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From the archives

Pax Atlantica

NATO’s long-lasting relevance

A Larger Role for Unions

Organized labour may be shrinking but the rhetoric is still upbeat

This United League

Will not die, will not perish

A Developing Situation

Scenes of the first five waves

Mary Hunter

Shadows and Light: A Physician’s Lens on COVID

Heather Patterson

Goose Lane Editions

176 pages, hardcover

When Heather Patterson, an emergency physician in Calgary, found herself feeling increasingly detached from her work, after yet another gruelling shift, she knew something had to change. She had been a doctor for a decade and had a busy life as a forty-one-year-old married mother of two. Was she experiencing a typical mid-life malaise about her occupational choice, an unease made worse by the realization that the many years required for medical training had restricted any alternative career routes? Or was she simply among the roughly 70 percent of emergency physicians who experience burnout?

At her husband’s suggestion, Patterson turned to an old passion, photography, to recharge. She dreamed of creating a “wellness-based project” that could rejuvenate both her love of medicine and her empathy for patients, as well as that of her colleagues. This was in January 2020. She had no idea that a pandemic was around the corner or that such a dream project would become reality.

Eight months after Patterson submitted her initial proposal, Alberta Health Services approved a broader plan, in which she would record the effects of the coronavirus in five Calgary hospitals: Foothills Medical Centre, Rockyview General, Peter Lougheed Centre, South Health Campus, and Alberta Children’s, where she works. AHS would also support her with the necessary paperwork and ethical clearances, including the delicate task of getting consent from patients.

Part coffee-table book, filled with black and white photographs that fluctuate between the journalistic and the artistic, and part personal tale that integrates professional viewpoints, Shadows and Light: A Physician’s Lens on COVID provides a visual chronology of hospital life during the first five waves of the virus. Moving from the early days of the pandemic, when the public banged pots and pans to show support for front-line workers, to the era of long COVID, the book’s eight chapters tell the story of how the crisis affected the lives of physicians, health care workers, and patients alike.

Cleaning and decontaminating an ICU room can take two people almost an hour.

Courtesy of Goose Lane Editions

Patterson’s compassionate account of patients — from the elderly to the newborn, from those with COVID-19 to those whose surgeries were postponed because of it — weaves a delicate path through individual narratives and political topics. She avoids sensationalizing trauma and outright partisan critique, though she makes clear the importance of vaccination, especially in a poignant photograph of two physicians, with arms crossed and stern faces, watching an anti-vax protest outside their hospital. “In a minute they’ll go back inside and keep caring for patients,” she explains in the photo’s caption, “many of whom held the same belief about vaccination as the protesters below.”

Physicians are often trained to be emotionally detached, so that they might maintain objectivity and work quickly. Motivated by a desire for more meaningful relationships, Patterson wanted to slow down, reconnect with her patients, and regain work-life balance. She saw photography as a therapeutic intermediary, an artistic outlet, a generator of compassion and healing. This lens differs from historical understandings of the medium among medical professionals, who have long used it to document and study illness and disease.

Photography was invented in the mid-nineteenth century alongside the rise of modern medicine. Because of its supposedly objective gaze, as well as its precision and visual acuity, it has often been linked with scientific medicine itself, which similarly aims to be rational, fact-based, and devoid of emotional or personal bias. The promotional blurbs on the back of Shadows and Light speak to this affiliation, and to the enduring faith many have in the unadulterated documentary nature of photography. The book is described as an “unvarnished portrait of the pandemic’s toll” (Jane Philpott, the dean of health sciences at Queen’s University) and as an “unfiltered look behind the doors of several Canadian hospitals” (Hilary Gauld, a commercial photographer). As part of a publicly funded project, the collected photographs are intended to be read as neutral records — to educate people about COVID-19 now and in the future.

Shadows and Light features roughly 125 images. Patterson, however, took about 47,000 shots with her digital camera. The book’s artistry, then, reflects her careful editing, which was subjective and aesthetically informed. As any photographer would, Patterson composed and framed scenes to create identities, to tell stories, and to evoke reactions. Empathy and other emotive responses are generated through an image’s subject matter (a dying patient, an empty bed, tear-streaked cheeks, and so forth), as well as by artistic conventions. Bright light and dark shadows create different moods; close-ups and wide-angle shots encourage the viewer’s connection with or distance from the people portrayed. Purposeful blurring and sharp focus, along with pictorial configurations, guide our looking.

The photographs in Shadows and Light do not push artistic boundaries, but they nonetheless deserve our attention. Some visual clichés remind us of early pandemic television ads, with their cropped portraits focused on the sad eyes of masked faces and their scenes of cheerful hospital workers raising patients’ spirits from behind glass barriers and layers of PPE. But others are intricate and absorbing, particularly those of hectic spaces, packed with people doing an assortment of jobs. It is worth spending time with these images especially, letting one’s eyes wander through the complex compositions, taking in the networks of medical tubing and machinery, shiny metal carts and tangled wires, and the orchestra of workers who gesture and move in tandem. They have much to tell us about the virus within hospital contexts, as well as the workings of the medical profession more generally.

Most of the photographs that depict people caring for patients — including those on the book’s front and back covers — show nurses, aides, volunteers, and family members rather than physicians. I doubt the author intended this as any type of statement or critique of health care in Canada, but it does speak to her personal dissatisfaction with emergency physicians’ struggle to follow up with their patients (they must move on to the next case). Patterson emphasizes the vital roles of all health care workers, particularly during the pandemic, and her portraits of a range of people — from cleaners to nurses and respiratory technicians — refreshingly move away from the familiar storyline of the doctor as superhero. However, her emphasis on the “teamwork required for this task” and the “pride in being part of the team” does gloss over the politics of occupational hierarchies and the radically different pay scales in medicine, as well as the role that sex, class, race, and even immigration status all play. It is hard to miss such underlying dynamics when looking at pictures of such a diverse range of people or when reading the accompanying text.

The book’s great strength comes from its visual juxtapositions, its detailed captions, and Patterson’s prose, which is honest, explanatory, and powerfully vulnerable. Her mixing of her own first-hand accounts with specialized medical information is fascinating, as is her description of an intubation — so difficult for patients and so stressful for physicians:

Later that day, I saw my friend and colleague Dr. Andrea Boone, who had worked for nine weeks in ICU as well as her shifts in the emergency department. She told me about intubating a man with a young family. He had spoken with a priest, called his wife, and prepared for the worst. Dr. Boone told him the team would look after him, but inside she was devastated, gutted. She guided him safely through the intubation, then went home and cried. She didn’t know if he had survived.

The pandemic has certainly highlighted the great demands placed on doctors in Canada. Emergency physicians, in particular, are expected to make rational decisions quickly, diagnose illnesses accurately, and move through cases at a rapid pace. Yet we also want them to calmly care for us when it’s our health on the line. Ironically, it was the camera, an apparatus historically linked to the objectivity, speed, and detachment of the medical gaze, that ultimately helped Patterson to take a moment, to reconnect, and to see once again through an empathetic lens.

Mary Hunter is an art historian in Montreal and the author of The Face of Medicine.