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Truths, Principles, Maxims, and Other Smart Things We Learned From J. Randall Curtis

  • Abby R. Rosenberg
    Correspondence
    Address correspondence to: Abby R. Rosenberg, MD, MS, MA, Palliative Care and Resilience Lab, Seattle Children's Research Institute, 1920 Terry Ave, CURE-4, Seattle, WA 98101, USA.
    Affiliations
    Department of Pediatrics (A.R.R.), Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington State, USA

    Palliative Care and Resilience Lab (A.R.R.), Seattle Children's Research Institute, Seattle, Washington State, USA

    Cambia Palliative Care Center of Excellence at the University of Washington (A.R.R., R.E., E.K.K.), Seattle, Washington State, USA
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  • Ruth A. Engelberg
    Affiliations
    Cambia Palliative Care Center of Excellence at the University of Washington (A.R.R., R.E., E.K.K.), Seattle, Washington State, USA

    Department of Medicine (R.E., E.K.K.), Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington State, USA
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  • Erin K. Kross
    Affiliations
    Cambia Palliative Care Center of Excellence at the University of Washington (A.R.R., R.E., E.K.K.), Seattle, Washington State, USA

    Department of Medicine (R.E., E.K.K.), Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington State, USA
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Open AccessPublished:December 29, 2021DOI:https://doi.org/10.1016/j.jpainsymman.2021.12.028

