Welcome everyone to this Luminary Lounge session. I'm delighted you've elected to join us. I'm Ernest Alexander from Tampa General Hospital. It's truly my pleasure to moderate this conversation with Dr. Margaret Parker. I'll start with a brief introduction of Dr. Parker, and then we'll launch into what promises to be a great conversation. Her work will be well-known to most of you already, but let me provide just a brief introduction about her. Dr. Parker is Professor Emerita of Pediatrics at Stony Brook University. She received her MD from Brown, did her residency in internal medicine at Roger Williams Hospital in Providence, Rhode Island, followed by a fellowship in critical care medicine at the NIH in Bethesda, Maryland. She was the head of the critical care medicine section of the critical care medicine department at the NIH for 10 years before going to Stony Brook, New York, to join the pediatric critical care medicine division. She was the head of the PDICU at Stony Brook for 27 years until her retirement as Professor Emerita in 2018. She's been very active in the society, serving as president in 2004. She's also an associate editor for critical care medicine and also senior associate editor for pediatric critical care medicine. Based on the conversations I've had with her, her passion for pediatrics and interdisciplinary team care is clear. This theme of pediatric care, specifically interdisciplinary team care, is evident in her presidential address back in 2004, entitled, Critical Care, You Are the Future. She's received numerous awards, accolades, including the Distinguished Master of Critical Care Medicine from the ACCM. It's my pleasure to introduce you to the Luminary Lounge, and I look forward to a great conversation. We'll start with just a few questions that help us to get a sense of your start, Dr. Parker. Tell us a little bit about your professional pathway, the path you took, your backstory. Thanks very much for that really lovely introduction. I don't have the usual path for a pediatric intensivist. As you mentioned, I did my residency in internal medicine, and I did a fellowship in critical care at the NIH. I worked at the NIH for 11 years and did a substantial amount of clinical research, as well as patient care, and learned a huge amount about critical care there. But I decided that it was time for a change. And as I was looking around the area for another job in critical care, a friend of mine asked me, what do you want to do? And I said, I'm not sure what I want to do, but I do know I don't want to take care of sick kids. Fast forward less than a year, and I was offered a job in the pediatric intensive care unit at Stony Brook. And after talking to a number of people I knew in pediatric critical care, decided to take it. And from the minute I walked into the unit, I felt like that was where I had always belonged and subsequently became board certified in pediatrics. And as you noted, worked in the pediatric ICU and was the division head for 27 years before I retired in 2018. Oh, that's fantastic. That's interesting how the past can really converge and how things can change. And you certainly have done a ton in pediatrics and it's very clear that you weren't quite really sure of where you'd ultimately end up and where your passions lie. And it's really quite impressive to see the work that you've done within that space. Shifting gears to Society of Critical Care Medicine, how did you first get involved with SCCM? While I was at the NIH, Dr. Joseph Perillo took over as the head of the ICU. He's a name that's obviously well-known to everyone and he was very much involved in the society and told me that I should join. So I followed his advice. I joined the society, presented my first paper there in 1983 and with Joe's mentoring and with my own involvement in networking with other people in the society, I became gradually more active and involved in the society and it's been my professional home ever since. And that's another luminary in the field too as well, Dr. Joe Perillo and how many individuals in leadership capacities within the society that he's influenced as well. What was your path to leadership within the society and what impact did that have on your larger career? My first involvement as in a leadership sort of position in the society was within the section of internal medicine. Initially, Joe was the section chair and he nominated me to be on the advisory board, which I did and subsequently was the chair of the internal medicine section. I also was on the program committee and chaired the program committee in 1995. That year I was elected to council and served on the council and subsequently the executive committee. And as you said, I was president in 2004. And so that was my leadership pathway. I also have served on the editorial board for critical care medicine for many years. I can't remember what my first year was and for pediatric critical care medicine and now I'm senior editor of critical care medicine and senior associate editor of pediatric critical care medicine. Wow, wow. That really just lays out the blueprint or at least a blueprint and a pathway for others who aspire to transition and do a walk in the footsteps that you've made is literally by taking a similar course of action. Would you say that that's true? Yes, absolutely, absolutely. I think being involved at the section level or at the committee level is a really good way to start. And being involved and active and most importantly, doing what you say you're gonna do