For the first three weeks of his life, Phineas was a model baby, but on the Friday night of that third week something changed. By six o’clock in the morning his mother was sure that all was not as it should be. She took him to the local hospital A&E (Accident & Emergency department). Unknown to her, that particular A&E had recently gone to a twelve hour opening as a prelude to being closed altogether. As a consequence there was only an on-call GP. His verdict? “It’s just a virus, take him home. He’ll be fine.” Up to a point he was right.
Three hours later Phineas’ mother trusted her instincts and took him to another hospital to get a second opinion. He was admitted immediately.
Phineas in the intensive care unit at ECH, May 2010. Photo: © Michael Cockerham 2010
What followed was a battle to save his life and diagnose the problem. By the Sunday afternoon his condition had deteriorated so much that he was retrieved to the Paediatric Intensive Care Unit (PICU) of the Evelina Children’s Hospital in Central London.
Phineas’ Friends is a photographic study of the doctors and nurses and clinicians that were involved in treating him during his six days at the Evelina. It is a study that forces the reader to challenge naturally held preconceptions about the size of modern medical teams, and indirectly asks the question: if all these people are necessary to a treat one baby with an infection, who in this new age of austerity can we afford to do without?
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Phineas is my third son. His mother, Laura, is my wife. Any parent who has ever asked a doctor if their child is going to die, and been met with a long pause and a non-committal answer, will have some idea of the emotions that were raging for us at that time. We were lucky. Although his condition was life threatening, he was in the best hands. Laura travelled to ECH in the retrieval ambulance with Phineas. By the time I got there the PICU team were hard at work stabilising him, and Laura, though still beside herself with worry, was comforted with the feeling that he was in the best place to get better.
Fatima Meho. Paediatric Staff Nurse, Beach Ward. Provided nursing care for Phineas on the ward. Photo: © Michael Cockerham 2010
The doctors in PICU were able to stabilise him sufficiently that he was moved out of intensive care onto Beach Ward on the Monday afternoon. From then on it was about supporting him as he got better, and trying to establish exactly what was wrong with him.
From the outset the doctors were fairly certain that he had a viral infection. The problem was that without knowing which virus, it was difficult to know exactly how he should be treated. At his worst Phineas had been cannulated to all four peripheries, his blood sugar was perilously low, his temperature was dangerously and stubbornly high, and he was on a CPAP (continuous positive airway pressure) machine to help him breathe. He was having bloods taken every hour or so, he had chest x-rays, and at one point they attempted to put a long line into him because his blood sugar was still dropping and he was on the limit of what could be given to him as a peripheral infusion without burning his veins.
Laura never left the hospital, only leaving his bedside to wash and eat. Over time it became clear that he was improving, but still the tests continued. Lumbar punctures, electro-encaphalographs, ultrasound brain scans. More infusions, more drugs.
Dr Emma Aarons. Consultant Virologist. Ensures any patient with possible viral illness has the right investigations, and where tests show viral diagnosis that the appropriate care is given. Photo: © Michael Cockerham 2010
On the Wednesday afternoon I was sitting with Phineas while Laura got some lunch. Staff nurse Fatima Meho was attending to him while I flicked through that week’s Sunday Times Magazine. The cover story was about a patient in the renal ward at Great Ormond Street Hospital. I held the magazine open for Fatima to see and remarked how ironic it was that the story should be published just I was sitting in Beach Ward (the Evelina’s renal ward) with my son. “No one ever writes about us,” Fatima replied. I asked her what the difference was between Great Ormond Street and the Evelina. “Nothing,” she said. Both hospitals have the same specialisations, only the former is world famous and leverages that fame effectively to raise funds. I have to admit that I had never heard of the Evelina until I needed it.
It was Fatima’s response which set me thinking that I should document Phineas’ story and get some publicity for the hospital. But what was the angle? I did not want to rehash a story that has been done many times before. The fact was that although it was important to me, it was not significant to anyone else. If I was going to publish his story, it needed an angle.
The following afternoon Laura and I got a visit from three doctors from the Infectious Diseases Directorate. At first I was struck by how different these three characters were. Nuria Martinez-Alier, Ian Plumb and Emma Aarons seemed at first an unlikely trio, but it quickly made me reflect on all the different characters we had come across during Phineas’ time in hospital. Not simply the diversity of characters, but the sheer numbers of people involved. I had my angle.
Dr Marilyn MacDougall. Paediatric Intensive Care Consultant. On-call when Phineas was admitted to PICU, she made the decision to retrieve him. Authorised the retrieval team and responsible for his initial treatment. Photo: © Michael Cockerham 2010
Over those six days Phineas was treated by about one hundred clinical specialists, about four fifths of them at the Evelina. There were doctors, consultants, registrars, nurses, matrons, ward sisters, students, phlebotomists, radiographers, metabolic specialists, virologists, and these were just the ones that actually saw him. There were as many, if not more, clinical scientists and technicians analysing and interpreting the various tests he was subjected to and samples taken from him. There was the ambulance technician and the retrieval team who collected and treated him on the journey to the Evelina. There was the counsellor who was there for us as parents.
