Face mask

Protection, communication, frustration

Protection, communication, frustration

‘I remember with painful, vivid clarity the terrified 92-year-old who thought the respirators we were wearing were gas masks from the war. I remember telling her we were in fancy dress for a party, and we laughed together. I remember standing outside her room, crying, and trying to pull myself together so I could finish the ward round.’

CM, acute and respiratory medicine consultant, north-east England and Yorkshire


The provision of personal protective equipment (PPE) was a controversial, politicised and well publicised issue for healthcare workers throughout the pandemic.

Many expressed their frustration about the limited availability of PPE, and their anger at the inadequate quality of the equipment they did have access to. Others spoke of their fear when having to work without PPE, and their relief when they finally received it.

The RCP museum received donations of many items of PPE used by healthcare workers. Looking at these items, it is possible to imagine the discomfort people described while wearing them. We can also gain some understanding of the challenges experienced by both healthcare workers and patients while trying to communicate through them.

Collage of healthcare professionals wearing PPE.

Selfies in PPE

Selfies in PPE

Donated by, clockwise from top left:

MK, respiratory consultant, Northern Ireland, titled ‘Covid Man2’

JB, geriatric medicine consultant, Scotland

SR, diabetes and endocrinology consultant, north-west England, titled ‘Hospital acquired COVID harm’

KF, palliative medicine acting consultant, north-east England and Yorkshire

RM, clinical microbiology fellow, north-west England

The RCP Museum received many photographs of healthcare professionals wearing their PPE.

PPE also appears as a common topic in many of the written accounts, interviews, and objects donated to the RCP’s collection, indicating that it was an important aspect of healthcare workers’ experiences of working during the pandemic.

‘I worked very closely over many months with ward staff and yet never saw their faces!’  

AS, geriatrics consultant, north-east England and Yorkshire

 

‘Some doctors were told off for wearing facemasks early on because it would “frighten” the patients and other staff.’

Anon., internal medicine CT3 (core trainee year 3) doctor, UK

Doctor in facemask respirator

 

Full face respirator, and photograph of SA wearing the respirator

Full face respirator, and photograph of SA wearing the respirator, 2020

Donated by SA, respiratory and intensive care consultant, Midlands

SA wore this respirator – a device intended to limit the wearer’s risk of inhaling hazardous or infectious particles – during the first wave of the pandemic, May to June 2020. SA’s name is printed on the visor to help his patients and colleagues in the intensive therapy unit (ITU) – many of whom were redeployed and unused to working in the ITU – to recognise him:

‘Everyone’s face is different and […] various mask types were required by individuals to ensure they fitted properly … we know many health care workers contracted COVID, some of which may have been from the workplace.

‘I really found the mask I have provided very difficult to wear – because it was a full face mask and very tight fitting – it was claustrophobic for periods of greater than 20 mins at a time for me, very hot, uncomfortable, difficult to communicate through and physically very heavy – it felt like I had a tight band around my head like a tension headache, but in this case because there were actually tight bands around my head! I [persevered] for just over a month but was relieved when another ‘half mask’ became available for me to wear that fitted and just covered my mouth and nose.’

Respirator Hood

  

Respirator hood, and photograph of AG wearing the hood

Respirator hood, and photograph of AG wearing the hood, 2020

Donated by AG, gastroenterology consultant, Midlands     

AG wore this ventilator hood when performing endoscopies (the insertion of a long, thin tube with a camera into the body) during the first year of the pandemic.

A belt-mounted blower unit delivered a constant supply of filtered air into the hood, via a hose, creating positive pressure which prevented contaminated air from entering. The fan was very noisy, making hearing difficult, and the hood became uncomfortably hot over the 4-hour shifts it was typically worn for.

The pen tally marks show how many times AG wore this hood – after 20 times it would be replaced. This type of hood largely fell out of use after 2020 with the increasing availability of smaller, close-fitting FFP3 masks.

Goggles and name badge.  Photograph of badge being worn.

