Ladies and gentlemen, please welcome Dr. Kusum Menon. Good afternoon. It gives me great pleasure to introduce this year's Lifetime Achievement Award winner, Dr. Deborah Cook. Dr. Cook is a distinguished professor of medicine, clinical epidemiology and biostatistics at McMaster University in Canada, and is an active intensive care physician who practices at St. Joseph's Healthcare in Hamilton. As academic chair of critical care medicine at McMaster University, she holds a tier one Canada research chair in intensive care medicine from the Canadian Institutes of Health Research, and was a founding member and chair of the Canadian Critical Care Trials Group. Dr. Cook has published over 700 peer review articles related to randomized control trials, life support technology, preventing complications of critical illness, end of life care and research ethics. Her numerous honours include fellowship in the Royal Society, CIHR's Distinguished Lectureship, Gold Leaf Award for impact, and the National Deborah J. Cook Mentorship Award, which was created to recognize her monumental commitment to training emerging scholars. She was also recently appointed an officer of the Order of Canada for her scientific leadership in improving global intensive care. Please join me in extending a warm welcome to my friend, mentor, and role model, Dr. Cook, as she presents a clinician-scientist journey, career reflections, and lessons learned. Sincere thanks to SCCM for this huge honour of a Lifetime Achievement Award. Actually, my very first conference as a critical care fellow at Stanford was an SCCM meeting. I was terrified presenting a poster on cortisol levels and septic shock, but I was encouraged by some constructive critique and inquiries made in front of my poster. And I was also struck by the interprofessional nature of attendees. And I knew right then that I found a great critical care community home at SCCM. I'm grateful to hundreds of people who've enriched my career over the years, colleagues, comrades, teachers, trainees, friends and family, including work, family. I've always appreciated my clinical colleagues in the ICU and in the hospital, and learned so much as a clinical investigator from stellar research coordinators, Nicole Zatarg, Franz Clark, and Ellen MacDonald, to name a few. My story is really a reflection of everybody's influence, and I dedicate this award to all of those people, as well as the patients and the families for whom I've had the privilege to care. Today I was invited to speak about anything at all. And I decided to share some personal reflections through the retrospect to scope. Some field observations were made, but I confess this is experience-based, not evidence-based, and there was no literature review involved. I have five messages to share, and you might consider these my own lessons learned. The first is be brave. Whatever we try to achieve in our career, we all face obstacles. We need to learn how to navigate inevitable bumps in the road, and sometimes the path is unclear, especially if we take the road less traveled. In my early university days as an aspiring scientist, I was seeking a particularly challenging project. After a couple of conversations with the prospective supervisor, he advised, I just don't think research is in your future. This statement haunted me for a while until I had the courage to initiate another project with a different supervisor. Eventually I went on to pursue a master's degree in clinical epidemiology and biostatistics, and became the first intensivist formally trained in clinical research in Canada. Later, as a young faculty member, after presenting a protocol for our first survey on nurse and physician views about withdrawal of life support, a senior colleague wondered aloud if it was actually unethical. That was shattering at the time and is still shocking. I thought it was unethical not to do the study given that withdrawal of life support preceded most deaths in ICU. Following encouragement from my wonderful mentor, Dr. Gordon Guyatt, and our open-minded Canadian critical care trials group, we forged ahead. And ultimately this survey helped to open up the field and was published in JAMA. I found in medicine there's sometimes a hidden agenda to retain the status quo, a pressure to conform and not rock the boat. Asking questions and particularly questioning authority and conventional wisdom can be unsettling to people. Witness the early evidence-based medicine movement I was privileged to help lead in our field, a sea change, but initially discredited and sometimes still deliberately misinterpreted in conservative circles. I've always tried to identify fruitful fields of research at the watershed of different specialties. Given the clinical and research strength in both critical care and thrombosis in my university a few years ago, I asked some thrombosis scientists what they thought about embarking on some studies at the nexus of critical care and thrombosis. All but two actively dissuaded me with these two individuals and interested ICU colleagues around the world. We forged ahead and completed a multi-method, multi-project research program on venous thrombosis in the ICU over the next 10 years. This experience was one of many that taught me that you should take every opportunity to hear other perspectives and either reconsider or re-evaluate your own experience. Or reaffirm your own. No matter what you do in your career, it's essential to talk to people with different points of view. No matter how open-minded