Aroha e te atua, aroha e nau makua, aroha e naa tupuna ka whakahiko, o ki a moku, o te ali'i, ka kui e wa, ho wao o nai ole, no maui mai kohana, parekuua e e, e nau lua ruu lau kaani holani, e na lau kiri, naa kiri kiri a te atua, ha'aleleho e ho'onui lalu, moe o lalakuna, moe iahu, ha'ana o kunawa o ka po'e, mu'ai mai a na lau ha'alele, ha'aleleho e o lalakuna, lua a me iwa, lua a me iwe moe na lalakuna, ha'ana o karani huni ka po'ali, o naa pulua o ka lani me ali, o a holo holo ka piko, o kaipu ka kuu ka muli e loa, o kahikili pa'a pa'aina keli ka po'ihanau, o nebenebene i maulinau keli o waki ianiani, o waniani kuu ka rani ka maka, o wailoa holo i ke kai, o wailoa kealaka e ae, e ole, e ole, ha'amama ua noa. Aloha! Welcome to the sacred shores of my ancestors. This place we call Hawai'i. The significance of the pū, the sounding of the conch shell, was to let the gods know in all directions of the universe that a great gathering is taking place right here, an exchange of minds. So the pū gathers all this energy so my ancestors My ancestors can talk story with your ancestors to plan for the future. So I want you to repeat after me. Say this word. Mo'olelo. One more time. Mo'olelo. Mo'olelo. My Kapu'u Wai. Mo'olelo is a way of telling stories. My Kapu'u Wai is straight from the heart. That Mo'olelo, this chant that I just did, was a story about this person named Hawai'iloa, who is destined to follow the paths of the fishes, the currents of the ocean, and lead a people from across the seas to a place where no man has gone before, this place called Hawai'i. He took that initiative and then kuleana, the responsibility, to make sure that his crew was safe, to make sure that all the canoe was sound, and the best were on board. You represent the crew of a canoe. Although it is a whole lot of different style of canoe, it is what it is because you obtained a seat here on board our canoe where we traveled from here to Tahiti in 1995. We had no modern instruments, only this, this, that, and this, all of our senses. It was a long journey, but what was really cool is we all worked together. Only so many seats on the canoe, and you, us, were chosen to occupy that seat. So be proud of what you've accomplished. Be especially proud of what you will accomplish. I know who I was. I know who I am. I think I know where I want to be tomorrow. So I challenge you with that, is to think about things for tomorrow. Hawai'i lua turned his sails into the wind, not away from the wind, because if the sails were going away from the wind, it would have taken him to places where other men have journeyed, but he sailed into the wind to make sure that he is going to a place where no man has gone before. Not at all. So this is a challenge to you. I want to bring to you today, I want to transplant a breath of fresh air into your lungs about how different Hawai'i is, what is usually the standard advertisements about Hawai'i, but I want you to walk away from here today with emotion. I want you to walk away today with pride. Pride because you're working together as one crew on board the canoe. The canoe cannot survive without all the minds working together. That is a challenge that you have, and I know you can do it because you're here. Congratulations, everybody. Aloha mi'vilina. Greetings from my ancestors to you. I hope you understand, and if you don't understand, it's even better because you're going to ask questions. Ask questions of each other. Go into each other's brain and try to ponder the thought of what are we going to do tomorrow? How are we going to better ourselves, better our clients, our patients, our colleagues, our family, our friends? This is what being a part of the canoe is all about. The success rate depends upon how you think, how you act. The mo'olelo, straight from the heart, is because in the ancient days we had no written language. Everything was chanted, danced, art form upon the rocks as picture clips or even hula and song. That is how we told our stories. It was like gold because what we came out of here, say this word, ah. All you pulmonary people know what that is, right? It is the breath of life. That is what we take pride in, and this is what it's all about. When we said something, the ha was gold. There was no lying. There was no making things up. All we did was factual. Then we had the Washington influence came in, and they taught us how to read and write. Things changed a little bit, but nonetheless, we are here to exchange ideas. With all of you here, wow, there's a lot of ideas going through this room, which is great because you've helped me, believe it or not, in the last seven days. I am a patient of yours. I have a special place in my heart and my lungs for all of you. Yeah, I did. I do. But nonetheless, I will be back again. We'll speak more about Hawaiian values, but the first value was mo'olelo, mai kapu'u wai, straight from the heart. Bang. Work that. Talk with each other. Go into each other's minds and hearts and say, what if we did this? What if we did that? And that brings success because there's always change as you set your sails into the wind. So I will leave you for now, but I'll be back and we'll learn more. Again, I am proud to be here in front of all of you. I'm still breathing. Aloha. Please welcome the chair of the Scientific Program Committee, Dr. Anissa Das. Aloha and welcome to beautiful Honolulu. My name is Anissa Das. I'm a professor at The Ohio State University and I am your program chair for CHEST 2023. Since we're in Hawaii, we will be embracing the traditions and celebrating the culture. This year, I am so proud to announce that we are launching the new CHEST community connections. First, we partnered with the Waianae Coast Comprehensive Health Center by hosting a CHEST booth at their farmer's market and distributing inhaler masks and spacers to the community. Additionally, you'll have opportunities to engage with all three of our partners at their CHEST experience presentations as well as at the Ohana Mixer. To guide us along the way, I'd like to extend a thank you to Clifford Naoli, who kicked off opening session by welcoming us to Hawaii. You'll see Clifford throughout the opening session, and we will be following his lead by sharing a portion of our own stories with you this evening. If it's your first time to CHEST, welcome. We are so excited to have you here. My fantastic team of faculty on the Scientific Program Committee, along with our unbelievably talented CHEST staff, have put together an amazing curriculum for you. To ensure that you take advantage of all that CHEST has to offer, a great place to start is the good old app. It has a unique ability to sort by content area, network affiliation, as well as session type. Whether you're interested in chest disorders or sleep disorders, pro-con debates, or case puzzlers, you can easily find a session geared towards your interests. And this year, I am proud to say that we had more than twice the number than ever before of case report and abstract submissions. I guess people are just a little bit excited to come to Hawaii. Every presentation you'll see this year at CHEST 2023 is intentionally diverse, with thought leaders and experts from around the world. Educators of different genders, race, and disciplines. This meeting caters to the whole care team, and I'm so happy to see so many advanced practice providers and respiratory therapists here. This is because CHEST is more than just an exceptional educational opportunity. It's a community, or as they say in Hawaii, our CHEST ohana. It's this exact sense of community that makes CHEST so incredibly meaningful to me. I encourage all of you to make at least one new connection this week. It often starts with a common bond, but relationships grow when we share the differences in our stories. These connections are so incredibly important to our overall wellness and our career satisfaction. With that in mind, I'd like to tell you a little bit about my story that starts with those who have deeply impacted who I am. I'm a blend of all of those people who have inspired me, influenced me, and mentored me. I'd like to take you back to my fellowship, when I worked with a faculty member who taught me one of the most essential lessons. She taught me how to be a fierce physician and a passionate parent at the same time. This is not always celebrated, especially as women in medicine. She taught through modeling. She was both a mother who was fully devoted to motherhood, as well as an excellent doctor who was fully committed to being an academic physician. She made it absolutely clear that it was okay to be both. She was authentic and transparent. I heard about her kids' accomplishments, if her husband was out of town, and she was honest when she was frustrated with a grant