Well, hello everyone, and welcome to another session on the Luminary Lounge. This is our effort to introduce the greats of critical care medicine over the years to the audiences at the SCCM annual meeting. And today, I have the distinct pleasure of having with me Carolyn Beckus. Carolyn, welcome and thank you so much for your time today. My pleasure and honor. So I'm going to try and do justice to a great and very illustrious career with a very short bio. And I'll tell you that whatever I say is probably not going to do justice to what Carolyn has achieved over the years. But it's an exciting day for us at the SCCM annual meeting that we're actually going to hear that story after I finish introducing Carolyn. So Carolyn is a critical care physician who currently is professor of medicine at the Cooper Medical School of Robben University. She's a graduate of Jefferson Medical College, and she joined staff of Cooper in 1977. She has served in various roles over the next several decades, including director of the ICU, executive vice president for medical affairs, and the CMO. At various times, she was responsible for graduate medical education, continuing medical education, research, the simulation lab, and several other responsibilities. Dr. Beckus was a member of the governing council of the National Society for Critical Care Medicine for 10 years, and then she became president of SCCM during the term 2000-2001. She has also served as the president of the New Jersey chapter of the Society of Critical Care Medicine, chair of the SCCM, and chair of the Critical Care Education and Research Foundation. She lives in Cherry Hill, and she has been a foster mother for two Vietnamese children and has many cats and dogs, and they're all rescue animals. So amazing, amazing, amazing all around. And Carolyn, once again, looking forward to the discussion today. I'm going to start right away by posing the one question that everyone wants to pose to you. How did you decide to pursue a career in critical care medicine? I think when I entered critical care, it wasn't a well-formed specialty. I was a medical student from Jefferson rotating to Cooper Hospital, which was a very good community teaching hospital. And the new chief of anesthesiology at the time, Eric Scott, loved critical care, loved taking care of patients in the ICU. As a student, he dragged me down there a lot, or when he was tied up in the OR, he'd say, go and see this patient, tell me what's going on. So I started getting very involved as a medical student, did an elective. And thereafter, when Cooper did my medical residency, I spent a lot of time in the ICU, and Eric Scott continued to encourage me. He encouraged me to attend, in fact, some of the early SCCM meetings with some of the founding fathers, and I sort of moseyed into it that way. At the time, there weren't very many critical care fellowships, and I wasn't goal-oriented enough at the time to know that's what I wanted to do. So I actually did a nephrology fellowship, but I only liked the acute care part of it. So I came to the realization that I wanted to spend my life in the ICU, and I was offered the position of the first director of the ICU at Cooper Hospital, which was an interesting process because at the time, it wasn't a recognized specialty. There weren't board examinations, and so there was a lot of skepticism from the medical staff that why do we need these people intruding on our patient care? We're competent. We're boarded, et cetera, et cetera. Interestingly, the people who were most receptive were the surgeons and anesthesiologists, and the most resistant were the internal medicine physicians. And coming from medicine, I was sort of very surprised by that. But eventually, we prevailed. I was hired, and that began my journey in the ICU. Eric Scott helped out by giving me coverage of time, and eventually, maybe five or six years later, spent most of his clinical time in the ICU. And as the specialty developed, we developed it at Cooper. I don't know if you want me to go into more detail about how it developed at Cooper, but I'm glad to. Yeah, certainly. We'll get to that as well. I just picked up on something very interesting that you said about anesthesiologists being heavily involved in critical care. Certainly warms my heart as a critical care anesthesiologist myself. It's interesting how that has evolved, and I'd love to sort of get you in on that. Sort of get your two minutes on that. You look at how that has changed from the 70s to today. In a sense, it's excellent because today, critical care is a truly multidisciplinary, multi-professional practice in the US. In the rest of the world, it seems to be morphing and evolving in a slightly different manner, but Europe still dominated with anesthesia, doing a lot of critical care and intensive care, as they call it there, and then other parts of the world like Australia and New Zealand actually forming intensive care medicine as an independent, standalone specialty. Do you have any insight on why this has evolved in several different directions, different parts of the world? I remember very many discussions over the years when we were talking about critical care, which should we form one specialty, as Australia has, or should each specialty have a subspecialty of critical care, and there were pros and cons. Very honestly, I think it evolved here based on political power and influence, that every specialty would have its subspecialty. For a while, we talked about having one board exam that everybody would take so we knew that the knowledge base was equivalent, but that didn't fly either. We had what we have now, where each specialty has its own subspecialty of critical care. There are a lot of similarities. I think that the training overlaps a lot and the board examinations, I'm sure, overlap a lot, but it's based on, I think, tradition and political power, very honestly. Right. So, coming back to your Cooper journey, it's interesting that you became the director of that ICU very early on in your career. I'm sure it's an interesting