you may be, some people may frown, others may politely disengage. I've learned it's okay to agree to disagree on occasion. Sometimes dialogue is more important than consensus. And sometimes you need to trust your gut. As George Bernard Shaw said, life isn't about finding yourself, it's about creating yourself. I found you're not growing unless you're getting outside of your comfort zone, getting comfortable with risk and uncertainty. You're not growing unless you're changing. Look, listen, and solicit advice along the way, but cultivate your own views and judgment. I've learned that defining moments for bravery could be right in front of you. They may come along when you least expect them. This might be your time to be brave, perhaps to create or innovate. Being brave is so important when you're young, but it's never too late to be brave. My second lesson learned is be humble. As we all know, critical care is a specialty marked by complexity, information mastery, and technical prowess, often at warp speed. This confidence crusade manufactures a sense of objectivity in practice and science, which conceals the reality of uncertainty. The constant drive for sharing performance excellence also mitigates against the culture of humility. So I find pride to be very prevalent and humility to be in short supply in our field. Humility encourages presumptions to be challenged and questions to be posed. Humility means being able to say, I don't know. Humility also means acknowledging when you need help. I remember when we started our first CHR-funded randomized clinical trial of ranitidine versus sucrophate for stress ulcer prophylaxis. Talk about humbling. Every month, it felt like we were climbing a mountain. Following submission of our interim report, which outlined slow but steady progress, funding was not renewed mid-trial. We had two choices, give up or regroup and press on. And we chose the latter. With enormous gratitude to clinical mentors and dedicated colleagues, such as Dr. John Marshall, we creatively problem solved and redoubled efforts. No question, I've learned so much more from such struggles in life than smooth sailing. You've got to grow through what you go through. This trial was eventually completed and published in the New England Journal of Medicine and acid suppression for ventilated patients became the standard of care for the next 30 years. I really believe we also need scientific humility as a critical care community. As data emerge and the landscape changes, so much we. The Declaration of Health, thank you, reminds us that even the best so-called proven interventions must be evaluated continually through research for their safety and effectiveness. This year with colleagues in Australia, Saudi Arabia, and the UK and elsewhere, we're launching the vanguard phase of another trial in stress ulcer prophylaxis, challenging the currency and the veracity of our original findings on acid suppression from years ago. As individuals and as a community, we need to stay humble. My third lesson learned is be humane. I've always believed in the sanctity of the patient clinician relationship. This focus has never sent me down the wrong path. To me, medicine is not a job or a trade, but it's a calling. However, I've often felt like a fish out of water, especially these days when patient is client, clinician is provider, and the family is a visitor. And when healthcare is riddled with business lexicon, corporations focusing on efficiency and economics. Having grown up professionally speaking in two departments at an incredible university, McMaster, where rigorous observations, experiments, and measurements were fundamental to the academic culture. This created a positivist view of science, and it was perpetuated through most of my training. I remember in fellowship at Stanford University, I was captivated though, with the excellent physiologic teaching that was augmented with attention to clinical ethics. Upon returning to Canada, however, I was actively discouraged from pursuing a study on the ethical dimensions of end-of-life care by a senior academic authority. He told me the topic was soft science or actually not science. His advice verbatim was that this was not serious enough for a serious investigator like you. So for years, I felt closeted. End-of-life care was a special locus of my practice and a favorite focus of my teaching. I quietly kept end-of-life research alive while pursuing epidemiologic investigations and randomized clinical trials on other topics. Fast forward 25 years, the idea for our Three Wishes Project germinated at an end-of-life conference I had organized for the Canadian Academy. I've invited a scholarly provocateur to the final session to spice it up. And at the end of the day, he threw down the gauntlet, urging everyone there to stand up and answer, what are you going to do to make a tangible difference in this field when you go home? Without realizing it, I'd been preparing for this moment without giving the Three Wishes Project a voice or a name. So rekindling acts of compassion at the bedside, several of us began to more deliberately elicit and implement individualized terminal wishes for dying patients, trying to ease the grief of family members left behind. By connecting to purpose this way, the Three Wishes Project has made work so much more meaningful, enhancing our sense of vocation by honoring the lives lived in the face of death. The soul of the Three Wishes Project has been career enriching for me personally and culture