submission. As a passionate mother to two pretty spectacular boys myself, I can't help but reflect on how integral her impact was to my career. Without her encouragement to probably wear multiple hats at once, I most certainly would not be where I am today. Another formative relationship began when I met an eminent leader in sleep medicine at a CHEST annual meeting. I was invited to speak with this woman who I greatly admired. The imposter syndrome was palpable, as she was the epitome of success in my field. Rather than rush off to her next talk after our session, she invited me to lunch, and she made a connection. Ultimately, it was her encouragement and sponsorship that empowered me to overcome my own insecurities. I can now say this once incredibly intimidating woman is now considered a very close friend. On that note, while you're at this meeting, it is okay to be intimidated. Dude, there's some serious rock stars here! But it shouldn't stop you. It should inspire you. Again, throughout this meeting, connect with one another over your commonalities, but then celebrate your differences. Connect with other foodies or coffee lovers by sporting one of our new fun ribbons. Network with new colleagues at our Ohana and network mixers. Hear more inspiring journeys at our CHEST after hours. The point is, immerse yourself fully in learning, in the experience, in the community. Be a part of the CHEST Ohana. As I stand here, representing all of those who have made me who I am, as a mother, as a physician, as a friend, I am so excited to welcome you to CHEST 2023, which truly at this point has become a whole other part of me. To all of you here, I hope that this meeting is the best you have ever attended. You never know who may have a lasting impact. And today could be the first day of a lifelong connection. I hope that this meeting and those you meet here today become a powerful part of your story. Before I turn the stage over to CHEST President, Dr. Doreen Idrizo-Harris, I would be remiss if I did not share the strong impact that she has had on my story. A wonderfully passionate person, I originally noted her East Coast wittiness and edge, especially as a Midwesterner who eagerly waves hi to every stranger on the street. However, I quickly learned that in addition to her intense passion, she brings a calm demeanor to chaos and demonstrates thoughtfulness at every step. She has taught me to pair my own passion and energy with deliberate pause for reflection, to better lead with purpose. Together, we created an unparalleled CHEST meeting. Doreen, thank you. You've been a great example and you have made me a better leader. And with that, I welcome her to the stage. It has been a pleasure over this last year to be working with Dr. Das. Energy doubled. Both of us have had a phenomenal time being the dynamic duo to get this meeting off the ground. But I do want to welcome you to CHEST 2023 here in Hawaii. For me, I was lucky enough to be in CHEST 2011 here in Hawaii. I was the Vice Program Chair with Dr. Chan, who was Program Chair, and Dr. David Gutterman, who was CHEST President then. Who would have thought in 2011 that I was going to be back here 12 years later as the President? Pretty remarkable. And all of you could do it. So I know that Hawaii is a very special place for us. And the first thing I want to tell you about is that giving back to Hawaii was extremely important to us before the meeting got going. We were able to go to the Gunstock Ranch and to try and reduce the carbon impact that this big meeting is having here. 42 trees were planted so that we could not only help rejuvenate the soil and bring back some of the normal animal habitat here, but to show that this is extremely important to us. Especially following the recent events in Maui, it's truly meaningful to contribute to restoring and preserving these lands. In recognition of the devastating impact of the wildfires on Lahaina in Maui, I'd like to have a moment of silence for the lives that were lost not far from where we meet today. Thank you. Throughout your time here in beautiful Hawaii, please remember to be courteous visitors and remain respectful to these beautiful lands, their people, and their traditions. Along the line of traditions, a sacred tradition of chest is to bestow the title of FCCP to deserving individuals. As the president, I get to honor the inductees of the new fellows of the college. Dr. Mark Rosen was my first mentor at chest. When I was inducted, Mark was program chair in 1999, and he gave me my convocation pledge. I was blessed to be able to be inducted with my dad, Dr. John R. Idriso. I know he is smiling from above today. Mark is the main reason that I became so involved in the college, and he mentored me for 20 years until his unfortunate passing in 2019. He was remarkable, one of a kind, a leader, an educator, a mentor. I'm honored that I am here today to give the pledge as Mark did for me. Since our last convocation ceremony, 123 of our members have been named as new fellows. We have 50 fellows here with us today, representing seven countries and 20 states, officers of the college, and distinguished guests. It is my honor to present the 2023 fellows of the American College of Chest Physicians. These individuals have shown a commitment to the practice of chest medicine and to our association. Just prior to the opening session, President-elect Dr. Jack Buckley and I had the pleasure of administering the No Tobacco Pledge and the Patient-Focused Care Pledge to these honorees. In upholding our long tradition, I will now administer the Pledge of Fellowship. New fellows and current FCCPs in the audience, I ask that you please join me in the pledge. In accepting the fellowship of the American College of Chest Physicians, I dedicate myself to the mission and vision of the college. I accept the responsibility to be a lifelong learner in the disciplines related to chest medicine and others so that I can maintain professional and ethical standards of excellence and provide optimum care for my patients. I will work in harmony with the college as a teacher and advocate, and I will assist and support the college in global efforts to advance patient care, support research, promote diversity to optimize health, and foster health equity. I join my colleagues in the American College of Chest Physicians with pride and enthusiasm. To all the new inductees, I'm so excited for you. Please use this step in your career to become more involved in chest and in your communities where you take care of your patients. Please feel free to reach out to me. I hope I can do for you what Dr. Mark Rosen did for me. Once again, congratulations to all the new fellows of the American College of Chest Physicians. Please welcome Cultural Advisor Clifford Naiole. Aloha once again. Congratulations to all. This new fellow, repeat after me. Onipa'a. Onipa'a. The ability to work as one. One hand is good. Two hands are better. Three hands make you even stronger. And aboard the canoe, mai kai ka hana. He po'okela naka naka. If the work is good, the person becomes great. And everything that surrounds you becomes great as well. From there, you are brought to another level. From there, you get more kuleana responsibility. We want you to work together. If you have a canoe and you're trying to paddle and everybody's paddling in different timing, different directions, this canoe only goes around in a circle. You may have the best steersman, but if you don't have timing, you have nothing. You may have the best crew, but if you don't have a steersman, the canoe still does nothing. So everybody has got to work together to make the voyage a success. I know you are on a voyage. I know that you are going to challenge yourself. But what I want you to do, again, like the Hawaiian navigators of old, they studied the stars, the wind, the temperatures of the water, the type of fishes they were catching. You're not going to do that in your profession unless you retire and go fishing all day long. With that, again, work together. Laulima, all is one, many helping hands. Onipa, strong, strength. And from there, the profession goes to success. Peace. Onipa. Aloha. I'm thrilled to move us into the awards section of the program. As president, it is my honor to bestow a select individual with the presidential citation. This citation is awarded to people who dedicate their time and talent to the mission of the college. It is my pleasure to award the 2023 presidential citation to my dear friend and often advisor, Dr. Scott Maneker. There is no one more dedicated than Scott. Most recently, Scott has been very involved with our health policy and advocacy committee and the joint chest ATS clinical practice committee. We'll let you take a photo while I finish. He has been a key