2020 : A Year of Tiers

Dr Nabeel Siddiqui, an intensive care registrar at Newcastle’s Royal Victoria Infirmary, has documented working conditions in an ICU throughout England’s three lockdowns. His series of photographs, entitled “2020: A Year of Tiers”, captures staff caring for some of the sickest patients as well as the adversity and toll faced by everyone on the ward.

I cast my mind back to early February of 2020. News was dominated by Brexit; Trump was still supposedly going to be impeached, yet Covid struggled to steal any column inches. I had recently started a job working in anaesthesia and intensive care at the Royal Victoria Infirmary in Newcastle. On our induction, we were told that the hospital had just admitted two patients with Covid-19, the first cases in the UK. We were told that all Covid cases would only be seen by qualified consultants, and that as a junior doctor I wouldn’t be expected to see to these patients.

Within a fortnight, the plan was scrapped. News started coming out from China and the Far East of this “mysterious virus”. A few weeks later, northern Italy was rampaged. Stark warnings from the brave Italian intensivists were sent to the UK, insisting that it was coming for us, too.

And so we went into lockdown. Worried but hopeful, my colleagues and I continued to work. Branded as heroes every Thursday evening across the nation, we felt proud to be the foot soldiers in this colossal battle. Our clinical director gathered the troops in the lecture theatre every Wednesday for a strategy meeting.

The wheels were set in motion. Intensive care was up-scaled, almost doubled in capacity, staff redeployed and retrained to work. Whilst the work was ramping up, I was unexpectedly enjoying work more than I ever had before. The normal day-to-day complaints about work disappeared. Camaraderie took hold. 

As the admissions started coming in, I found myself repeatedly thinking that this historic period needed to be documented, and that as an intensive care doctor with a background in photojournalism, I had the tools to do so.

So after much deliberation, I once again picked up my camera, and with consent of patients and staff, began photographing the environment where I spend most of my time. Whilst much of my previous work has involved capturing snippets of culture in the third world, often outdoors in a tropical surrounding, this was the polar opposite. I decided to abandon any preconceived ideas of how the images should look or what the message should be. I simply photographed the climate in which I work with an open mind, and the photographs that resulted are simply what came out in the dark room. Unedited and raw. 

Despite the adversity, the nation has persevered. Persevered through the seemingly never-ending cycle of tightening and easing of restrictions, through the loss of earnings and financial uncertainty and challenges to their wellbeing. We should be proud of this. There are many, some of them my colleagues, who are angered and frustrated at the individuals who bent the rules or simply broke them altogether. I take a different outlook on this.

Throughout this pandemic, people have been forced to choose, and to constantly reassess their choice. That is the choice between social isolation and deteriorating mental health, versus protecting their families and friends to keep them safe. There isn’t an instruction manual or a YouTube video that can help you make this choice, it’s a personal one, and everyone will have their position on this spectrum. Everyone has their red lines.

We woke up in the New Year to find that we were in the depths of yet another predictable wave. Hospitals pushed to the brink. The constant fight, for that one vacant ICU bed for the next Covid admission. Every day, I learn more about this disease and how to treat it, but above all I have learnt that the people I work with, and in fact, the entire NHS workforce isn’t one that backs down in the face of hardship. 

In this job, I am continuously humbled by the power of nature, by the ruthlessness of disease. I am constantly nurtured by my learned seniors. I am proud to be standing alongside such talented and compassionate nurses who seem to show no end to their dedication. And now, with a vaccine, there seems to be light at the end of the tunnel. If there is a silver lining to this story, it would be that after all this, if the NHS survives, it will outlive us all. 

Thank you to staff, patients and family members who kindly consented to be part of this journey.