As a photographer I found myself thinking about all the hidden talents within this huge team of people – the unsung men and women whose work as technicians and scientists underpin the decisions that the doctors make and the nurses carry through. The doctors get the plaudits, but the reality is that all these different facets of modern medicine need to work together to produce the outcomes that we as patients and parents yearn and pray for.
The more I thought about all these people, the more I kept thinking about Richard Avedon’s seminal work The Family, and more recently of Nadav Kander’s Obama’s People. Both these projects used portraits shot against plain backgrounds to highlight the differences in character – the repetition of style and of people was the motif, and yet it is this approach that highlights the enormous differences from subject to subject.
Tom Walton. Biomedical Scientist. Analysis of urine by gas chromatography and mass spectroscopy. Photo: © Michael Cockerham 2010
It is a form of typological study that was perhaps made famous by Bernd and Hilla Becher and their studies of blast furnaces, and taken up by other photographers including Donovan Wylie and his study of the Maze Prison. The difference is that with people the subject has the capacity to introduce its own character and agenda to the way that they are recorded; it is necessarily a two-way process. Certainly these are “my” portraits and they reflect something of my intention, but as each individual sits for me, they have control over the face that they present. For a good portrait there must inevitably be a balance in that “dialogue” between the subject and the photographer.
Avedon chose to shoot in large format black and white, with a simple white background. His subjects were the men and women who ran and shaped America. From Gerald Ford as President to Roger Baldwin, the founder of the American Civil Liberties Union.
Kander chose to use a similar approach to document the nascent administration of Barack Obama as he was about to take office, but in this case he shot in colour, with a creamy background. The images have been digitally worked to some extent, putting a shadow close in behind each person, and emphasising the texture of each person. There is a kind of hyper reality about them which makes each face fascinating to look at. Although the work was regarded by some as something of a departure from Kander’s norm at the time, it was nevertheless imbued with his artistic sensibilities. It had his “signature”.
Sean Hayes. Retrieval Technician. Part of the retrieval team that brought Phineas back to the Evelina PICU from Darent Valley Hospital. Photo: © Michael Cockerham 2010
Both of these bodies of work were successful for the combination of simple, arresting portraiture and the fact that the subjects were either household names, or held positions of power that made their faces worthy of closer inspection.
For Phineas’ Friends I felt certain that a similar approach would be ideal. To the best of my knowledge no one had taken this approach with a medical documentary before, and the strength of the story would reside in the fact that as the reader moved through all of these portraits it would dawn on them that the common link for all of them was a single patient – a baby. None of these people are famous, nor was the patient. But the pull of such a small child as a narrative element is undeniable. Perhaps more importantly, we are all able to see ourselves in that baby. And when we do Phineas’ friends become our’s. These are our doctors and nurses and technicians and scientists. These are the people that keep each of us alive if we need them. As Phineas is a metaphor for all patients, so too his friends are a metaphor for all the clinicians working in all the hospitals around the world. Once we realise that, the old narrative beloved of dramas and documentaries seems a pale approximation of the truth – modern medicine is not a doctor and a nurse, it is a vast team of specialists.
Habiba Kawu. Neonatal Staff Nurse. Agency nurse providing constant care and monitoring of Phineas' condition while in intensive care. Photo: © Michael Cockerham 2010
Nevertheless I was conscious that for the project to work, the standard of the portraits needed to be high. Each image had to work individually while they all worked together as a set. The choice of background, the style of lighting, the choice of lens, and the subtlety of any direction I gave would have to complement the image and the intent. I wanted very much to give viewers something of the experience of the parent or the concerned relative. Hopefully I have succeeded.
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I decided on a whim to enter the book of Phineas’ Friends in this year’s Photography Book Now Awards. Although it did not win, it was shortlisted in the Documentary Category, and as a result was eligible for the People’s Choice Award. To have been shortlisted by the jury in the first place is a tremendous honour. But more importantly it gave me a glorious reason to push the work in front of people as I tried to garner all the votes I could. I was able to enlist the help of a great many influential people around the world, and that in itself has helped in my quest to raise the profile of the hospital. All of you who voted, thank you. Your support means a great deal. But it does not end there.
As I intimated earlier, my motivation from the outset has been to help publicise the work of the Evelina and perhaps raise its profile just a bit. As a part of that process, Blue Filter has published Phineas’ Friends in three formats: as an iBook for the iPad and iPhone, as a small format paperback, and as a limited edition signed hardback. All of these can be ordered from this site, and the profits from the sale of these books will be donated to the Evelina Children’s Hospital.
Please, buy the iBook or the paperback. If you are feeling flush and want some exclusivity, buy the hardback. But whatever you do, encourage all your friends, family and acquaintances to read this post and buy the iBook too. If you just want to donate with nothing in return, you can do that as well.
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Buy the iBook for iPhone & iPad
Buy the paperback
Buy the limited edition hardback
If you would like to support the Evelina Children’s Hospital, some of the Evelina Team recently undertook a sponsored climb up Mount Kilimanjaro, and you can still donate now. Their target was £400,000, with the current total raised standing at £396,616.63. It is to this fund that monies raised from the sales of Phineas’ Friends will be donated, but if you would rather donate directly, please click here.