changing for many in our unit. As qualitative interviews across North America indicate, we are not alone. Humanity doesn't always have an invitation to the table today in healthcare, but for me, humanity is the foundation for everything we do. Stay humane. My fourth lesson is to lend a hand. Lend a hand to your colleagues. I found that most clinical investigators are on a quest to make a difference, discover something, advance a topic, answer a question, inform practice or policy. I've always tried to be there for them when it matters most. I try to bring my A game to their table, not just my own. Whatever the cause, yours or someone else's, it usually takes a village. Early in my career, I was so busy being busy that I didn't fully realize the importance of enrichment through conversation. I sometimes wish I'd been more deliberate, sustaining a contemplative and conversational life. I'm much better now at disciplining myself to disconnect from devices and connect with colleagues. I'm well aware of the slippery slope of multitasking and digital dependency. I listen more and talk less. I try to eat, drink, dance and celebrate, but not be afraid to cry. I try to spend time with people who help me to be my best self and do the same in return. I seek collaborators with shared values and recognize authentic friendships. As we all have been reminded during this pandemic, and as we will celebrate soon, meeting and talking face-to-face still matters. Lend a hand to young people. This was a guiding principle of another mentor, Dr. David Sackett, and it is a commitment of mine to this day. I always acknowledge and value the reciprocity of teaching and mentoring. Facilitating McMaster's Academy Group with Dr. Maureen Mead, we share the privilege of working with brilliant research fellows and early faculty dedicated to our specialty. Sometimes in this setting, it's actually hard to tell who is mentoring who. Recall what it was like when you were young. Foster the growth and independence of young people. They are the future. Lend a hand to a worthy but unpopular cause. In the 1990s, for me, it was quality improvement. Back then, basic science mattered most. Clinical research, not so much, and health services research wasn't even in the game. Was quality improvement an unpopular cause? Yes, but it was not unworthy. I knew there'd be more in store for quality improvement. It was just a matter of time. And as a phys ed grad, and as a phys ed grad, I try to channel the great Canadian Wayne Gretzky, who often said, "'Skate where you think the puck is going to be.'" So I've tried to conduct a quality improvement project in our unit every two or three years. Tried to make a difference in my own backyard, standing shoulder to shoulder with nurses, respiratory therapists, physiotherapists, dieticians, pharmacists, social workers, spiritual care clinicians, as we all try to define and deliver and then evaluate high quality critical care. Gradually, quality improvement became more professional, interprofessional, just like our practice. New methods were ushered in and a fresh lexicon emerged. Knowledge translation, implementation science, adoption, made room for de-adoption as initiatives such as choosing wisely surfaced. Today, most hospitals, universities, funders, healthcare systems, invest heavily in the new quality improvement. Indeed, a bedrock of our healthcare system. Lend a hand every day to a worthy but unpopular cause to your colleagues and to young people. My last message is to let passion be your guide. It will not fail you. When you work from a place of passion, you have problems to solve, places to go, and people to meet. You work in crescendo. Intellect, ideas, training, and time, they're not enough. An audacious hope to make a difference helps, but passion fuels you to aim a little higher, think a little harder, and stretch a little further. I've always tried to learn what others are passionate about. I've always tried to learn what others are passionate about because their energy can be infectious and inspiring. We all find meaning in striving toward our passion. It keeps the fire in the belly and sustains us through dark times. And we all know there are dark times. At the same time, when a burning flame damps down, when your passion dies, I've learned it can be important to let it go and move on. I've found it necessary to shift or reimagine some aspect of my career every few years to keep it fresh. I try not to keep prototyping, but sometimes to countertype. And then divine the next passion, something new to learn, something to enhance, or even advance. For me, recently, it was microbiome modification and its potential in critical care. The challenge of a new body of knowledge, new language, new metrics kept me up some nights, even without the need for a coffee. Striving towards our passion can even lead to thriving. Let's ask ourselves where, how, and with whom can we make our best contribution? When we are fueled by passion, we have problems to solve and communities to serve. Striving in partnership towards a passion we share with other people can be so energy giving, and we may actually co-create joy at work. Suggestion, always assume that your most important work is ahead of you. Assume it is your job to help change the world, even just your little corner of it. Find and follow your passion. It's up to each of us to make critical care better tomorrow than it is today. Well, welcome everybody to the conversation with Deborah Cook, who just gave an inspiring