      Key Words

      Introduction

      It is a true privilege to work with a colleague who can consistently teach and inspire those around him. We are fortunate to have worked with Dr. J. Randall (“Randy”) Curtis for most of our careers. We have been his mentees, collaborators, peers, and – for the past seven years – his co-Directors on a National Institutes of Health (NIH) palliative care research training grant.
      • Kross EK
      • Rosenberg AR
      • Engelberg RA
      • Curtis JR
      Postdoctoral research training in palliative care: lessons learned from a T32 program.
      In these roles, we have watched Randy mentor and advise over 50 trainees and faculty who share his goals of advancing clinical research and improving the experiences of patients with serious illness and their families. We have also heard him repeat several truths, principles, and other smart things - phrases we fondly call “Randy's Maxims.”
      As readers undoubtedly know, Randy was diagnosed with bulbar-onset amyotrophic lateral sclerosis (ALS) in March of 2021. At that time, we began to observe and catalogue Randy's Maxims to ensure that his wisdom could be shared. In November of 2021, Randy published his own version of four lessons he had learned during his career.
      • Curtis JR
      Life lessons after a career in intensive care medicine.
      Here, we add to his voice and describe our “top 20″ of Randy's Maxims, as they relate to being a “good” mentee, being a “good” mentor, conducting grant-funded clinical research, sustaining an academic career, and living life with meaning and purpose (Table 1). We share these Maxims for those who have heard them to remember, for those who have not yet heard them to have the opportunity, and for all of us to benefit.
      Table 1Randy's Maxims.
      DomainMaxim
      On Being a MenteeYou will get more out of your mentor if you are willing to be vulnerable.
      Set goals, timelines, and expectations with your mentor. Review them regularly.
      Learn what you want to learn.
      Have more than one mentor.
      On Being a MentorMentoring is a two-way street
      Early in your mentoring career, only take on mentees who want to work on your existing projects.
      Be neither too critical nor too nice.
      Be responsive.
      On Conducting Grant-Funded Clinical ResearchEmbrace unstructured time and give yourself permission to be curious.
      It is never too early to start thinking about your next grant.
      Grant-writing is a skill. Practice it.
      Perseverance is key.
      On Sustaining an Academic CareerHaving a five-year plan means having a 10-year plan.
      Pay yourself first.
      Know the difference between urgency and importance.
      Academic opportunities ebb and flow. Notice when you are too busy and notice when you are eager for more.
      On Living with Meaning and PurposeEnrich your life.
      When you feel out of work-life balance, you're probably right.
      Work with people you like or even love.
      Live every day like you have a terminal illness.
      On being a mentee:
      • 1)
        “You will get more out of your mentor if you are willing to be vulnerable.” The business literature commonly recommends that mentees articulate their specific professional needs and goals.,
        • Prossack A
        How to be a great mentee.
        Randy takes this principle a step further. He asks mentees to also share their broader hopes, dreams, worries, and struggles. He directs them to think less about saying and doing what they think their mentor expects, and more about what matters to them, personally. This not only requires psychological safety (created by the mentor) and vulnerability (demonstrated by the mentee), it is also necessary for mentors to be effective. Good mentors want to help their mentees thrive – inside and outside of work – and they need a full picture of the mentee's goals and values to do so. It is okay if those goals feel nebulous or conflicting. Mentors can help translate lofty, evolving, or seemingly incompatible ideas into realistic objectives with concrete steps towards success.
      • 2)
        Set goals, timelines, and expectations with your mentor. Review them regularly.” As goals and priorities become clearer, Randy asks mentees to create explicit timelines for projects, grants, papers, and other activities. Even seasoned academicians find that scholarly projects take longer than expected. Mentors can help mentees create realistic - and ultimately more successful - timelines. Mentees should review their goals and timelines with mentors regularly. Randy recommends that mentees come to meetings with an agenda, an update on progress, and specific topics for discussion. The latter might include barriers to success, pragmatic ‘how to’ questions, and/or plans to brainstorm new ideas. Randy also insists on meeting with mentees even when they say they have nothing to discuss. His reason? These are often the times mentees feel the most stuck, disconnected, or lost.
      • 3)
        “Learn what you want to learn.” Academic medical trainees are used to being outstanding students, and clinical research trainees are no exception. Often, when taking graduate-level methodological coursework needed to support their research, trainees prioritize “straight A's” over spending time on their ongoing research projects. Randy worries this is a mistake. First, he says (somewhat heretically), “getting the ‘A’ may mean having studied a bit harder than necessary.” Instead, he recommends that mentees “learn what they want (or need) to learn” to engage in their scholarship. Second, Randy explains that much of research learning is hands-on; the best way to succeed is to try – and sometimes to fail.
        We should note that urban legend around Randy's career suggests he was a “straight A” graduate student, himself. When recently asked about this, Randy laughingly suggested people “do as I say, not as I do.” He said he hoped people learn from the things he might have done differently.
      • 4)
        “Have more than one mentor.” Clinical research is team research. Randy suggests that each mentee have – at a minimum – a local mentor who can advocate for them within their institutional department or division, a methodologic and content mentor who can advise them on their science, and a sponsor who can help them network, build collaborations, and navigate the arc of academic career development. Sometimes a single person can fill all these roles. More commonly, however, mentees need to expand their mentorship team to include mentors from other disciplines, areas of expertise, and/or institutions. It is also important to remember that mentorship relationships evolve over time. Mentors become peer-collaborators, and new areas of academic interest will demand new teachers.
