health

'Know you are loved': hope and tragedy in NHS hospital as Covid vaccine launched


As Margaret Keenan, 90, was being discharged from University hospital in Coventry this month, hand-in-hand with her daughter and grandson, she carried a newspaper with the headline: “One small jab for Maggie, one giant leap for all of us.”

“You’re so famous they’re comparing you to the astronauts who walked on the moon!” one nurse quipped.

The previous day, at 6.31am, Keenan had become the first clinical patient in the world to receive the initial dose of the Pfizer/BioNTech Covid-19 vaccine. “Yesterday was a massive day for me and for the rest of the world as we all look to get back to some sort of normality,” she said.

As she left the hospital, well-wishers recognised her and offered their congratulations. The vial and syringe used in her groundbreaking vaccination were dispatched to the Science Museum in London for posterity.





Margaret Keenan, 90, with healthcare assistant Lorraine Hill







Margaret Keenan leaves hospital accompanied by her daughter and grandson



  • Margaret Keenan, 90, was the first patient in the United Kingdom to receive the Pfizer/BioNTech Covid-19 vaccine. She left hospital accompanied by her daughter and grandson. All photographs by Jonny Weeks

University hospital, which is part of the University Hospitals Coventry & Warwickshire (UHCW) trust, is one of about 70 hospitals around the UK participating in the vaccine rollout. Initial priority is being given to people aged over 80, care home workers and vulnerable NHS staff. Every day, about 300 people are being vaccinated at University hospital alone.

Mark Easter, director of pharmacy, oversees storage and delivery. “The vaccine has to be stored at between -60C and -80C and we don’t normally have freezers like this in the pharmacy, so we had to get one sent in,” he said.

His colleague Santosh Kalair, wearing thick, insulated gloves and a gown, opened the freezer door to retrieve what’s known as a “pizza box” containing 195 vials.





Santosh Kalair, senior pharmacy operations manager, retrieves the vaccine from the freezer.







A vial of the Pfizer/BioNTech vaccine. Each vial contains five doses







A nurse draws up the vaccine and reconstitutes it with saline.







The staffing schedule inside the vaccine rollout room as a nurse carries away a box of used needles.



“It’s a novel drug and very fragile, so we can only keep the door open for 43 seconds,” Easter said. “We have to take it out and defrost it for three hours in a fridge on a Saturday night. Then the nurses have to reconstitute it by adding saline, at which point it has a six-hour shelf life. Once it’s in the syringe, they have to use it immediately.

“We’ve got people booked in for jabs every five minutes from 9am this morning to 4pm, and we’re repeating that every day. But you’re only immune a week after the second dose. The first dose is in effect a primer.”

Santosh Kalair and May Parsons

May Parsons, who delivered the first jab to Keenan, said: “It was nerve-racking because people were watching her every move and her reaction, but there were no shaky hands when I saw the TV footage.

“I was really concentrating on Maggie. You know when you look at your patient and you think: I just want to make sure she’s OK. It’s all about distracting the patient from the needle. I squeeze their arm to get their mind off what’s coming.”





May Parsons speaks to a patient in the vaccine clinic







Candice McGrane winces as she receives her vaccine







Roger Ash is vaccinated



Among the first hospital staff to get the vaccine were Candice McGrane, a modern matron, and Bernice Dudkowsky, a consultant in critical care and anaesthesia. McGrane winced in anticipation. “I’m not great with needles considering I’m a nurse, but it was actually fine,” she said.

Dudkowsky said: “Being at the forefront of anything, there’s always a slight element of nerves, but somebody’s got to go for it. It’s been approved and I’m personally thankful that I’ve been given the opportunity to be vaccinated. If we can protect the NHS staff, the elderly and the vulnerable, then everyone else can get back to normal.”

Warning: readers may find the images below distressing

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A patient receiving oxygen via a Cpap machine in the intensive care ward.



Yet such optimism is tempered by the knowledge that many patients are still profoundly ill. On October 12, University hospital had 25 Covid-positive patients, two of whom were in critical care. By Christmas Eve, the numbers were 112 and 13 respectively.

Some patients are conscious during their time in critical care. In one bed, a patient required Cpap (continuous positive airway pressure) to help her breathe. In another bed, a woman gasped as her oxygen mask was removed.