talk about a career as a clinician scientist that has been unparalleled, to be honest, and has inspired me as well as clearly many others. Maybe I could just start off with a question of mine, Deborah, and it sort of reflects some of the questions that have been asked in the chat. You talk about being brave, but how did you find that courage? What was in you that made you find the courage to bring up ideas that people might've laughed at or people might've not been enthusiastic about? How did you find that inspiration and how did you find the right time and the way to bring up those ideas that maybe people weren't as enthusiastic about? Well, that's a tough question. I guess unusual ideas or ideas that might challenge the status quo are not always welcome or appreciated or even considered more generally. And probably like all of us, when we've got a notion for something, we start with conversations with friends and colleagues to just reflect on the issues at hand and do, I guess, a little bit of field research just through conversation. And naturally speaking with some advisors and mentors, I think those are the first few steps to sorting out whether a field is worth pursuing or a question is worth addressing. And it's important to know when it's not an ideal topic or question or it's not the time. There's many ideas I've had that I think I've saved them for later, shall we say? And recognizing the adage, right time, right place, right people, a little bit of instinct, I guess, there too. That question is Beth Taylor's. I hope, Beth, that that sort of answers your question. Jose Diaz Gomez asks, in this sort of era of social media, when in some ways it's easy to connect with people, but in other ways, it's harder to meet people, how do you get your career going, especially if you don't have a mentor? Well, I'm certainly no expert in social media. I've just decided for myself, I have so many wonderful connections through other vehicles that I couldn't comment on social media at all, except it's obviously a hugely important aspect of society. So to the question on mentors, I think the traditional idea of a mentor being, a mentor-mentee relationship being sort of dyadic is maybe a little bit outdated now, when in reality, I think there are many different mentoring models. So there's the community model that you know very well. Some of you may not know that Dr. Menon is the incoming chair of the Canadian Critical Care Trials Group. And we've developed this community mentoring model whereby anyone can make suggestions or comments or give constructive critique and groups of people thereby sort of foster the development of projects and ideas. So that's one concept that I think is quite important today and community mentoring is huge and not just obviously in person. Another is a local team mentoring approach which often involves individuals potentially from different disciplines that could be outside one's own institution, could be across the country or in this day and age around the world. And one of the nice things about team mentoring is that again it shakes up this concept of a senior person mentoring a junior person. As I was alluding to, I've learned so much by my peers and folks who are earlier in their career than I think ever was the case years ago. So the notion of team mentoring by people at different levels in their career and with different disciplines I think are sort of important facets of mentoring today that may be fostered beautifully through connections and social media. So in that sense I think there still is the desire for an individual who may play a more prominent role I suppose in guidance, but if you think of all the verbs, all the things that a mentorship relationship could offer, they may not all be identified in one individual. So it's you know counseling, advising, and coaching, and encouraging, and befriending, and there's all kinds of things a mentor could do. And then sometimes there's role modeling and sometimes we may see individuals in our midst who are role models for us and those people may not be mentors or mentors may not be role models depending on the relationship in the situation. So I think it's a much more complex and an interesting relationship these days when one considers mentorship because it can be with many individuals across many spheres and perhaps connections are far beyond the face-to-face kind of approach that has characterized mentoring in the past. I think one of the things that Dr. Cook really highlights is that what brought her to my attention as a mentor was that she didn't focus on the science right away. She came and asked me about myself as a person and I think when looking for a mentor, when somebody shows interest in you as a person, as an individual, I think that's a really good sign that they're going to be a great mentor. Ruth Kleinpel says congratulations Debra on this well-deserved recognition, sending best regards. Jose asked another question here about when we're part of a large team, would you put more emphasis on the team's collective win rather than the lack of excessive individual ego? Oftentimes colleagues hesitate to praise others freely. There's no I in team as this thing goes and for sure research is very much a group, collective activity and science, especially clinical research, is a social enterprise and I've always very much loved that aspect of clinical investigation. That's certainly my philosophy and the idea of group activities where everyone has a voice and everybody's input is