Society of Critical Care Medicine Presidential Address–54th Annual Congress, February 2025

It’s been more than a half century since clinicians and researchers came together to share their thoughts about critical care and a professional organization that would serve as their “home”. In January 1970, our founder, Max Harry Weil met with 29 key individuals and then founded the Society of Critical Care Medicine (SCCM) in Los Angeles. I am extremely humbled and honored to stand before you as your incoming President as I follow in the footsteps of leading figures in the field-some of whom are in the audience today. They have given, and continue to selflessly give, to critical care as they mentor and inspire so many of us. In preparation for today’s address, I found one specific notion that kept returning to me: the amount of time, effort, and understanding that so many people have shared to make me the intensivist as well as the person that I am today. Summarizing this realization was a single word: GRATITUDE, followed by two more: GIVING BACK. I anticipate that these words resonate for many as we each reflect on our personal journeys to critical care medicine. You may have come to recognize someone–or perhaps several someones–to whom you owe a debt of gratitude for guiding you to where you are today. The result of their guidance, teaching, mentoring, and generous support is that we now enjoy the immense privilege of working in an ICU team of nurses, physicians, advance practice providers, respiratory therapists, physiotherapists, pharmacists, dieticians, researchers, and more, caring for the most critically ill or injured patients. Such care reflects the culmination of advances in health care, research, education, and innovation in bedside care, where human life hangs in the balance. Furthermore, providing bedside ICU care is underpinned by the wisdom, education, skills, and knowledge of those who taught us to follow in their footsteps. And over time, this wisdom ultimately instills in us more subjective qualities such as confidence, empathy, curiosity, introspection and compassion. It is an honor and true privilege to treat critically ill or injured patients in a most difficult and vulnerable episode of their life. Such complex care, though, cannot be rendered alone or in isolation; a team is required. That is why research, education, and mentorship as collaborative undertakings are so fundamental to the Society. You can explore each of these aspects of daily practice in sessions throughout Congress. Our Co-Chairs and Program Committee have done a fabulous job crafting education, controversy, reviews, and interactive opportunities across every critical care discipline. We have each followed different paths to critical care medicine and to this year’s Congress. Our footsteps were guided by those who taught us in the classroom, the bedside, as well as at home. I can trace my personal path to intensive care to my late grandmother in Spain. She was a single mother who escaped her husband’s violence while pregnant with my father. With his infant brother in her arms, abuela Flora escaped her village and fled to Barcelona at the height of the Spanish Civil War. She would later share with us that her highest priority during that difficult time, right next to her daily struggle to put food on the table for her two boys, was to ensure their future higher education. My father, Jose, later became the first of five siblings to graduate from college and earned not one, but two, doctoral degrees. My grandmother’s sacrifices imbued him with both knowledge and skills. He later used these tools to instill in me the rigor of study, self-discipline, intellectual curiosity, and a passion for discovering the ‘why’ of things. My mother, Phyllis, on the other hand, was not an academic; her formal education stopped with high school graduation. Nonetheless, what she taught me was equally precious. By example, she imparted in me the importance of listening, collaborating, communicating, being empathetic, kind and doing the right thing even if no one is watching or you are exhausted. There is no doubt that my day-to-day bedside demeanor, care, and rapport with patients has been forged by the examples and teaching of my parents−bedside skills that I will treasure and share until I retire. My pathway to critical care medicine began with undergraduate education that developed my love of science. Medical school and surgery residency ignited my interest for caring for the most critically ill and injured patients–often at the brink of death. In parallel with many of you, key people guided my professional development. In mid-residency I met David Mulder, a gentleman and the epitome of the surgical mentor who first introduced me to trauma and critical care medicine. Later, in the McGill University Sepsis lab of Nicholas Christou and Jonathan Meakins, I learned the basic tenets of bench research and scientific investigation. Those foundations provided the basis for the next phase of my development. Throughout a trauma and critical care fellowship at the University of Pennsylvania I benefitted from the immense mentorship of pioneers in the field including C. William Schwab, Donald Kauder, and Patrick M. Reilly. These individuals may be familiar to you because they established and shaped a globally standard approach to life-threatening injury care known as Damage Control Surgery. Speaking of great influences on personal and professional development brings me to the doorsteps of SCCM. The guidance and shared knowledge that I accrued through SCCM was fundamentally different from all my prior experiences as it spanned practice settings, parent disciplines, and approaches in a multiprofessional fashion. I received immeasurable support, coaching, and