Badge, and photograph of SH wearing the badge

Badge, and photograph of SH wearing the badge, 2020

Donated by SH, infectious diseases, IMT1 (internal medicine stage 1), north-west England

SH wore this badge over his PPE while working in an intensive care unit (ICU) between March 2020 and December 2021, so patients could see a human face behind the visor. The badge was developed by the hospital’s speech and language therapist. SH recalled that:

‘Waking up from anaesthetic/severe illness is so terrifying that for me, [the badge] made communication easier […] Often [the patients’] gaze fell on the badge (I had it on a retractable string so I could bring it to their eyeline) and they seemed to realise there was a human there.

‘I had comments from patients who were at the end of their ICU stay/on the wards after stepping down that they recognise me from the picture. It made me feel more human too, when you're looking after someone for so long you want to build a relationship, and it’s impossible if they don't know who they are talking to.’

Goggles, 2020

Donated by SH, infectious diseases IMT1 (internal medicine stage 1), north-west England

Alongside the badge, SH bought and wore these goggles while working in hospital between August 2020 and December 2021.

‘I bought the goggles for myself when I rotated from intensive care to infectious diseases – we didn't have full PPE on the wards so felt I needed something to further protect myself when reviewing patients on the infections ward and in A&E. I felt at the time they provided some protection, but I did get covid fairly quickly after rotating to the wards and away from an environment with full PPE. It felt almost an inevitability when I finally caught COVID in Nov’ 20.’

SH described the distress the goggles could cause: ‘Patients often wake up so disoriented that seeing someone in goggles/mask was terrifying for them.’

‘One patient could only understand if I wrote everything out on paper – quite a challenge for a CPAP [continuous positive airway pressure therapy] withdrawal. Making eye contact while someone took their last breath. Learning to do things by phone and video we would never have dreamed of.’

SY, palliative medicine consultant, London

  Homemade scrubs

Homemade scrubs

Homemade scrubs, 2020

Donated by M-CR, palliative medicine specialist registrar, London

M-CR received a set of scrubs from her neighbour back home in Ireland, for her to wear while working at St Joseph's Hospice, Hackney. M-CR described the comfort these scrubs provided:

‘My neighbour at home in Ireland sewed me scrubs from a bedsheet. I think the pockets sewn on were made of old PJs! She posted it over to where I worked in London for me. It was at a time when scrubs and PPE were advised but not in great supply. They looked a bit unconventional but I was grateful for them and when I wore them at work I felt close to home.’

Although these scrubs were worn during the pandemic, they are not contaminated and are safe to display. The SARS-CoV-2 virus does not survive on surfaces (porous and non-porous) for more than a few weeks at most.

Transcript: AH talks about wearing polyester scrubs

A H – Polyester Scrubs

When you’re working in a very, very hot environment and you’re post-menopausal, you do tend to chose for yourself quite cool and airy stuff and so I had a lot of very professional cool and airy outfits. But one day, the word went out with Covid that we were all going to wear scrubs and that we were all going to wash them at 60 degrees. And so we turned up at the laundry the next day to get our sets of scrubs, or three sets of scrubs, which is what you normally get. My husband, who does some operating, he had some lovely, soft, cotton scrubs with his name embroidered on, the department embroidered [on] and the ladies took the legs up for him. But I turned up and I got given two pairs of really hot thick polyester scrubs with legs about eight feet long, and I said, ‘Would you be able to sew them up?’ And they looked completely harassed. 

And I said, ‘No, no, no,’ and they gave me a length of sticky-on tape you had to iron on. So, when I got back about nine o’clock that evening, having just rolled them all up all day, I thought, I got this sticky-tape, I tried to iron it on, it got all tangled everywhere up it was such a mess. I did both pairs and then, because you weren’t allowed to wear the scrubs into work, so I would get on my bike, with my scrubs in my bike bag, cycle into work, get changed in the toilets, and then go to work, and then come back and get changed back, and then cycle home. And I lost one pair pretty quickly, don’t know where they went. So, I was down to one pair of thick, hot, I sound like a real moaner here, polyester scrubs, badly sewn up around the bottom that I had to wash every night and put in my bicycle bag and cycle back with. Too bad, that’s the scrubs!

