"I have spent the past 30 years working in intensive care
medicine. I was drawn to intensive care as a trainee for
several reasons. First, I enjoyed the opportunity to care for
the sickest patients in the hospital and to use technology,
evidence, and experience to try to save their lives. Second,
I enjoyed the interprofessional teamwork that is inher-
ent to high-quality intensive care. I enjoyed being “the
physician in charge” and knowing that my expertise was
nearly useless without the amazing interprofessional team
that works together in the intensive care unit. Finally,
whether we could save a patient’s life, I was honored by
the privilege to care for patients and their families during
this incredibly difcult time in their lives—to fnd ways to
support them in all realms including physical, psychologi-
cal, sONcial, and spiritual. In fact, this fnal reason for my
interest in intensive care was the motivating factor for my
research career: I wanted to fnd evidence-based ways to
communicate with and support seriously ill patients and
their families during and after critical illness.
Now, 30 years later, I fnd myself facing a serious illness.
I was diagnosed with bulbar-onset amyotrophic lateral
sclerosis in March of 2021. Tis illness was not part of my
plan—just as critical illness is rarely part of the plan for
our patients and their family members. I fnd myself on
the other side of goals-of-care discussions now. Tis ill-
ness has caused my family and me great stress and dis-
tress. And this illness is also an opportunity to refect on
my life and my career. I write now as part of this refec-
tion on my career and to share, with those who are inter-
ested, some of my life lessons (see Fig. 1).
Te frst lesson is to work with people you like and even
love. We don’t always have a choice of work partners, but
often we do. As I refect on the past 30 years, it is memories
of working with those I really liked, or even grew to love,
that has made my career the most rewarding. Tis includes
physicians, nurses, respiratory therapists, researchers, and
research staf. It includes bosses, colleagues, people who
worked for me, and trainees. I have been able to surround
myself, in my work environment, with people I really like. I
recommend you do the same whenever possible.
Te second lesson is to take sabbaticals. I had the great
privilege of spending a year working and playing in Paris for
the academic year 2017–2018. It was a remarkable year that
will stand out forever in my memory, as well as the mem-
ory of my wife and our then 14-year-old daughter. It was a
magical year for us in so many ways. I’ll spare you reading
about most of these ways, but one was that the sabbatical
gave me the opportunity to recharge with time and space
to reconnect with why I love what I do and to think truly
creatively about my work. In the prior 10 years, I received
25% of the grants I submitted—a reality of the funding cli-
mate since the 2007 stock market crash. During that year
in Paris, I worked on 8 grants and 7 of them were funded.
I believe this high proportion is not a coincidence. Having
the time and space to think creatively had a remarkable
impact on my work. I realize not everyone can spend a year
in Paris. However, everyone can fnd ways to create time
and space to recharge, nourish their creativity, and refect
on what is most important to them about their work.
Te third lesson is to prioritize your family. By “fam-
ily”, I mean those you love most. Tis could be a biologic
family or a family of choice. I believe that making my
family a key priority has been tremendously important
to my happiness, personally and professionally. Having
a fulflled and prioritized family life has made me a bet-
ter intensivist, colleague, boss, and mentor. I won’t pre-
tend that I have always put my family frst throughout my career—I have had some lapses. But when I have lapsed, I
have found it very rewarding to re-center myself and re-
orient my priorities to bring my family back to the center.
Sometimes, I could do this with a well-planned and truly
“unplugged” vacation. Other times, it required a long talk
with my wife, daughter, or a trusted friend, or seeing a
therapist. Identifying the imbalance and then fnding the
right way at that time to re-balance has been very impor-
tant for the longevity and success in my career.
My fnal lesson, learned more recently, is to live every
day as if I have a terminal disease. I don’t mean to glorify
having a terminal disease by any stretch of the imagina-
tion! I would give almost anything to not have ALS. How-
ever, having this disease has allowed me to focus on what
is most important to me and to let go of things that are
not as important. Focusing on the important has been
something I have worked towards for 25 years and with
which I have struggled at times. In the past, I would often
classify too many things as “important” and fnd myself
unable to really focus on the most important because of
too many distractions. Nothing about the physiological
efects of ALS has increased my ability to focus. Instead,
realizing how limited my time is, I have found the inner
strength to focus. I believe I always had that strength, but
oftentimes chose not to use it. My advice, for what it is worth, is to fnd that strength even when you aren’t put in
that position by a terminal illness.
Tese lessons are not intended to be all-encompass-
ing or universal to everyone. Tey are a few of my most
treasured lessons from a career in intensive care. I share
them now in the belief they might help others." Randall Curtis
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