sought and listened to. It's really how I've tried to live my life and speaking about the three or four, five, six research coordinators with whom I've worked most closely, I've learned an enormous amount from them and with them and this sense of teamwork surely includes investigators, colleagues, collaborators, but the research coordinators who are the heart and soul of so much of clinical investigation. So France Clark and Ellen MacDonald, Nicole Zatarik, Marilyn Swinton and so many others, the team approach is very much predicated on the activity of so many individuals and it's not obviously just doctors or just scholars with professional expertise at the bedside clinically, but the research coordinators and staff are key. So that's certainly been my philosophy and I think it's the only way it really sings. Kind of moving along to the team, how do you balance, speaking of, you know, it takes a team to do the research at work, it takes a team to help you set up your life so that you can actually do the research. How do you balance your work life, you know, demands and stresses? Any advice to young people starting out? Well, I couldn't presume to give advice in that department because I am certainly a work in progress in that area, but I have found it very helpful to try to eat well and exercise and spend as much time as I can with friends and family and acknowledge work family and I've always gravitated toward people and reach them through shared values in the workplace and that has been incredibly nurturing. But on the balance, I think it waxes and wanes, we've all got times when we've got crunches, busy, busy times clinically at work and grant times and furiously scrambling to wrap up projects or initiate projects, so I think the reality is there's sort of a dynamism to balance and it's not a single state, it is a state we approach and achieve and regress from at various times. Over my career, I know I've floundered out of balance often for weeks at a time and self-awareness about that has been hard won, I'll say. Very interesting question in the chat. As a female, sometimes we get told we're emotional. If you were told that at work, how would you respond? How would you deal with that? I'd acknowledge that I am and I think it'd be a great tragedy to suppress one's emotions when one spends so much time, when one is awake at work or doing work and shutting down on that aspect of ourselves as clinicians and as clinician scientists, I think is sad if that occurs and that's part of staying humane and recognizing our shared humanity. It's beaten out of people and a lot of individuals I find are very sensitive on the inside but that aspect of balance with emotional intelligence doesn't always come to the fore, it's hidden and it's usually there but not manifest, shall we say. I remember one time I was being emotional by someone exactly as you suggest who was probably more sensitive inside and so I acknowledged that yes, I was and I was upset that day and I took them aside and I said, I'm sorry, does that bother you? And if it does, I'm curious as to why. You work in an intensive care, people cry and are emotional all the time. Is it because I'm a colleague? What is it about me being emotional right now that bothers you? And I think they were really taken aback and what they said to me in the end was because I think I'm going to cry now too. So I think you touched on something there that sometimes people say that not because they want to be mean but because they're struggling with their own ways of coping. So that's a really good observation, I think. The coat of armor is strong, we all put it on. Some people keep it on, some some people keep it on, some people never take it off. Some people make the coat stronger, put on more coats and everybody just has a different way of living which and everyone's entitled to their approach I guess and personality but without judgment ideally. But being emotionally available enhances the connections that makes the world go around and I don't know that's been a truism since the beginning of time, even in critical care. One of the things that you know we struggle with as you pointed out earlier is that things go up and down, your emotions go up and down, your career, your passion goes up and down and you go through different stages of your career as well. In the beginning as a junior member you're looking for a mentor, in the middle stage you still feel like you need a mentor but you're being asked to be a mentor. How do you navigate that piece and balance the need to have a mentor with the request to be a mentor? It's acknowledging as you're saying it's not an either or. We all appreciate guidance and reflective comments from individuals who, and I still do, who have been my mentor and were my mentors and still are my mentors and now there are people who I have mentored who mentor me on certain aspects of work life. So I think it's multi-dimensional, it's phasic and it may be situational as well. There can be people who I've learned so much through conversation with many about different things and we maybe wouldn't use the word mentoring, we'd speak about having a conversation or advising but really the nature of the dynamic is mentoring and just being open to that. It requires humility again, it's not an attribute everybody is willing to acknowledge or have or share or display because courage is so necessary. But I think being open to different things we all appreciate or need or seek and looking for help and advice and the