A consultant's heartbreaking stories and images from behind the scenes

The Royal Gwent Hospital was the frontline of the coronavirus battle in Wales. At one point it saw one of the highest number of infections outside of London when the pandemic took hold. Hundreds of infected patients entered the Newport hospital, and at one point it came close to being overwhelmed.

Nurses preparing a deceased patient for transfer to the mortuary A consultant's heartbreaking stories and images from behind the scenes

Now one of the hospital’s top doctors has given his heartbreaking account of life during the first wave and shared his incredible images from inside the intensive care unit.

Throughout the pandemic, intensive care consultant Nick Mason photographed what he saw first-hand – from exhausted colleagues and ICU beds full of infected people to huge temporary morgues and dead patients. The dad-of-one has now revealed what life was like during the first wave, why he decided to photograph his work and the emotional impact of the virus. And although his camera now sits in his office drawer, Nick shares his anxiety over a second wave.

Nick has worked at the Royal Gwent for around 13 years, and has been a photographer since his teenage years. So when the pandemic started it felt natural to Nick to document what was happening.

A consultant's heartbreaking stories and images from behind the scenesNick has been a photographer since he was a teenager

He said: “I’ve always wanted to sort of do a photo project on the ICU because I think it’s just something that is a very very powerful environment. “And then it became apparent of the unprecedented, historical significance of what the pandemic represented.

Never before in intensive care have we reached the point where we came within days of being overwhelmed. “I mean, if you walk around an intensive care unit, normally, you know would be the patient in bed one could have been in a road accident, the patient in bed two will have pneumonia, the patient in bed three might have had a perforated bowel and been operated on. “But this, they all had the same disease.

So for ICU to be hit like that was just unprecedented in the history of the NHS, and unprecedented in the history of intensive medicine. It immediately became obvious that it needed to be documented because of that.”

A consultant's heartbreaking stories and images from behind the scenesAn NHS worker doffing PPE at the end of his shift

The Aneurin Bevan University Health Board, which covers Blaenau Gwent, Torfaen, Newport, Caerphilly and Monmouthshire, had at one stage the most coronavirus cases per head in the UK and for a long time saw levels way above the national average. At first, Nick approached the hospital management and asked if they would bring in a photographer to document the virus and work being done.

But due to the safety concerns it wasn’t possible, so Nick picked up the camera himself. “And that’s how it started. It was really the recognition that this was something historically significant and unprecedented,” he said.

As he photographed his workplace, Nick, originally from just outside of Coventry, said themes emerged and aspects of the virus he felt needed to be captured.

A consultant's heartbreaking stories and images from behind the scenesA proned and ventilated patient

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He explained that one of them was the “extraordinary effort” of those behind the scenes. This included the cleaners to the healthcare support worker right at the bottom of the NHS payscale who orders all the stock for the ICU. Nick explained: “[The people] who get paid very very little but without whom the whole thing would just come crashing down, and we wouldn’t be able to work.

I became very keen, as started to think about it, that I would document their stories.” One example came not while Nick was working on the ward, but parking his car in the hospital car park.

A consultant's heartbreaking stories and images from behind the scenesVince, a mortuary technician

He said: “It was round the back of A&E and down the hill from St Woolos (hospital), where we have our oxygen tanks, which is where we store all the oxygen. “There was a point at which some English hospitals declared major incidents because they were on the verge of running out of oxygen.

“We forget because we breathe it in, but from a medical point of view, oxygen is a drug and one of the most important drugs that we need intensive care and that we needed to treat Covid is oxygen. “And a gentleman got out of his truck with a hosepipe and started hosing oxygen piping down and I’m curious. “I wondered across and said ‘what are you doing?'”

The man explained that if the pipes get too cold frost can form, which creates additional weight that can cause them to bend and potentially snap. Nick said: “So every day this chap called Greg comes down with his hosepipe and just hoses down the pipes. Now nobody knows about Greg and yet without him, we wouldn’t have any oxygen.

“Those are the sort of people behind the scenes who we just would have never got on without.”

A consultant's heartbreaking stories and images from behind the scenesA proned patient on dialysis

The tireless work of his colleagues was a key part of the images. But as the pandemic developed Nick realised he had to capture every aspect. He said: “As time went on we saw an awful lot in the media of clapping anytime someone came out of ICU, and lots of clapping when people went home.

