Hello, I'm Roshni Sridharan. I'm an anesthesiologist and critical care physician at the Cleveland Clinic. I'm the program director for the Anesthesiology Critical Care Medicine Fellowship here. I have the distinct honor and opportunity of moderating a conversation with Dr. Lou Kaplan in this luminary lounge. Dr. Kaplan is a critical care surgeon at the University of Pennsylvania in the Division of Trauma, Surgical Critical Care, and Emergency Surgery. He is the section chief of surgical critical care at Penn Affiliated Medical Center. I was introduced to Dr. Kaplan several years ago when I was on the in-training section steering committee and Dr. Kaplan was the council liaison. Since then, he has been a constant source of support and inspiration. He is the immediate past president of the SECM and a luminary in the field of critical care. Welcome, Dr. Kaplan, and thank you for taking the time to speak to us in this luminary lounge. A lot of these questions that I have have been mailed in by our society members who really want to hear from you. To start off, could you please tell us a little bit about your career in critical care? How did it blossom to what it is today? Yeah, thanks, Roshni. My career sort of took a left turn. I was absolutely certain from the age of eight that I would be a heart surgeon. I knew it. I was sure of it. All through college and medical school, in fact, the early part of residency, that was my career path. I spent two years in a cardiac surgery research lab. I didn't match the first time around, but I did the second time. What to do for that empty year? Well, I stayed where I trained. I spent half my time doing heart surgery. It was great putting people on and off pump, doing my half of the coronary anastomosis that the person I operated with most was my research mentor. So it was grand. The rest of the time I spent doing trauma and acute care surgery in critical care. Well, there was a Friday and I operated all day and all night. And that Saturday morning, after I was done with my 11th operation, my mentor was on for cardiac and he looked at me and I was exhausted. He said, in nine months, aren't you so thrilled? This will be gone. I looked up at him and I was, I was weary, but I was energized. I said, absolutely not. I know what I'm going to do with my life. I realized I liked taking care of the post-CABG patient in the ICU more than I liked making the anastomosis. So that led me to the University of Pittsburgh and I did my fellowship there and, well, that opened up all kinds of doors. It taught me things I hadn't thought about in ways I had not imagined. I became a strong iron acid base convert. That was for sure. And it, it led me along a career path in SCCM. I had no idea about council when I joined. It was a great Congress. I got to meet lots of people. Eventually, those people, well, they guided me. Sort of the, the dynamic that you and I have had over the years, I had that with others as well. In particular in the surgery section, names that will be familiar, Phil Barry and Lena Napolitano and Craig Coopersmith. They helped guide my career within SCCM and, and well, there was a council position that was open. The person who was the chair of the surgery section was my good friend. I thought I was supposed to be the designated loser. We had that back then. We don't now. Now everyone can be a very good candidate. But I won and totally confused, but it got me on council and one thing led to another. And well, here I am having traveled the world from this particular office. It's in my home. It's in the basement with COVID. I couldn't travel any place, but I did it just the way we're having this conversation now by Zoom. That's wonderful. That's, that's so inspirational. And one of the things, I mean, a lot of people have questions about, you know, mentors are so central to career growth in whichever direction that might be. And I mean, we have several mentors along a career path. How did you find your mentors? It's sometimes a question as to how do we find these people? How do we find these people who are going to guide us and lead us into, you know, the paths that are going to lead to success? I'm going to parse that question in three different ways. There are some people that help you to learn how to do something. They, they serve as coaches. You have lots of those people to teach you how to intubate, how to put in a central line, how to navigate the menus, the electronic health record. You have lots of those. There are some people that you turn to for advice and they're guides. They are temporary wisdom givers, if you will. Should I take this elective or that one, or how should I approach this problem? They're very different than mentors. The mentor relationship is bi-directional. You see something admirable and worthwhile in them, but they see exactly that same kind of thing in you. These are the people who invite you into their lives and you do the same and they span your career. I have several of them and it's, it's hard to sort of plan to find them. You simply fall into them, people with whom you resonate, something in particular that dovetails with both of you. I have mentors that are surgeons and mentors that are not surgeons. They each help with different pieces of my career. So if you're open to finding someone, regardless of what discipline they are, what gender they are, it just doesn't matter. You'll find someone that will help you and then you'll learn in turn how to help someone else. Absolutely. Now, how, you've had such an impressive CV and you have such an impressive CV and how, what we, what would we not know about you just looking at your CV? Oh, there are a couple of interesting things and some of it relates to healthcare and some just not. The healthcare piece is that I have a daughter with autism. And so that thinking about how you take care of someone that is neurodiverse, the appropriate term now, is not something that we routinely would think about. Everything from how does she undergo a GYN evaluation to how