It’s been 17 years since Johnny Cash powerfully reinterpreted Nine Inch Nails’ “Hurt” into a somber reflection on the pains and regrets that accompany a long life. Now the song, an anthem to self-reproach since the original version by Nine Inch Nails in 1995, has been revisited again, changing its meaning altogether into a message of hope.

Canada’s SickKids Foundation, which supports The Hospital for Sick Children in Toronto, continues its years-long “SickKids Vs.” campaign of emotionally potent fundraising spots with “This Is Why.” The new ad takes viewers behind the scenes of the hospital to see the wide range of treatments, recoveries, heartbreaking moments and hard-fought triumphs taking place there each day.

Created once again by agency Cossette and director Mark Zibert, the 140-second spot begins with a quiet moment of strength before setting off on an increasingly intense journey through the hospital’s halls, wards and waiting rooms. The soundtrack slowly builds and reveals itself to be a different kind of message than fans of “Hurt” might be expecting.

“Our goal was to shine a spotlight on what goes on behind the doors of the hospital, the life-or-death battles taking place every minute of every day that not everyone gets to see or appreciate,” says Craig McIntosh, executive creative director for Cossette. “This project was ever-evolving based on who we met at the hospital on-set and what their story was. We created a campaign that stayed true to the kids we were filming.”

There’s a reason the new spot isn’t a glowing, smile-filled celebration of medical efficiency. Its intensity matches that of the limitations being faced by the 70-year-old hospital, which struggles to meet modern building codes and where “our most vulnerable patients are crammed into overcrowded rooms,” according to the fundraising site. SickKids Foundation is working to raise $1.3 billion for a new hospital.

“People who have had a direct experience with the hospital have seen the great work that goes on inside SickKids, and they have also seen the unacceptable limitations of our physical space,” says Ted Garrard, CEO of SickKids Foundation. “The current hospital was built for fewer patients and simpler challenges. This 1949 building has been outpaced by 21st-century medicine, the technology we use to support our patients, and our approach to family-centered care. A new, reimagined hospital will provide the infrastructure we need to advance our mission of transforming child health in Canada.”

Cossette developed the spot, with music provided by The Music Project Choir. Media planning and buying was managed by OMD. More than 40 real SickKids patient families are featured in the ad, as are 25 hospital staff.

The hospital’s ambitious and urgent fundraising goals have inspired it to create some of the world’s most celebrated ads in the medical category. In 2017, Cossette took home eight Cannes Lions for the campaign’s launch, which was honored again in 2018 with a silver Creative Effectiveness Lion for its results.

“The Vs. campaign has been recognized around the world as a bold shift in tone for a children’s hospital,” says Lori Davison, vice president of brand strategy and communications for SickKids Foundation. “With SickKids Vs., we celebrate the resilient spirit of our patients, families and staff, and showcase the good ‘fight’ that goes at the hospital each day. Our advertising is bold because we have a bold, audacious goal; and this year, Vs. is bringing it back to focus on the reason we’re fundraising to build a new hospital: for our patients and staff.”

The spot will begin running on Canadian broadcast TV next week, including during the Toronto Maple Leafs’ first home game of the season on Oct. 19.

Here’s a look back at two of the earlier spots in the campaign: