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Special Series: Tribute to J Randall Curtis
The Science of Context: Transforming Serious Illness Care Though In Situ Observation
There is an expression, often attributed to Einstein, “If I had 60 minutes to save the world, I would spend the first 55 trying to figure out what was wrong with it.” Dr. J. Randall (Randy) Curtis’ approach to improving serious illness care has been so effective for exactly this reason. Before considering how to make things better, you must first understand what is happening and how we got to our current state. For critical care, that required listening to clinician and family communication —what people actually said— while it was happening in the intensive care unit (ICU).Supporting scholarship in palliative care across the medical specialties
In this essay, we share our experiences as three academic nephrologists at different stages in our careers who work closely with Randy Curtis at the University of Washington. Our experiences provide a window on Randy's remarkable ability to support scholarship in palliative care outside his own specialty of pulmonary and critical care medicine. We begin by providing a brief description of our experiences working with Randy and what this has meant to each of us. We then draw on these individual and collective experiences to distill out key practices that we think are especially conducive to supporting scholarship outside one's own area of specialization.A parade of firsts: J. Randall Curtis, MD, MPH modeled a future for palliative care academics
Palliative care history is short, and the history of its research is even shorter. In 1997, when I first met Randy Curtis at a Project on Death in America Faculty Scholars meeting, the field of palliative care as we now know it did not exist. The American Academy of Hospice and Palliative Medicine (AAHPM), a tiny organization, had just emerged from the even tinier Academy of Hospice Physicians. American Board of Medical Specialties board certification would not appear for nearly another decade. And, whereas our clinical and educational infrastructure felt threadbare, the palliative care research landscape was completely unstitched.Mentoring women well: Perspectives of junior physician-scientists on what it really takes
The life of a physician-scientist is fast paced, at many times exhausting and simultaneously exhilarating. Never-ending demands, both from our work and personal lives, make it challenging to take the time necessary to reflect on where we are, how we arrived here, and where we are ultimately headed. Then, in a flash, something earth-shattering happens to us or someone we care about. In those moments, when life makes the least sense, we are forced to pause. The news of a terminal diagnosis for our beloved mentor, Randy Curtis, was one such moment.Leading from the Heart
The Sojourns Scholar Leadership Program was founded in 2014 by the Cambia Health Foundation to enable emerging palliative care leaders to execute impactful projects and grow as national leaders in the field. Since the program's inception, J. Randall “Randy” Curtis, MD, MPH has been deeply involved in this vital endeavor: serving on the advisory board and personally mentoring eighteen scholars. Randy has sharpened our thoughts, guided our growth, and imparted wisdom in the process.What Does it Mean to be an Excellent Mentor? J. Randall “Randy” Curtis’ Living Legacy
“Before my (ALS) diagnosis, I used to think of my legacy as the papers I had published and the impact that my research has had on the field of medicine. Since my diagnosis, my thinking has changed. I now see my legacy as the people I have mentored and helped mentor and the people that they have mentored. This vision of legacy gives me much more joy and happiness than my old vision of legacy.”—J. Randall Curtis, UW Medicine Huddle, December 6,2021.1A Career Changing Trip to Seattle
As a young non-palliative care trained oncologist, I always felt like an outsider in the palliative care research community. I did not know any individuals in the field especially well, as most palliative care investigators at that time were conducting studies outside of oncology. I felt insecure about engaging with other palliative care investigators in light of my background, lack of experience, and junior status in the field. However, I also did not feel like I had a home in oncology. Most oncologists had not yet embraced and acknowledged the importance of palliative care research for patients with cancer, and so I was uncertain about how to move forward with in this research agenda and build a successful program without support and guidance from experienced investigators.J. Randall Curtis's Legacy and Scientific Contributions to Palliative Care in Critical Care
J. Randall Curtis (“Randy”) has had a profound impact on the culture and state of the science of palliative care in serious illness, particularly in the critical care setting. He has accomplished this by bringing rigorous and innovative empirical research into understanding and improving communication, decision-making, and culture around end-of-life care in the intensive care unit (ICU). His legacy extends far beyond his scientific contributions through the personal impact of his compassion, creativity, and visionary brilliance on the cultures of ICUs and hospitals around palliative care.Surrogates of Patients With Severe Acute Brain Injury Experience Persistent Anxiety and Depression Over the 6 Months After ICU Admission