do you administer a vaccine? Not just a COVID vaccine, but the routine ones or have a laboratory draw. All of those things are very challenging. And as your neurodiverse child ages, mine is now 25, thinking about the things that bring you into an adult hospital, appendicitis, diverticulitis, pneumonia, whatever it happens to be, urosepsis. Finding a place that has preparation and people that are aligned with neurodiverse care becomes very challenging. Not everyone is willing to have a neurodiverse person in their practice, right? That's sometimes disadvantageous from a workflow standpoint, and it takes a unique skill set. So you wouldn't know that just from looking at my CV. The other is that I'm an avid motorcyclist. One of my uncles was a Philadelphia motorcycle police officer. He taught me how to ride and, and it's, it's very surgical. You have to use both hands, both feet, your eyes, and your head all at the same time. So if ergonomics are involved, it's, it's simply blissful, but you wouldn't get that from my CV either. And I have Akitas, love big dogs. They are genetically closest to wolves and they're lots of fun with lots of fur. Yes, yes, absolutely. So through your career, how did you balance your clinical work, the organizational work that you're doing and your family? And what kind of advice do you have for people who are trying to do the same? Well, how did I do that? Badly at first. I made the mistakes that most people make early in their career. You feel the need to establish yourself. You have to set out your own domain. And of course, if you're in an academic setting, well, you have to publish, don't you? You need more research and maybe you need grants and funding and collaborators. From where do you steal that time? Well, it's only two places. One is sleep. I went through the unrestricted work hour spaces. So that's okay. I was used to not having sleep, but you then take it from your family because there isn't really enough time. So that part I did very badly. And then I got some advice from people who seem to have it all together and had very good time management skills. One of the things that, that I learned from LD Brit was if it lands on your desk, if it's at all possible, get it off your desk the same day. That might be a journal review, but maybe it's a performance evaluation or it's a particular request. And I learned to set boundaries. I'll give you an example. On the weeks that I wasn't on service, I wouldn't go in at the usual time. Instead, I went to a local coffee shop. The bottomless cup of coffee was very good. I put in some earbuds and I could work. When my wife had dropped kids off at school, she would then come and join me and we'd have breakfast. But I would have had a couple hours of work that I got done. So taking a half an hour break like that was very restorative, non-kid time, but it helped provide balance. When I go home, that is not work time, unless there's something that is really pressing. There's time for me, maintaining health and fitness and doing something each day that is just for me. Maybe it's reading a science fiction fantasy novel on a Kindle. Perhaps it's exercise. I like doing both. Sometimes it's a ride on the motorcycle. But I also learned to ask the rest of the people in the family, what do you want from me? So that you can figure out whether Friday night is family movie night in a room that has no electronics other than the TV, so that you're just all together. So those kinds of inquiries help to maintain life balance with work, because if you don't do it, you'll do it the way I did it, which was pretty badly at the outset. That's wonderful advice. And also, as far as your clinical work at the hospital and your surgical practice and the organization, because we are committed to all of these, how did you balance those? Well, sort of the clinical work balances itself. But the practice pattern that you have is very important. Early in my career, if you saw the patient, that patient was yours, always, except after Saturday at seven o'clock in the morning, up until Monday at seven o'clock. And then one of my partners would own that patient. But that would mean that every single night, the operator could call you with their second cousin twice removed on their mother's left side that has appendicitis. Could you come in and take care of that patient? This is very disabling. In a group practice, people expect there are times when you simply are not on. That was really helpful. The trade-off was there was in-house call for that, but then you expected that you would be working. No one expected you to be anyplace else. So that kind of clinical work has its own set of boundaries. The administrative work falls back into that, get it done today. And unless it's really life or death, almost no administrative things are, it will wait for tomorrow. It does not need to be done when you go home. There's dinner and family and the rest of those things. Yes, absolutely. These last two years have been extremely challenging for all of us. I mean, that's an understatement. What in your mind has been the biggest challenge for the SCCM as a society and how did we surmount? Oh, wow. Biggest challenge is probably the relationship things. We are so adapted to seeing each other, hearing people's voices that don't come out of a speaker, having a cup of coffee or an adult beverage or a meal together, but that kind of relationship gets very much threatened when you are only at the end of a screen. We are social creatures in every way that you can imagine. And so keeping that piece alive is hard. You've noticed the plethora of things that come out by email and blogs and webinars. All of those are ways that SCCM has tried to keep all of that afloat. And there's a very personal aspect to the president's communications. You probably read and heard it through mine. Thank you for taking care of patients, but also caring for one another. We didn't say that a whole lot before, but it becomes even more important now. And I know that Greg Martin, who