This is a story about recovery. A monumental undertaking, necessitated by critical illness, Covid-19 and its consequences. There were many times we thought Geoff Woolf wouldn’t make it, from my first meeting with him in March 2020 on a Covid ward in London’s Whittington hospital, to turning him over unconscious in the intensive care unit, and even in the last weeks of his 127-day hospital stay. Geoff was 74, a capable and sharp man, having retired only 18 months earlier from a career in law, and then begun studying the history of art in his retirement.
I’d been documenting the pandemic in my hospital during the first wave of Covid, and when Geoff was settled on our respiratory ward, waiting for his bed in a rehabilitation hospital, I went to visit him. I explained that I’d helped care for him and he was keen to see some of my photography work and the other staff involved. I’d documented a lot about Covid within our hospital, but what of those who’d survived this initial ordeal? A huge challenge would come when they left hospital – a new chapter in their lives.
I asked Geoff and his family if they would consider being involved in a project that would tell the story of someone who had been through such hardship, showing the road to recovery we often don’t see or hear about. Over the space of two years, I had the opportunity to follow his remarkable journey. Geoff’s story is one of many varied experiences of Covid and other critical illness leading to intensive-care stays, and it isn’t supposed to represent everyone. But I do hope it gives insight into a world unknown: surviving a critical illness, leaving hospital and dealing with “morbidity”. What does someone’s recovery process look like, and to what extent can we recover?
A doctor and nurse monitor a patient being ventilated in prone position.
An anaesthetic doctor checks the position of a patient’s breathing tube after they have been turned over.
When we first met, I was one of a team of anaesthetists responsible for overseeing the sickest Covid-19 patients on the wards. I clearly remember Geoff, a pleasant man in the middle bed on the right of the bay; one among our first cohort of Covid patients in March 2020. He was on a continuous positive airway pressure (CPAP) ventilator, a high-pressure oxygen facemask, with an effect akin to sticking your head out of the window of a fast-moving car.
He’d taken off his uncomfortable mask in the confusion caused by the illness, causing the alarm on his monitor to start beeping and dropping his oxygen levels dangerously low. I explained that they were the levels he’d experience at the top of Mount Everest. Geoff understood and stoically put the mask back on. It wouldn’t remain on for much longer, however.
Geoff talks laboriously, covering the hole in his neck, which is still healing from where his tracheostomy tube was inserted. An image of him taken before his illness is taped to the wall behind, almost unrecognisable.
When I came to work a couple of days later, I found out he was intubated and ventilated in the intensive care unit (ICU). I wouldn’t speak to him for another three months. Our only interaction came when I’d carefully help move his unconscious body into prone position – face down – or move his head and arms to try to prevent pressure injuries.
About 50% of patients who required intubating and ventilating in intensive care didn’t survive. Geoff suffered many complications from Covid-19, including a stroke. His chances of recovery looked slimmer by the day.
He remained the last of our original cohort of first-wave patients in ICU. I was amazed to hear he’d made it out of there – after being ventilated for 67 days – and on to the ward. The tube in the front of his neck, his tracheostomy tube, was now removed. However, his long stay came at a high cost.
ICU patients face a host of physical and psychological challenges, from muscle weakness and feeling short of breath, to trouble sleeping or feeling low and anxious.
Geoff without his bandaged lip: a cut caused by shaving that was continuously bleeding upon our first attempt to get a portrait the previous day. We joke about this, and that personality shines through; the person and not “the patient”. A pressure sore on his head that has nearly healed is a reminder of his long time spent in the prone position.
I’d heard Geoff was progressing well, and the aim was to discharge him to a rehabilitation hospital for his stroke. He was the last first-wave Covid-19 patient in our hospital in the summer of 2020.
Any critical illness not only affects the physical body, but also the mind. Initial confusion, memory loss and general “cognitive dysfunction” are common, as well as low mood, anxiety and potentially PTSD. Geoff’s memory had been affected, and to make sense of what had happened, his brain had automatically filled in the blanks. We explained how he had come to hospital, and that he hadn’t been in a car accident, as he had assumed.
Geoff working on his arm mobility with two physiotherapists. He has to be supported from behind and cannot lift his head fully.
During an intensive care stay, the loss of muscle mass is considerable: about 3%-4% (cross-sectional area) per day. This will affect the muscles that help us to move and functions such as swallowing and coughing. About 46% of patients in ICU with severe sepsis, multi-organ failure or who have had mechanical ventilation for more than seven days will have “ICU-acquired weakness”. After months of limited or no activity, even sitting requires support, and Geoff was unable to fully lift his head despite tremendous effort. The small things many of us take for granted became an intensive workout for him – but a necessary one to help him gain some independence.
During these final weeks, awaiting a neuro-rehabilitation hospital bed, Geoff caught pneumonia. I was worried he wouldn’t survive it, as his body was so worn down by his long hospital stay – and he nearly didn’t – but with some early antibiotics and a bit of luck, he pulled through and was able to be discharged.
However, the hard work wasn’t over. It had only really just begun.
Left: Geoff, in his wheelchair at the rehabilitation hospital, lifts his right arm up to show me how it is unusable due to the stroke. Right: smiling for a portrait.