      On being a mentor:
      • 5)
        “Mentoring is a two-way street.” Randy will point out that all the above Maxims also apply to mentors. Modeling vulnerability, introspection, and goal setting is one of the best ways to normalize common challenges in academia – as well as the ways past them. Randy often shares his own stories (and struggles) with mentees. Mentors must also set clear expectations for communication, feedback, timelines, and scholarly work. Randy is explicit about how to reach him and schedule meetings; timelines for review of written materials; expectations for meeting attendance, presentations, grants, and manuscripts; and aspects of career development such as authorship and future collaborations. Just as a mentee must know what they want to learn, a mentor must know their own limits with regards to what they can teach. When needed, Randy is quick to invite others to help a mentee succeed.
        Finally, mentors must remember that they, too, learn and benefit from mentees. A strong mentoring relationship is just as rewarding and enriching for the mentor as it is for the mentee. After his diagnosis, Randy reflected on what brings him the most meaning in his work. Mentoring was at the top of his list.
      • 6)
        “Early in your mentoring career, only take on mentees who want to work on your existing projects.” Mentoring – when done well – takes time. Although these relationships benefit both mentees and mentors, taking time to mentor can detract from the mentor's own research and career development efforts. This compromise is particularly important for early-stage investigators whose time is necessarily focused on launching their own scholarship. Randy routinely advises early-stage faculty to be parsimonious with the number of mentees they take on, and to ensure that mentees are interested in research that is like the mentor's own. His reasons are two-fold. First, when project interests are similar, the mentee will help the mentor to be productive. Second, when project interests are dis-similar, the mentee may not gain as much benefit from the mentor's experience and resources and, importantly, require more of the mentor's limited time and effort. Thus, similar and aligned research aims become a “win-win” for early career mentors and their mentees, while dissimilar and unrelated research aims can hinder both the mentor's and the mentee's development.
      • 7)
        “Be neither too critical nor too nice.” While constant criticism can demoralize, constant accolades can limit learning. Neither type of feedback helps people to thrive.
        • Buckingham M
        • Goodall A
        The feedback fallacy.
        A good mentor is ready to provide both constructive opportunities for improvement and specific praise. Randy is famous for doing both. After thoughtfully reviewing a mentee's work, he is deliberately kind in the way he highlights limitations (“I worry about this…”). He is also unafraid of having difficult conversations with mentees if doing so will set them up for later success. This includes dramatically reframing a project's scope (“This feels overly ambitious. Let's talk about what needs to change.”) and even reframing a mentee's overall goals (“I think we should talk about your career plans and if we still think they're right for you.”)
        Randy is also the first to share a mentee's joy. He routinely (and zealously) celebrates small and large milestones. Emails with “CONGRATULATIONS!!!” are routine and he ensures that his mentees get credit for their successes. Here, we should underscore that Randy's joy is often manifest by his (liberal) use of exclamation points. Another urban legend surrounding his style is that a response with fewer than two exclamation points is worrisome, and responses with three or four confirm his enthusiasm. (We hope he responds to this essay with at least a “!!!!”).
      • 8)
        “Be responsive.” Not only should mentors be responsive to a mentee's work via thoughtful and timely review, they should also be readily available. Randy ensures that his mentees know how and when to reach him, and what to expect from his time. When they send him an email or materials for review, he responds within 24-48 hours with a brief and friendly acknowledgement of receipt, plus a reminder of his timeline. When he is particularly busy, he lets his mentees know in advance, and suggests additional strategies to keep their projects moving in his absence. Regardless of his own busyness, he almost always reminds mentees, “if you need me sooner, let me know, and I will make time.
      • On conducting grant-funded clinical research:
      • 9)
        “Embrace unstructured time and give yourself permission to be curious.” Ideas require creativity, and creativity requires time to think. That time can be rare in academic settings. Worse, people who are used to being busy can feel anxious when they are not; a common question Randy's mentees ask is, “what should I be doing with my time?” Randy encourages them not to fill it with extra tasks and activities. Instead, he suggests they allow themselves time to read the literature, brainstorm questions, revise ideas, and generally follow their curiosity.
        Indeed, one of the four pieces of advice Randy shared in his own publication was to “take sabbaticals.”
        • Curtis JR
        Life lessons after a career in intensive care medicine.
        Although he acknowledged that not everyone in academia has the luxury of taking extended periods of time off, he underscored the necessity of finding unstructured opportunities to think. “Everyone can find ways to create the time and space to recharge, nourish their creativity, and reflect on what is most important about their work.”
      • 10)
        “It is never too early to start thinking about your next grant.” Grants also take time to develop and prepare, and many researchers under-estimate how much time this takes. This is particularly true for earlier career investigators who might forget to integrate time for their mentors’ review and subsequent processes of revision. For context, one of the National Institutes of Health suggests approximately five-months of full-time work for a “simple R01 that does not include human subjects.”

