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At Breaking Point

Panos photographer Tom Pilston was granted rare access to the Intensive Care ward in London's University College Hospital, one of the city's largest, at a critical moment in the ongoing health crisis that has gripped countries around the world to varying degrees.

As you approach the imposing tower of University College Hospital on London’s Euston Road, 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 onto the wards that any semblance of ‘normal’ disappears.

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.

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.

But, 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 of here alive.

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 onto 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.”

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 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 but she is now scared. "The virus is worse this time and we are physically and emotionally exhausted. It is claiming younger people, whole families have come in. I looked after a couple in their 70s who came in with their son in his 40s. They were all very ill. The parents spoke of not wanting to leave their son alone but felt they could not fight on. They died that same night, but their son is still alive and he cries. I dream about them often."

"I so want to go home to see my family."

Where are they, I ask.

"The Philippines."

Tom Pilston, 2021
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