followed me, has echoed those same kinds of things because we have not had relief. It's been COVID and then non-COVID care and more COVID care, but not the break that you'd like. And there seems to be no limit to how much we are now asked to do without an increase in resources, but in fact, a decrease. Nurses in particular are really on shortage, not so much for physicians, but the bedside critical care nurse, the ED nurse, the OR nurse, they're in short supply. Absolutely. I think that's one of the biggest challenges for clinical critical care right now is a shortage of critical care nurses. Agreed. Yes. What were some of the blessings that, you know, the unanticipated blessings that came through when you were leading this organization through this pandemic? Yeah. Well, the blessings firstly came in the form of staff. Until you start working within committees for SCCM, you don't understand how powerful the support staff structure is. There's always a staff partner and sometimes two or more. Other organizations, well, they don't have that same underpinning. It is how things get done. You may have a great idea and have it laid out, but marshaling those resources, your staff partner helps you. So that was one thing because they really rose to the challenge in unanticipated ways. The second thing was that it forced a reevaluation of what was important. What programs are important? What do you need to keep behind a paywall and what must you release? What is good for all? Things that you had to remember to get access to like fundamentals of critical care support. We exported lots of that in a very durable fashion and other kinds of programs followed suit. We developed partners that we didn't have before. We had never had webinars with the American College of Emergency Physicians, not one more than we had two. We had multiple webinars with the European Society. We'd only partnered with them around surviving sepsis campaign. And now we had other things. We realized something else. We became household words. The whole critical care team, intensivists in particular, and all of a sudden we had a face and we had a name and someone wanted to hear about us. The media exposure during that year was staggering. Most of the presidents didn't really have a whole lot of media interviews. I had hundreds. Live radio broadcasts in Melbourne, Australia or Saskatoon, Canada, a couple from Los Angeles and innumerable interviews for a wide variety of journals and TV stations. So that was very unanticipated, but it was helped in particular by having media training. And if you might be in that position, media training is awesome. Very different from how we present at a scientific meeting. And it takes a little bit of time to get used to giving your message up front and then providing the details of why that message is important on the back end. Awesome. I'm a little curious about media training. How did that happen? Did you intentionally have to get trained for it because of all of the collaborations that you had to do? It preceded that. One of the things that happens as you move up within the SEC and leadership is that in particular at Congress, and it was mostly at Congress, somebody asked you your opinion about something. And increasingly we have reporters and people that cover different media outlets show up at Congress. There are planned sessions. Well, if you don't know how to interface with them, you need to be trained. So that was one of those things that on the Executive Committee of Council, I had the fortune of undergoing media training. It was one of the best days of education I've had in a long time because it was utterly new. Yeah, yeah, absolutely. Now, with DEI being the theme for our upcoming Congress, how do you envision sustaining DEI efforts within the SCCM so it's not just like a checkbox type of approach like it is in many institutions? Understand that the SCCM DEI approach didn't start this year. One of the important things that you'll learn if you end up on Council, or in particular the Executive Committee, is that the president-elect has the power of appointment. Well, how do you do that? There are 1,600 people on average that submit an application for the creative community, and everyone gets put on a committee. How do you understand where to put them? One of the things that struck me was that I had no idea. I asked David Martin and the staff to create dashboards so we could see where do those volunteers come from? What's their gender? How do they identify? All those kinds of things. So for every single committee and every task force and every work group, we have that dashboard. So we've started doing this years ago. More than that, we've asked people, when you renew your membership, tell us more about you. Some are comfortable, some are not comfortable. More are getting comfortable with telling us all of their details. That's great. That there is a very specific focus that permeates how we evaluate papers that are submitted for evaluation, what are official society work products. They all have a DEI metric. Now, if you look at council, we're really well balanced in terms of gender. We're not so well balanced in terms of academic versus community practice. It's hard to get people in the community to say, I'm going to spend a whole lot of time on council instead of being in my practice where, you know, I have to make money for this, that, and the other. I'm going to go volunteer that time. That's difficult. Same thing with international members. We tried that. It's very hard to make the timeframes work. But we're reasonably well balanced in other ways. And you can see we have a different discipline who serves as president every year. We do that part really, really well. So if you look over the next five to ten years, will you see greater balance in all of the different spaces? Yeah, you really will because that's a consistent effort. Congress program planning is probably the most balanced committee that we have. It's one of our biggest. And it is involved with that