I visited Geoff in Putney neuro-rehabilitation hospital. It was now six months since he had contracted Covid. He showed me that his right arm hadn’t gained any strength back, a consequence of his stroke. On the bright side, he was making steps towards being able to perform simple, essential activities. We chatted about his cooking for the first time and making a dhal. Although speaking was still an effort for him, I was struck by the huge difference in the clarity with which he spoke and the duration for which he could speak. He could now manage a couple of words together in the same breath. He still had difficulty finding his words, however, and became frustrated by having to repeat words multiple times due to his struggle to enunciate them.
Geoff is hoisted out of his chair and on to a tilting table for exercises.
While Geoff still needed a hoist to get him out of his chair, he was making progress using a standing frame, which would help build his strength and make transferring between his chair and bed easier when he went home.
A tilt table is used to make squatting exercises possible when a patient cannot support their own weight. By changing the angle, you can increase or decrease the load on their legs. The physio showed Geoff which muscles he should focus on, particularly in his right leg, which had been weakened by his stroke. I was impressed by the improvement he’d made since I last saw him. With progress being inevitably slow, Geoff found it hard to see how far he had come, as there was no big shift week on week. Through my record of his recovery over large intervals, the progress became much clearer.
Geoff using the tilting table.
It’s not just like “popping to the gym”. The sessions were challenging, and in particularly Geoff found that the combination of exertion with the hoist made him nauseous.
The team provide him with a sick bowl.
Meanwhile, Geoff’s sons were busy making preparations at home for his discharge, and after a five-month stay in Putney, Geoff made it back to his by now heavily adapted house. His entire living situation had been relocated downstairs, with space upstairs for a carer. I planned to visit a few months later. However, due to two further waves of Covid, it was more than a year before I saw Geoff and his sons again in February 2022.
Geoff back home, pictured in his living room.
Critical illness is a huge punctuation in someone’s life, with the physical transformations more obvious to us all: the wheelchair; a bed in the living room to avoid the difficult use of stairlifts. Transferring from chair to chair is a big effort, and something Geoff has made impressive progress with. With assistance from his carer, he can get up and use a standing frame to pivot between where he sits. This may not seem like much, but it means he can get out of bed and into a wheelchair without needing multiple carers or complex hoists.
His son Sam and I were keen to show Geoff how far he had come since his hospital stay using some of the images from the project. Geoff’s memory has been patchy around his critical illness, with about one year a complete black spot in his mind.
Geoff likes to use his e-reader, as, unlike books, it only requires the use of one hand.
While at the beginning of the project Geoff would remember aspects of my visits from day to day, week to week and even over months, now he could no longer fully recognise the images from his hospital stays.
His son Sam and I used some of the early images to show Geoff how far he had come. Geoff commented on the images of him in the rehabilitation hospital with short hair, which left him feeling unnerved and uncomfortable, rather than seeing the progress he had made. While he didn’t mind others seeing the images, he said he didn’t want to see them again.
The huge psychological impact of illness, although not seen, had clearly left its mark and shifted over time. The conscious or unconscious need to separate these identities isn’t uncommon, and may go some way to explain why in his long time as a patient and identifying as being one, Geoff was OK with seeing pictures of himself as such. Now that phase was behind him and mostly forgotten, Geoff couldn’t identify with that person. Perhaps he didn’t want to be reminded of that difficult stage or felt unnerved by how little of it he remembered. It’s an example of how recoveries from difficult life events are unique, complex and evolve over weeks and years. While some people value one thing at a certain time, their opinion can reasonably change as time progresses in a way that can be hard to predict.
I find it hard not to feel emotional about Geoff’s experience – one I can relate to, as members of my family have also been through it. I want to capture something he enjoys . We talk about the books he’s reading about art history, an interest which Geoff was pursuing before his illness. I’m still left feeling his fatigue as he explains how he’s “just tired all the time”, the weight he’s carrying as part of this new existence.
While his son Sam attempts to fix a problem with the electric door – one of many adaptations that require constant attention – another of Geoff’s sons, Nicky, happens to pop in, coffee in hand from the local cafe.
Geoff and two of his sons joke during his speech-therapy exercises.
Sam begins reading out some of Geoff’s vocal exercises to show me how his speech is coming along. As Sam tees Geoff up for one of his regular jokes, I make a jibe that Sam is practising for his latest acting role. This is where I find that warmth, the light I’ve been wanting to find in this story of Geoff’s. That smile I’ve seen throughout even the tough times of his journey beams out again. In a city I can find so disparate, there’s this gem: the community of this family and the serendipity of them dropping in, supporting one another and still retaining great humour.
This isn’t a “happy ever after” story. Rather, it is of a life now with significant challenges, and a family’s shape changed for ever. It shows the power of unity in the most challenging times, and how challenging those times can be. Geoff has shown incredible strength and constant determination to gain and maintain some independence. With physiotherapy still booked three times a week, speech and language therapy continuing and a goal to make a speech at his son’s wedding, this hard work will need to be maintained to prevent weakness setting in.
The challenges of illness can be so huge that someone’s personal identity can completely shift, and while we can see images of the physical impacts of illness, the psychological effects are less tangible and require longer to appreciate.
Thank you to Geoff, his family and all the members of the teams involved in Geoff’s care for facilitating this project. It’s been a privilege to witness his recovery.