EYEWITNESS TO HISTORY
For Patricia Collins, the adage "a picture is worth a thousand words," is most fitting. Upon entering her room in K-wing at the Sunnybrook Veterans Centre, you can't help but notice a striking collage of black and white photos on the wall beside her bed. The faces are familiar; it's like a page from another chapter in time: Shirley Temple; General Eisenhower and Prime Minister William Lyon Mackenzie King.
Each picture tells a unique and wonderful story, all of which begin when Ms. Collins (nee Holden), along with her mother and brother, moved from New Brighton, England, to stay with family friends in Montreal. A year and a half later, Ms. Collins joined the Royal Canadian Air Force, in April, 1942.
At the beginning of the Second World War, the Air Force experienced a shortage of personnel. Ms. Collins was one of 17,400 women to serve with the Women's Division of the Air Force. "I put my age up a couple of years," she admitted. "I was really just hoping to meet new people and go dancing."
Initially, she was a clerk typist. However, a short time later, at just 17 and with virtually no photography experience, Ms. Collins was sent to the Rockcliffe Air Station, an Air Force training site in Ottawa, for a twelve-week course on photography. She passed the exam and a year later was posted to London as a senior photographer, where the assignments were mostly weddings, funerals and medal presentations. Sometimes, she and her Speed Graphic press camera were sent to photograph the destruction caused by the bombings in London.
"From wartime, the thing I remember most was the first coverage of Belsen. It was horrible when those photos surfaced from the German concentration camp. I don't recall his name, but they were taken by a reporter from the London Free Press. We stayed late that night to develop the negatives."
After the war, Ms. Collins was hired by news agency Reuters, where she covered leading women's fashion houses. As a young professional she was profiled for a Pathe Pictorial short movie called, Women Going Places. This mini-documentary was shown in movie houses and featured Ms. Collins as the modern woman in her role as photographer on Fleet Street.
"I remember being sent to photograph Queen Elizabeth at Buckingham Palace when she was leaving for her honeymoon. It was very magical." During this time, Ms. Collins also captured leading American movie legends, such as Cary Grant, David Niven, and Rita Hayworth, while they were visiting Britain to help boost the economy after the war.
Ms. Collins's life could be a movie in its own right. After the war, she became reacquainted with a fighter pilot named Art Collins, who was awarded the French Legion of Honour and Distinguished Flying Cross. He had tracked her down, and they married and raised five children together. As a mother, Ms. Collins shifted her photography talent to capturing the lives of their children and seven grandchildren. •
THE RESEARCH TEAM
ONE COOL MEDICAL CREW
A cardiac arrest happens every 12 minutes in Canada. It is often sudden, cutting off vital blood supply to the brain. At Sunnybrook, a research project called PACT (Post Arrest Care Team) is changing the way these patients are treated.
One treatment the team is using for some cardiac-arrest patients in a coma sounds rather unorthodox: inducing a state of hypothermia for 24 hours to help the patient recover more fully.
"This therapy is meant to cool the body temperature of the patient to about 34°C. Normally we're at about 37°C," says Sandra Abud, registered nurse and member of PACT. "When the patient is cooled, research indicates that it protects against cell injury and cell death, and that is beneficial for patient outcomes."
Twenty staff members from the Schulich Heart Centre's Cardiovascular Intensive Care Unit (CICU) make up the team, including 19 RNs, five Critical Care physicians and two Emergency Department physicians. One RN, and one physician are available 24/7.
When an out-of-hospital arrest is en route to Sunnybrook, PACT is notified and goes to the Emergency Department (ED) to work with ED staff to ensure the hypothermia protocol is implemented.
Pamela Meyer, patient care manager of the CICU, says, "The staff in the CICU are very enthusiastic and committed to this research initiative. It is giving us an opportunity to share our knowledge and expertise with others, as well as make a difference in the recovery and outcomes of these patients' lives."
"One of the reasons I knew I wanted to be a part of the PACT research project was a case we had a while ago in the CICU," says Sandra. "A young woman who had had an out-of-hospital arrest came in, and because of the cooling techniques we implemented she survived and had a good outcome. Later she came back to the unit with her children to say thank you. It showed me just how powerful and necessary this research is. I really believe in this work, and it is extremely validating to see everyone work together to make it happen." •
THE EMERGENCY MANAGER
THE ER ON WHEELS
For Patrick Auger, SARS was not only a crisis, but also the impetus to make a major career change. As a critical care flight paramedic, Patrick was already immersed in health care. But when the province got hit with the severe acute respiratory syndrome crisis in 2003, "it was a huge learning curve," he says. "SARS really identified that we needed a group of specially trained experts who could work in situations never encountered before."
In 2006, Patrick earned his Masters in Emergency Management and later took on a new role: Incident Commander with Ontario's Emergency Medical Assistance Team (EMAT), which is operated by Sunnybrook and the Sunnybrook Centre for Pre-Hospital Medicine. Referred to by many as a "hospital on wheels," EMAT is a first-of-its-kind mobile medical field unit that can be deployed anywhere in Ontario. Since EMAT's inception post-SARS, Patrick has been involved in four deployments – including an e-coli evacuation, two fires and the G8 Summit – and 12 training exercises.
EMAT has been able to recruit a group of experts in their respective fields.
Patrick's role in this multidisciplinary, 150-member team could arguably be the most challenging: making sure everything runs smoothly. Patrick says the devil is always in the details. "We have fuel systems, oxygen systems, ventilation and telecommunications. We've deployed full-scale training exercises in minus-25-degree weather, so you have to make sure all the doctors have warm coats. The little things add up to a lot." Thanks to Patrick's expertise, EMAT can set up a 56-bed unit that provides a staging and triage base within 24 hours anywhere in the province with road access.