        Timeline to plan and write your application. Accessed from: https://www.niaid.nih.gov/grants-contracts/timelines-plan-write. Accessed at: December 14, 2021.

        When we add the time for other clinical, learning, and research commitments; for career development components of a grant; for materials related to human subjects protections; for mentors and collaborators to help develop and revise materials; for institutional submission processes; and for the creativity and thinking highlighted in Maxim #9, the timeline becomes substantially longer. This is not to say one cannot write a grant with less time, but it may highlight one of the secrets of Randy's success.
        In general, Randy suggests that investigators give themselves a full six months to develop their “Specific Aims,” plus another 6-12 months to develop the rest of the grant. This usually means that when people realize they want to write a grant for an upcoming deadline, they are too late. To avoid this stress, Randy reminds them that advance planning is necessary.
      • 11)
        “Grant-writing is a skill. Practice it.” Just as clinical care skills must be honed and maintained, so too must writing skills – including grant-writing skills. Randy advises investigators to write at least one grant per year not only to secure funding, but also to be knowledgeable, and comfortable with grant-writing itself. As part of this process, he encourages people to consider, and creatively explore multiple future research ideas. This helps with Maxim #10; when investigators are constantly imagining and refining their proposals, they are more prepared for the next opportunity. Alternatively, when investigators are in the process of writing a specific grant, he sometimes advises them to work on the “little parts” that are more structured and predictable. Doing so can help grant-writers feel less overwhelmed with the volume of work, in turn providing mental energy for the more challenging, and creative parts of writing. This helps with Maxim #9; Randy understands that when writers have the time to critically think and question, they are more likely to write successful grants.
        • Curtis JR
        Life lessons after a career in intensive care medicine.
      • 12)
        “Perseverance is key.” Randy likes to tell a story of a grant he submitted to the NIH 8 times before it was funded. He tells the story for two reasons: 1) to normalize the experience of grant rejection; and 2) to demonstrate that most grants are ultimately funded if investigators keep trying. A more recent urban legend around Randy involves this fabled grant: When it was funded, the program officer wrote Randy to say that she was very pleased to be funding it not only because it was a critically important project, but also because she was exceptionally glad to not have it come back for another review.
      • On sustaining an academic career:
      • 13)
        “Having a five-year plan means having a 10-year plan.” If a typical NIH grant lasts for five years and takes two years to write plus two years to obtain, then most investigators are considering their next grant as soon as the first one is funded. Moreover, successful grants necessarily include a brief description of “future directions” (the next grant). Together, this means that successful investigators are thinking 10 years ahead. Randy encourages academicians to be curious when exploring such forward thinking (rather than locking themselves into a particular future).
      • 14)
        “Pay yourself first.” It is easy for schedules to become overwhelmed with meetings and other administrative needs. Generous academicians can find themselves sacrificing their own responsibilities to support other people. Randy compares this to the airplane instruction to put your oxygen mask on before putting it on the child beside you. If you cannot help yourself, you will be unable to fully help others. While things like sabbaticals and unstructured time help, Randy also blocks what he calls “pay myself” days, where he is essentially unavailable (or, at least less available) for meetings. He makes clear to his mentees and collaborators that the purpose of this practice is to fulfill his own responsibilities and career goals.
      • 15)
        “Know the difference between urgency and importance.” The “Eisenhower Matrix” (also known as the “urgent-important” matrix) is a two-by-two table designed to prioritize tasks (Fig. 1).

        The Eisenhower matrix. Accessed from: https://thedecisionlab.com/reference-guide/management/the-eisenhower-matrix/. Accessed at: December 14, 2021.