Unperforated roll of aprons.

Disposable apron roll

Disposable apron roll, 2020

Donated by AS, geriatrics consultant, north-east England and Yorkshire

‘At the beginning of the pandemic we had no PPE, and later on it was insufficient to properly protect us and of a very poor quality. My ward colleague caught COVID and died. I caught COVID shortly following this.’

This roll of faulty disposable aprons was issued to the hospital where AS worked as a geriatrics consultant during the pandemic. AS described how, when he tried to use this roll, he found it had no perforations and was unshaped, and his heart sank. He continued to use them, by knotting them around his waist or neck to make them functional.

Even when functional, AS felt that these aprons did not provide sufficient protection at the beginning of the pandemic, when the contribution of surface-borne transmission was less well understood. They left arms and shoulders exposed to droplets containing virus particles from coughs and sneezes. 

  PPE

No PPE

No PPE, 2020

Donated by CO, internal medicine doctor, Nigeria

‘My most negative experience is the lack of personal protective equipment in Nigeria.’

Healthcare workers outside the UK also experienced the fear of working with inadequate PPE provision. CO worked in a COVID-19 isolation and treatment centre in southern Nigeria.

PPE with split sleeve

PPE with split sleeve, 2020

Donated by JB, respiratory consultant, Midlands

JB donated a photograph of himself wearing his ‘3rd plastic gown that split down the forearm upon putting [it] on.’

‘It was emotionally draining, especially speaking to scared staff in care homes with COVID outbreaks and insufficient PPE. I have no access to PPE supplies, it’s not something my organisation is involved with, but we did have to give those care homes advice on protecting themselves – and what advice can you give when the homes have no kit?’

Anon., health protection consultant, UK

  Respirator

Before and after wearing a respirator

Before and after wearing a respirator, March 2020

Donated by CM, acute and respiratory medicine consultant, north-east England and Yorkshire

CM photographed herself wearing a respirator and visor immediately before starting a COVID-19 ward round in March 2020. She photographed herself again after completing the round.

This respirator caused distress for an older patient, who confused it with a gas mask from World War II.

CM spoke about how the respirator was uncomfortable but gave her comfort: 

‘We were very lucky to some respects in this area, Teesside’s a very industrial area and so a lot of our industry – unlucky for them obviously – a lot of the businesses were shutting down, they couldn't work, so the teams that do a lot of the asbestos removal in the area they came in and they fitted us with their respirators that are used for when they are removing asbestos.

‘So we all went along and we literally had half an hour session where we were fitted with these face masks. So very tightly over your face, they’ve got the valves on the outside, and they look like gas masks from the war, so they’re very uncomfortable, they’re not comfortable at all, but we felt safe in them.’

Transcript: CM speaks about her PPE being mistaken for a 1940s gas mask

C M - Gas Masks

And we’d gone in to see this lady, on the ward round, and she was absolutely terrified; she didn’t have any of her family there. And she saw us in all of this gear, and she thought she was in the Second World War because obviously she’d lived through that, so she started crying and she’s saying, ‘Oh, why have you all got gas masks on?’ And I was trying to explain to her, ‘They’re not gas masks, honey, they’re not gas masks, it’s just to protect us from the virus and from the germ.’ And then one of my colleagues said, ‘Oh we’re in fancy dress.’ And she said, ‘You’re in fancy dress?’ And I went, ‘Yes we are, my darling, we’re having a fancy dress party!’ And she was like, ‘Oh that’s so lovely, that’s so exciting.’ And she calmed right down after that and it felt like such -- like a nice little glimmer of hope, and then we went outside and we were crying for about ten minutes, just thinking, ‘This is awful. This is not how we deal with our patients. This is not the level of communication that we want.’ You want to be able to sit and hold the hands of these frightened people. I think that was really one of my worst memories of the situation, just how scared she was. But the best as well because it just brings out the kindness in your colleagues.


Part of the exhibition Fortitude

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