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Dr. Heather Patterson has been using her camera to capture health care’s continuing surge in child admissions. Her goal: to capture the joy and pain she sees daily – and to spark discussions on solutions. She and two colleagues reflect on the hard realities they face on their shifts

Heather Patterson, Katharine Smart and Rodrick Lim
Contributed to The Globe and Mail
Avery, age 23 months, came to the pediatric ICU of the Alberta Children's Hospital simultaneously infected with multiple respiratory viruses. She needed a form of positive pressure ventilation to supply oxygen and to support her breathing, as well a nasogastric tube to feed her liquid nutrition.

Heather Patterson is a Calgary-based emergency physician, photographer and author of Shadows and Light: A Physician’s Lens on COVID. Katharine Smart is a pediatrician in Whitehorse and past president of the Canadian Medical Association. Rodrick Lim is an Ontario-based pediatric emergency physician and the Wellness Chair for the Canadian Association of Emergency Physicians.

Crisis. Collapse. Unprecedented. Whatever word you choose, it’s clear that our health care system is buckling under the strain of children and families flocking to community and children’s hospital emergency departments in droves. The “tridemic” – simultaneous outbreaks of respiratory syncytial virus (RSV), influenza and COVID-19 – as well as a national shortage of pediatric pain, fever and antibiotic medications and three cohorts of children meeting many nasty viruses for the first time, has resulted in system strains and wait times that are sustained and unrelenting.

Children’s health care has been underresourced for decades. Children wait longer for surgery, diagnostic imaging and mental-health services than adults. We have been walking toward our current disaster for years.

Hospitals are doing what they can to meet the demand – using a heated portable to extend the waiting room for one emergency department, redeploying respite and end-of-life care staff, calling the Red Cross into a large pediatric hospital, postponing surgeries that require postoperative intensive care or admission, creating new spaces for admitted patients and moving older teens to adult hospitals and intensive-care units. Staffing shortages because of illness and burnout are leaving managers scrambling to find nurses to fill the schedule. Emergency departments, wards and pediatric ICUs are full. It feels eerily like déjà vu.

The crisis is not only seen in cities with specialized pediatric hospitals: 65 per cent of children who seek medical care receive it outside of these centres. Pediatricians in rural and remote areas provide care to children 24 hours a day, and as the pressure on children’s hospitals grows, we are challenged to do more and more, caring for very sick children without the specialized nurses, respiratory therapists and other health care team members available at children’s hospitals. Every day on the front lines, patients, families and the people trying to care for them are suffering.

While acknowledging the severity of our health care crisis, we must also be taking time to celebrate the unparalleled commitment and compassion of those who work in the field. Behind this crisis lives a dedicated group of hospital leaders working to problem-solve, create and innovate, and health care workers determined to provide excellent care to the children in their communities. During these times of crisis and distress, it is critical to find moments that connect us to the purpose and privilege of working in health care.

Is there hope? Are there solutions? With optimism inspired by the hard work of those on the front lines and those leading change, yes. Navigating this moment will require us to remember that we are all in this together, as Canadians, as health care teams, and as governments. We can no longer solve these problems in silos. The road may be long, the process difficult. We need community action so that people stay home when sick, mask during viral surges and get vaccinated.

Immediately, we need a clear plan to mitigate the current viral surge and augment resources to meet the acute health care needs of children. To prevent this same crisis in the future, we need a co-ordinated plan of action to adequately fund and resource pediatric health care across Canada. We must be better prepared to deal with the predictable viral surges that will occur during the colder seasons. Critical right now is to pull together and act to allow us to keep doing what we do best – caring for children.

Photographs for this feature are part of Dr. Patterson’s documentary photography project, which shares the realities of the current health care crisis with an emphasis on finding joy and purpose within staff members’ daily work. The photo series continues at heatherpattersonphotography.com.

Toddler Aubrey waves at hospital staff through the window in the ER door. She and her parents spent 10 hours at another ER, then 38 hours in this one waiting for a bed on the pediatric ward. Her parents, while exhausted, said they were grateful to staff for making sure Aubrey was safe and well cared for.
With nearly every bed filled at the pediatric emergency department, the waiting room overflows into the entranceway alcove and sometimes into the parking lot. The staff computers decry the state of crisis: waiting. There is a wash of sound from the waiting room – coughing, crying, vomiting.
Respiratory therapist Andres Morin adjusts the ventilator of an infant with both COVID-19 and influenza. In Alberta, as in the rest of Canada, children are having a rough season of respiratory viruses; at the same time, pediatric treatments for pain, fever and antibiotics are scarce.
Rebecca Parr, a pediatric ICU nurse, gently adjusts an intubated infant's feet. At the bedside, the juxtaposition of treasured childhood items and syringes of lifesaving medications is an uncomfortable reminder of the tragedy faced by families and staff.
Avery’s parents provide comfort while she receives high-flow oxygen and medications in the emergency department’s resuscitation room. She had been rushed in with critically low oxygen levels and was struggling to breathe. This was the start of a long journey in the hospital for this family.
For Avery, a giraffe-patterned mask and duck booties can’t disguise the markers of critical illness: multiple IV lines and monitors, oxygen tubes and masks. The pediatric ICU provides life-saving care and support for families. This season, they are filled to capacity with critically unwell children.

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