leader on the chest journal editorial board and professional standards committee of which he is now chair and has advised us quite a bit. Scott has always been there to give us his knowledge, his advice whenever we need it, and sometimes when we don't, which is a quality I truly appreciate about Scott. Thank you, Scott, for everything you have done for me and for the college over the last 20 years. You truly deserve this citation. Thank you. Now I would like to recognize and introduce you to the annual award recipients. These individuals have been nominated by their peers and selected for their dedication to chest and the profession of chest medicine. The Alfred Sofer Award for Editorial Excellence recognizes Laura Reardon, a former chest staff member who has worked in scholarly publishing for nearly 20 years. She served as managing editor and director of chest journals from 2020 to 23, a very tough time indeed. During Laura's time, our flagship journal had to meet the needs of clinicians navigating the pandemic. We all wanted the evidence yesterday. She led the journals doubling the volume of content and publishing faster than ever to remain a timely, reliable source of clinically relevant information for our clinicians. Lauren also helped to expand the journal by starting two open access journals, CHEST Pulmonary and CHEST Critical Care. Currently, Laura works for CHEST as an editorial consultant. Congratulations, Laura, on this amazing award. The Early Career Clinician Educator Award recognizes the achievements of a clinical educator who has made significant contributions to education, to CHEST and beyond. Dr. Viren Kaul is our recipient of this award. Viren's a pulmonary critical care clinician educator with areas of expertise that include airway management in critically ill patients, mechanical ventilation, and pleural diseases. He's the vice-chair of the clinical education and pleural diseases. He's the vice-chair of our mechanical ventilation and airways management section. He serves on the critical care network. He was on our COVID task force and he serves on the CHEST journal editorial board. Congratulations, Viren. Thank you so much. Thank you. The Master Clinician Educator Award recognizes long-term significant contributions to CHEST by serving as faculty and holding leadership positions within CHEST. This award goes to Dr. Chris Carroll. Chris has been a colleague of mine for many years. He is a phenomenal clinician and has been an advisor to me dating back to when we were both on the CHEST Foundation Board. In addition to serving as a trustee, he's a current board of regents member, the chair of our critical care network, and he's deputy editor in web and multimedia for the journal CHEST. When he's not busy at CHEST, he spends his time as a pediatric critical care physician, his communication skills, which pediatricians have good ones, social media, and IT expertise, and his outstanding clinical knowledge and leadership make him so deserving of this award. Congratulations, Chris. The College Medalist Award honors a fellow of the college for the meritorious service in furthering work in CHEST medicine. The awardee, they're getting bigger, these awards. The awardee is usually a clinician, author, teacher, or investigator, and this year's award goes to someone who is all of those things. This year's award goes to Dr. Chris Carroll. This year's award goes to someone who is all of those things, Dr. Stephen Nathan. He's an internationally renowned clinician and researcher in the areas of interstitial lung disease, pulmonary hypertension, and lung transplantation. He's the medical director of Inova Fairfax's Advanced Lung Disease Program and Lung Transplant Program. He's a prolific author with over 500 publications and has been a teacher and mentor for more than 25 years at CHEST. His teaching legacy has been far-reaching, not only domestically, but to all parts of the world, including Saudi Arabia, India, South Africa. We are thrilled to honor him today with the College Medalist Award. Thank you. The Distinguished Service Award is given to a fellow of the college who has made exceptional contributions to CHEST through commitments of time, leadership, and service. It is bestowed to an honor and individual who has devoted much of themselves to improve the organization. Dr. Victor Test is so well-deserving of this award. Thank you. He shows compassion for his colleagues and patients like no other, and he gives of his time unselfishly. There isn't much you can ask Victor to do that he won't say yes to, other than maybe share his wonderful cowboy boots. And for a woman who loves shoes, I envy his collection. Cowboy boots aside, Victor has led CHEST on so many fronts. He is a senior member of our Board of Regents, was on our Council of Networks as the chair in 2018, our program chair in 2020, and he's been involved in our Pulmonary Vascular Disease Network and everything that CHEST does in the pulmonary vascular space. Congratulations, Victor. Thank you. The Master FCCP designation is the highest honor that the American College of Chess Physicians can bestow upon one of its members. This year, I am pleased to give this award to my dear colleague, Dr. John Studdard. He joins the group of 40 Master Fellows. Dr. Studdard has been actively involved with chess for over 30 years. When I think of John, the first word that comes to my mind is passion. He is passionate about his community, his patients, and everything chess. John was our esteemed president in 2018, and he also led the Chess Foundation as president in 2015, and he's been involved in almost every area of the college. In addition to being a great leader, mentor, clinician, and colleague, his biggest passion is advocacy. He's been a thought leader and a recognized national authority in the pulmonary critical care and sleep space for many years. John is also passionate about diversity and shared our first diversity and inclusion task force in 2018. I congratulate our new Master FCCP. Once again, please join me in offering all of our award winners as this year's recipients. I would like now to take an opportunity to recognize a group of CHEST educators who have made tremendous contributions over the past year. These individuals have spent countless hours using their collective wisdom and skills in the design and execution of our CHEST programs. For this and so much more, they deserve our sincere appreciation. Please help me in congratulating this year's distinguished CHEST educators. The 2023 DCE recipients represent the top 4% of CHEST faculty. This year, we recognize 171 individuals, including 14 who are receiving the designation for the first time. We are truly grateful for all faculty who advance CHEST as an international leader in clinician education. Thank you. I would also like to mention that we have a number of honor lectures that will be taking place during the course of the meeting. You can see them here. And I would like to just to shout out the presidential honor lecture, which happened today. Dr. Anne O'Donnell, a mentor and colleague of mine for many years, gave a phenomenal talk on bronchiectasis. So thank you, Anne. And thank you to all the others. Please, please join their lectures over the next three days. Thank you. Okay. So this next value is going to be a little harder. Say lanakila. Lanakila. Hou. Hou. Put it together. Lanakila Hou. Lanakila Hou. The new champions. On board our sailing vessel going to Tahiti, we were always looking for a sparkle in somebody's eyes. The person that we're going to pass the responsibility on to. The person that could accept the kuleana, the responsibility and the consequences to make the right decisions. Lanakila Hou, the new champions, was about a spirit and a soul that this person sitting on the canoe may not even think he or she was not worthy of the responsibility. But as we all know, sometimes in life, responsibility grabs you by the neck and puts you here. And it says, sorry, you are chosen. You are the chosen one. So please, Lanakila Hou, we celebrate the new champions, the passing of the torch. We celebrate all these wonderful things because only greater things will come. Lanakila is champion. You can be a champion of all different sorts, but in your profession, you're the expert in what you do. Therefore, you are a champion in all that you do. I will be back to speak more about our voyage. In the meanwhile, all of your champions, congratulations to the passing of the torch for those in hand. What an impactful story. Thank you, Clifford. And part of his ohana for sharing their traditions with us as we visit this home. So for me, this has been a very busy year. It's been amazing. I've had an opportunity to work with so many people as CHESS president. I can only tell you that I