signature event, Congress, which is still unfortunately virtual. But that's where we've put our efforts in. Who's going to come talk to you? What do they represent? Will we be part of that plenary session that says DEI is part of who we are? Do we encode that in our policies? The answer is yes. So that's how it's sustained. It's not just about making the picture look the way you'd like. It's about making the organization perform better on the basis of inclusion in all sorts of ways. Absolutely, absolutely. As far as opportunities go, what kind of opportunities do you foresee for critical care and our society maybe in the next ten years? Oh, that's a fun one. Think about what we have had happen this year. Something incredible. We sent people who had absolutely zero astronaut training into space. Think about that for a moment. This opens up an entire new area of critical care work. Because if you can send them into space where they have absolutely no idea how to manage that particular spacecraft, troubleshoot or do anything for it, how long will it be until you put people in space long-term? Colonies on the moon, orbiting space stations, where now you need someone to provide critical care in a completely different environment. But that's just up. That's not down. You can spend some quality vacation time at an undersea resort. But that's recreational in terms of the depth. What happens when we need more space for people? And now we start looking a half mile or a mile down. Completely different set of needs. And then, of course, we will need to integrate all of the machine learning and AI pieces into how we practice. You may not be very good at doing that, but you're going to need to learn how to use it. And I suspect we will soon have data scientists that are part of our routine teams when we're looking at performance or quality improvement, outcome metrics. Because if you're like me, I don't like thinking in logs and I certainly don't perform well in the SQL environment. Don't ask me to manipulate your database. I'm happy to do your bedside care. But if someone else can run through that and help me understand how to adjust my care, that's grand. Yeah, yeah, absolutely. Now, you spoke to us about how you came into the society and how you grew. What advice do you have for the next generation of critical care clinicians who want to come into the society and kind of move up into leadership, into the SCCM? Oh, volunteer. Be vocal about it. When you volunteer and you interface with a staff partner, share your enthusiasm. Ask for feedback. Ask what else you can do. Because we often look to the staff partners, who's performing well in this committee? Who would like to do more? They're absolutely invaluable in that process. But if you only limit yourself to committees, you will sell yourself short. There's a section for you. It is your opportunity to demonstrate that you can work in a collaborative fashion with your peers and accomplish something. Do not be afraid to suggest what your section should do. Projects that are important to you will have the most support from you than they will from someone else. Generate enthusiasm around those. Because if you do that, all of a sudden, you're a whole bunch of different places within the organization. And it becomes fun. And you know what they say, nothing succeeds quite like success. Yes, yes, absolutely. And I have to say, the SCCM is one of those organizations that truly nurtures the interest that a volunteer shows in a particular area. It really is nurtured. And it's much appreciated by the volunteers who are there in this organization as well. You know, there's a lot of talk about developing a mentoring program. And yet, SCCM is one of those places that has this very lovely informal guidance and mentoring program that works really, really well. Unlike some societies where if you are a very new member, you really can't pick up the phone and call that person who's a very senior person. Here, it happens all the time. It's great. We expect people to reach out. And when we finally get to be together again, you'll find odd conversations that will be struck while waiting for your nonfat latte. That's my preference. Or whatever else you're getting at Starbucks. Because the person in front of you is a past president or a past chancellor or is on council. And we're friendly. Hi. Absolutely. I'm Lou. Who are you? Where are you from? You never know what happens with that. But it happens routinely. And so it's up to you to take advantage of that. And I think the idea of having a council liaison on most of our committees and section meetings and steering committees, I think it is wonderful. Because the people who are there, the volunteers who are on the steering committee, they have an opportunity to hear from council liaisons. And it humanizes them. And there's just people like us who have grown to where they are. So I really think that is a great initiative by the SCCM that there is a liaison on all of these committees that we have. Which really helps volunteers kind of grow into the organization. Agreed. Yeah. Of all these years that you've had on council, what is your favorite memory? And this question came up a couple of times. So I'm like, they really want to know about this. Wow. My favorite memory. I think my presidential address. Because there are so many others that compete. But it was the sine qua non of finally having made all of the work that I did in different spaces get me to a place where I had an opportunity to tell people a little bit about me. A lot about the organization. But to help them recognize that if I can be on that stage, oh, they can too. Because it just takes work and dedication. But you don't have to be unique. There are lots of surgeons like me. You have to choose where you'll spend your time. It put me in a position where I could do good things for people who needed it to be done for them because it was the right thing to do. Many people that I hadn't known them. We have 16,000 members. You can't know everybody. But