4/ Here’s the bottom line: we’re all going to die. If you’re reading this, you too will die someday. Right now, you have the power to think about your life and prepare your loved ones for the care you’d want.

I think many of us who work in clinical environments where emergencies are common have had this experience: you’ve assessed a situation, developed a plan, and some part of that plan needs to be carried out by others. Those people arrive at the bedside, and suddenly you find yourself having to revisit the events and decisions that led to that plan. I try to take my ego out of these situations. The people coming to help have their own informational needs. They may have important questions or perspectives that haven’t been considered. But it does make me wonder why, in some situations, a team comes together almost seamlessly, everyone gets the information they need, and the plan moves forward quickly. And in others, it feels like pulling teeth to get everyone moving in the same direction. I think a lot of it comes down to trust. Particularly in large medical centers, so many of us are pulled in different directions that it’s difficult to build a core group of people who know and trust one another’s clinical judgment. We’re often working with people we barely know, sometimes meeting for the first time in the middle of a crisis. Without that established trust, even getting everyone on the same page can be difficult, creating tension and sometimes unnecessary delays. I think back to residency, when I worked with a relatively consistent group of colleagues. There were people I trusted implicitly, and who trusted me. That didn’t mean we didn’t question one another. But there was something reassuring about walking into a room knowing we could work together and move quickly because that trust was already there. I don’t know that there’s an easy fix, but it makes me think about how we build that kind of rapport and trust when we’re so often working with unfamiliar colleagues, under enormous pressure. It doesn’t feel as easy as it used to be.

About sums up how I feel pulling into work tonight…

I fully recognize that criticism is part of the job, and usually an important part of making our work better. But every once in a while, peer review makes me want to abandon academia and become a gardener. 🫠🌱

Yesterday, I had the chance to bring together current and former recipients of the @atscommunity Ziskind Clinical Research Scholar Award. The Ziskind Award recognizes pulmonary and critical care fellows with exceptional promise as clinical researchers. And often, for someone early in their career, there is an implicit assumption about what the path ahead will look like: fellowship → career development award → independent funding. But careers rarely follow such a straight line. So, we wanted to get the Ziskind community together to talk honestly about the many paths a clinician-scholar career can take, and how our definitions of success can change along the way. A few things from our conversation stayed with me: Sometimes the work you think is most important is also the work that is hardest to get people to support. If you are trying to disrupt an established system or ask a question outside the mainstream, finding mentors, collaborators, and funding can be harder, especially early in your career. That does not necessarily mean the idea is wrong or that you should abandon it. If you believe there is an important problem to solve, keep looking for the people who see it too and are willing to champion the work. Make career changes from a position of opportunity when you can, rather than waiting until you are miserable and looking for an escape. I thought this was such a useful way of thinking about career decisions. You can explore another path because it is genuinely exciting, not because your current path has become intolerable. And finally, grants and publications may be the currency of academic medicine, but they are not the definition of a successful career. Maybe success is better measured by asking: Are you fulfilled by what you are doing? Are you advancing the science? Are you helping improve care for patients? Because ultimately, that is why we are doing this in the first place. I came away from the hour feeling very grateful for the honesty of our Ziskind community, and hopeful about the many different ways a career in clinical research can evolve.

Intraoperative Dobutamine Plus Norepinephrine to Prevent Postoperative AKI in Septic Shock jamanetwork.com/journals/jam…

Vasopressin Initiation Threshold in Septic Shock jamanetwork.com/journals/jam…

I miss the South so much.

Development and Validation of an Adult Medical Urgency Score for US Donor Heart Allocation @WF_Parker very nice! jamanetwork.com/journals/jam…

Influenza is already making an appearance here in Seattle. If you’re in the area and haven’t gotten your flu shot yet, now’s a good time!

Looking forward to trying this out! Hats off to my colleagues @UWMedicine for developing this app. apps.apple.com/us/app/evd-ed…

In medical school, one of our professors had a test question where all you had to do was spell the word… Aneurysm. Apparently it was a pet peeve of theirs that people misspelled it so often.

Interesting review on whether medicine is still functioning as a profession. The authors never use the term “moral distress,” but I thought of it almost immediately. Jameton’s original formulation: “moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.” That feels closely related to what this paper describes: physicians holding one set of professional commitments while working in systems whose incentives and structures can make those commitments difficult to enact. jamanetwork.com/journals/jam…

A really nice review of how ICU trials have changed not just what we do, but what we’ve learned not to do. rdcu.be/dguFghEcy1Ba

Maybe that’s the self-check: why am I digging through Supplement 4 of this paper when I don’t do that for the others?