career story, but just go back to being director for a second. Was that intimidating for you for a second? What is this? New specialty. I'm the ICU director. There's not enough board-certified intensivists in the United States. What am I getting into? I didn't think that globally. I just enjoyed doing it and I was glad to have a job and finish my training. I just thought it was fun. I enjoyed persuading the people who had trained me that I had something to add to their patient care. I just remember these speeches. Any internist can run a ventilator. They took it as a personal slight that critical care was saying we should be involved. What they didn't get, and we tried to explain to them, was that they may be very smart and very competent, but they were in their office when the patient was having a change in status. Our availability was something that eventually they caught on to the fact that it was very useful to have somebody there who was knowledgeable and could take care of their patients. Of course, we developed technical expertise, putting lines in that they didn't want to spend time putting lines in. Eventually, I think we were able to persuade them that we were competent. I guess I was young enough in those days not to know what I didn't know, so I just bore on with it and spent a lot of time. Obviously, because I was the only one for a long time, I was there a lot of hours, but I wasn't seeing every patient because in those days there weren't mandatory consults. I was seeing the patients who the physicians would consult us on. Eventually, it ended up being the whole unit, but at first it wasn't. I spent a lot of time there, and I think it was a challenge to try and demonstrate to people what our worth was, why they should support the development of critical care. I'm just trying to get an idea of the timeline here. Are we talking about the late 70s, early 80s now when you talk about this role of yours? Yes. I came full-time in 1977 is when I was hired as full-time ICU director. Then over the next few years, Eric Scott eventually spent more and more time in the ICU and taking call and covering and then taking weeks on service. And we developed a fellowship program at about 1983 and started to have critical care fellows. I think it was well-recognized at Cooper at that point that critical care had something to offer the patients and was a worthy specialty. At the same time, though, all these other things were going on nationally and internationally, but it developed, I would say, in the 70s and 80s. We were very fortunate that we had some very strong people who came and practiced with us. Cooper now, I think, has a very, very excellent program. I'm not practicing it now. I'm not seeing patients, but I'm very pleased to see what's going on. Certainly. I mean, you guys have a legacy and you've produced some of the greats in the field that we know, and some of them are still practicing and contributing to academics and research. So congratulations for what you started all these years ago. I'm going to step into your role into the SCCM a little bit. Now, this is going on. You've taken on this new challenge as ICU director, and then you're also getting involved with the SCCM leadership. When did that start for you? Well, Eric Scott got me to go to some of the early meetings with the founding fathers, and I saw... Can you say those names again? We love to hear the founding fathers' names. So who did you interact with? I didn't personally interact, but I admired Shoemaker, obviously, Max Harry Weill, Acky Brendvik. I mean, there were some very strong people. I'm sure I'm forgetting some of the people, but... The reason I want the audience to know this is like for us, our generation, we hear these names, textbooks, grants, awards at SCCM, and we've not been fortunate to interact with them or even see them in real life. And it's just great hearing from you that you actually sat in a room with them. I was fortunate to be able to do that. And I would say that I came from... I didn't come from the background that they came from. They were very smart, academic, research-oriented people. And I came from a community hospital, so I always felt a little intimidated by them. But I was pleased that I was able to be there and participate. And many of them supported what I was doing over time, and I learned a lot from them. And they were good role models. So what did your early leadership journey with SCCM look like? Was it based on section leadership? Was there the same sort of... Now SCCM has upwards of 13 to 15 sections and all of these committees and subcommittees different in the 80s, I guess, right? Back in those days, we didn't have the sections. The way I became active was I knew I wanted to interact with individuals at the national level. And I was able to invite several of them to my institution to give grand rounds. And so they were very kind to take time out of their schedule. Dennis Greenbaum was one of the first. Phil Dellinger was another one. They took time out of their schedule to come to Cooper. When they were there, I had the opportunity to interact with them. They got to know me. I got to know them. And that led to Dennis, who was one of the earlier presidents, inviting me to participate in guideline development. And eventually, I was chair of the Guidelines Committee for a number of years. And in that position, I was invited to council meetings to give reports. And so I got to know other members of the council. And they got to know me and the fact that I could make things happen. And so that sort of was my entree into the leadership, was through the guideline development. It's been a fabulous career. And certainly, the year 2000, 2001, saw you become president of the SCCM. Tell us a little bit more about what that felt like. And I'm going to ask you a very sort of naive question. Youngsters who go to their first SCCM meeting look at SCCM presidents as these larger-than-life figures and feel like, wow, I wish someday I could stand on that stage and address the whole world. What advice do you have