and following through are keys to success professionally in all aspects of your profession. Being a leader in the society, also you had asked me the second part of the question, how did that affect my overall career? Led to national and international recognition which was recognized also at my institution and was instrumental in the promotions that I got. That's awesome. Thank you so much for sharing that. Talking a little bit about your practice, could you highlight the most important role that you played relative to pediatric critical care? Well, the most important role was as the director of the pediatric ICU taking care of critically ill children and their families. Something you said that you'd never want to do. Yeah, but I was wrong. I was wrong. It was really where I had always belonged and that's where my passion is. And I love doing it. I love taking care of the children and the parents. Don't always love some of the administrative challenges that have come my way. I love the patient care and I love working with the nurses and the other members of the multidisciplinary team. Working together to care for these really sick kids and support the families through outcomes that sometimes are wonderful and sometimes are difficult is really a rewarding and enjoyable thing to do. Yes. And to have that impact on the scale that you've had it, meaning hundreds and thousands of lives that you've impacted, that's really truly very, very impressive. How has the interdisciplinary care changed during your time in practice? And you can even reflect on post-retirement too as well. Yeah, I think the team concept has evolved. I mean, SCCM has always been a multidisciplinary society, but at the bedside, when I started in medicine, to a large degree, it was the doctors made rounds and the nurses did their own sign out. And over time, it has become really team rounding the nurses, the respiratory therapists, the pharmacists, sometimes other members of the team, physical therapy, nutrition, and so forth, round together to discuss along with the family members if they so choose to discuss the care of the child as a complete care, not in silos, but to bring it all together. And I think I'm grateful that I retired before COVID, but I think COVID really struck a blow in some sense to the ability to round together as a team. I think intensivists around the country and around the world have been very creative in maintaining, working to maintain family involvement and working to maintain team communication and team input. It has not been easy. Agreed, and you're absolutely right. Dealing with the COVID pandemic has been a real challenge and it's really tested our use of technology as in using platforms like the one that we're on today and in many ways, really trying to get outside the box, but also at the same time, really, I think staying in, staying well-grounded in what really matters, which is physical contact and human interaction, which is so important too as well. Yeah, absolutely. What further changes do you see relative to pediatric critical care in the next decade? There has been so much advancement in pediatric critical care, particularly over the last decade that has laid groundwork for literally an explosion in clinical research and medical advances. And one of the areas that I think is rightfully receiving a great deal of attention and will more so over the next decade is that of long-term outcomes, which are so important in pediatrics with the developmental considerations and so forth. So I think there's gonna be major advances in how we take care of children to improve their long-term outcomes. I think there's also going to be a continuing development of technology that allows us to monitor and treat kids less invasively. So there will be a greater ability to take care of kids non-invasively. At the same time, very invasive techniques, such as ECMO and other life-supporting technologies have also advanced and are in greater use. And I think how those technologies are used to improve both short and long-term outcomes will also be looked at very carefully and be part of what advances. Awesome, thank you for sharing that. And look forward to continued advancements and the next decade's got a lot to offer. Going back to and reflecting on your presidential year, what would you say was your favorite experience during that year? Well, I got to do a lot of traveling, which was wonderful. I got to go to a number of different places around the world, loved Italy. I went to China three times. I went to Brazil, a number of other places. But I think what I really enjoyed the most was getting to know and work with the other members of the executive committee, and in particular, the SCCM staff, who are just wonderful, passionate, highly skilled and competent people who are just a joy to work with. So I think the people connections were what I most enjoyed. That's awesome, thank you. So many folks wonder this question, especially for busy professionals like yourself, how did you manage your time? Like balancing professional as well as your SCCM leadership activities? One of the perhaps advantages of critical care as opposed to a more primary care field is that you have on-service time and off-service time. I think obviously you have to have off-service time. to reduce the chances that you're gonna burn out and also to provide optimal care. But I used my off-service ICU time for my SCCM activities, for many of my teaching activities, although most of my teaching was probably done at the