reciprocity of that approach, that's more a reality-based way to live and ride out the the journey of one's career. As a former chair of the Canadian Critical Care Trials Group, you're very used to the model of interdisciplinary research and having people very different backgrounds on your research team and encouraging people from physio, occupational therapy, nursing to conduct their own research. What advice would you give to centers where they would like nursing to become more involved or to be focused on some evidence-based nursing practices but that hasn't been the culture? What would you suggest or advice for getting that started or building that culture in the center? I think finding a project that excites people is a good one, finding a project that is relevant and designing something that is manageable and yet is rigorous and ethical, doesn't even have to be fundable or huge. But beginning with one project that helps people coalesce with different backgrounds is important and not seeking necessarily this sort of obvious leaders in a group may be one good way to do it. So I've always thought that scientific leadership within any discipline including medicine, it doesn't come necessarily with a seniority or people who've had experience in research or training. And starting one project, making it relevant, making it rigorous and democratizing the whole process such that everybody has a voice is really, really important. Because sometimes in meetings, especially in early days of project development, the people who are the most opinionated speak most, the people who are the most senior speak most. There is a lot of pressure on the people who are the most there is depending on the vehicle of communication, it favors some individuals more than others. Some people are super great on email and they're very comfortable to and can do long beautifully prosaic emails, which effectively silences others who'd rather have been put through conversation. So I think in any kind of collaboration, particularly interprofessional collaboration, I think it's important to be mindful of the who and the how, as well as the when. So people who might otherwise have lots of great input aren't somehow excluded because they you know, can't meet at certain times. And it's a fostering that mindfully does require being deliberate about the dimensions of the who and the what, and the when, because usually the why is pretty clear. If it's around a project of interprofessional interest, usually the why is, is there, and trying to make those those first projects be, you know, be very democratic in their ethos and trying to make them successful, I think is important because success of early projects begets success for future projects. And acknowledging the activity and the leadership, particularly amongst people who haven't necessarily been holding such a title, it has is really, really important. That's been extremely exciting part of of what I've enjoyed with interprofessional projects in our own backyard at St. Joe's anyway. We talked a little bit earlier about life balance. What advice do you have for people starting out and partway through about the work work balance, where you want to focus on your research, you want to build your program, but you want to also be a good citizen and contribute to the administrative load at work, the clinical load? How do you find that balance? And how do you get people on board to see that your contribution within the research is as valuable as contributions within the other realms? I guess the main suggestion I have is to periodically, publicly, and strategically revisit one's portfolio of work. So this was started many years ago with David Sackett, and we've been doing it in Hamilton for for quite a while, Maureen and I, and I know it happens to a certain degree in other areas whereby folks are early in their career, and I still do this many years into my career, either metaphorically or actually write down the activities that one is engaged in and proportion of time, it's not just time, it's effort and it's emotional, shall we say, cost of being involved in certain things, and revisit the mix and the emphasis, because ideally it should change over time as projects come and go, and I've always tried to sort of modify things I've been engaged in along the way, let projects go when either they don't seem to be going ahead, or when they've, you know, served their purpose, or when they're actually finished, and try to consider what new activities we would like, you'd like to engage in. So we had this periodic priority list David Sackett used to start, where make a list of things that you're engaged in, you'd like to continue things that you are engaged in, but you'd like to wrap them up, things that you're not yet engaged in that you would like to start working on, and how to modify that. So this kind of analysis is good for self-reflection or self-talk, and I used to do that with our annual career reviews all the time, but we found it instructive with some folks in early and mid-career, and had an additional section on things to celebrate, because I think so much we're looking forward about what has to be done, and we're judging what hasn't gone well, and is the glass half empty or half full, and we're so forward-looking all the time, and productivity-driven, and that will always be the case, but it's important to have that reflection on is this the right mix at this time for me, or how might I change, and when I said publicly, those sort of quarterly reports