for someone who's sort of going to their first SCCM meeting and dreams of getting there one day? Yeah. It's first of all, it doesn't happen overnight, I would say to them. I found that I ran for council. And when I was running for council, I knew a lot of people didn't know me because I wasn't up there giving a lot of lectures and I wasn't publishing a lot. So at the annual meeting, I hung out and talked to a lot of people and just introduced myself, made them aware of what I was interested in, what I thought we ought to be doing. Once the sections developed, I participated in the sections and developed a lot of supporters that way, people who were willing to vote for me. I was elected to council, I believe, in 1990. So I was 10 years on council before I was president. And when you're on council, in the early years, we had meetings that you had to go to, four or five a year. I was flying out for a long weekend to meet with other members of the council. So you put a lot of time and effort in. I really loved it because, as I sort of mentioned at first, there wasn't a whole lot of support at home for critical care. It was wonderful to go to council meetings and talk with people who had similar ideas about critical care and the role of critical care in patients. I'd also be remiss if I didn't mention Norma Shoemaker, who was the first executive director. She was very supportive of my development and my career and tried to facilitate my functioning in this role. But it was a 10-year process of getting on council, going to the meetings and taking different responsibilities and eventually getting on the executive committee and being president. I would say if you aspire to that, you're going to have to put the time in and get to know people. It's hard these days with all the virtual meetings because you don't get to see people. I would hang out at the front desk of the annual meeting where everybody was registering and introduce myself and get to know them and then hang out in the exhibits and talk to people at that time. I think the more you get to talk to people, the more they know what your interests are and you share and you find that you have similar interests, then you're going to get the support. But it's a long haul. Right. Do all of us miss talking and meeting people in reality? Hopefully all of that is going to change this year and we'll get back to it. Going back to your year as president and even time on council, are there specific things that you remember fondly as memories or achievements or something that you saw or did that still stays with you as something remarkable that you could do as on the leadership? I think having the guideline process mature and develop was something that resonated with me since that's how I started with the society. The leadership on council at the time, Joe Perillo and Phil Dellinger were absolutely key in developing the society that way and getting the journal going. It was just, I think there are many, many things that I found satisfying, but the guideline development was one that was dear to my heart. I also was active in the college, and that, I think, meant a lot to recognizing people who've achieved certain milestones and certain achievements in critical care. I thought that was important. So how do you think we've changed and evolved? You served as the president, and now 22 years later, when you look at what we're doing now with SCCM and what we're doing in clinical practice, are you happy that we're going in the right direction, or is it just not possible to compare the two? Go ahead. It's great to see what's happening. When the society started, it ran out of Norma's backyard in Anaheim, and so we had, for all of our council meetings, we all had to fly into Anaheim, which was mostly inconvenient and a long travel, but that's how it was. Around the year 2000, 2001, the society transitioned to a more traditional, not-for-profit organization and structure in Chicago, which gave us an opportunity to expand our, what had been very good, I think, administrative staff. We had had wonderful administrative staff in early years, and Charm and others were really great people, and without them, we wouldn't be where we are, but we had a much larger pool once we moved to Chicago, and the year that we moved, it was a difficult year because there were some staff who couldn't come with us who were in Southern California and weren't gonna move, but we recruited some good people for the year. Barry Shapiro acted as an executive director, so it was different having a physician there acting as executive director during the transition while we were recruiting somebody new, but I think we moved to a more professional society, and the ability to interact with other societies was very important, and being in Chicago gave us that ability. So I think from the perspective of the professional society, SCCM has come a long way and has done the things that you would expect. The journal has been one of the jewels of our society, but we've had a lot of other activities that have made a mark, I think, on critical care. And how about the practice of critical care when you go to your ICU now, very different compared to when you started. Do you feel we're moving in the right direction with that as well? Yeah, when I started, of course, in solo practice, I didn't sleep in the hospital at night, and I came in when a resident said things to me that made me nervous. Once we got fellows, it was a little more comfortable having somebody at a more senior level in the hospital at night. But you still didn't have somebody at an attending level. And so I think the evolution of critical care to having somebody in-house often, I think most hospitals, or at least the majority of hospitals these days are moving toward 24-hour coverage by an attending physician as well as the health staff. I think that's improved the quality of care. If I were a patient in the ICU, I feel a lot more comfortable having an attending physician hanging out there at night than an intern. So I think that that's come a long way and led