Severe Acute Brain Injury (SABI) is neurologically devastating, and surrogates for these patients may struggle with particularly complex decisions due to substantial prognostic uncertainty.Transformational Leaders Transcend Specialities
Anesthesia and anesthesiologists have deep roots within the specialty of intensive care medicine,1 but anesthesiologists in the United States comprise only 13% of intensivists, compared to 20% with specialization in surgery and 65% internal medicine.2 With frequently separate training programs, different funding options, and departmental divides, anesthesiologists can sometimes feel as an “other” within the field of critical care. Yet, innovative leaders and mentors such as Randy Curtis bridge that divide.Sunset and the Birth of New Ideas
We met each other through academic medicine, in search for answers, and found friendship. Its value in my life was abundant, unearned grace. In Dr. Curtis, I learned the truth of the words of Thomas Mann, “Illness was merely transformed love.”ProPACC: Protocol for a Trial of Integrated Specialty Palliative Care for Critically Ill Older Adults
Each year, approximately one million older adults die in American intensive care units (ICUs) or survive with significant functional impairment. Inadequate symptom management, surrogates’ psychological distress and inappropriate healthcare use are major concerns. Pioneering work by Dr. J. Randall Curtis paved the way for integrating palliative care (PC) specialists to address these needs, but convincing proof of efficacy has not yet been demonstrated.Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients
Outcomes after cardiopulmonary resuscitation (CPR) remain poor. We have spent 10 years investigating an “informed assent” (IA) approach to discussing CPR with chronically ill patients/families. IA is a discussion framework whereby patients extremely unlikely to benefit from CPR are informed that unless they disagree, CPR will not be performed because it will not help achieve their goals, thus removing the burden of decision-making from the patient/family, while they retain an opportunity to disagree.Utilization and Delivery of Specialty Palliative Care in the ICU: Insights from the Palliative Care Quality Network
Palliative care (PC) benefits critically ill patients but remains underutilized. Important to developing interventions to overcome barriers to PC in the ICU and address PC needs of ICU patients is to understand how, when, and for which patients PC is provided in the ICU.Improving Outcomes Measurement in Palliative Care: The Lasting Impact of Randy Curtis and his Collaborators
Palliative care research is deeply challenging for many reasons, not the least of which is the conceptual and operational difficulty of measuring outcomes within a seriously ill population such as critically ill patients and their family members. This manuscript describes how Randy Curtis and his network of collaborators successfully confronted some of the most vexing outcomes measurement problems in the field, and by so doing, have enhanced clinical care and research alike. Beginning with a discussion of the clinical challenges of measurement in palliative care, we then discuss a selection of the novel measures developed by Randy and his collaborators and conclude with a look toward the future evolution of these concepts.Translating Individual Mentorship to Generalizable Action: Lessons Learned From J Randall Curtis
Academic mentoring is a topic that has received significant attention given its key role in career advancement and success. Much of the literature on mentorship talks of specific types of relationships including “mentor,” “coach,” “connector,” and “sponsor.”1 These mentoring phenotypes are often discussed early in one's career when trainees are particularly vulnerable to demands of time, academic productivity, home life, and competing opportunities. As a result, numerous publications focus on the characteristics, and behaviors of successful mentoring relationships.To J.R.C. with L.O.V.E.
In reading the remarkable contributions in this issue of the Journal of Pain and Symptom Management devoted to the career of one man, Dr. J. Randall (Randy) Curtis, many words were offered by his enormous network of colleagues and mentees: compassion, devotion, empathy, commitment, loyalty, honesty, humor, dedication, courage, and brilliance. Another word–love–is mentioned sparingly, and while understandable, we wish to ensure it is not overlooked. Though of course, as with so many things, Randy beat us to the punch even on this, through the advice he has given for years to “Work with people you like, or even love.” We have heard him make this point to individual mentees, to small groups, and, most recently, in his moving presentations and publications since his diagnosis with ALS.Truths, Principles, Maxims, and Other Smart Things We Learned From J. Randall Curtis
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.1 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.Defining Bravery
Writing this piece about my friend and colleague, Randy Curtis, is truly an honor. When I began to contemplate the subject of a piece about Randy, the term “bravery” immediately came to mind. Why bravery? If we accept a definition of bravery as not being afraid of who we are, then what better characterizes Randy's approach to his family, his career, his mentees and colleagues, than being completely brave? Randy's willingness to simply be exactly who he is, which inspires his mentees to trust themselves and appreciate the importance of being true to themselves as a key to success, has distinguished Randy as an unusual mentor.
