My year serving as your Society of Critical Care Medicine (SCCM) president has been an amazing honor. I cannot thank each of you enough for this opportunity and privilege. I have met so many great people! There’s been a lot of travel, a lot of conversation and a lot of insight gained. I have learned so much from each of you. To me, what is most inspiring is your ceaseless commitment. You are wonderful people who do so much for so many, every day. Thank you!
Our work is hard -- it’s physically demanding, emotionally taxing and never ending. We interface with patients and their families at some of the most intimate and difficult times in their lives. Their pain becomes our pain. And it’s cumulative. Every time we sit down with a family to discuss difficult or life-ending circumstances, we remember the patients who came before them. We try to process all of this -- the tears, the grief, the pain -- but time doesn’t cooperate. Our next patient is being admitted to the ICU now. Every patient requires our undivided attention and empathy. We try to keep his blood pressure barely above horrible, turn up the drips, and then ready him for intubation. Go, go, go.
All of these are sacred responsibilities, but they can change who we are. So, we assess for burnout and talk about resiliency. We try to measure our moral distress. All of this can be incredibly difficult. I don’t have any unique answers or revelations to offer. I’m just another guy in scrubs struggling with these same issues. In fact, the longer I do this, the more difficult it becomes. Life can leave scars and our patients count on us for hope. Fatalism is insidious. Be wary. Some days shake you to your core. In truth, I worry about all this. What about my colleagues? Are they OK? For that matter, do I have enough left in my own tank? I do know this: we have to be vigilant and care for each other. We are sisters and brothers in critical care.
During SCCM’s 2014 Critical Care Congress in San Francisco, I highlighted multiple boundaries that we need to break down. Subsequently and during many talks, as well as in my columns for Critical Connections, I have tried to limit my focus to two unadorned messages. I believe that these two messages most point the way to our future.
First, critical care is not a place. This embodies many things. For instance, we must find our patients before they find us, including the ones who are not hospitalized. In addition, with the exception of some sporadic events, an unplanned cardiac arrest (code response) in a hospitalized patient is a process failure. We own the outcome for all hospitalized, critically ill patients, not only the ones who crash-land in our ICUs. Location and workforce cannot be limiting determinants. We must find a better way.
Second and in the same vein, our future is critical care prevention. Our specialty was founded by cohorting the sickest hospitalized patients in a centralized location. This has served us extremely well for decades. We will continue to care for these patients, and ICUs are still vital. But the ultimate answer is not more ICU beds; it is preventing the need for critical care. The most efficacious critical care is the care that our patients never need. This has multiple meanings and ramifications -- far too many for this brief column. But in short, this is not about “blocking” ICU admissions; it’s about preventing the need in the first place. Again, we must find a better way. Find me and let’s have these conversations; your insights are vitally important. I will continue to carry your messages forward.
So, let me wrap this up. You are amazing. SCCM provides all of us a great opportunity to come together, to plan, to learn, to support each other, and to advance the care of our critically ill and injured patients. Above all else, reach out and put your arm around your nearest colleague. After all, we are all in this together. Thanks for a great year!