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J D Williamson
Hospital doctor & photographer

Our latest Z Creator Dr J D Williamson – Jonathan to his family and friends – has been taking photographs since his primary school days, initially focusing on the natural world he loves so much. Now, as an NHS anaesthetist, he’s using his photography skills between hectic shifts in a North London hospital to capture the stark, harshly lit realities of Covid-19 for both patients and medics.

Published by Photo London 2020, Tortoise Media, NBC, Sky News, ITV London, Channel 4 and Channel 5 News, Dr Williamson’s remarkable project opens an intimate, insightful window onto a world that’s rarely captured by anyone with a real understanding of what is actually going on.

We catch up with him to find out how Nikon’s mirrorless Z-series cameras and lenses – and the experts at Nikon School – have helped him overcome some of the unique technical aspects of his project. We’ll also hear about the clinical and ethical challenges involved in creating a sensitive, nuanced photographic record of the pandemic.

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When you first became a doctor, did you ever imagine you’d be taking your camera into work?

Not at all. I got into medical photography when I started my anaesthetics training at University College Hospital in London. It’s a dynamic place with lots of educational projects going on that need imagery. So I began by shooting in operating theatres, outpatients’ clinics and on the wards. I soon realised what a challenge taking photographs is in the clinical environment, and also how satisfying.

When the pandemic hit, I was in my current post at the Whittington Hospital in North London. My consultant supervisor, knowing I was a photographer, thought it would be a good idea for me to document what was happening. I’d had a similar thought, and we ended up approaching each other on the same day.

I started shooting in April 2020, using my Nikon Z 6 and the 24-70mm f/4 kit lens. Everything was handheld because a tripod would have got in the way, and was also a contamination risk – for the same reason, I didn’t even use the camera strap. I wanted to shoot in a raw, unstaged manner with available light – flash would have been too disruptive for the patients and staff. I wasn’t after studio-style, perfectly lit portraits; I wanted to show the processes, patient journeys and themes, to educate people about the pandemic and to document the medics’ stories, too.

Are there any tricky issues around consent for photography in a hospital setting?

Patients can give consent even when they’re unwell, but you have to be certain they understand what they are doing, you ideally need to check the family are all on board, then I believe you have a duty to follow up with the patient when they’ve recovered to make sure they’re still happy for the images to be used. Rolling consent is such a complex proposition, and if at any stage they decide they don’t want the images to be used further, then that’s it. So I generally photograph people who are non-identifiable and I go to great lengths to make sure it stays that way – if I think there’s enough of the back of their head showing to identify them, I’ll blur it out.

Most of the time, I focus on staff because consent is far easier, especially as it’s predominately my own team I’m photographing. I’ve been working here now for 17 months, so I’ve been in the intensive care unit (ICU) many times, and lots of staff know me on the wards as well. They’ve all seen my work – some of it’s displayed around the hospital – and most are very engaged and actively want to be involved. Some photographers take pictures when people are particularly stressed or crying but I don’t do that, because I don’t want to be invasive. I gauge whether it’s appropriate to approach someone, I always ask if it’s OK and I limit how much I shoot, because you don’t want people thinking they’re constantly being watched.

How difficult is it to fit the photography project in around your work as an anaesthetist?

I’ll do it maybe one shift a week – that’s usually all I have time for. It’s about being highly vigilant and reading the room. I’m in a really unique position where I know the people, I know about the patient journey, I know what’s appropriate, I know what’s a safe environment, and I know what will get in the way. It’s about finding the breaks when it’s clinically appropriate to seize your chance and take a photograph; it’s often just a window of 30 seconds.

So it’s about using my medical knowledge of what’s going to happen, then quickly picking up the camera and shooting high bursts at the maximum aperture and slowest shutter speed I can get away with. I want to stress that I don’t photograph when I’m by myself with a patient, only when I’m with my team and only when I’m not responsible for the patient’s care. Sometimes I stay after my shift if I know something is happening. That’s how I got the “proning” images – where the patient is being turned onto their stomach to aid their breathing. My shift had finished and they’d got enough team members to do the procedure, so I was able to capture it with a 20mm f/1.8 wideangle.

