NAVIGATING COMPASSION THROUGH CRISIS
A Personal Glimpse inside St. Paul’s Hospital’s Emergency Department

By Dr. Wendy Sarkissian
(click images to enlarge)

St. Paul’s Hospital, a historic gem on Burrard Street, has been a cornerstone of healthcare in Vancouver since its establishment in 1894. Over its 125-year history, this venerable institution has evolved from a modest 25-bed wooden structure into a comprehensive medical facility featuring multiple wings and significant expansions.

The founding vision of St. Paul’s Hospital was deeply rooted in the values of compassion and service, as exemplified by the Sisters of Providence who established it. The original hospital was designed and built under the guidance of Mother Joseph of the Sacred Heart and her Catholic nuns. These pioneering women, driven by a profound commitment to care for sick and under-served people, laid the foundation for what would become a legacy of compassionate healthcare. Their mission was to provide not only medical treatment but also spiritual and emotional support. Their practice embodied a holistic approach to patient care that remains a core principle of the hospital today.

The current facility, which has undergone numerous renovations and expansions, includes several multi-story buildings. The original structure was replaced in 1912 by a modern fireproof building, and subsequent additions in 1931 and 1945 further expanded its capacity. The most recent expansions, completed in the 1980s and ‘90s, introduced two ten-story towers adjacent to the original building. The hospital now encompasses multiple wings and floors, reflecting its extensive growth over the decades.

**St. Paul's Hospital has seen many renovations, additions, and upgrades since its founding**. (Vancouver City Archives)

Architecturally, St. Paul’s is constructed primarily of traditional brick and concrete, materials that represent its historical roots. The design of the hospital integrates these classic elements with modern construction techniques, striving to accommodate the diverse needs of patients and staff. Although exact figures on the number of rooms fluctuate due to ongoing renovations and updates, the facility includes numerous patient rooms distributed across its various wings and floors.

The Emergency Department (ED) is a central feature of St. Paul’s, handling approximately 81,000 visits annually, averaging about 222 visits per day. The ED is supported by a dedicated team of healthcare professionals.

A critical component of the hospital’s approach to care is its robust social welfare team, which plays a pivotal role in addressing the needs of patients facing significant social and economic challenges, particularly in Central Vancouver where homelessness and poverty are pressing issues. This team is crucial in connecting patients experiencing homelessness with essential services, including emergency shelter, long-term housing solutions, and community resources. By providing case management and facilitating access to social services, they help bridge the gap between hospital care and stable living conditions.

Addressing homelessness involves recognizing the unique healthcare and housing needs of this population. People experiencing homelessness often face a disproportionate amount of acute and chronic illnesses and encounter systemic barriers to accessing and adhering to care. These issues can lead to a “revolving door” of hospital admissions, which highlights the need for a coordinated approach to their care.

The hospital's commitment to improving outcomes for homeless individuals is further exemplified by the Navigator Program, launched in September 2023 and modelled after a similar initiative at St. Michael’s Hospital in Toronto. The pilot program aims to enhance hospital experiences and post-discharge care for people without housing by focusing on trauma-informed, recovery-oriented harm reduction approaches. It underscores the importance of reducing stigma, enhancing training for providers, and fostering intersectoral relationships to improve care coordination.

The program advocates for systematic and consistent procedures of discharge and referral, ensuring that patients’ housing circumstances and needs are assessed and communicated to community health providers. Respecting patients’ autonomy by clearly communicating diagnoses, medications, and after-care plans empowers them to make informed decisions and adhere to their after-care. The program also addresses the need for more appropriate discharge locations and housing options, while emphasizing the importance of medical respite facilities, priority shelter beds with healthcare supports, and increased affordable housing stock. These measures aim to provide adaptable and universal design to support a wide range of needs.

As St. Paul’s continues to adapt and expand, the enduring spirit of the founding Sisters of Providence continues to guide its mission. The aim is that the hospital remains a model of compassionate care and innovation as it seeks to address the complex needs of its community.

MY EXPERIENCE
I’m A Doctor Too

**Most West Enders are familiar with this entrance to St. Paul's.**

“I’m a doctor too,” I call after Dr. Raine as he navigates around piles of discarded personal items, shoes, and clothing in the Emergency Department waiting room at Saint Paul’s Hospital. It’s 4:30 a.m., and the atmosphere is a strange mix of chaos and quiet.

Dr. Raine turns briefly and gives me a weary but kind smile. He turns back to check my IV drip. “Hang in there, Wendy. Just let the medication do its work.” His voice carries both fatigue and reassurance.

I can only imagine the night Dr. Raine has endured before he treated me for a kidney stone that refuses to pass. A kidney stone is scary for anyone, but at 81, it’s downright terrifying.

“This isn’t my first encounter with a kidney stone,” I confide earlier to the nurse who takes my blood sample. “Eight years ago, I had one just weeks after the car crash that took my husband’s life.” Her eyes soften with understanding. “I’m so sorry,” she whispers gently, handing me a tissue and patting my shoulder.