mentoring from Pamela Lipsett, Clifford Deutschman, Todd Dorman, Vinay Nadkarni, Timothy Buchman, Lewis J. Kaplan, Craig Coopersmith, and Lauren Sorce–all SCCM leaders–as well as from a host of others. SCCM’s impact is similarly multidimensional and marked by the direction of our CEO, David Martin, who has helped steer the society for over 24 years. Together with the Council, David has helped bring SCCM to national and international prominence as a premier critical care society. Sadly for us, but happily for him, David intends to retire following next year’s Congress in Chicago. He will be dearly missed. Looking back, I am humbled–and deeply grateful−at how much I received these individuals for no reason other than them wanting to guide me. To teach me. To make me a better surgeon, intensivist, and caregiver. You as well may reflect and with little effort draw up a short list of individuals who steered you to whom you are today–professionally and personally. Yet, there is one other group that is perhaps the most deserving of our gratitude–patients and their loved ones. They influence us and guide our growth in often unnoticed yet profound ways. I am amazed and humbled daily by the trust families place in us within in the ICU, allowing us to hold their loved one’s life in our hands. Each day they walk away, leaving their wife, husband, mother, brother, or child in our care. They leave them…with you...and me…trusting us whether it is to obtain vascular access, invasively assess hemodynamics, insert a chest tube, or establish airway control–sometimes surgically–and sometimes emergently! These are responsibilities that we should all embrace with courage tempered by gravity. Are we really giving this trust of a fellow human being the importance it deserves? Do we have what it takes to honor this trust and are we truly capable of stepping up to that privilege? Such self-questioning may be distressing but may re-focus cognitive, technical, and relational skills on earning that trust during every moment of care. During fellowship at the University of Pennsylvania, there was one more key mentor I had the privilege of meeting: Army Major John Paul Pryor, a surgeon who deeply shaped thoughts such as the ones above. Immediately before deploying on his second tour of duty in Operation Iraqi Freedom, he shared with my fellowship class that he relied on a readily embraceable personal mantra while he rendered care in the ICU. Dr. Pryor explored the answers to five questions after each and every ICU patient for whom he provided care: 1) was I intellectually prepared? 2) were my skills adequate? 3) did I gather all possible resources? 4) did I have presence? In other words, was I there at the bedside? and 5) did I have a relationship with the family? Dr. Pryor–JP as he was known−ultimately died in combat on Christmas Day 2008. Nonetheless, his guidance lives on in me–and now, also in you. JP’s questions artfully describe deep introspection at the bedside. Those five questions served as his “north star” of personal and professional development. In sharing them with me–and a host of others–he led from the front. He actively repaid what he was taught by sharing it with others−every single day. Sharing is precisely what each of you do as you volunteer within SCCM’s Creative Community–you give back. Our programs touch clinicians–and patients and their families–around the world. JP would have been proud; I most certainly am. But there are opportunities to do more–to give back. Together. SCCM is unique as one of the few truly multiprofessional critical care societies. As our Founders noted, critical care is a concept, not a location. This holds true for our members who work in diverse complex care spaces outside of the ICU. Our members care for patients and each other within and outside of the hospital. Whether in the ED, OR, ICU, or outpatient clinic, these are all member spaces. So too are areas of military conflict. SCCM’s programs are purpose-built for each of those spaces to help care for patients as well as for each other as a team. Indeed, the Fundamentals Line houses programs from basic critical care in an acute care facility to resource limited locations, providing care where it’s most needed. Fundamentals also provide education uniquely focused on specific patient populations such as obstetrics or surgery. Those courses and books have been translated into seven different languages, expanding their penetrance in a global fashion. Los materiales educativos en español de la SCCM han sido traducidos, desarrollados, mejorados y diseminados por vosotros, nuestros miembros hispanos, y en los últimos seis años, han educado más de 8000 personas estudiando cuidados intensivos a través el globo, un trabajo de un valor inconmensurable para nuestros colegas hispanos del mundo entero. Critical care is similar to surgery as both rely on teams to provide effective and high-quality care. Moreover, both rely on establishing personal connections with patients, family members, and each other–sometimes in a rapid fashion during a crisis. Critical care may be challenging and emotionally draining, consequences that were magnified during the early portions of the pandemic. Regardless, they were problems for which SCCM had established resources that were shared across national boundaries. Relatedly, the past four years have witnessed a substantial expansion of SCCM’s global critical care efforts. Whether those efforts arose as digital platform linkage across continents for education, dissemination of clinical care guidelines, or international outreach efforts, SCCM has established itself as a global organization. Importantly, key portions of the SCCM portfolio are deployed to resource limited or conflict-ravaged spaces for