I was in the right place at the right time to help them. So that's probably my favorite moment because it allowed me to do all of those things. And it was much more than just me. So an interesting question. I hadn't anticipated that. Yeah, I did see it. And I was looking at the questions that our volunteers had sent in. And this had come up a couple of times. And I think it's very interesting. And the other question that did come up, and I'm very curious to hear, is that you've had so many, many mentees through your career. What is your favorite mentorship story? Oh, that's lots of fun. Well, I won't give away this individual's name. Yes. But this was about the middle of my career. They came to me and said, I don't understand why you do what you do. That was a fairly blunt question. What do you do with that? Do you simply answer it? You could. I chose to do something different. I said, let's go get something to drink. And I want to know why you asked that question. And the underpinning of it was that my life looked as if it was so frenetic, being pulled in so many different ways, that to the external observer, it seems as if that would be antithetical to having a work life and a life life and having any kind of joy. That ended up being a relationship that continues to today. And it allowed the individual who approached me to reevaluate her perceptions, what she valued, and to align her career in a way that made sense for her. She doesn't do what I do. She does something completely different. But that one question became important because it wasn't the usual. It wasn't, can you help me do this? Or how do I do that? It was very off track. And so that one, that she felt comfortable enough to ask me that. That's exactly what I was going to say. She felt comfortable enough that she could approach you and ask this question, which is wonderful. I remember I was at an early meeting of the Association for Academic Surgery. And it was held in a hotel in Chicago. And it was in my first year of laboratory research. And they had all kinds of interesting speakers. And one of them was Judah Folkman, who was critical in identifying angiogenesis factor. He sat at our table, asked me anything you'd like. So I asked him, what advice would you give to us? He looked at me and he said, without missing a beat, you won't understand this right now, but your kids won't read your CV. And I didn't understand it then, but I do now. I'm just dad. It doesn't matter what the size of my CV is or what the impact factor is of the journal or what positions I've held. When you walk through the door, you're just dad. So that kind of advice that allows you to take your work persona and your home persona and all those things that challenge it and put them aside, it keeps you humble and it keeps you grounded. Absolutely. Absolutely. Such a wonderful career. In this long career, if you had to pick one thing you're most proud of, and I know it's extremely hard to do that, to pick one thing you're most proud of and what you've accomplished, what would you say? There are a handful of patients and they all have a commonality. There are just a few patients for whom minutes and moments matter. So being in the hospital at the right time for that person coming in through the emergency department, truly trying to die and being there and being able to give them back the most precious thing, their life, isn't all of it. Because for those same people, you end up developing a relationship. And I know this sounds strange for a surgeon to want long-term relationship instead of patients that are on the table as you put them with a tube in and not talking. This is the best part. So they invited me into their life and they became part of mine. There's only a handful, but you've already met one of them. She was our first ICU hero. Oh, wow. So I'm most proud of that because it's not about the technical pieces. It's about the rest of the things. And I think you used the Gabby Harris humanizing the ICU. You humanized your council members. This is all part of that. She and her husband have come to visit. I've gone to visit them. We have an enduring relationship. They can do that and they're comfortable with that and it works for all of us. I'm pretty proud of that. Absolutely. And that's so wonderful to hear that you have those connections with these patients over these years. It's wonderful. If you had to do it all over again, what one thing would you change about your career? What would you change? If I could go back and know that I really wanted to do trauma and critical care and emergency surgery, I would have done that from the start rather than having a year in between. But other than that, nothing. It was really quite nice. The place where I trained and where I worked the first part of my career was, in essence, a large community hospital that had a medical school attached to it. It was a place where issues were resolved over lunch in the cafeteria where everyone ate. All of the people who cooked knew your name. And to get into the corridor where the CEO's office happened to be, you just opened the door. I think in most places I now work, my badge doesn't actually open that door at all. So it was very, very personal. So I love that. I've worked in many different places since that. I shouldn't say many. Three. Yale Penn and its VA. But they all have a different flavor to them. But starting there, that was great because I think it really set the tone for relationships that have permeated the rest of my career. That's wonderful. Lou, it was wonderful talking to you, and I really appreciate the opportunity to spend this time and talk to you about all of this. I've learned so much, and I'm sure our audience members have learned so much about you and have appreciated the advice that we've received from you as well. Thank you so much. Thank you. It was a privilege.

Dr. Lou Kaplan

critical care surgeon

mentors

balancing work and personal life

Society of Critical Care Medicine

COVID-19 pandemic

future of critical care