Calgary emergency room physician Dr. Heather Patterson says she's not sure how she'd be coping today — in the throes of a fourth wave, exhausted from treating record numbers of patients or, worse yet, watching them die from COVID-19 — if it weren't for the endless hours spent carrying a camera rather than a stethoscope around her neck since last November.
The fourth wave has taken a toll on health-care workers as it's pushed ICU admissions beyond normal capacity.
"It's been a heavy burden to carry because I feel like I'm witnessing just a higher density of tragedy," Patterson says.
"But as a photographer, I'm able to follow people along and see the true longitudinal progression of what they're experiencing in hospital and the joy of seeing people go home and celebrate being reunited with their family — that's what keeps me going."
Patterson says the photography project, approved by Alberta Health Services, emerged after an extremely tough shift in emergency. It included losing a patient who she thought would survive, and giving a terminal diagnosis to a 50-year-old.
After she got home, she and her husband, who is also an emergency room doctor, debriefed the trauma she had witnessed. They decided she needed to find a way to slow down and look for all the good things on the job she'd loved for 10 years.
Patterson says that when she first launched the project, she focused her attention on front-line staff and the care they were providing to COVID patients. She says she wanted to showcase the good work that was being done behind closed doors.
But, over time, and through the waves, she's widened her lens to include patients, families, visitors and behind-the-scenes staff to let people know the important role everyone plays in patient care.
She says she's taken tens of thousands of images but only posts a few on her Instagram account, which now has more than 12,000 followers.
"At the beginning, I had to really sneak into the background and make sure that people didn't notice I was there. And now that people are really aware of the project, I walk into the room and people are like, 'Oh, you're here, great,'" said Patterson.
Frustration, sadness, moral injury?
Patterson says she clearly separates her two roles at the hospitals. When she's a physician, she puts her emotions aside and focuses on providing often life-saving care.
As a photographer, she says she is able to feel what's happening in the moment, which impacts what she sees through the lens.
During the fourth wave, she's been feeling overwhelmed. Frustrated. Sad.
"Sad that we were going to lose so many, many more people. I really felt the weight of the tragedy.
And I find that whenever that happens, my natural response is to start looking more assertively for the good."
Patterson believes she's getting better at capturing peoples' emotions but says there's one newly emerging feeling — which she calls "moral injury'" — she has yet to photograph.
She describes it as that feeling that is hanging over front-line staff who worry they may have to make some extremely tough decisions in the near future if the health-care system gets too swamped and critical triage care kicks in.
"The feeling that we might not be able to provide the degree of care, the extent of care that we want to … this is.something that's keeping me awake at night."
The critical care triage protocol describes how the health-care system will cope if intensive care units (ICUs) no longer have the resources to care for every critically ill patient.
It says the first phase would be deployed if 90 per cent or more of Alberta's critical-care surge beds are in use — during what is described as a "major surge."
So far, ICUs in Alberta have stayed below that 90 per cent threshold.
"Does it look like a sleepless night?"
"And how do you capture this sense in the car as you drive to work, wondering who you're going to see and if you're going to be able to help them."
Helps to keep tabs
Dr. Rick Morris, another Calgary emergency room physician and colleague, appreciates Patterson's ability to make this pandemic so real for the general public, many of whom may never step foot into a hospital and see it for themselves.
"I think a large part of the fear and the disbelief is because people don't see their friends, their families or neighbours or loved ones struggling like we do every day, struggling to breathe and being so alone," said Morris.
As an ER doc, he says he usually doesn't know what happens with his patients after he patches them up or intubates them and sends them off to ICU.
But by following Patterson's Instagram account, he has been able to keep tabs on some patients' care and outcome.
"As an emergency doctor, we often don't get what the family, doctors and consultants get, we get kind of one time events, and so getting to really know these people and their families has been a unique thing and a very positive thing for me," said Morris.
Patterson says she agrees. She says she's been able to make connections with patients beyond the emergency department.
"I love these people, and they've shared a small bit of their journey with me and with us as a society by allowing me to tell their story."
Some of them, she says, just want to share their COVID experience.
Others, she says, want to motivate others to follow the public health guidelines or get vaccinated, to spare them a similar near-death experience.
"And that's exciting to see. But it's equally on the opposite skill, disappointing and frustrating when people after coming out of the ICU are still feeling quite suspicious of the care that they've received."
Patterson is in the process of writing a book about her project that is set to be published next year.
In the meantime, she's working with the Calgary Health Foundation to produce a video of her images and interviews with nurses, doctors, respiratory therapists and patients who have survived COVID, overlayed with music composed by another Calgary physician, Dr. Grant Kennedy.