or annual reports can be shared with colleagues. I know I've shared a few with partners in the past to just sort of reflect on what's going on, and had the annual career review with chairs, and that deliberate and public approach is also good to share with clinical colleagues who might wonder like what's going on, what's going on right now with so-and-so, and everybody is trying to make a difference in some way, in some realm, and that's one of the things I've appreciated in Hamilton, where we do try to share with each other the portfolio of activities, and how things are going, because everyone's making contributions administratively, educationally, in research and practice innovation, and everyone's got a balance, and that balance differs, and it's dynamic over time, but I think being analytical about it, and reflective, and sharing it publicly has a lot of utility, and sometimes I don't know for whom is that utility greatest, for oneself, or some of the people with whom we're sharing that information, but you know, I think that process has been helpful, and sometimes shockingly illuminating. For example, I was on the research ethics board at St. Joe's for 15 years, and I just, I couldn't believe it when I stopped to think about it, that's a lot of time, and I loved it, and I learned lots, and I hope I contributed lots, but I soon realized, wow, this is a great opportunity, and someone else's turn to engage in this way, and learn, and contribute, but it wasn't until that exercise had been completed that I knew that balance needed to shift a little bit in one part of practice. Kind of similar to a previous question, in this era of COVID, where it's really hard to meet people, and don't know how long this might go on for, how does a junior person sort of get started? How do they meet people? What are some alternative suggestions, or ideas for the next year perhaps? Well, the way people now communicate so much virtually, I think there's, this is obviously here to stay, and there's many amazing innovations, and communities, like the communities that have been started that I'm aware of in different aspects of healthcare, and this is probably going to continue to be the case, and maybe a gem, initially a hidden gem, initially a hidden gem, but now a very obvious MO for years to come through virtual meetings, and it's been in many ways the great equalizer, democratizer, if done well, and it too has its challenges, as everybody knows, but I think they're going to be the options, and probably the necessity to develop strategies that make this, you know, into a winning formula, because it's going nowhere fast, this approach, eventually meeting face-to-face still clearly is wonderful, but perhaps this will foster more collaborations in one's own ICU, in one's own hospital, where there are still so many of us in the front line, and working clinically, and doing research, and teaching, and so there still is that option for a face-to-face, but physically distanced collaboration, which could be a great way to get projects going around a common purpose, around a pressing common purpose relevant to COVID, and the community internationally has obviously come together in an extraordinary way around the clinical research, particularly randomized clinical trials for COVID, which has been incredible, and this has obviously been fostered hugely by virtual connections, but also conversation and discussion of how patients are faring, and where they are being cared for, and what is happening right in the ICU, and across the hospital setting, so I think already we've seen, you know, the creating the tension for change has really sparked something transformational in clinical research, particularly for COVID-related randomized clinical trials, and so much, so much innovation comes under times of change, and particularly when change brings stress, because it doesn't always, change is often, you know, fun and joyous even, but when there's a tension for change, that can bring out the best in science, and in collaboration, you know, depending on the what's at hand, and who's at the table, shall we say. We have just over a minute left. It's been a great conversation, in sort of summing up, do you have a favorite project that you worked on over your career that you look back and say, yeah, that was really fun? I don't have a favorite, honestly. They've all been amazing, and they've all had their ups and downs, like life itself, but been incredibly rewarding, and you know, it's great to be doing projects, it's great to have them completed, it's great to have a chance to inform, practice, or guide, practice, or policy, and it's an incredible gift to be able to be curious, ask questions, and answer them, but I guess for me, the most rewarding thing is about the relationships made along the way, and this Lifetime Achievement Award is really received in name, but it's for all of the teachers, and the trainees, and the collaborators, and co-investigators, and family members, work family members, who've helped along the way. That's been the greatest joy. Well, thank you so much, Dr. that has been just a wonderful walk down memory lane, and a nice chat with you, and some great answers, and suggestions, and advice for the future. Hopefully, we know we will hear lots more from you, and we'll hear you talk again. Thanks again. Thanks.

Dr. Deborah Cook

Lifetime Achievement Award

clinician-scientist

humility

patient-clinician relationship

Three Wishes Project

passion

work-life balance

mentors