bedside in the ICU and my various administrative activities. So I was able to sort of compartmentalize them. I couldn't completely separate them because there are times when you're on service that something comes up administratively that you have to deal with. But I got pretty good at juggling multiple balls at once. That's right, and compartmentalizing. This is a segue into my next question and you may have answered it already. Have you ever experienced burnout and how do you support and treat it? I never felt that I had burnout. I always loved what I wanted to do and always enjoyed my work and always felt fresh. And there would be days that would be more difficult than other days, but I personally never really felt that I had burnout. I think it's obviously important to enjoy what you're doing and to focus on the positives and help support the people around you. And my husband likes to say, did I have fun every day? I had fun every day. Obviously not everything you do is fun, but something is fun every day. And that helps keep things refreshed and... I don't know. That's a great outlook. It really is. I'm gonna adopt that one myself. I'm stealing that one for sure. This is a more philosophical question. Do you think the ability to be coached or mentored leads to good coaching and mentoring? The short answer is yes. I mean, in order to really grow and develop professionally, mentoring is an important part, but mentoring is a two-way street. And it's important that you have a good mentor, but it's also important that you listen to and follow that mentor and learn from that. And by doing that, that teaches you mentoring skills that you can then apply to mentoring the next... generation or level of people or people that you work with. And you can be both mentored and mentoring at the same time by people who are in different places in their careers. Awesome. Thank you for sharing that. I've got a couple of questions from some of the membership. Basically we did a poll and got some folks, their thoughts and questions for you, Dr. Parker. What advice do you have for would-be investigators in preparing for grant applications? Boy, that's a challenging one. I have to go back to you need a good mentor. I think having a mentor who can help guide you through the process is critical. A mentor who has been there and knows how to present the grant and follow through on it. And it's not just writing the grant, it's also carrying out the study once you fortunately, or if you're fortunate enough to get the grant. So mentoring is key to that. And the second thing I would say is be persistent. Don't give up. And this applies to some degree to papers that you submit to journals. The first rejection you get, doesn't mean that's it, that's no. Look at what you have, take the feedback that you're given and try again. Resubmit. Very few major grants get approved on their first try. I don't know if that ever even happens anymore. Go back and try again. Don't give up. Sage wisdom. Thank you. You mentioned, and we talked a little bit about role models and mentors. Who's your role model and why? Well, I would have to say Joe Perrillo. He really, when he came to the NIH, the critical care medicine department had me and one other faculty member. And I wasn't sure how long that other faculty member was going to stay. So I was like, I don't know if I'm still going to have this job. But Joe came and very quickly built a highly successful department that everybody knows about. And he also guided me and he mentored me throughout all of my career with SCCM. And he taught me a huge amount of critical care with the bedside. He really, I used to say he taught me everything I know about critical care. I think that might've been true up until I hit pediatrics and then I learned a few other things. But he clearly was my primary mentor and continues to be an important figure in my career. Oh, that's awesome. Thank you for sharing that. What are some ways we can enhance critical care research collaboration across the PD adult divide? That's a great question. I think pediatrics, the PD folks have gotten together and done a really good job at collaborative research and setting up collaborative groups. Polisi is one of the best known and very productive. And it was necessary to do that in pediatrics because the numbers of patients are so much smaller. I kind of refer you to what oncology has done. Pediatric oncology made huge strides because they worked together because there weren't enough kids with, for example, leukemia for small groups or single institutions to make significant progress. Whereas in adult medicine, there are many, many, many times more patients that could be enrolled in studies. And the adult world has, at least in oncology, not been as successful as the pediatric world in enrolling people in clinical trials, which is how the progress is made. I think some of our adult colleagues in critical care have looked at what pediatrics has done. There are now adult collaboratives in critical care that are working to follow this sort of model. As far as adult and pediatrics working together, I think that that has potential at these sort of how do we do this together level, less so at the specific studies or research interests with the possible exception of some overlap in the adolescent group. But I think philosophically, both groups can learn from each other. And I think having collaborative groups for the purposes of discussion of how to approach research as opposed to necessarily specific studies might