am truly honored and I'm really humbled by the amazing leaders this organization has and the phenomenal members and energetic staff. We couldn't do all we do without everybody working together as a team. For me, there are lots of things I wanted to achieve this year, and if you know me, I usually have a list that I wanted to accomplish yesterday. But there's a lot of things that take a lot of effort and work, and we've been putting a lot of effort into a number of them. So I want to highlight them for you. For me this year, strategically partnering with our sister societies, both globally and domestically, was extremely important to strengthen our message around the world. One of the events that I wanted to highlight was the CHESS Philippine delegation where Dr. Stephanie Levine was able to be our representative. And here's another example, the ALAC Congress, where Dr. Mauricio Donkers went to give a lecture in Spanish in the Dominican Republic. We've strived to keep these connections together so that we can spread the education that we do to all members of the world. It's also been extremely important to me to expand our community. We have been welcoming new members. At this meeting alone, we have almost 2,000 medical students, residents, and fellows. Amazing. We will be breaking our record that we set in Nashville. If you are passionate about providing excellent patient care, you belong here at CHESS. It's extremely important to me to welcome the whole health care team and every level of clinician. We are striving to create more opportunities, not only for our attendings, but for our nurse practitioners, our physician's assistants. We're partnering with the critical care nurses, our respiratory therapists, and on and on. This year, we formed several communities, one for our respiratory therapists and the other for women in chest medicine. So we're very, very excited to be starting those. Our commitment to strengthening the whole team is for the benefit of all of our patients. I'm very, very blessed to come from New York City and to work for a phenomenal health system. Under the leadership of Dr. Dan Sturman, we have a phenomenal faculty and fellow group. More than 100 faculty, and right now I have 28 fellows in my 22nd year as program director. And I have several hundred fellows across the United States and some even internationally that have graduated. I'm blessed to be at Bellevue Hospital for the last 30 plus years and be able to serve such a diverse patient population and to work with such a diverse team. I also have a photo of my bronchiectasis team at NYU Langone, where we serve and treat patients from all walks of life who have bronchiectasis and NTM. And I couldn't do what I do this year and probably for the last 20 years without the help of everybody in those photos and beyond. So thank you to that group. Thank you. But this type of diversity can be experienced here through the CHESS community as well. And one way it's reflected is in our new organizational values. Our values of community, advocacy, integrity, innovation, and inclusivity are the result of a tremendous amount of time and effort encompassing input from a wide range of CHESS members, leaders, and staff. These values are reflective of the CHESS organization and will guide decisions for years to come. They also serve to elevate the work we are doing in social responsibility and health equity. Advocacy is the driver of health equity, and CHESS has made significant strides advocating for members and their patients. Here you can see CHESS' fifth pillar, which was added this past year, the pillar of social responsibility. It encompasses our organizational values, all the advocacy efforts that we do. You can see CHESS Advocates is a new e-portfolio that you can access online. Philanthropy efforts, I'll tell you a lot more about those, and DEIB initiatives. And you can see that under philanthropy, we have repositioned ourselves with four very important pillars. And this year, we partnered with the American Medical Association, along with Dr. Studdard and our advocacy team, and we were able to impact improving patient access to supplemental oxygen therapies and removal of barriers to care for lung cancer screening in Medicaid programs, two resolutions that were on the floor that were passed. Over the past 10 years, our philanthropic efforts have allowed us to give out more than $12 million in research and community impact grants. The goal is, is that in the next five years, we should double that. We have five community impact grants this year, covering topics such as rural lung disease in Rwanda, vaping education in the Philippines, Medical CHESS Ambassadors Project in the Philippines, pediatric critical care resources in limited populations, and a tuberculosis awareness program for African immigrants in the Washington metropolitan area. Other research grant recipients will be formally recognized at their network meetings on Tuesday. I'm also very proud to let you know that we were able to give 36 diversity travel grants, and many of these recipients are here today. They come from 18 states and Puerto Rico. And we hope that we will be able to increase the number of diversity travel grants that we give out at every meeting and mentor these recipients so that they, too, can ultimately become leaders at CHESS. One special program that I want to highlight for you is a collaboration that we're doing with the APCC MPD, the Program Directors Group, on a fellowship that we put together for medical educators. You may ask, what is this program about? This is a unique fellowship program. It will fund a mentor who is an experienced medical educator from one institution, and that mentor will have a mentee from another institution who would like to do a year of research in medical education. The fellowship will support protected time for the mentor, and it will also support a one-year research project for the mentee. The intent is supporting a fellow who would like to pursue a career in medical education and significantly contribute to the diversity of the medical education community. We're excited to do this with the Program Directors Group and are thrilled to announce the mentor of this inaugural program today. The mentor is Basak Charu from the University of Washington. We are so thrilled that Basak is going to be the mentor. This is a $100,000 grant that goes to the mentor and mentee to achieve these accomplishments. Fellowship applications are due December 1st, so all you fellows out there that are interested in medical education, please do not forget to apply, and we will be announcing the mentee at the Spring Program Directors Meeting this year in Las Vegas. If you would like to support this fellowship or any of the philanthropic efforts that CHEST is doing, please stop by the Experienced CHEST booth in the Exhibit Hall. I've spent a long time talking about the CHEST community, which is near and dear to my heart, but we all know why we are here today, to take part in the top-notch education that CHEST uniquely provides. It will bring us together here in Hawaii and to annual meetings from here to come. I would like to let you know that we found out this morning that Hawaii is our largest meeting ever. So thank you, thank you, thank you. Who would have thought that we would be here after COVID? COVID taught us so many things, lessons we don't want to forget. One of the most important things we've learned was that we have to be able to respond very quickly. It's critical to saving lives. As clinicians, none of us want to be caught unprepared, which is why I authorized the formation of a standing rapid response task force, which evolved from the ad hoc COVID-19 task force that Dr. Steve Simpson put together in 2020. The rapid response task force will create a repository of information for crisis scenarios, share best practices with clinicians looking for guidance, especially in the areas affected, and adapt resources quickly based on the current environment. And you can see here, because of the wildfires in Maui, this infographic was put together on the health effects of wildfire smoke. And we hope to have them involved throughout the year as these crises occur. CHEST is doing so much in the area of education. I did want to highlight our two new journals, CHEST Pulmonary and CHEST Critical Care. And I wanted to mention our clinical curriculum pathways, which is a new way to learn. The asthma education pathway is available, and we just launched a lung cancer curriculum pathway. You can learn the basics of asthma, or you can learn what you need to know about severe asthma. These pathways are available to our clinicians and can be used by trainees, as well as our primary care colleagues. There are two other special programs that I want