EMAT's latest deployment in July included a 20-hour drive to Thunder Bay to assist with evacuees from fire-threatened communities in northwestern Ontario. "You get that phone call and you have to get things moving," he says. Sixteen-hour work days are normal during deployment, fed largely by adrenaline and the desire to do good work. "While these situations don't happen very often, we are there when they do and can make a tremendous difference. It's all very satisfying." •
THE BUG BUSTER
A GUT CHECK FOR C. DIFFICILE
Infection from C. difficile is one of the most common found in hospitals and long-term care homes. Most often, the bowel-damaging bacteria grow in patients who have taken antibiotics.
"The vast majority of patients with C. difficile have had some antibiotic exposure in the weeks leading up to their infection," says Dr. Nick Daneman (above), an infectious diseases physician at Sunnybrook and scientist in clinical epidemiology at Sunnybrook Research Institute. "Any discussion around antibiotic-resistant organisms has two problems we need to deal with–transmission of these bacteria between patients or health care workers, and overuse or inappropriate use of antibiotics in hospitals."
There are an estimated 220,000 cases of hospital-acquired infections in Canada each year. When a person takes an antibiotic, a natural selection process is launched, through which non-drug-resistant bacteria are killed off, leaving drug-resistant bacteria to multiply and emerge as the dominant strain inside the body.
"Organisms adapt to survive and we're giving them pressure from the antibiotics to pick up new ways to overcome these treatments," says Dr. Daneman, who is also the physician lead of Sunnybrook's antimicrobial stewardship program, initiated two years ago in the hospital's intensive care units (ICUs). The program involves collaboration between the hospital's pharmacists and critical care staff to monitor antibiotic prescriptions in ICUs to reduce their use. Over one year, the ICUs saw a 21 per cent decrease in broad-spectrum antibiotic use, which was associated with a 30 per cent decline in C. difficile infections.
Dr. Daneman says more rigorous research is needed on curbing unnecessary antibiotic use and antibiotic resistance, at Sunnybrook and other hospitals. "One thing we learned through these quality improvement efforts is that this is a very young field and there's a lot still unknown out there," he says. "One of the goals of the program is to advance the science of antimicrobial stewardship to help not only our institution, but other programs around the world trying to introduce this concept in their hospitals." •
SPREADING THE SEEDS OF KNOWLEDGE
When nurses specialized in cancer care visited Kenya, they learned that cancer in the local culture is often viewed as a curse.
The Odette Cancer Centre oncology nursing group of Kathy Beattie, Angela Boudreau, Marg Fitch and Sherrol Palmer-Wickham traveled to Nairobi and Eldoret. Their work, and the work of others at Sunnybrook, is helping to transform health care globally.
"We went to Kenya to help be a catalyst for moving things forward from within the system. We gained profound respect for these nurses who deliver care despite significant challenges," says Kathy Beattie, supervisor of the Chemotherapy Unit at the Odette Cancer Centre.
The group, who went as part of International Society of Nurses in Cancer Care twinning programs, saw how resourceful the local nurses are. For instance, there is no funding for free access to the Pap test. Instead, local nurses conduct acetic acid tests and visual examinations, a low-resource and moderately effective screening method for cervical cancer.
The group met with health-care professionals at rural and urban facilities and local outreach clinics. They worked with staff from Aga Khan University Hospital and Moi Teaching and Referral Hospital to develop chemotherapy workshops for local nurses.
The group also learned about how cultural factors affect patient care.
"We learned that cancer is viewed as a curse and factored this sensitivity into our patient-care discussions with the participants," says Sherrol, manager of Ambulatory Clinics and the Chemotherapy Unit. "For a woman diagnosed, her personal 'value' is affected, as is the value of her family and the marriage-ability of her daughters. The woman and her family are viewed as cursed. Often she will not risk telling anyone about her illness and does not seek treatment."
For many of these reasons, cervical cancer, a highly preventable disease in North America, remains prevalent in African nations. •
FROM GRIEF TO GIVING
'You don't have to be alone."
That's the message Jennifer Bassett has for those struggling with the loss of a baby, as she and her husband Cameron Sievert were in May, 2005. Their daughter Olivia had developed a diaphragmatic hernia and died shortly after being born at 30 weeks, weighing only 2 lbs 3 oz.
"You've had a loss, and it's okay to grieve — in fact, you're supposed to grieve," Jennifer says. "But you don't have to do it alone."
Jennifer and Cameron have thrown their support behind Sunnybrook's Perinatal Loss Clinic with a donation of $25,000. The clinic will support women through their immediate physical recovery after the loss of an infant, and guide families through the next challenges, such as planning a funeral and interacting with family and friends. Families will find help in managing both their grief and relationships.
While she calls the care and service she received "phenomenal," Jennifer also points to holes in the system that will be filled with the Perinatal Loss Clinic. The clinic will offer mothers and fathers — equal partners in this tragedy — a place for support and attention, and to deal with the loss in their own way.
"It's not just about the mother; my husband went through agony, too, as did the grandparents and the aunts and the whole family," says Jennifer. "It equally affects the family, and after people receive this sort of devastating news, you need to take them somewhere and let them take it all in, have a cry and hug in privacy."
The clinic will also support important research into the causes of pregnancy loss, and will help develop new treatments. It will provide a place for consultations with counsellors and other health-care professionals, and a private room for family discussions.
In the end, Cameron adds, it will help families move on to the next phase in their lives.
"Life will get better; it's just very hard at the time to see that," says Cameron, whose family with Jennifer now includes Mackenzie Olivia, 5, and William Bassett, 4. "We now have a beautiful family, so we're really trying to make this clinic a hopeful place for other families." •¬¬