be a way to kind of move that forward. That makes sense. Thank you. What advice would you like to share with others about stepping into the learning zone in pediatric critical care? Keep an open mind. Keep your options open. I got into pediatric critical care, as I told you, really by sort of serendipity and despite the fact that I thought I didn't want to take care of sick kids when the opportunity presented, I kept the option open and kept the door open. I would often talk to medical students or residents who were so concerned they didn't know what they wanted to do with the rest of their lives. Well, it took me more than 10 years to find what I wanted to do with the rest of my life. And so keep those options open and don't be afraid to take a new opportunity. And as far as pediatrics, enjoy the kids, enjoy the families. Yes, sometimes they're challenging. The other thing is, in pediatric critical care in particular, you can't put your child in the bed. You can't put yourself at the bedside. I raised four children and I obviously took care of a great many kids that, God forbid, could have been mine. And I never allowed myself to say, oh, that could be my kid. I could be that mother at that bedside. But that doesn't mean distancing yourself. You can be compassionate and warm and caring and understanding as a parent without being that parent. And so learning how to do that is also important, I think, in avoiding burnout too. That's excellent. And this is a perfect segue into my fun fact question, or at least one of the fun facts. I've got a couple of them here. So you're married to a physician. You've raised four sons. You're a busy mom and an intensivist. Tell us more about being on the leading edge as a female physician. Yeah, it was, I think my medical school class was the first or second one that had more than a handful of women. So I was on the leading edge of women going into medicine. Actually, when I was a medical student, my preceptor in surgery said, I don't think women should go into medicine. And I said, why not? And he said, well, because they get married and they have kids. Well, I got married. I had kids. But he thought that meant they left the field, and I didn't. I think it's obviously clear that having a career in medicine and having a family are not mutually exclusive. It requires organizational skills. It requires frequently having a plan B and sometimes a plan C. And often, maybe less so now, but often, those rules for what's the plan B and who has to leave work if the kid is sick and that kind of stuff often falls on the mom. Every family negotiates that. In my family, that's kind of the way we worked it out. But if I was on service, I couldn't do it. My husband had to do it or my other, my nanny or my mother-in-law or whatever. You need to have lots of backup plans and good child care, and that's important. It's proof that it can be done. And so glad that you didn't listen to what they had to say. You and so many others have really continued to blaze the trail and pave the way and really show that it can be done. You stand as a perfect representation of how it can be done. And so many members, those that are viewing and participating in this session will gain an appreciation for that and how they can overcome, too, as well. Looking into the future, I asked you previously about five, 10 years out, what do you think the ICU will look like in year 2050? Ooh. Boy, that's a challenging question. You know, I think at one level, it will look technology heavy, but I think the patient will be more obvious and more centered. You often see pictures of ICUs where you can't even see the patient because there's so much equipment around them. And I think the ICU of the future, the patient is going to be more prominent because technology will allow us to support them with smaller and less obstructive, perhaps, equipment. But at the same time, the family will be there. And I think clearly there's a move in that direction, but the family will be integral in the ICU. And hopefully that'll apply to adults as well as pediatric ICUs. But I think there will be more focus on the patient and the family or more obvious presence of the patient and the family. Who is this patient? And how are we going to get them to be that at the end of this journey? Yes. Excellent. Excellent distinction, too, as well, relative to pediatric and adult care, relative to family involvement. Whereas, I think it's intuitive and certainly highly supported in a primary thing in a pediatric setting. And I'm glad that you drew that correlation between it. It also needs to be that way on the adult side, too, as well. Here's a question about the teams. So what do you think needs to be done better by members of the interdisciplinary or multidisciplinary team? I think there's still room for improvement in the relationships across the members of the teams. We are all equal. As the physician, I may have the final say in some of the decisions, but I'm not better than anybody on the team and they're not better than me. And we all are working for the same purpose, which is to improve the life of this person, to support the life of this person in the bed, regardless of where the end point is on that. And I think respecting each other as people is an area that could stand some growth. There's a lot of emphasis on communication and improving communication. And I think that will help. And allowing people to speak up and voice their opinions without fear of blowback, if you will, is also improving. And I think