerie characteristic of hospital wards that they seem calm and controlled, even in a crisis. All about me are people at breaking point. Becky Lennon, a 37-year-old staff nurse on critical care, has reached the end of the line. I watched her working with her team as they proned patients, turning them gently on to their stomachs to help them breath. Capable, intelligent and dedicated, she has just handed in her resignation. “We have just had three pregnant women in intensive care, one is still here. I want another baby, I don’t want to end up in one of these beds.”

I don’t want to end up in one of these beds

Becky Lennon

  • Though still seriously ill with Covid-19, Felix Mboko-Nemak gives the victory sign while being treated by deputy charge nurse Halimato Konteh and healthcare assistant Mohamed Hussain on T8, an infectious diseases ward at University College hospital. Staff attend to patient Felix Mboko-Nemak.

Staff attend to patient Felix Mboko-Nemak
  • It takes a team of seven people to turn a patient with precise, safe motions onto their stomach so they are lying face down.

Chris Leck, an anaesthetic associate, leads the proning team. His voice is strong and clear. “On the count of three, turn to the right, well done, now five inches to the north, thank you.” Chris is a methodical, hardworking young man. “I’ve been blown away by how our team has come together, the morale is amazing, considering the circumstances. Personally I just keep going. When the dust settles, that’s when it will hit me.”

Downstairs in the acute medicine unit, senior staff nurse Patricia Barrazona (seen below with senior nurse for staffing, Carol Stiles) has just finished a shift. Her young friendly face still bears the marks of the tight, hot PPE. Like many in this hospital, she is a veteran of the first wave of the pandemic but she is now scared.

  • Senior staff nurse Patricia Barrazona and research clinical trial practitioner Subarna Roy discuss a patient. There is a close working relationship between clinicians and researchers as research staff attend to consent patients for clinical trials in a bid to find out more about Covid-19. Below, senior staff nurse Patricia Barrazona is embraced by staff nurse Adaobi Umeibekwe.

Patricia Barrazona: senior staff nurse in the acute medical unit

“My colleagues and I work in a 19-bed ward that is full of Covid patients who are on non-invasive ventilation. Sometimes they can be weaned off that, and sometimes they need to go to ITU. The first 24-48 hours are crucial in deciding what level of care someone needs. Patients who stay in our unit generally stay for a week or so and then move on to a Covid ward. But unfortunately a good number of people just pass away.

Left, senior nurse for staffing, Carol Stiles. Right, senior staff nurse Patricia Barrazona
  • Left, senior nurse for staffing, Carol Stiles. Right, senior staff nurse Patricia Barrazona.

“Dealing with death is an unavoidable part of our job. We’re really good at being resilient when patients are in their last days or hours. I have a strong personality and I can deal with physical exhaustion. But the work just now, including seeing a lot of death, does take a big toll on me emotionally and psychologically.

“I have nightmares sometimes. I wake up in the middle of the night and I can hear the sound of the ventilators alarming to tell you that someone’s oxygen saturations have dropped, or infusion pumps to say their medication has finished, or their heart monitor telling you there’s something wrong.

“We get some couples coming in, who both have Covid, and that’s really hard to deal with. They are usually separated and can’t see each other. I remember one couple who came in, in their 70s or 80s, and then a few days later their son came in, too. They all had Covid. He survived but he lost his parents, unfortunately. He lived with them and was their main carer. It was so difficult because we couldn’t do anything for him to help him feel better. To lose both your parents at the same time, it’s heartbreaking.”

  • Critical care physiotherapist Alison Gordon works tirelessly on her patient, assisting with the clearance of mucus from the lungs by performing vibrations on his chest.

Alison Gordon: respiratory physiotherapist in the critical care unit

“Myself and my team of specialist respiratory physiotherapists work with Covid patients who are ventilated and also those who are getting better. When they’re on a ventilator we help to keep their airways clear of phlegm. If there are any areas of their lungs that aren’t inflated properly we work on that, using manual techniques which we usually use on patients with cystic fibrosis. With patients who are sedated and can’t move we also use both our arms to do upward movements on their diaphragm, to mimic a cough, again to clear their airways.

“We work with patients for weeks or even months. ITU patients can need ongoing care for 12 or 18 months after leaving hospital. We love it when they come back and visit us and say hello, when they’re popping back into hospital.

“When we eventually see a patient leave our care it’s very emotional. We call it ‘rehab joy’. I get a lot of what I call ‘train tears’ – I cry a lot on my commute home but then slap on the smile to walk through the door to my children, to be a mum.”

Dr Sophie Coles with senior staff nurse Maria Izquierdo Casado