to improvements in patient care. It also brings with it challenges though, because that's not an easy model to fund. It's expensive to have people at the professor level staying in-house or whatever. And so I think critical care, one of the challenges that we face is if we're going to practice the way we think we should by having people with expertise taking care of the patients, it's gonna cost money. And we have to demonstrate to the world why they're spending the money on us. Yeah, that's an interesting perspective. I'll take a slightly different viewpoint on that as well. And that I often feel that your interns and residents got great training because they were by themselves in the ICU and they were functioning at a pretty high level, I'm guessing. So I can only imagine what sort of almost mini fellowship they ended up doing at least internally and probably inspired a lot of them to actually go do a real critical care fellowship back then. But luckily these days we have simulation labs. And so the house staff and students can do a lot of that training in a sim lab, not on a live patient. And so the world has changed a little bit and that resource is available. And so ideally you'd like people to do some initial training. I remember my first CDP. I was an intern and my resident, I called them and said, this patient needs a CDP. It was a renal failure, GI bleeder, and he didn't show up. And so I went to the switchboard and said, did you call him again? Could you call? She plugged in the switchboard and I heard him snoring into the telephone. And so I knew I wasn't gonna get a lot of guidance on putting in a CDP there. And it was an LPN on duty in the ICU who talked me through it. That certainly isn't the ideal way for an intern to learn how to put in a central line. And so having some experience in a simulation lab would have been very valuable. And a resident who would wake up would be very valuable too. Wow, this is just the kind of story I wanted to hear. I hope that resident is still around somewhere and it's going to, this is a great story. But we're talking about evolution of care. Also, we have now gone to an era of, like you said, trying to get 24 seven staffing. It's challenging. We are still short staffed and COVID has exposed that even more. We're also doing EICU based staffing. What's your take on the EICU model? Are you a proponent or do you feel it's really taking us away from the bedside? I don't have enough experience to have a strong opinion. I have to think that it's better than no coverage, but probably not as good as being at the bedside. But I don't have any data to support that. Doing critical care these days is exhausting, both physically and emotionally. And as you say, the pandemic uncovered that even more. But even without the pandemic, you don't have a lot of staffing. You don't have the staffing that you would like to have and still have people have time to do teaching and research and all of the other things that you wanna be doing. Doing patient care is very rewarding, but teaching is rewarding too. And there are a lot of other things that we wanna be doing. And sometimes the staffing is so short that you really have to just focus on the patient care and you can't do these other things. And that's too bad. And do you think that the electronic medical record for all the good things it's given us is also partly responsible for the exhaustion that you talk about now? Well, it was one of the things that led me to stop doing patient care. And that isn't to take away from its value because it's very valuable, but it does take a lot of effort to learn it. And if you don't do it very often, it's hard to get back into it. So really the people who do it every day are very facile and can get the most out of the electronic record. And it's, I think, the most useful even outside of the hospital. As a patient now, I go to one place and the record is available from one office to another office. So I think having electronic records has improved patient care, both inpatient and outpatient. It just is, it's a challenge for those of us who are used to pen and paper and to learn how to do it differently. But for those who are younger and more facile with electronic and technology, it's a good thing. Now, there's something that everyone really wants to talk to you about as a female president and a female leader in critical care. What's your opinion on the evolution of diversity and inclusivity within SCCM, within critical care in general? How difficult was it initially? And are we sort of doing the right thing now? As I mentioned to you earlier, we don't have hard data and we're looking for some hard data on participation of women in the society and in the journal. I would say to you that I didn't focus on that very much as I was going through. My attitude always was, if I do a good job and I work hard, I'm going to succeed. And I didn't say, oh, as a woman, I'm making a record or whatever. I really didn't. I just went on and did what I liked doing and talked to people. I have a funny anecdote. When I was president, I had obviously come through a lot of meetings, a lot of executive committee meetings where it was all men and me, and occasionally a nurse, a female nurse. But most meetings were just, and of course the obligatory talk about the football game or whatever at the beginning of the meeting. And you just went, okay. When I was president, the majority of the executive committee was female. And at the beginning of the meeting, we talked about the shopping opportunities. And the one male in the room said, what are you talking about this? I said, I don't want to hear it. We'd listened to all the sports talk over all the years. Now we get our chance. And it was enlightening, I think, to him that the world had changed a little bit and there were more women. I really don't feel that there was any systemic bias against women. I just think there weren't a lot of women at that level doing the research. And I think as we did things and demonstrated our personal abilities, we were invited to