those interpersonal relationships are going to improve over time, hopefully. I also think the recognition of the need for the multiple members of the team is greater and will hopefully be better financially supported by hospitals. They pretty much recognize now the importance of a pharmacist, but physical therapists and nutritionists and chaplains and child life people and social workers all play really important roles in the ICU. And anybody who's working in ICU has probably had the ancillary team members say, we don't have enough time. There aren't enough of us. So hopefully, supporting all members of the team so that they are available on a more consistent basis, I think, needs to happen. Yes, it's definitely an uphill climb. I can tell you just as an ancillary and being a pharmacist and certainly appreciating that perspective on things, it's definitely a journey and we're continuing on that journey. It reminds me, and I made a note of this relative to your presidential address, you state, no drug or device in the past three decades has been shown to have a bigger impact on patient mortality in the ICU than organizing the ICU service. Our patients need and deserve integrated service by a team of experts dedicated both to the care of the individual patient and to the organization of the ICU. So what you're saying clearly aligns with that. Just making sure that world-class organizations providing world-class care provide world-class resources and not just in the technology, but also in the human resources too as well. In terms of deep philosophical questions, if you had it to do all over again, what one thing would you change about your career? Oh, gee, I am not sure I would really change anything. My first thought was I never took the pediatric critical care boards. I took the critical care boards and that was perfectly adequate for what I needed to do. I did take the general pediatric boards. My first thought was I didn't take the pediatric critical care boards. But in terms of my career itself, that wouldn't have made any difference. I was respected as a pediatric intensivist both at my institution and within SCCM. The insurers didn't know the difference between pediatric critical care boards and internal medicine critical care boards. So I don't know that I would change anything. I loved my time at the NIH. I learned a huge amount. It laid the groundwork and I ended up where I belonged eventually, and I don't regret not being there earlier. I love that. No regrets. What's your favorite food? Oh, probably ice cream. Ice cream. Wow. That's awesome. Which specific kind? Oh, golly. My current favorite flavor is Ben and Jerry's white chocolate raspberry truffle. Oh, wow. That sounds... It is so good. It sounds so good. It sounds so good. Well, you know, I think we're coming near to conclusion. I just wanted to ask Dr. Parker, is there any specific additional information you'd like to share with our audience? Anything that's on your mind or last parting thoughts? You know, as you were talking about world-class care, it occurred to me that I really was talking about the US and developed countries, and there's a huge number of people in low income countries around the world that don't get the resources or the attention. There is ongoing effort to provide research and development and recommendations for care in less resourced areas. The Pediatric Surviving Sepsis Guidelines have recommendations, for example, for lower income countries or lower resourced countries for different management. You know, in an ideal world, all of the resources would be available for everybody, but obviously that is not the case, and that's not going to be the case in my lifetime. But I really would like to see us as a medical community and as a human community work to improve care for children, adults, but my focus has been children throughout the world and improve care for those in low income, low resourced areas, as well as the resources that we are fortunate to have in this country. Absolutely, yes, and that involves outreach. I know that Society of Critical Care Medicine has really done a great deal in this area, and I'm certain that they have intentions of doing more. You know, are there any other specific targeted areas or strategies that you think should be implemented or would advise to start relative to that endeavor? Yeah, I think, you know, as you said, the SCCM has made efforts in that direction. There are a lot of groups around the world that have the Fundamentals of Critical Care Support course, I think, has been a very positive step for a lot of countries with lower resources. It's not designed to make people into intensivists, but it is designed for healthcare practitioners to be able to provide the initial critical support. And for many people in, well, even in this country, but throughout the world, that initial support may be enough to make the difference. Yes, that's awesome. Thank you so much. Yes, the FCCS course is continuing to expand and grow just exponentially. I want to thank you very much, Dr. Parker, for sharing time and your story with us today during this Luminary Lounge session. Also, I want to thank you for your leadership and all the contributions that you've made to society, to pediatric care, to critical care as a whole. Thank you very much. It has been my pleasure and my honor. Thank you. Pleasure's ours.

Dr. Margaret Parker

pediatric intensivist

interdisciplinary teamwork

family involvement

long-term outcomes

less invasive technologies

collaboration