Hello everyone:

Greetings from the Amtrak Northeast Regional 147, now rumbling past fields, streams, and warehouses to Washington, DC. Early Monday, I’ll attend my first meeting of the ATS Education Committee. That afternoon, I'll end my term as Chair of the Ethics and Conflict of Interest Committee.

I've attended ATS almost every year since I began fellowship in 1992, almost always rooming with my friend, Lloyd Friedman. I used to present at poster and poster-discussion sessions, and, when my work deserved it, at mini-symposia. I eventually chaired major sessions and spoke to larger audiences. Such is the arc of an academic career.

Seeing old friends is the best part of ATS. The annual Yale reunion attracts scores of graduates from as far back as the 70s. Each day, I find old medical school and residency friends wandering the convention center. More recently, I've reunited with our own residency graduates, many in fellowship, others about to start "real" jobs. In recent years, I've mentored junior faculty and fellows; last year fate paired me with Elisabeth Sacks, a Yale alumna, now finishing fellowship in Pittsburgh.

As the years rumbled by, the science of critical care evolved. As fellows, we placed Swan Ganz catheters in most patients with septic shock and ARDS, but in the late 1990s we learned at ATS that Swans were useless, and we moved on. In the early 2000s, we grappled with the SARS epidemic and feared for colleagues in Asia and Canada who risked their lives caring for victims; in turn, we began to think more deeply about the ways we confront danger as physicians. Over the past fifteen years, early goal directed therapy came and went, and, instead of sedating patients, we push them to do physical therapy. These days we're using low tidal volumes to save ARDS patients who would have died in the past, but we're hoping new biological therapies will save even more lives. We've recognized the value of teamwork in critical care, the critical importance of checklists, and the imperative to prevent line infections. Finally, we've come to embrace families as care partners in the ICU as they join us on rounds and keep us focused on the patient.

As the train rumbled along this afternoon, I watched "What Makes Life Worth Living in the Face of Death," a TED-Talk by Dr. Lucy Kalanithi. Most of you know that Dr. Kalanithi is an internist and Yale Medical School graduate. Her late husband, Paul, was a neurosurgery resident who wrote "When Breath Becomes Air" as he battled lung cancer. When you can, please watch Lucy's talk, and learn how humans can flourish amidst suffering, especially if they can forge meaningful relationships with one another.

After a quarter century in medicine, I love medical science as much as ever. But more importantly, I realize how privileged I’ve been to spend my days with colleagues, friends, patients, and families that I care so much about. Gratitude for this privilege fills my soul as the Northeast Regional rumbles south.

Enjoy your weekend everyone, and I’ll see you back in New Haven next week,

Mark