Intensive Care: read an extract

04 January 2021

Intensive Care is about how coronavirus emerged, spread across the world and changed all of our lives forever. But it’s not, perhaps, the story you expect.

Gavin Francis is a GP who works in both urban and rural communities, splitting his time between Edinburgh and the islands of Orkney. When the pandemic ripped through our society he saw how it affected every walk of life: the anxious teenager, the isolated care home resident, the struggling furloughed worker and homeless ex-prisoner, all united by their vulnerability in the face of a global disaster.

In this deeply personal account of nine months spent caring for a society in crisis, Francis will take you from rural village streets to local clinics and communal city stairways. And in telling this story, he reveals others: of loneliness and hope, illness and recovery, and of what we can achieve when we care for each other.

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Read an extract below.


‘[I]t is my opinion, and I must leave it as a prescription, viz., that the best physic against the plague is to run away from it.’
Daniel Defoe
A Journal of the Plague Year

At the Covid clinic car park the barrier points skywards: the requirement to pay is suspended, along with so many other rules in this strange, in-between world of coronavirus. The clinic doctors had told you to come alone. You walk to the door, breathless even at that brief exertion, then push a buzzer that will shortly be wiped with alcohol to decontaminate it from your touch. You wait, with your cough and your fever. The door opens; inside, a nurse in blue scrubs, face mask and visor helps you put on a face mask, then leads you down the red or ‘dirty’ corridor (though it is decorated in pastel shades and looks freshly mopped) into a small clinic room with too-bright lights and wipe-down furniture. You’re gasping now for breath, have some pains in your chest, you’re flushed and sweating, frightened by all you’ve heard and read of this virus, this pandemic. The millions downed by it, the lack of ventilators, the military drafted in to help, the global economic ruin.

A doctor comes in; she too is dressed in impersonal blue scrubs, a mask with a spray visor, a flimsy plastic apron and bare forearms ending in blue-gloved hands. She asks you a few questions – how breathless you feel, how high your fever has been, when did your symptoms start, where you have been travelling. She puts a sensor on your finger to gauge the oxygen content of your blood, then slots a thermometer into your ear. You feel hungry for air, and notice her gaze on you, as she counts your breaths.

Your oxygen is too low, your breathing too fast; a wheelchair is brought, a porter takes you to a lift. You still have your mask on and when, inside the lift, you ask the porter where you’re going, his own mask makes it difficult to understand the response. The lift door opens, behind it more blue-suited figures dressed in masks, aprons and gloves. One approaches with a swab on a stick, but you can’t make out clearly what is said. You feel swallowed by the hospital, by the virus, by this pandemic that has broken over the world.

This story begins on 31 December 2019 when the Chinese authorities alerted the World Health Organization (WHO) to a new and dangerous strain of viral pneumonia that had arisen in Wuhan, central China. That virus didn’t yet have a name, though it had already been circulating for some months. As the world turned into a new year, midnight fireworks igniting in a band across the globe, the virus began its worldwide spread. The story of 2020 is the story of this virus, its transmission, its ramifications for global and local economies, for how we travel, how we deliver healthcare, and how we plan for the even more damaging epidemics that will come.

My ambition has been to chart the evolution of this modern epidemic as I saw it, as a GP and as a member of the communities I work with, and for, in Scotland. In fact, the story that I am telling has proven more complex, and its ramifications more extended, than I anticipated in the early weeks of the crisis. Back then my fear was of a deluge of infections and deaths caused by the virus. I didn’t see that this would become not just an account of a pandemic infection, but of the sudden warping of an entire way of life, of all those lives which have been thrown out of kilter and whose trajectories were now so uncertain, and the care those people would need as a result. I didn’t foresee how much the profession that I love would be bruised, transformed and reshaped to cope with the impact of the virus. This book is a contemporary history, an eyewitness account of the most intense months I have known in my twenty-year career, a hot take on the pandemic that speaks of the tragic consequences of measures taken against the virus as much as it tells stories of the virus itself.

‘Crisis’ is a Greek word which originally described the moment in the evolution of an illness on which everything hinges, when death and recovery are held, for a moment, in the balance. The slightest nudge towards one or the other may determine the outcome. In a hospital, the intensive care unit or intensive therapy unit (ICU or ITU) is where the sickest patients, those whose organs are failing and who will die without drastic and intense interventions, are looked after. Those units do extraordinary work, but over the months of this pandemic it has often seemed to me as if many other clinicians, scientists, carers and charity workers outside the ITU have been engaged in something comparably intense. It has frequently seemed as if society itself is on life support, and intensive measures, including huge efforts of selflessness, vision and compassion, have been required to sustain it. ‘Care’ is something we do for others, but it’s also an emotional attitude of attentive compassion, of kindness, and delivering it can be a privilege as much as it can also be a burden and a responsibility. I’d like to cast a modest spotlight on the care I’ve seen delivered in the communities I work with – a care that has often been delivered quietly, without headline news, in rural village streets, community clinics and communal city stairs. It’s my hope that sharing some of those stories will help readers see more clearly what has been gained and lost so far through Covid-19, and what we’re still in danger of losing. It’s only by learning from this pandemic that we can better protect ourselves for the next one.

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