J D WILLIAMSON: ON THE INSIDE – COVID 19

J D Williamson is a London based Anaesthetic Doctor and Photographer. This recent work has embraced subtle and conscientious shooting to document COVID-19 from inside a London Hospital; a photographic challenge due to difficult conditions and minimal equipment use. What shines through is a personal journey, shared with the subjects of his work.

“I’m both an anaesthetist in a London hospital and a photographer. A Diploma in expedition medicine, active hobbies and a love of nature initially led me and my camera predominantly outdoors. When COVID-19 hit, I turned to my skills in medical photography to shine a light on the pandemic from my own unique angle, in the midst of a London District Hospital. I have learnt to love the power and ability for these images to communicate with others in the way words cannot, enabling our journey as staff and patients to be shared. It’s life, in all its unique components, a journey of discovery for the viewer, as much as myself.

“Despite having an inside view to document the Coronavirus pandemic – it is not a straightforward one. The windows for taking photos in hospitals are extremely limited, patient care cannot be interrupted or delayed, and the breaks from my medical work are often short and sporadic. There are technical issues too – hospital lighting is varied and often poor, while the use of flash can be disruptive and therefore I avoided it. As a doctor, I was incredibly aware of contamination of equipment and therefore all images were taken with only a handheld Nikon Z 6 – I couldn’t even use the camera strap, as it was too difficult to clean. Of course, all photographs were taken with consent and when clinically appropriate, and safe for both staff and patients.

“The anticipation was almost as nerve-wracking as dealing with the very sick Covid-19 patients. The week or two before we were hit with the huge wave of COVID-19 patients, we were challenged with huge system changes and troubleshooting. This image of a physiotherapist being taught how to put on PPE to work in the Intensive Care Unit (ICU) shows both focus and anticipation. Other healthcare professionals look on – most unfamiliar with working in ICU. I kept the crop of the image limited, wanting the dripping alcohol sanitiser to intrude and distract in the right-hand corner – cleanliness and contamination heavily occupying my thoughts. As cases start to rise again, I’m sure I’m not alone in feeling the anxiety creeping back in – for fear of returning to the following scenes.

“The most unwell required breathing tubes and ventilation on ICU. We used special ‘Negative Pressure’ isolation rooms to do this procedure, as it can generate large amounts of coronavirus spread by aerosolisation. A consultant looks on, as an Anaesthetic Registrar uses a walkie-talkie wrapped in packaging made from gowns to communicate with the outside team. A specially designed intubation checklist developed by our hospital for COVID-19 patients is being used. The glare from the glass window disrupts the clarity of the scene and creates an image almost from a dream. It certainly felt like it at the time and more so upon reflection.

“Vast numbers of anaesthetic and ICU staff are seeing preparing the sickest of patients for intubation. In keeping with the surrealist undertones of the previous image, on-looking staff are visible in the reflections on the glass – ethereal in nature.

“Doctor Gulia, dressed in PPE, turns around before she enters the Intensive Care Unit. Name badges increase the risk of infection, so she has written her name on her overalls, choosing to add hearts to lighten our moods. The hospital spotlights provide some stark contrast – something you will see in a number of my images. Despite this, high ISO (1800 in this case, at 1/125 sec f.4) was still a necessity when shooting with my compact 24-70mm f.4 lens. I ended up not missing the use fill flash. Eyes shrouded in shadow is not the classic approach to a portrait and certainly wouldn’t score any fine art points. It disengages the subject from the image, however, I believe it better conveys the complexity of emotions many of us felt.

“A dental nurse reemployed to assist staff in the starkly contrasting environment of ICU. She’s visually afloat in swathes of information. The equipment mounting ‘stack’ dominates the image, intended to convey the intimidation of this new environment.

“A patient gown and a trolly creep into the bottom corner of the image, nearly obscuring the focal point. The ICU was at double capacity, with two patients now occupying one bay. I selected this image, as it conveys this claustrophobic working space, filled with people and equipment.

“Dr Vino, an anaesthetist, checks the breathing tube of a COVID-19 patient before turning them over. This procedure requires meticulous planning, due to the dangers of disconnecting vital equipment and changes that can make it hard to ventilate and deliver oxygen to the patient. A checklist is being used and at least seven members of staff are required to turn this patient safely. Up to 11 or 12 staff are needed for the large patients weighing over 100kg in the Intensive Care Unit.