free. Those efforts capitalize on grants to address key deficiencies in given geographical locations. For example, in December 2023, Jose Luis Diaz Gomez, MD, FCCM, our incoming treasurer, traveled to Ukraine with a team of educators to teach fundamental ultrasound skills to frontline clinicians. We have also expanded our humanitarian activities to build sustainable oxygen infrastructure in under-resourced hospitals in Africa. In partnership with others, we recently installed systems to provide solar power and oxygen to hospitals in The Gambia, Sierra Leone, and Liberia. The Africa Infrastructure Relief and Support (known as AIRS) project has enabled local hospitals−some for the first time−to provide reliable oxygen to patients. Our members provided humanitarian relief after the devastation of Helene and Milton hurricanes when we partnered with others to dispatch shipments of vital supplies to clinicians in Florida, North Carolina, and Tennessee. These key and grant-supported resources enabled care delivery amid the chaos of natural disasters. Each of these efforts relies upon your volunteerism for success–a spirit which aptly characterizes SCCM. Our Creative Community embraces over 2000 members volunteering in a host of roles across committees, taskforces, and workgroups. How can you give back if you are not yet part of the Creative Community? Join! It is truly that simple. Join a committee–there are over 60 of them. Join a Section–we have 16. Or collaborate in a multiprofessional Knowledge Education Group. If you wish to pursue new knowledge–there are opportunities within the Discovery Research Network to pursue with your team. For some, giving back begins closer to home as members may become involved in outreach efforts within their local community. Continuing our tradition of holding public health outreach events in conjunction with Congress, the Society held a training program at the University of Central Florida addressing the management of critically ill geriatric patients for physicians and allied health trainees. Once again, the Surgery Section is hosting a Stop-the-Bleed training and certification session in the Exhibit Hall over the next few days. While there, I encourage you to participate in the blood drive as well. All our activities–including outreach−are designed to benefit patients, and leverage education as a key method. The public needs to know what we do, how we work as a team, and how critical care provides a cornerstone for society’s health and wellbeing. The pandemic broadly introduced the public to critical care. This was one of the few good things associated with that tumultuous time because it put a face–your face–on critical care. No longer just a concept, critical care was embodied by team members at the bedside. With the family. And in the public eye across every media platform. While we generally focus our work efforts outside of our homes, allow me to suggest a slightly different approach. Bring just a little of it home, and for a very specific reason. Sharing my day with my wife and children over dinner sometimes offers them a glimpse of that day’s experiences and important lessons−some happy, some less so−and others that are emotionally challenging. Some experiences are hard and exhausting but at the same time rewarding and laced with great hope and the opportunity to do great good. I find that by sharing my day with my family it gives them a better understanding of my passion for our profession. I am truly blessed to have my family with me today. Allow me to introduce them to you all. First, my college kids. Mateo is finishing a master’s degree in biomedical engineering and Charles is midway through a master’s degree in mechanical engineering. Both are at Drexel University, close to my hospitals and my lab. One of my most precious joys is to have lunch with either or both on campus or in the hospital…Dad always pays! My daughter Caroline is at the University of Pittsburgh pursuing psychology with a minor in neurosciences in the prelaw track. As my only daughter I assure you, I treat her with no special deference. My youngest, Stéphane, is a sophomore in high school who anchors me during those dinner table conversations. He has a scientific mind, and I am sure he will do great things in the future. Finally, and most importantly, the person who is my love, my confidante, my best friend, and my greatest supporter. The pillar who has stood by me whether I was immersed in completing my PhD thesis, surgical residency, or fellowship−my wife, Dominique. I cannot thank you enough for being there for and with me. In many ways, SCCM serves as an extended family for me. It may do so for you as well. It is within those dynamics that we find a host of ways to give back to colleagues around the world. Within our professional practice, through teaching, coaching, mentoring, and sponsoring, we find ways to give back to trainees, partners, and team members. Doing so establishes critical care not as a job, but as a vocation–a calling–that one must pursue. It has been said that we make a living by what we get–but we make a life by what we give. That notion quintessentially describes the critical care clinician. Who you are as a compassionate person is more than a career choice…Giving back to others. For me, and I hope for you as well, SCCM is the ideal multiprofessional home within which to expand, refine, and share all of that. I am excited for the amazing program that our Congress Co-Chairs and the Program Planning Committee have crafted. There truly is something for everyone from Thought Leader lectures to awards to the popular Quiz Show! I remain both humbled and filled with gratitude to serve as your incoming President.

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