Critical care consultant Aoife Abbey said: “We’ve had a number of deaths [in the weeks before Christmas] and we’re finding that the patients that are put on ventilators now are really very, very sick. It’s hard because most of these patients were relatively well, they were enjoying their lives previously.

“In the second wave of the pandemic, the average age of admissions is early 60s. There are people who, if it wasn’t for coronavirus, certainly would not be dead right now.”

She added: “The people that I’ve lost recently wouldn’t have [qualified for] vaccinations yet anyway.”





A Covid-positive sign on a door inside intensive care







A nurse seeks assistance







A patient is cared for in intensive care







Medical staff attend to a patient in intensive care



Roger Townsend, formerly the clinical lead in critical care, said changes had been made in the second wave of the pandemic to allow compassionate visits for family members.

“I think we got the balance wrong when we opened the pubs but kept the hospitals closed to visitors,” he said.

“We all agree that visiting is good for patients, their families and the staff too, so we should have improved the visiting situation [sooner] because it’s been miserable. It’s much easier for loved ones to accept that the treatment isn’t working when they can see that we’ve struggled, that we’ve fought the good fight.

“Access was strict in the first wave and it had to be because we didn’t know where it was going or how transmissible this virus was; we didn’t want people coming in to visit loved ones and then taking it home to their families.

“But people who work in critical care don’t seem to be super susceptible to the virus so it tells us that the PPE [personal protective equipment] we use is working and the environment is a reasonable place to visit.”





Members of staff in critical care



  • Members of staff in critical care. Top row (l-r): Russel De Lara, staff nurse; Jhoan Detubio, clinical sister; Aoife Abbey, consultant; Roderick Daguio, healthcare assistant; Luke Closs-Parry, physiotherapist. Bottom row (l-r): Yesita Putri, junior doctor; Roger Townsend, consultant; Tamiru Feyie, staff nurse; Samuel Collier, staff nurse; Michelle Blackstock, staff nurse

Among the clinical and support staff in critical care were Tamiru Feyie and Sushma Lapsley. Having been fit-tested for an FFP3 mask, Feyie was starting his first shift just as Lapsley, who has been with the NHS for 42 years, was completing her last.

“I was going to leave but I stopped on to do my bit because of Covid,” Lapsley said. “I thought we would have it sorted [by now] and there would be fewer patients. But it’s not going to just end, is it?”





Tamiru Feyie, a new member of intensive care staff, is fit-tested for an FFP3 mask







Sushma Lapsley is congratulated on her retirement



  • Tamiru Feyie, a new member of intensive care staff, is fit-tested for an FFP3 mask; Sushma Lapsley is congratulated on her retirement

With Christmas approaching, many staff had expressed apprehension about the potential impact of five days of loosened social restrictions. There was relief at the imposition of tighter measures.

Speaking ahead of the festive period, Abbey said: “The restrictions are of course sad. They will bring with them much more economic loss and mean that some people spend Christmas apart from loved ones. But other festivals have suffered before this one: Diwali and Eid, for example. In each case there’s been sacrifice, but it is entirely necessary.”

Regarding news of a more transmissible strain of Covid which is sweeping the south-east of England, she added: “The message that this new variant isn’t necessarily associated with more severe illness is welcome, but the spectrum of illness that’s possible with Covid already includes such horrific outcomes that just knowing it’s [up to 70%] more transmissible is enough to make me very worried.”





A scene inside intensive care during the coronavirus pandemic







A patient in a private room in intensive care



Midway through her shift, Abbey learned that another middle-aged patient with whom she had built a rapport had passed away. She was visibly moved and shared an embrace with a colleague.

“Today’s been a really tough day but look what I found,” she said. In the palm of her hands, she displayed a small card that had been left for her at the patient’s bedside, anonymously offering her moral support.

It read: Here is a little pocket hug to keep you safe. Hold it close to your heart and know that you are loved.”

Abbey said: “My colleagues and I are not robots and the volume of tragedy and sadness does get to us. That little card wasn’t asking if I was OK, it was an acknowledgment of ‘I know this isn’t OK and I’m here with you’, which was so lovely in that moment.”





A card left anonymously in the ward



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