Unmasking the pandemic

Three writers, all with medical backgrounds, have come together to chart the NHS experience during the Covid-19 pandemic. Rachel Clarke, Prasanna Puwanarajah and Jed Mercurio explain why ITV’s Breathtaking might be the most important drama they will ever write.

Just a month ago, UK broadcaster ITV was setting the political agenda with a four-part factual drama called Mr Bates vs The Post Office, which dramatised what is thought to be the most widespread miscarriage of justice in British legal history.

The story recalled how sub-postmasters and mistresses were erroneously accused of fraud and theft and pursued through the courts with devastating effects, leaving viewers outraged and politicians quickly promising action and new laws to right two decades’ worth of wrongs.

Now, another ITV drama is set to capture the attention of a nation. Breathtaking is a three-part series that delivers a shocking, upsetting and thought-provoking portrayal of the Covid-19 pandemic through the eyes of an NHS doctor – Joanne Froggatt (Downton Abbey)’s acute medicine consultant Dr Abbey Henderson – standing on the front line of a hospital’s battle against the virus.

Episode one begins in the weeks leading up to the first UK lockdown, as doctors prepare to care for the first wave of patients but quickly become overwhelmed in the face of national guidance that often contradicted their experience on the wards. The series then follows Abbey during the first lockdown, as concerns are raised about care home discharges and inadequate PPE (personal protective equipment), and later when she begins to voice the true impact of the pandemic while also dealing with more rising cases in winter 2020.

Produced by HTM Television and directed by Craig Viveiros (Angela Black), the series is based on real-life doctor Rachel Clarke’s memoir of the same name, which was recorded as the pandemic unfolded. In a unique collaboration, Clarke, a former documentary journalist, then teamed up with former junior doctors Prasanna Puwanarajah and Jed Mercurio to adapt her book for television.

“Everyone thinks they know about the pandemic. We all lived through it as a country,” Clarke tells DQ. “But actually, unless you were there inside the closed hospital doors, it’s almost impossible for anyone to really have a sense of how things unfolded. It was that that we wanted to bring onto the screen and into people’s front rooms.”

Clarke describes wanting people to “see, hear, feel and experience” what she herself went through day by day on the Covid wards. She then channelled that real, authentic clinical experience – “the fears, anxieties, determination, exhaustion and the horrible, claustrophobic barriers of PPE and the horrors of having to separate patients from their loved ones” – into the drama, pulling viewers out of their normal lives and into the shoes of the medics on screen. Viveiros’s handheld directing style also helps to recreate the fast-paced, often chaotic atmosphere in the show’s fictional hospital.

Throughout development and the writing process, she and her co-writers stood by one principle: it has to be true. “Everything you see on the screen is real. Nothing is exaggerated. Nothing is invented,” she says. “When somebody can’t have a cancer operation because there aren’t enough ventilators, because Covid has overwhelmed the hospital, that’s there because it happened to real patients. I just felt from the outset that that has to be our bedrock, and then we built this world from the facts up.”

Perhaps one of the most shocking aspects of Breathtaking is the use of archive footage of real politicians’ speeches at the time of the pandemic – then-prime minister Boris Johnson revealing he was shaking hands with Covid patients, for example – that is juxtaposed with events in the hospital, where PPE is running out and patients with Covid symptoms are denied testing.

“That mismatch between the public messaging and professional reality is the centrepiece of the drama,” says Mercurio. “If the messaging to the public had been transparent, I think people within the NHS would have felt more supported, more heard and more listened to.

Puwanarajah, best known as an actor in Payback and Ten Percent, first met Clarke several years ago when he was a junior doctor and she was one of his students. They struck up a friendship and have kept in touch, even discussing the potential adaptation of one of Clarke’s other books about palliative care. But when Puwanarajah revealed he was collecting first-hand testimonies from healthcare professionals at the start of the pandemic, Clarke said she was already writing a book about her own experiences.

The actor knew Mercurio, the Line of Duty creator who has previously made medical dramas including Bodies and Critical, in which Puwanarajah appeared. They had also written a graphic novel together, and Puwanarajah thought the three of them would be the perfect team to bring Breathtaking to the screen.

“Jed obviously brings that huge wealth of experience in television writing and exec producing, and a heritage of medical shows,” he says. “The material was a total insider’s account, and I felt we could together really imbue it with honesty, heart and spirit, as well as the kind of bunker-like, Das Boot grimness of things. I took it to Jed, and Jed was considering doing some kind of pandemic piece, so we met at this point in the road and the three of us got to work on it.”

They also worked with medical consultants to ensure the series was as authentic as possible, and shared the scripts with various healthcare professionals who could provide their own insights into the pandemic.

“We folded all of those things into the final scripts that we shot,” Puwanarajah continues. “We were absolutely forensic about all the detailing in the show, and we did our absolute best to depict the real world.”

Coming from a medical background, Mercurio says it was natural that he wanted to do something within television drama about the pandemic. “I’d already started talking to the TV channels about whether there would be an opportunity to do a drama about some aspect of the NHS experience of Covid. And then because Prasanna knows Rachel and I knew Rachel’s work from afar, I read the memoir Breathtaking in one sitting and thought this is an authentic account from the front line. That felt like the story we had to tell.”