participate more. And I think that we're to a point now where people, there are very many good people, men, women, whatever, that contribute. And there's no bias that I'm aware of. Thank you. And love to hear that kind of a balanced approach. I really feel that what you said about the football stories versus the shopping stories is so relevant in a way, right? We've got to learn to understand each other. And really that is part of the culture change that we have to bring along as we develop the society. So thank you for those comments and that story that really, really is funny, but it's really enlightening in a sense. Make the point. Right. So COVID-19, I know you're not actively now in the thick of things. As COVID-19 evolved, you probably saw it evolve. And what do you think we've really learned as a specialty from COVID-19 in terms of caring for our patients? And say this had happened 20 years ago, when you were very much in the thick of things, would you have handled it any differently at the local level or even at the society level? I think we were fortunate that our ICU, and I can't speak for all, but our ICU had a 24 seven staffing model. So there were experts at the bedside time and that was fortunate. I think there was a lot of fatigue among the physician and non-physician staff in the unit. The nursing staff worked very hard and the physicians were very, I think, torn. They were very torn. When they dealt with a patient who didn't get vaccinated when they could have, and then they were critically ill, there were a lot of like short tempers on why are we doing this? Why did they not take advantage of the opportunity? So I think the fatigue factor played a role there. But American Medicine stepped up and I think we in critical care stepped up and brought a lot of people through this who 20 years ago would not have made it because they didn't have the advances that we have these days. So I think back in a hundred years ago when they had the flu pandemic, the outcomes were nowhere near as good as ours. So I think we've stepped up and we're gonna continue to improve, obviously. The research that's done and the education is going to lead to a generation that even does better than we are. But I think we should be proud and hold our heads up. So you think that the ICO of 2050 is going to be a really futuristic entity. Can you even imagine what it will look like in 2050? Do you not even want to imagine that? I'm smart enough. I mean, I would never have guessed about prone positioning and that's something that I never would have envisioned. And yet that was something that is now well accepted. So I can't imagine, but if it isn't better than we have today, shame on us. Right, right. Well, Carolyn, again, thank you for your time as we're coming to the end. I'd like to open it up for you. Do you have some words of wisdom, parting like a message for everyone who's virtually a part of this and mentors, colleagues, anyone else you'd like to thank and talk about as we wrap up? Yeah, I have a lot of people to thank. I want to thank, of course, my mentor, Eric Scott, who's no longer with us. Joe Perillo and Phil Dellinger came to Cooper to practice and took Cooper to a new level and helped us achieve academic health center status in a medical school. And so I have a lot of, I want to thank them and acknowledge them. But there are a lot of other people and I don't want to slight anybody. The people in our ICU now are tremendous and I rest easy that if I ever, God forbid, end up in the unit, that there would be somebody good taking care of me. So I would just say to others who participate in this society that this is one of the more rewarding things you can do with your time. I have, I made tremendous relationships with colleagues around the country that I never would have known otherwise. Anne Thompson and I worked so closely together and I would never have come across a pediatric intensivist in the ordinary way, but through the society I did and I've learned a lot from her. Some of our nursing colleagues, Maureen Harvey, showed tremendous knowledge and ability to advance the profession. So I don't want to slight anybody by forgetting them, but I would say that I don't regret one minute that I spent doing society business and I miss it. But it's time for the younger generation to carry the ball and as they say in football, carry the ball over the goal line and somebody else do it. But it was a wonderful experience. I was grateful to the society for giving me the opportunity and for the people who mentored me along the way. Thank you, Dr. Beckies. I will tell you as part of that younger generation, if I may call myself at least relatively right now, I think, you know, when we talk to people like yourself and we hear all of these great names that you've talked about right now, I think that that serves to inspire us, that serves to actually energize us again, because, you know, COVID has hit all of us in several different ways, especially those of us who practice critical care. And, you know, when we hear your stories, we do get perspective into, you know, it wasn't easy and it'll never be easy, but, you know, you hear all these stories and you want to go back and, you know, work really hard for the society and, you know, work for your patients and do all the great things that you guys have done. So congratulations on a fabulous career and I wish you many more years of, you know, a healthy, hearty, academic and fulfilling personal professional life. And thank you for being a part of our lounge today. Well, thanks for inviting me. It was really nice to hear from the society and to have an opportunity to contribute again. So good luck to you. Keep things going. I wish you the best. Thank you. Thanks guys. And thanks everyone for being a part of the Luminary Lounge. I'm sure this has inspired you and we'll see you at another SCCM Luminary Lounge. Thank you so much. Bye-bye. ♪♪

Carolyn Beckus

critical care physician

Society of Critical Care Medicine

evolution of critical care medicine

ICU

leadership roles

patient care