to tell you about that were developed specifically to impact patient care and the clinician-patient relationship. A little bit different than the usual education that we do. They were introduced in Nashville, and they've made great strides since then. The first five minutes program is a CHEST initiative that focuses on getting to know patients better in a short window, five minutes, and establish a better connection, faster and more meaningfully. It's offered online and in person. And I was lucky enough to bring this to NYU for a live course. I invited many of my key faculty and program directors from many other subspecialties. And I was a little suspect. What could I learn after all these years about communicating better with my patient? But I'm very open-minded, took the course. We had a blast. We bonded. And then the next week, we went to clinic to see if we could utilize some of the things that we learned. And I have to tell you, it really impacted me. I now stop three, four, five seconds before I knock on the door of the next room. Normally, I'm trying to go as fast as possible and tell the patients their CAT scan results and their PFD results and schedule the follow-up. But I stopped just for five seconds to think about that patient more than just their CAT scan results, about them as a person, about them so that I could find a way to connect. And with a little bit of calmness, more than my usual craziness in clinic, walked into the room and spoke to them and let them tell their story. I know we're all afraid that the patient is going to talk for five minutes, ten minutes, a half hour, and you have to go to see the next patient by then. But based on evidence, if you let them tell their story, it's usually not more than a minute or a minute and a half. They feel comfortable. You may hear very important things, and you bond with them. And in the end, actually save time in your visit. So it's really changed the way we run our clinic, and I would encourage all of you to look at the online modules or even try and host a live meeting at CHEST. Another initiative with the goal of improving patient care is Bridging Specialties, Timely Diagnosis for ILD. This initiative seeks to get to an ILD diagnosis faster by partnering with our primary care physicians who often care for these patients in the beginning. The steering committee created a clinical toolkit to more quickly identify signs of complex disease, and the next step is to get the toolkit into the hands of our primary care colleagues. So we recently awarded Dr. Amritwati Abdullah and Dr. Kavitha Selvan each a $100,000 grant to put research towards implementing the toolkit in their institutions. So I'd like to congratulate both of them. We can't wait to see the impact that you have. At this point, I get to say my thank yous. The first group that I would like to thank is our CHEST staff. I want to thank our CEO, Dr. Bob Musacchio, and all the staff who put all of these initiatives into motion. Their energy and commitment to CHEST and its members is truly unique and exceptional. We wouldn't get anything done without them. My Board of Regents, what a group. Their wisdom and diversity of opinions has really helped me through this challenging year. We've had countless discussions and countless discussions and countless discussions that have gone on and on about topics until we really felt comfortable to coming to a decision. I can't thank them enough. The other P's who I meet with very frequently, Dr. Jack Buckley, Dr. John Howington, and Dr. David Shulman, are all there for me whenever I need. They always give me honest feedback, no matter what question I'm asking, and I can't tell them how much I appreciate that. It's been a pleasure to be working with them, and I will miss doing that every week. And the last group that I want to thank, and I miss them, is my family. I have to thank my husband, Dr. Lauren Harris. He is my pillar and my soulmate. My wonderful daughter, Danielle, who is truly my right arm, and my son, Jeffrey, and my mom, Amy, who is here with me today and comes with me to almost every CHEST annual meeting. All of my brothers, sisters, aunts, uncles, nieces, and nephews have been with me, supporting my career since I started, and they do believe in one for all and all for one and help me out whenever I need. So I can't thank them enough. We now have reached the time where I introduce you to our President-elect, and I transfer the symbol of the Office of the Presidency. Although his term does not officially start until January 1st, it is my distinct honor to now formally welcome him as the 2024 President. Let me tell you a little bit about Dr. Jack Buckley. Jack is a master educator. We initially met at the beginning of our careers when we were very involved in the APCC MPD and ACGME, and now we are together here at CHEST. I feel very secure handing over the wheel to Jack as our new captain, as he has been involved in all that CHEST does. What I have learned about Jack is that he's a wonderful listener. He is patient and fair. He's a passionate clinician, educator, and family man. He also knows how to enjoy life, which is so important. He loves fast cars, nature, and fine wines, especially ones from the Piedmont region in Italy. Who better to lead us as the 86th CHEST President? Everyone please welcome CHEST President-elect, Dr. Jack Buckley. I'm Jack Buckley, and it's great to see you all here in Hawaii for CHEST 2023. It's my honor to serve as CHEST President for 2024, and this role of the President is to guide the Board of Regents as we provide governance and direction to the organization so that we can fulfill our mission. It's not one person, but it's a collective, and we use the values that Doreen just shared to shape our actions and help define who we are. And there's work to do. As our world changes around us, we must not only adapt to the current environment, but anticipate the future and take the lead by influencing the direction we believe to be important. But shaping the future requires some reflection on the past. CHEST started as an organization centered around preventing and treating tuberculosis. As progress was made, the entire field of pulmonary evolved from those tuberculosis experts. From there, critical care emerged and continues to evolve. Now we're seeing tremendous growth in the roles of the advanced practice providers, and in the ICUs, and more recently, a resurgence of our cardiology critical care group. So we're excited to welcome these colleagues into CHEST as we move forward. But reflection on the past is more than looking at how we've treated diseases and how those have evolved. It also means reflecting on who we are as people, which is why our diversity, equity, and inclusion efforts are so important. Unfortunately, the progress of medicine has not been shared by all, and the data are clear. The health disparities in the U.S. are significant, and we know that patients do much better when they share a background and identity with health care providers. We know that's so true. But if we're being honest, our field is not very representative of our society. And fixing that will require more than encouraging medical students and residents from historically underrepresented groups to pursue careers in pulmonary critical care. According to Dr. Fryer, it probably starts in elementary school. So why do I bring this up? Because each of you can help in your own community. Reach out to your local elementary school and offer to help inspire these young kids to get into health care. Yeah, you can tell them it's hard work, but let them know from an early age that they can do this, too. Be a mentor. Make it meaningful and make it enduring. And while you're at it, send me a note about your experience. I want to hear from you. I want to hear what your experiences are. The importance of this mentoring lies in the positive impact these young people will have on the external world. But there's an internal reward to mentoring as well, which is the privilege of that behind-the-scene view of getting to watch your impact on hardworking young people who are accomplishing great things. So let me highlight three. I've known Dr. Geneva Tatum since her senior year in medical school. She's the program director at Henry Ford in Detroit for the past 14 years and recently served as president of the Association of Pulmonary Critical Care Medicine Program Directors. I met Aaron when he was a freshman in college. We went to the same undergrad a few years apart. He's now in his final year of Pulmonary Critical Care Fellowship at the National Consortium at Walter Reed Medical Center and was just featured in our alumni magazine for his own mentoring success. Now many of you know Dr. Gabe Bosslet, whether it's through CHEST or maybe it's