        Randy likes to draw this matrix to help people consider their priorities and their schedule. For example, while tasks in the urgent/important quadrant are high priorities, they should only be placed in that “box” after being carefully scrutinized; hopefully, few tasks reside there. Many (perhaps most) tasks start in the non-urgent/important box and can thus be tackled with advance planning. Randy encourages mentees to schedule time for activities in this non-urgent/important box, as often these critical tasks get pushed aside to prioritize urgent (and less important) tasks. Indeed, Randy suggests that less important tasks be minimized, if not eliminated altogether, to keep room for meaningful work.
        Fig 1
        Fig. 1The Eisenhower (“urgent-important”) decision-aid.
      • 16)
        “Academic opportunities ebb and flow. Notice when you are too busy and notice when you are eager for more.” There are moments in our careers when we feel too busy, if not overwhelmed. Too many urgent/important tasks are demanding our attention, and we don't have the time to plan for non-urgent/important ones. These are the periods when we begin to feel burnt-out. By contrast, there are also periods where we feel a relative lack of urgency, and we start to crave being busier. These are the periods when we can take on new opportunities. Randy pays attention to both. When he is overly busy, he tries to re-assign tasks by downgrading some to “less urgent and less important,” and by delegating others. He also notes that the busy period will pass if he says “no” to additional urgent opportunities. When he is less busy, he says “yes” to more ideas, and plans for future needs. In both periods, he remembers that opportunities come, and go. Sometimes, we need to accept them, even if it makes us busier. Other times, we can wait until we have room.
        Randy acknowledges that saying “no” may be more difficult for early career investigators. Here, he reminds them that a good mentor can help differentiate between both urgencies, and opportunities. Mentors can also help mentees turn down opportunities that aren't a priority. Randy frequently volunteers himself as the reason for a mentee to say “no”: “Blame your mentor,” he says, “Tell them I told you to say ‘no’ because you need to prioritize other things first.”
      On living with meaning and purpose:
      • 17)
        “Enrich your life.” In his own essay, Randy explicitly recommends prioritizing family.
        • Curtis JR
        Life lessons after a career in intensive care medicine.
        And, by “family,” he means the people we love the most – be they biologic or families of choice. Indeed, Randy talks proudly of his family, and the time he spends with them. He demonstrates that important people enrich our personal and professional lives.
        Randy also enriches his life with things and activities. For example, he likes to share (and recommend) non-fiction books he found helpful in his own career. Recently heard suggestions include “Essentialism: The Disciplined Pursuit of Less,” by Greg McKeown (recommended when folks are struggling with over-filled ‘urgent-important’ boxes), or “Transitions: Making Sense of Life's Changes” by William Bridges (recommended when folks are navigating major life or career changes). Randy is an avid runner, cyclist, skier, and swimmer, recently braving the cold waters of Puget Sound to maintain his love of sport. Put simply, Randy makes a point to embrace (and model) ways to enrich his body, mind, and spirit.
      • 18)
        “When you feel out of work-life balance, you're probably right.” Just as we can be busy in work, we can be busy in life. Randy encourages people to pay attention to the balance of both. While he sometimes says he prefers the term “work-life integration” over “work-life balance,” he also believes it is easier to notice a lack of balance than a lack of integration. Thus, when he feels out of balance, he makes a change.
      • 19)
        “Work with people you like or even love.” This idea, too, was highlighted in Randy's own essay.
        • Curtis JR
        Life lessons after a career in intensive care medicine.
        We work with hundreds of people over the course of our careers. Colleagues and friends at work make the stress less stressful, and the joys more joyful. Randy has prioritized being in positions where he is able to control or influence the people he chooses to work with, and has expressed how much meaning, gratitude, and happiness this practice brings to his professional and personal life.
      • 20)
        “Live every day like you have a terminal illness.” It is bittersweet to write this one, even as Randy himself stated it in his own essay.
        • Curtis JR
        Life lessons after a career in intensive care medicine.
        It is also easy to assume this is a newer Randy-Maxim; it is the kind of thing one might say after being diagnosed with ALS. And yet, in our experience, this is not a new philosophy to Randy. Randy has lived his life richly and fully, be it with sabbaticals in Paris, paddle-boarding with Orcas in the Puget Sound, devoting his career to the wellbeing of patients with serious illness and his mentees, or spending quiet moments with the family he loves. He has never seemed to over-prioritize work or tasks that are less important in the end.
        The final urban legend we want to share is about just this. Shortly after his diagnosis – so the story goes – Randy's daughter asked him what was on his Bucket List. Randy answered by saying he had always felt like he was living his Bucket List. There has been little left un-done, un-said, or un-lived.

      Conclusion

      In the weeks after his diagnosis of ALS, Randy spent a lot of time thinking about what (and who) matters most to him, what (who) he loves, and how to spend his time. It came as little surprise when he shared his priorities of continuing his research and his mentoring. These are two of the things that most define him: he cares about patients with serious illness, and he cares about his family. And, to Randy, colleagues and mentees are part of his extended family.
      We know that others will tell the story of Randy's scholarship, and myriad others will share what they have learned from him. There is no way to do justice to all the things he has taught us, and there are plenty more “Maxims” where these come from. For now, we hope that this little piece of Randy's story will help all of us to remember – and thank – this brilliant man who shaped our lives so meaningfully.

      Acknowledgments and Disclosures

      None of the authors has a financial or other conflict of interest to disclose. This essay was not supported by a specific funding organization. Dr. Rosenberg currently holds grants for unrelated work from the National Institutes of Health, the American Cancer Society, Arthur Vining Davis Foundations, and Cambia Health Foundation. Dr. Engelberg has received grants for unrelated work from the National Institutes of Health and Cambia Health Cambia Health Foundation. Dr. Kross has received grants for unrelated work from the National Institutes of Health and the American Lung Association. The opinions herein represent those of the authors and not necessarily their funders.

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      1. Timeline to plan and write your application. Accessed from: https://www.niaid.nih.gov/grants-contracts/timelines-plan-write. Accessed at: December 14, 2021.

      2. The Eisenhower matrix. Accessed from: https://thedecisionlab.com/reference-guide/management/the-eisenhower-matrix/. Accessed at: December 14, 2021.