A kidney stone, for me, is synonymous with unfathomable grief. So, I try to stay present, focusing on my body and not letting my mind drift back to those dark days. I decide to be a participant observer.

WHAT WILL THE NEW ST. PAUL’S BE LIKE?

I’m discovering that the Emergency Department at St. Paul’s Hospital is a living miracle in the heart of Vancouver’s West End. I’ve found myself there several times in recent years, often late at night, and, like an anthropologist or participant observer, I’ve witnessed its realities. That night, I asked two of the hospital’s social workers how they imagined the Emergency Department in the new St. Paul’s Hospital would function. It’s set to open in 2027 on a sprawling campus in Strathcona with all modern conveniences.

**An artist's vision of the new St. Paul's, currently under construction.**

“What do you think it will be like? Like, culturally?” I ask.

The two young women smile and reflect. I’ve watched them while they evicted Brian from the waiting room, where he’s been sleeping, twitching, moaning, and sobbing for several hours.

“This hospital is a refuge for people who have no other home. Everyone knows that,” one of them whispers. “Bathrooms and seats are available, and it’s easy to grab a white and blue striped blanket to wrap around your body,” the other adds. “It’s safer, warmer, and drier than lying on Davie Street. But it’s a hospital, not a hostel. We have to move people on eventually.”

What is remarkable about this cultural icon that functionally combines an emergency department with a shelter for unhoused people is the staff’s flawless teamwork. They must attend to their patients, many of whom look fragile and frightened. Others may feel shame about their condition. Perhaps this medical emergency is our fault: we didn’t manage our medications, diet, exercise, or general well-being. Now, in the middle of the night, we fear a diagnosis that will wreak chaos in our lives.

Shame is not the primary emotion, however, for most of us who arrive by car, Uber, or taxi. We’re desperate for medical help, and we receive it. All I need is a healthcare card, and I’m admitted and cared for.

I watch these two young women usher Brian out into the warm midsummer night. But not before they give him a drink, a sandwich, some yoghurt, and applesauce. They rouse him from his slumber and call him by his first name. He knows he has to move on, and reluctantly, he does, staggering out into the darkness, trailing his white-and-blue hospital blanket.

I imagine Brian’s birth. The joy on his mother’s face. Her son. This man, who could be my son. The situation is beyond tragic.

Everyone knows the rules at St. Paul’s Emergency: You can sit in the waiting room, use the bathroom, wash yourself, change your clothes, grab a blanket, and sit in a chair. But eventually, you’ve got to leave.

HOME — WHAT A CONCEPT!

After my five-hour stint, one of the social workers calls a taxi for me. The driver quickly asks if I have a voucher. (Maybe some people have vouchers to get them home, wherever that might be.) He delivers me to a clean, warm, dry apartment, and I fall into a bed with crisp sheets and soft pillows. I weep with gratitude. This pain will pass, and I will recover. And I reflect on my hours in St. Paul’s Emergency Department.

“I’m a doctor, too,” I repeat to Dr. Raine. He smiles but doesn’t say anything. “I’m a doctor of professional ethics,” I whisper, now to myself.

Professional ethics is partly about how professionals navigate challenging lives. It’s about the principles and standards that guide the behaviour and decision-making processes of professionals in their work. Throughout the night and into the morning, I observed how professionals (from security guards to doctors) operate in a high-pressure medical environment that’s resonating with fear, shame, desperation, pain, and hopelessness.

Dr. Raine looked exhausted. Nevertheless, he sat down beside me, smiled gently, and offered impeccable advice, answering every one of my faltering questions with precision, generosity, and goodwill.

However, the one question neither of us can answer is the elephant in the room: how can we help the unhoused people in our city?

In this hospital emergency ward, the staff treat all comers with respect and care. In ethical terms, their behaviour is about considerability. The staff (and clearly, the hospital management) deem these people to be humans and “worthy of consideration.” Everyone, including the incredibly patient and generous “Relational Security” staff in their blue t-shirts, knows the rules.

Back home, only a few streets away, I curl up in my bed and ask myself: where will these desperate people find that ethic of caring when our beloved St. Paul’s Hospital is demolished and the new hospital opens in 2027?

And I wonder: where did Brian go, and what will become of him? And I reflect: there but for good luck, go I.

I had some really lucky breaks after a rough start in life.

And Brian? Sadly, not so much.

Canadian-born Dr. Wendy Sarkissian has lived in the West End since 2017. Formerly a community planner and planning academic in Australia, she is now a full-time author, ethicist, and activist. Her books include: Creative Community Planning; Kitchen Table Sustainability; and Housing as if People Mattered. She recently published a climate memoir, Creeksong: One Woman Sings the Climate Blues.

You can find out more about her book at www.creeksongbook.com or get in touch with Wendy by email at wendy@sarkissian.com.au