on social media. And like Geneva, he's also been a fellowship program director. And like her, a number of his trainees have also gone on to be fellowship program directors, which is a role that's been near and dear to my own heart. Now looking ahead to next year, which is my job, I'm happy to share that Gabe is also our program chair for CHEST 2024, which will be held in Boston. Planning has already begun. In fact, the call for topics is currently open. So while you're here, use the opportunity to develop ideas and build a session for next year's meeting. And if there's a session that you want to see, network around and try to find the perfect panel. As you do, keep in mind that the CHEST Scientific Program Committee favors sessions that are delivered from a diverse group, whether that's gender, race, type of clinician, institution, and even geography. Keep that in mind. This is an opportunity to meet someone new. And like, come on, I'm giving you a conversation starter. So take full advantage of our meeting. Network with some colleagues, meet up with some old friends, and learn something new. Have fun and have a great meeting. I told you it was going to get harder. So this value is called, Ikaika nalaao koa, uka mauna, ameka moana, ika vaakau lua. You got that one? No, real short. Koa. Koa. Koa is our prize tree that grows up in the forest, the hardest of woods. We're able to withstand any challenge coming to it. Because of this, it has adopted a disposition that we put to our warriors of today. Nakoa. The ability to stand balanced. The ability to withstand any challenge that comes their way. With intelligence. The ability to bend sometimes, but not to break. That is koa. The beautiful wood grain of the wood, everything is appreciated. Our canoes were made of this material. So all of you, Nakoa, be brave. Steadfast. I am thrilled now to move on to our keynote. I want to tell you a little bit about our speaker and why I chose him. I really wanted a presenter who could relate to all of what each of us goes through each day. I don't think the world quite understands how complex our jobs are. Who better to hear from but one of our own? Dr. Cedric Jamie Rutland is the jack of all trades and a delightful human being. Jamie is a practicing physician in the field of pulmonary and critical care medicine and so much more. He practices pulmonary critical care in every setting and he collaborates with industry in a number of cutting edge areas that are advancing, particularly immunology and interstitial lung disease. The best thing about Jamie is that he has a very realistic but optimistic look on the world and on the career of being a pulmonary critical care physician. He doesn't let the day-to-day challenges stop him and if one door closes, three more open for Jamie. He believes in self-accountability. Jamie is an outstanding communicator, as you will see, and I want you to know that if you see him around the meeting, please make sure to congratulate him because he's also one of our new FCCPs today. Please help me welcome Dr. Cedric Jamie Rutland. This is very humbling. Thank you for that kind introduction. I really appreciate it, but I think we're here to spread some messages, so let's get to it. I've been asked to talk to you guys about a new perspective on diversifying medicine, but when you actually think about it, diversity, what does that even mean? For most folks, diversity ideally means people of different races, different genders, different ethnic groups, different religions all working together cooperatively, but for me, diversity in medicine is so much more than that. It's beyond the bedside. It's beyond the clinic. It's beyond those white hospital walls that we're always walking down. In our world today, patients demand explanations, and if we don't give them one, misinformation fills the void. Diversifying medicine is finding new, creative ways to take years of our education and experience and communicate this knowledge to the public, all of the public, because the more we all know, the better we all do. We all know natural selection gets the best of those that choose not to evolve. You can't feast on the fresh leaves at the top when your neck is too short. The evolution of media, social and other, the newfound dynamic of post-COVID independence has provided so much opportunity in giving people more control to create a better life balance in terms of patient care. For me, this balances 40% outpatient clinic responsibilities. With this, I still do what I love. I get to see patients, hear their stories, treat their diseases, but I also have the opportunity to learn the business model, to understand the ins and outs of insurance, to educate myself about the finances of medicine, an essential skill we as physicians do not receive in our training. In my clinic, I also work closely with PA and medical students. I always wanted to stay in academics, and I'm very jealous of so many of you out here. I even flirted with getting back into a university, but then I realized my calling is right here, right where I am. A lot of people have their thoughts, but I had a purpose before anyone else had an opinion. And as a private practice physician, I had to figure out a way to stay in touch academically. I also feel like physicians are losing power in health care, and I didn't feel like academic medicine did much to regain the autonomy we once had. 10% of my time is spent in the ICU, working with, not for, because there is a difference, another private practice group. I sign on for the hours that I want, then I work at night, six to seven nights a month. And I get to do all the things I love about the ICU without burning out, without missing every holiday with my family. I finally own my own time. And for the other 50% of my time, I've been able to truly nurture my passion for education, whether it be for the general public or for my peers. I want to thank all of my guests today. A special thanks to Dr. Cedric Jamie Rutland. This is Barbershop Medicine. To be able to generate or manufacture a vaccine, you have to know what the virus looks like. We really appreciate you being on today's episode of Barbershop Medicine. It's great to be with you guys. Thanks for having me. We're going to jump on the expert line and head out to the Los Angeles area where we're going to connect with Dr. Jamie Rutland. You are a board-certified pulmonologist. Dr. Cedric Rutland with the American Lung Association. It's so much easier to prevent a disease than it is to treat it. Trust me. One of the primary reasons we, minorities, are not getting the vaccine is because it's not offered in the places that we trust. What we're working on as far as limiting and eliminating access to the vaccine. It's better now that you're getting the vaccine. You have to push it forward now. And the absolute goal item for everybody that's listening right now is to learn CPR. I'm Dr. John Wright, Chief Medical Officer at Rutland. And I'm delighted to be joined by Dr. Cedric Jamie Rutland. Thanks for having me today. Much appreciated. When you were going through your initial phase, what were those conversations like? I'm Cedric Jamie Rutland and this is the day in my life. I do it all. I do it all day long. Minute by minute. Hour by hour. He's the greater threat to our case. Meaning, and it's about speaking easily. We just finished having a speech we got four hours ago. I like people. I like talking to people. Where they came from. I just want to know what brought them to that very moment where we are standing right now. It hasn't been easy. This hasn't always been easy for me. You know, and I always go back to this story. Second year of medical school was really challenging. It was really hard. If there's one thing i have because of my mom who's sitting in the audience, it's awareness. And i began to notice that as i spent more and more time in the books and more and more time studying, I actually couldn't read longer than 35 minutes. I'd get up at the coffee shop, talk to the people next to me, horse around, meet new people, meet the owner of the coffee shop. I'm not really a complainer, but i did approach our school counselor and she suggested i see a psychologist. So i go to the psychology office at university of iowa where i went to med school. And i end up in a waiting room with ten 7-year-olds and a 26-year-old. Me. After some testing, it turns out i had adhd, add, i didn't even know they were different at the time, dyslexia and dysnomia. But apparently the amount of information i could absorb in those 35 minutes was insane and that's how i got to where i was. I never looked at these diagnoses as a disadvantage because i can wear many hats and pay attention to a lot of things at once. But when you need to focus on just one thing, being