What technical challenges have you had to contend with?

The environment is incredibly harsh to shoot in. The lighting is awful, mostly ceiling spotlights. You get lots of black areas, and because it’s downlighting you often miss people’s faces. There’s a vast amount of movement. I’m usually wearing a visor, too, so I’m shooting off the screen most of the time.

It’s very hard trying to gauge what shutter speed to use. You’re trying for as slow as you can, and then there’s unexpected motion. I don’t ask people to pose for photos because I don’t want to interrupt clinical work, so it’s been a process of trying different lenses and working towards as big an aperture as I can get my hands on – while struggling with depth of field, glare bouncing off visors and moving subjects when autofocus doesn’t necessarily pick them up.

There’s also a big issue around cross-infection. I have a particular area where I’ll leave my camera and lenses. I’ll clean my hands before I use them and carefully decontaminate everything afterwards. As an anaesthetist, I’m very used to doing procedures where you have to be sterile, so it’s easy to keep track of what I’ve touched, what is clean and what isn’t, which is a real advantage.

Tell us a bit about your kit…

Since I started the project, I’ve amassed a ton of amazing gear on long-term loan from Nikon, along with my own kit. At the outset I was getting a lot of noise, even at f/4 with a reasonably low shutter speed like 1/250sec or even down to 1/100sec. The images just weren’t really what I wanted to achieve, so I rang Nikon for advice and to try to get some support with gear. When I explained what I was doing to Neil Freeman at Nikon School, he said, “You’ve set yourself a bit of a challenge there, haven’t you?”

Since then, Nikon has been so helpful. I can call Neil up for technical advice – for example, asking which lens he would recommend for what I’m trying to achieve. By the end of the first wave, I had three Z-mount lenses: the 20mm f/1.8, the 35mm f/1.8mm and the 24-70mm f/2.8. The 24-70mm was great for the odd day when I didn’t particularly know what I’d be shooting and just needed to have a lens on the camera to be ready, particularly in well-lit areas. In darker parts of ICU, I’ve tended to use primes.

During the summer Nikon loaned me the 45.7MP Z 7, along with the 50mm f/1.8 prime, and that’s what I mostly shoot with now. I’ll also take in the 35mm or the 20mm, as it’s great for busier wideangle shots. They’re such compact lenses and the image quality is outstanding. Recently I’ve also borrowed the 50mm f/1.2, which is incredible – by far the best lens I’ve ever shot with. It’s so fast that I can capture amazing sharpness and bold-looking, shallow depth-of-field images, all without using flash, which is a game-changer for environments where the light is awful. It’s an absolute saviour in ICU. I also sometimes use my F-mount 105mm f/1.4 with the FTZ adapter for long shots through bays.

The other aspect where Nikon has been great is in helping me get the story out there. In the first peak, I didn’t have enough time to get much publicity off the ground, but since the summer the PR team have given me some excellent media contacts.

Which pictures have affected you the most?

There’s one in particular, from spring 2020, of a colleague coming out of intensive care. It’s a simple close-up of his face. He was at university with me and we ended up having the same training job in the same hospital, so it’s almost like taking a photo of myself, reflecting my own emotions. Another is of a patient in ICU lying face down, with just their toes peeking out of the bottom of the sheet. It really struck home – a sliver of humanity in an otherwise unidentifiable shape, and a subtle reminder of what’s happening, rather than an in-your-face shot of a patient dying.

There are also some images of a baby being born by C-section that I love, especially where he’s emerging, screaming, holding his hands out to the world, with fluid dripping off his heels and his mother peering at him over her facemask. It’s slightly bizarre for a couple of reasons: most people don’t see images of childbirth, and most women giving birth aren’t wearing a mask. I took it during a week when I was mostly intubating Covid patients but then also had a shift in obstetrics. I wanted to capture some contrast to everything else that was going on, the symmetry of life and death. It’s all happening within the same hospital. A three-minute walk down a long corridor from ICU, and babies are being born.

