Dr. Sabira Valiani was one of the frontline physicians working inside Saskatoon’s critical care units four years ago, during the initial lockdowns of the Covid-19 pandemic.

“It was really weird,” said Valiani.

Valiani said ‘a lot of light bulbs went off in my head’ amid the automated stillness of the unit, as she watched ventilators breathing for heavily sedated patients.

Covered in head-to-toe personal protective equipment, staff in the intensive care unit struggled to simultaneously treat patients, communicate with family members, and enforce hospital policies.

“Those patients aren’t talking to us,” Valiani said. “It was empty, it was overwhelming and it was disconnected all at the same time.”

Valiani has now spent seven years in critical care, a move that started with her enrolling in a critical care and ICU elective in Ottawa.

“I loved it. I loved on the medical side, how you could see the life support that you were giving a patient immediately have a physiologic effect and stabilize that patient,” she said.

Driven by her experiences during the pandemic, Dr. Valiani delved into research focused on improving patient and family experiences in the ICU. She collaborated with a multidisciplinary team and patient partners to understand the challenges faced by healthcare providers and families alike.

In this article for the Canadian Association of Critical Care Nurses, she and her colleagues examined the effect of visitor restrictions during the pandemic.

Valiani remembers tearful goodbyes, families gathered around screens, unable to hug or touch loved ones infected and dying with Covid-19.

"The family's role becomes significantly diminished,” she said. “So much of that was disrupted during that time."

In the months and years that followed, visitor restrictions relaxed, but Valiani noticed communication between families, patients and staff still felt awkward.

Valiani and her colleagues turned their lens last year to key moments for Canadians of diverse ethnicities during the critical care journey, in the Canadian Journal of Anesthesia. The findings revealed the strain on healthcare providers playing multiple roles and families feeling disconnected from crucial information.

She estimates 30 per cent of Saskatoon’s ICU patients travel from remote communities, making it crucial to find ways to keep family members informed in a language they understand well.

“People kind of naturally turned towards communication technology in the pandemic,” said Valiani, noting a number of families cannot be present in-person during the day, as intensivists attend rounds.

Clear and open communication between patients, care providers and families is the key, Valiani said.

“What if we could use artificial intelligence or AI to just translate a medical progress note into an understandable family update?” Valiani asked.

“It doesn't have to be high tech, right? Like it can be a phone call.”

Together with the Saskatchewan Health Research Foundation, Dr. Valiani now works at enhancing patient-family engagement through practical solutions. She emphasizes the importance of involving families in care decisions, acknowledging their unique expertise in understanding patients' wishes.

Her team presented its findings in 2022 at Toronto’s Critical Care Canada Forum.

“We have this cohesive approach to defining the problems,” said Valiani. “Now we can take this to decision makers and say….these are the things people living this experience actually want.”

Daphne Yau can trace her interest in endocrinology back to a beta-cell physiology experiment during her master’s degree,  working with laboratory mice with Type 2 Diabetes.

“It was the part of the pancreas that makes insulin,” she said. “It was fascinating. It also made me realize that maybe pure laboratory research wasn't quite for me."

From there, her interest in hormones and fluctuating blood sugar levels grew.

Yau is no stranger to medicine. Her mother was a pharmacist, while her father and aunt both worked as physicians. Following in their footsteps, Lou completed her pediatrics residency at Queen’s University, with fellowship training at McGill. She then focused on congenital hyperinsulinism at the Children’s Hospital of Philadelphia and Royal Manchester Children’s Hospital.

She still remembers her residency, and meeting a premature baby with a rare genetic disorder  in neonatal intensive care.

“The blood sugars were horrendously low right from the start,” Yau said. “Their brain uses most of that glucose, so that's why it's so critical in that period that they get a steady supply.”

Together with an endocrinologist and a multi-disciplinary team, Yau and her colleagues traced back the root of the hyperinsulinism — the infant’s mother and grandmother also suffered from rare forms of diabetes.

Unregulated, plummeting blood sugar levels in infants can cause brain injuries and permanent neurological damage, Yau said.

