Special Series: Tribute to J Randall Curtis
- 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).
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.