easily distracted, not great. So i started taking medication, methylphenidate, as needed. And for me it was career trajectory changing, life changing. I took advantage. I started over in the middle of medical school. I learned my current curriculum but went back and reread everything from first year to build on my foundation that was just full of defects. I filled these gaps. I stopped collecting dots. I began connecting dots. Immunology became my love. All the cytokines and chemokines released made sense to me. White blood cell recruitment or just cell recruitment in general, it made sense. It was like the body making a bunch of phone calls and giving instructions which led to patient symptoms. So i applied this and i kept applying this moving forward and i just built. I just laid this foundation of information, framed the doors, laid brick by brick. I learned to explain cell communication better than most and continued to expand my interest in pathologies. Started with interstitial lung disease and idiopathic pulmonary fibrosis. It's now transitioned to the immunology of asthma, pulmonary hypertension, interstitial lung disease and bronchiectasis. These are all things that i like to educate about on my youtube channel Medicine Deconstructed. Just think about a cut on your hand. The two areas of the cut are going to be able to touch one another. And then the healing cells go in between that cut and mend that fence. And the alveoli, which is an empty space, when you have that break, you don't catch that other side to try to heal it together. You're just going to keep laying down that scar. Let's go inside the body, take a dive in and look at what happens actually. What's up Paul, how you doing? So it looks like we're in the airway. Let's talk about what surrounds us. Once this allergen or this antigen hits this airway epithelial cell, the airway epithelial cell is going to secrete certain cytokines, what we call alarmins. A concept called antigenic drift. And what happens is the hemagglutinin protein, that structure that you saw on the virus, changes a little bit every single year. So as these amino acids change, so does the virus. But remember, there are five antibodies floating around in your bloodstream. IgA, IgM, IgG, IgD, and IgE. When you look at the structure of an antibody, there are heavy chains and there are light chains. Antibody tips can change the way they look to bind specific targets on organisms when we're sick. This tip is called the fab fragment, and these fragments have been manipulated by scientists and have led to monoclonal antibodies. Those are going to bind specific products. But new particles, which are pieces of the antibody called the nanobody, have been created. A nanobody is a fragment of the heavy chain. It's basically just the tip of that heavy chain. And what's being done is linking this tip with other tips, which may bind other products simultaneously. Imagine having to only take one medication that binds multiple targets instead of taking ten different ones. And so, you know, when you think about it, when we're talking to patients or we're talking to our colleagues, there's different language that needs to be used. But all of this came from my diagnosis, and my ability to communicate came from sort of neurodiversity. It's all thought of as a disadvantage or a disability, but it wasn't really. I understood the need for diverse forms of communication due to my own struggles. Concise, visual, entertaining delivery of information was necessary, and it's how I educate. This is how I effectively communicate with all patients, all my patients. Yes, those who think and look like me, but also those who are culturally, ethnically, educationally, spiritually, all the ways you can think of, different from me. Black Americans are over three times more likely to die of particulate matter exposure than white people. Exposure to dangerous pollutants harms health by increasing the risk of asthma, heart attacks, strokes, cancer, and low birth. When inhaled, soon particles get into the lungs and kill up to 200,000 people annually. This risk can be attributed to environmental injustice stemming from the historical legacy of redlining, structural racism, and unfair zoning practices allowing polluters to build power plants in toxic industries near and in black communities. In short, diesel trucks are driving through black neighborhoods. They ain't driving through white neighborhoods. And I know my culture, but I have to continue to learn others' cultures as well, because I don't know everything. But I do listen really, really well. But then I got to this point where I wanted to know what drove me, what paid my path, what motivated me to see people, to hear people for who they are individually. And I know my wife might be saying, he doesn't hear me sometimes, but I do, I do. But what I'm going to show you next is not only how I arrived at my purpose in medicine, but also how I continue to move forward. And what follows right now, and I have two beautiful little girls, an 8-year-old and 11-year-old. But what I'm about to show you is my older daughter explaining something to me. She's going to communicate something to me that she got from her teacher. And you're going to see this right now. I film a lot at home, and so the kids come in after school, and they just kind of say whatever's on their minds. I film a lot at home, and so the kids come in after school, and they just kind of say whatever's on their mind. But if you didn't get that last clip, my daughter's teacher told her to ask me about slavery because I was black, and I would know about it. She's a teacher in America, and I'm supposed to be the expert. I didn't know how to respond. So I learned, right? It turns out that my family is lucky enough to know a little bit about our history as it was written down. We have family members and slave masters that wrote letters. And someone in my family would know, and I've got some of these letters to prove it. Here's one of them. I have given bequeathed my wife, Isaiah Westmoreland, all my Negroes, Dina and Rachel, Ailsie and John, Mary, Isaac and Mark, and all their increase. If there should be any rumor, Westmoreland, Coretta County, State of Georgia. First day of September, 1845. That was my great-great-grandfather's slave master reciting the names of his Negroes in a document. The names mentioned are also within my family. But the names were Dina, Rachel, Ailsie, my aunt's name, John, my brother's name, Mary, Isaac, my great-great-grandfather, and Mark. So, yeah. My daughter's teacher was correct. I guess I do know something about slavery because of my ancestors. But that's what a stereotype is. It's an assumption that it's not always wrong, but it cuts off your ability to look deeper. To see someone as themselves, independent from all stereotypes and preconceived notions to see a person's whole unique story. If a written word is the same, that's plagiarism. And in DNA, it's cloning. But not a single one of us is the same. This is my great-great-grandfather, Isaac Westmoreland. He was born a slave, along with his mother Ailsie, like I said, my aunt's name, sister Mary, and brother Mark. But slavery wasn't the most defining or interesting part of this man's life. In his letters, he barely mentions it. He had a shoemaking business. Look at my shoes. You guys all know that I'm a sneakerhead. You guys all know that I'm a sneakerhead. But with that business, he managed to send nine, and I'm going to tell you this again, nine of his eleven children who survived adulthood to college. To college. This is in Boston. He's in Wilkinson. Son is Ike. He's in the city of Washington. There's my baby boy. He works at the summer resort above Boston. With his clothes, he's going to school. Take care of yourself, my dear brother. And try to meet me in heaven. I remain your loving brother till death. Isaac Westmoreland. It's crazy that we have these letters. He was so proud of his kids and all that they had accomplished. His goal was to do something for his family. Knowing all the disadvantages that they faced, I know for sure he didn't think about what was fair or not. He didn't think about why it was impossible or what he couldn't do. He just put one foot in front of the other. No excuses. No complaints. But this is a heavy weight on a person. Having to defy what is expected of you. Watching your children to escape the world that sees you only as one thing. All of what my great-great-grandfather went through. No complaints. He just kept moving. I imagine him as a patient. What would he be thinking? In the world he came from, would he even bother seeing a doctor? Did his pain ever matter? Would he even feel comfortable communicating his symptoms if he had them? Remember that first definition of