Have you always been into photography?

I started taking photographs when I was around six or seven, with a simple film camera. I got a compact digital camera in my early teens and my first DSLR, the Nikon D60, aged 17. That stayed with me for years until I inherited my sister’s D90. Then in 2017 I did a diploma in expedition medicine. Part of the course was a placement in Morocco, and one night I took some photos of scorpions glowing in the dark under UV light. Realising the magic of discovery in an image was a real turning point for taking my photography more seriously. So I did my research and got the Nikon Z 6 shortly after it came out. I needed something I could carry around easily, and the Z-series mirrorless cameras have inbuilt image stabilisation, which means their lenses are smaller and more compact. I also liked the look of that incredibly wide Z-mount.

Medical photography is brilliant, especially for the educational aspects and the challenges it gives me, but I didn’t set out to be a medical photographer. Outdoor photography is my first love – especially shooting things you wouldn’t normally notice with your own eyes, like stars or macro details. Even in lockdown when you can’t travel far, you can still find stuff if you look for it – I got some great shots of a little spider traversing across a corner of my patio. I love that you can discover these small worlds through your lens.

Why did you go into medicine?

To be honest, it’s the classic medical-school CV answer – I wanted a job working with people, that was practical, scientific and had a purpose. More interesting is that, when you look into it, there’s quite a lot of crossover between anaesthetics and photography – in fact, quite a few of my anaesthetist friends are into photography.

At their core, both are very technical, with lots of science behind everything, lots of numbers, and more than one way to do things if you know how. But you can’t just solve the problems by doing numbers; there’s an element of art form in both subjects. With anaesthetics, you’re constantly problem solving, which is why it’s so satisfying. It might be a very scientific problem, or it might be a logistical one – regardless, you’re constantly trying to find solutions.

There are so many parallels with the photography I’ve been doing, yet it’s only this year that I’ve seen them. Knowing the medical systems helps me solve the photography challenges. I’m not there yet. I’m still learning. I’ll still come back to my photos and think, could I have done that better with a different lens or angle?

… and why the sideline in expedition medicine?

I grew up in the Hampshire countryside and I love being outdoors – it’s where I’m happiest. I’ve shot myself in the foot by working in areas of hospitals without many windows. The expedition medicine diploma was a way of combining my love of photography and the outdoors with my job. My initial plan was to spend 2020 doing expeditions before I started my new anaesthetics post. Then the training programme changed (and COVID), and it made more sense not to take that time out.

So, despite being qualified, I haven’t yet been the named doctor on any external expeditions. I have been on many of my own, though. I regularly go skiing and love to ski tour. I’ve fortunately done lots of travelling and some of my favourite trekking has been around Peru, New Zealand and Nepal. I also love cycling, kite-surfing, climbing and diving – I’m a bit of a collector of outdoor hobbies. I’ve got my PADI Advanced Open Water Diver certification, so doing underwater photography would be amazing – you can just pause by a reef and see these incredible little creatures. But it would also be challenging, with all the movement and the terrible light – not unlike shooting in the clinical environment! Perhaps that’s something for the future.

What’s the most important message you’d like your pandemic project to get across?

I’m trying to portray a realistic, unstaged view of the pandemic as someone on the inside with medical insight, who can help the public understand more. There’s no pressure on me to get these images, other than a personal one to be able to tell the story and get the public engaged on an emotional and intellectual level– that’s become a significant driver as the pandemic has stretched on.

It’s been hard for hospitals to document it, for so many reasons: infection control, to protect patients’ privacy, out of respect for families who can’t visit their loved ones, because it’s not clinically appropriate, because it’s too busy or because it’s not safe. And then sometimes you’ll see a press image with an explanation that doesn’t actually fit with what’s going on, and it confuses the whole scenario.

I once read that there are two questions you should ask yourself: does this story needs to be told, and am I the right person to be telling it? If you can fulfil those two conditions, then it’s worth doing. Having the opportunity to tell the story properly, and being able to do it, it feels like my duty.