Used to writing factual stories, Clarke found it “incredibly liberating and exciting” to write something where she could play with the shape of characters and the events they faced, all while adhering to the facts. She also had clear ideas of what the show should and shouldn’t include.

For example, she didn’t want Abbey to work in an intensive-care ward. Instead, she runs a general medical ward, one that becomes overrun with Covid patients when the crisis spirals out of control.

“The vast majority of patients with Covid were treated on a ward. They did not go to intensive care, and the vast majority of the deaths from Covid in a hospital also took place on ordinary wards,” she says. “The staff who had to look after those patients are often slightly overlooked in the public narrative of Covid. Everyone thinks about the amazing ventilators that could save people’s lives. But the tragedy of the pandemic is most patients who were really sick were far too frail to ever be able to cope with a ventilator, and they died on Covid wards where, crucially, the staff did not have high-level PPE. That was my experience of Covid, and I wanted to try to represent that and always give voice to the staff and patients in that environment.”

That’s not to say the series doesn’t have moments of levity, not least touching scenes between staff members or when patients do recover and are released from the hospital – which was actually a meticulously assembled set built inside a disused university building in Belfast.

“Conditions are often really tough inside the NHS, and when there isn’t a single bed in the hospital and the corridors are filled with patients, the way we all get through it is to seize every opportunity to joke, to laugh and to just show a bit of warmth and humanity to each other, to our patients or to family members,” Clarke says. “That’s one of the things that people love about the NHS, that staff really try to do that even when conditions are tough. And it was very easy to bring these little moments of light into the script because they were what punctuated every day I spent at work in the pandemic.”

When it came to writing the scripts, Clarke brought together the key narratives that Puwanarajah would “blacksmith” into three episodes of drama. Mercurio’s input came in the form of “sharp-edged editorial observations” about things that weren’t working, things that didn’t feel clear or right, and areas where the scripts weren’t pushing the narrative hard enough or weren’t provocative enough.

“I would say I probably spent the most time in the actual scripts, but Rachel was heavily leading in terms of narrative shape and narrative verisimilitude, and Jed with his editorial eye and rewriting,” Puwanarajah says. “By the end of it, it would just be a case of, ‘Who’s available to rewrite a scene?’ It started quite sort of disparate and we had very clear roles but, by the end, we were all hands at the pump.”

Clarke jokes that sometimes their writing sessions could get “really intense,” as she and Puwanarajah “tag-teamed” on drafts of the script. “Then once we had a finished episode, we would meet up with Jed, and the three of us would intensely debate and discuss the first draft,” she says.

“Jed has this absolutely amazing ability to zero in on what isn’t working, rather like a senior medical consultant on his ward round identifying what his junior doctors have done wrong. That was great because he would say, ‘This isn’t working,’ and we would thrash out why it wasn’t. Sometimes we’d have incredibly heated arguments about that, which were always good-natured, even if they were all so ferocious. Then we would just go away and refine things, and we ended up with this distilled version of the scripts that were just so much better than the originals.”

Mercurio adds: “We agreed pretty much up front it would be an equal collaboration, so we would get equal credit and work together with a completely flat hierarchy. Personally I’m so used to writing on my own that I really found it a rewarding experience, and working with Rachel and Prasanna is one of my career highlights. It was fabulous to be part of a great team.”

In the wake of the success of Mr Bates vs The Post Office, the Breathtaking writers hope their series can have a similar impact when it airs across three consecutive nights on ITV, beginning next Monday. ITV Studios is distributing the series internationally.

“I would love a television audience to feel able to bear witness to these people who looked after us all in the pandemic,” Puwanarajah says, “and the national conversation that I would love to emerge from this is how we can begin the process of really holding to account the people who led us in that time and the way in which that leadership took place.”

For Clarke, who still works as a palliative care doctor, Breathtaking lands at a time when she believes the country can collectively reflect on the handling of the pandemic – which led to more than 230,000 deaths – and the lessons that need to be learned in the event of a similar crisis. The official UK Covid-19 Inquiry is ongoing, having begun in June last year.

“Already some of the testimony we have heard in that inquiry is eye-popping. It’s jaw-dropping,” she exclaims. “My great concern is, at the moment in the UK, there is a real counter-narrative, a revisionist history of the pandemic, which is that ‘lockdowns did more harm than good. We should never have had them.’ Anybody who has worked inside an NHS hospital during the pandemic knows how incredibly wrong that is.”

That means now is “absolutely” the right time for a TV drama to show what really unfolded on hospital wards.

“We can’t hide away from it and just pretend it didn’t happen, move on and hope we never have to deal with it again,” Clarke adds. “There will be another pandemic. This is a public-interest series in the most profound sense, because we know another virus of some kind is coming. We will confront this situation again – and the first step to doing things better and more safely next time is looking clear-eyed and unflinchingly at the events that unfolded first time around.”

tagged in: Breathtaking, HTM Television, ITV, ITV Studios, Jed Mercurio, Prasanna Puwanarajah, Rachel Clarke