“Dr Finn emerges from the Intensive Care Unit. He has removed his visor from his PPE after two hours of proning (turning over) patients. A physical and stressful job, his hair is soaked in sweat, with a bead trickling down his temple.

“In contrast to image three, I wanted the viewer to really connect with Finn in this honest, face-on image, in which my friend has no emotional guard up. A bright top spotlight was used again, in the dark corridor exiting ICU. In order to let some light into his eyes, I asked him to pause just before walking directly under the light.

“Taking his PPE off, keen to get out of the stifling and sweaty PPE. I turned the shutter speed down to 1/100 sec in order to capture some motion – with a balance of enough focus on more static features such as his face, so the emotion is still clear.

“Dr Finn, an anaesthetist, is preparing to review a COVID-19 patient on the ward, after just being told he may have to intubate the patient for intensive care. The marks from previous wear are still etched on his cheek. Eyes steeped in darkness; at times it felt relentless.

“Members of theatre staff communicate between ‘zones’ in theatres. In this scenario, a patient is undergoing a surgical procedure to insert a ‘tracheostomy’.

“I wanted to show the fear, caution and uncertainty in operating under these new conditions. The doors create a sense of the subject being trapped within the image and claustrophobia generated by the sense of being surrounded by the virus and contaminants.

“The talk of PPE shortages and severe supply constraints, from both the public media and internal emails, caused great anxiety for staff members. I found one of our operating department practitioners explaining how he made a facemask with a viral filter from hospital equipment, after seeing the idea circulating online. A contingency plan, should we be faced with no masks. Thankfully, it was not used.

“Domestic staff disposing of contaminated material in ICU. Shot at night when the patients bay lights are off, he’s nicely positioned under another spotlight, creating a vibrant scene.

“Coming through such an ordeal is unique to every patient. No one expects to end up in this position. Pictured here is one of our ICU patients reflecting upon his journey. A dressing over the hole made into his windpipe, for his tracheostomy tube used in ICU, is just visible above his gown.

“I’ve often avoided monochrome when shooting COVID-19 scenarios, as in my opinion, it can separate the image from time and feel less real or ‘present’. In this case, however, I wanted to capture the environment in a way that captured our discussions about his past as a medical student and time in hospital. The beautiful shadows cast from behind the blind, combined with the lighting give the image a nostalgic feel.

“In the midst of the pandemic, I wanted to capture birth during these ‘times’, as a reminder and contrast. A simmetry of both death and new life. The first seconds of new life are seen here, amniotic fluid still dripping off the babies feet as he reaches out to the new world. The new mother piers over a mask; making an unusual scene to many, have an extra twist.

“I like to think the babies giving a knowing wink in this image. The white blanket gives a stark contrast to the blues in the scene and really highlights the incredible feat of new life. His masked father looks on. Thankfully babies can’t register faces at this age.

“In an intensive care spotlight, both physically and metaphorically. Dr Badacsonyi, an ICU consultant, was one of those under unprecedented strain to care for patients. As COVID-19 patients start to return to our hospital wards and ICU, the pressure returns.

“Despite the PPE’s raw imprint on Dr Finn’s face and the work he has had to do, he still manages a smile. The bond between teams helps us to combat the pandemic day by day.

“Doctors prepare to see suspected COVID-19 patients on an ICU ward round. I wanted to catch the conversational tone of preparing – an indicator of the normality of the situation developing in June (2020).

“Beautiful light is rare in the hospital. In our new staff room however, a sharp ray of sunlight strikes my colleagues face, revealing half. Relevant to anyone, particularly in these times – we often only see the face we choose to show. The rest of us far less visible.” – J D Williamson

About the author:

J D Williamson is a London based Anaesthetic Doctor. He has a Diploma in Expedition Medicine and a broad range of photographic interests. In the last few years he has developed his medical photography, most recently documenting Covid-19 from the unique angle of a Doctor in the midst of the Pandemic. This recent work has embraced subtle and conscientious shooting, using as little equipment as possible, to document vivid emotions of friends, colleagues and patients. What shines through is a personal journey, shared with the subjects of his work. His photoessay for Tortoise Media ‘A Patients Progress’ provides a raw, previously unseen insight into the impact of Covid-19. He is continuing projects with the support of Nikon UK, to investigate this further.

All images © J D Williamson 2020. To request rights please contact via website www.jdwilliamson.co.uk. Instagram @drjdwilliamson.