“And despite the fact we did remarkably well considering we have the fewest number of ICU beds in any hospital in Britain, we serve an incredibly deprived population and were hit as hard as anywhere in the UK if not Europe, our mortality rate was phenomenal – but it still meant a third of the patients died. “And I don’t feel as though that part of the story has been told yet. “With the local lockdowns and cases ramping up, and that human memory is very fickle, and people have kind of forgotten why we took the steps we took and just how bloody serious this disease is.

“A lot of people said to me, you’ve got to tell the story of the people who are dying. And that became a really important part of the story. ”

A consultant's heartbreaking stories and images from behind the scenes‘The final journey’ A consultant's heartbreaking stories and images from behind the scenesThe temporary mortuary for 480 bodies

After speaking with the mortuary team to reassure them he wasn’t being “ghoulish”, they allowed him in with his camera. The images show the huge temporary morgue built to cope with the worst-case scenario.

Nick said: “It really brings home to you just how severe this is when you see that shot of the morgue with the forklift truck, which was used to move the bodies around. “There’s not a body, there’s not a patient there, there’s not a person there, but that to me brings home just how serious this disease is.” Nick said it had capacity for 480 bodies, and at one point around 140 to 150 bodies were stored there.

As part of his role, Nick would have to update families on the condition of their loved ones, and in some cases pass on news of the worst.

A consultant's heartbreaking stories and images from behind the scenesNick captured his colleagues at work

He said: “One of the lasting memories for me of the first wave was, first of all how incredibly understanding families were. “The phrase time and time again, ‘it’s not your fault doctor we understand’ when you apologise was very striking. “And I think the other thing was having people crying down the telephone.

“That’s probably the emotionally jarring memory that I have, was hearing people crying down the telephone when you either phone them up to tell them things weren’t going as well as they’d hoped they would, or that they’d lost somebody.” He added that two of the most difficult parts of the job were not being able to speak with families direct, and the mental toll it took day-to-day.

A consultant's heartbreaking stories and images from behind the scenesDoctors performing a tracheostomy

Nick said: “I think one of the hardest two things was the sheer cognitive load, the sheer amount of brain power. Because there were so many patients and they were all very similar.

“They were all of a similar age, they all had the same disease, and they very quickly merged into each other. “But each one would require something slightly different doing to them and so I think the most difficult thing I found was just how intellectually exhausting it was. Your brain was just exhausted at the end of the day.”

Nick would photograph at the end of his shifts or on his days off. Olympus provided him with a “dirty” camera that he could keep on the ward and not risk spreading the virus. But there were some moments he was too busy to capture.

Nick said: “One particular point was just standing and taking a moment in the ICU and looking down the unit. “We’d fitted beds between beds. So there was just this row of beds.

“And all of the patients were prone, so they were lying on their front, which is something that we do when we treat severe respiratory failure that isn’t responding to the normal therapies we use. “So just this sight of these beds and all of them on their front and, as a photographer, my only regret is I didn’t take the picture of it, but it was just too busy.”

A consultant's heartbreaking stories and images from behind the scenes

It’s now been several weeks since the ward saw a coronavirus patient. But with a growing number of cases and more local lockdowns being imposed across Wales, fears of a second wave are growing.

And even though it was mere months ago that the whole country was under lockdown and normal life came to a grinding halt, some suggest that people are forgetting how serious the virus can be. Nick said people have to remember that even if they don’t become sick they could pass it to someone who does. He explained: “There has been an awful lot of misinformation and I think we’ve forgotten, very quickly, as to just how deadly this disease is and there are a significant proportion of people who get Covid and who will either be left very seriously ill and be left with significant consequences from the damage to their lungs, but around a third people who come to ICU die.”

Nick explained that those who get older, even those in their 40s or 50s who are relatively fit and well, might have an underlying issue that could put them at greater risk, such as diabetes or high blood pressure. “It may not be you who suffers, you may have mild symptoms or symptom-free, but you are still potentially carrying the disease and pass that to people and that can kill them.”

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Nick said the anxiety he felt ahead of the first wave is now returning. “There is this growing and palpable anxiety of things about to ramp up – and the unknown.

“With the tracing system and local lockdowns, does that mean that we’re going to be able to keep a lid on things and just be presented with ongoing numbers of patients with Covid, but manageable? “Or is it going to surge again and are we going to going to come close to the point we were back in April when we were almost, but weren’t, overwhelmed?” Nick said he hopes his work will be exhibited publicly outdoors and discussions are ongoing.

More of his work can be seen here.

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