“Your brain can't really store much in the way of glucose and it can't make it on its own the way some other tissues and organs in the body can,” said Yau.

“If you test a child who's had hypoglycemia when they're two or four, you may not actually pick up on this. Not till maybe later on, when they're in school and they're struggling.”

Yau joined the College of Medicine five years ago as a pediatric endocrinologist and assistant professor of pediatrics. Today, she’s based at the Jim Pattison Children’s Hospital. Her research focuses on understanding and addressing congenital hyperinsulinism, as well as screening for diabetes and other metabolic disorders.

In this episode, Dr. Yau pointed to recent success with a project inspired by Dr. Mark Inman. Together, their team is trying to improve diabetes screening and education in northern Saskatchewan, particularly for Indigenous children and teenagers.

She said the heel prick hospitals often perform on newborns inspired them.

“Could someone at home prick their finger, put some few drops of blood on this card and have their A1C measured that way as opposed to having to go to the lab?” Yau said.

The results to date show promise, which could make it easier to screen young patients in remote communities for diabetes.

Yau is also working with researchers in the United Kingdom who study blood sugar dysregulation in infants, exploring alternative treatments and lower doses of medications such as diazoxide, to mitigate side effects.

“What are the levels we really should be targeting to minimize the potential for long-term harms?”

Haissam Haddad inadvertently horrified his family when he signed up for engineering courses in his first year of university.

The teenager returned the next day to change his major to medicine -- a move he's glad he made.

Dr. Haddad practiced family medicine in Syria for three years, then arrived in Canada in 1986 to visit his wife's family, who urged him to stay.

Haddad faced an uphill battle when he investigated the possibility of becoming a Canadian doctor. One colleague even told him he’d be better off opening a Syrian grocery store.

“This gave me a lot of energy to prove him wrong,” said Haddad.

His early years in Canada were characterized by relentless perseverance, as Haddad confronted the arduous process of certification and integration into the medical system. He focused on learning English every weekday, picking up back-to-back twelve-hour shifts at a Halifax laundromat every weekend, to support his family.

“The first day it took me, like, almost 16 hours to read one page,” Haddad said. “I had no option to fail.”

After three years of English lessons and intensive studying, Dr. Sam Haddad earned a passing score on Canada’s medical licensing exam.

In this episode, Dr. Haddad recounts pivotal moments that steered him towards cardiology, including formative experiences in cardiac surgery during his residency at Dalhousie, which took place during the HIV epidemic.

“I’ve always liked the heart,” said Haddad. "I decided to do cardiology because it has less blood and less risk.”

Haddad’s dedication to improving patient outcomes through research soon became evident, as he tackled clinical gaps and treatment efficacy in heart failure management and heart transplant protocols.

“Almost on a weekly basis, you have a patient who did not respond to the usual treatment,” said Haddad. “This is the research question. How come this patient is not getting better?”

As his expertise grew, Haddad became one of only two Canadian cardiologists who were part of the National Institutes of Health Heart Failure Network. His patients took part in clinical trials that led to significant advancements. 

“A lot of our patients didn't have private insurance,” Haddad said. “We can do a lot of work to help patients who are not able to buy their own medication."

Haddad led the cardiac transplant and heart failure programs at the University of Ottawa’s Heart Institute, exponentially increasing the number of transplants performed. At the same time, he said at cardiovascular medicine was making revolutionary strides with artificial hearts and improved anti-rejection medications.

When he began, half of heart failure patients died within a year. Now, over 90 per cent survive.

After moving to Saskatoon to become Saskatchewan’s Provincial Head of Medicine in 2016, Haddad continued his clinical practice, taking on leadership roles in medical education and research.

Instrumental in recruiting almost half of the specialists practicing in Saskatchewan today, Haddad also established the University of Saskatchewan Cardiovascular Research Group, fostering a collaborative environment for innovative research initiatives.

Last year, Dr. Haddad was appointed as an Officer of the Order of Canada..

“Nothing comes easy,” said Haddad. “You have to work hard. You have to fail multiple times before you're successful.”