diversity. The part about different races, religions, etc. All working together. To achieve that, we, all of us, me included, must remain vigilant and park our biases outside the examination room. Not just because it's rude and insensitive or ignorant sounding, but because medical stereotypes have real clinical outcomes that can be deadly. In the United States, rates of stomach cancer in men are highest for Koreans. And rates of cervical cancer are highest among Vietnamese American women. If you group all Asian people together in a single stereotype, you're going to miss that difference. Half of trans people report being mistreated medically, a quarter of those don't even seek health care because of this fear. Stereotypes also persist in my community. There are still ideas that persist about physiologic differences between black and white patients. Beliefs that black women don't feel pain come from slavery. Social experimentation on black women without anesthesia, I kind of proved that years ago. Could this explain the higher maternal mortality rates amongst our population? The spirometer is given a racial correction because of the perception that African Americans or blacks had inferior lungs. The big fact is we didn't, we don't. We were just doing all the work that led to inflammation in our lungs. But this was all based off something Thomas Jefferson wrote in 1785, it's 2023. This all has consequences. You guys all know this. As a doctor, to do my job effectively, I have to break through these stereotypes of who my patients are and those false notions of who I am. The third year of medical school, I was on an ob-gyn rotation. I was on gynonc for 10 days. At University of Iowa, you do gynonc for 10 days. I mean, you did, God, 15 years ago. There was a 77-year-old female with metastatic ovarian cancer in the surgical intensive care unit. This was actually my first ICU experience, too. I was the med student on the case. We all remember this. We have all the time in the world. We have all this time. So I updated the family daily, drew pictures, showed pictures, showed x-rays, explained CAT scans. This is when I really taught myself how to read imaging. This family was from the northwest corner of Iowa, and they were farmers, typical all-American farming family. Yeah, they were white. They didn't look like me. And when I first began to update them, when I walked in that room for the first time, you could feel the tension in the room. They weren't comfortable with me. As a black person, you know when it's that. But I kept going. I explained it all. It helped me. It helped them. They got more and more comfortable. I was being me, and they were open to letting me explain because they didn't have a choice. I had the most time by far. My 10 days on the rotation went by quickly, but I remember the P family fondly. I left the rotation. The very next day, my classmate Kevin, who is a radonk in the DMV area somewhere, he finds me in the hallway. He's like, Cedric, Cedric, Cedric. You're the P family. He's like, yeah, I do. Kevin and I weren't friends. He's like, well, Mr. P said something I thought was racist. What did he say, Kevin? He said, I've never loved a colored fella as much as I love Jamie, but I do. I almost let it bother me, but the guy said Jamie. Then I turned to Kevin, and I said, it wasn't racist. It was quite the opposite. At that moment, I realized me communicating openly with that family may have changed Mr. P's outlook and that family's opinion of an entire race of people. All I did was use my gift, communication. I felt good at something besides basketball. We may not always have 10 days to connect to a patient or their family that doesn't like them because of their own prejudices, but it's still on us to try. The lesson for me was this. Kevin was stereotyping because of the language he used to communicate his thought and appreciation for the care they received, the language the patient's husband had used. It had clinical significance. Instead of hearing the family is happy with the care their relative received, Kevin heard racist old white man from Iowa and not the clinical context of his statement. This happens. I want you guys to take a look at this picture. Can you tell which one is my grandfather? Yeah. Look closely. So my grandfather started his career during World War II with the Tuskegee Airmen. That's when the United States trained black fighter pilots for the first time. Everybody knows this. Granddad wasn't a pilot. He was a civilian who worked in logistics. He was always where the action was. My mom and her siblings grew up in Europe. My mom speaks French and German and English, and I just speak English. We'll talk about that later. But granddad stayed with the U.S. Air Force after the war, eventually retiring as a top civilian at McClellan Air Force Base in Sacramento. Even though Sacramento isn't the Deep South, racial discrimination, particularly in housing, was rife in those postwar years. Granddad was unable to do what his white co-workers did easily, routinely, buy a house in a decent neighborhood. But he got around the problem. He asked his white friend to buy a lot in an all-new white subdivision, then sell the lot to him. I think about my granddad having to fight a stereotype that hard, fighting your way to get the basic equality you deserve, having to jump through hoops to get your basic needs met. He was the man who raised me as a son. I'm going to tell you something that you're probably going to find interesting. He always told me, it's never because you're black, boy, that's what he would say. He didn't want any of us, including my brother and siblings and everybody else in the family, he didn't want us thinking that there were limits. And I never heard him once complain, despite the era that he lived in. He picked me up every day after school. Mom was at work during the day and law school at night. And in the fifth grade, Sister Ann, I went to Catholic school, she made us write down two short-term goals and two long-term goals. Short term, score 20 points, get straight As. Long term, get a scholarship to North Carolina or Georgetown and then go to the NBA or go to medical school and become a doctor. I put those goals on my grandparents' refrigerator. They remained there for 20 years. My first year of college, Granddad would take me from Sacramento to UC Davis every other weekend. I was recruited to play hoop. But on one of those drives across that Yolo Causeway, Granddad had a serious look on his face. He's driving, and Granddad always drove a Jaguar. But he turned to me to say, listen, boy, he didn't say boy, but I can't say the word he used. You can't chase women, play basketball, and try to go to medical school. One of those has got to go. I quit basketball. I wasn't sad. I wasn't mad. My knee hurt at the time. It probably made it easier. But he was always direct with his communication towards me. It was very effective. We all know that communication means the imparting of, exchanging of information or news. When I applied to medical school and interviewed at the University of Iowa, there was no way I wouldn't be there. I loved Iowa. I still love Iowa to this day. But I also knew I didn't have the academic record of the average student accepted or so they published. You get there, you're like, did you really have a 3.9? No, bro, I had like a 3.3. Several months after my interview, I received a letter, and it was that small envelope. We all know what the small envelope means. But it read, we will place you on the out-of-state wait list, number 104. I was like, shit, number 104? I had been accepted at Howard, and I figured I was headed to D.C. Not a bad way to go, but I wanted to go to Iowa. So in the letter, I was labeled as a number. And at that point, I decided I wanted Iowa to know my name. So I did what most applicants don't do. I called every day. Annette answered the phone most of the time, but occasionally Penny would answer, Linda would answer, and others would answer. My legal name is Cedric, but I preferred Jamie. My middle name was James, and my grandmother decreed that I would be called Jamie. So from Iowa, they would say, hey, Cedric, how's it going? How's the weather in California? I got to know them very well, since I called every day. But my final sentence was always, any movement on the wait list. So I should get three weeks of this, right, and I'm calling every day, and I went from like 104 to 97 to 75 to 69. I can tell you every single number, but I've got to keep this shorter. But I got all the way to number 7, and at this point, I thought I had a shot. Then a couple days later, I saw this phone number that started with area code 319 on my phone. It was Iowa City's area code, and it was Linda. I knew their voices now, and she said, Jamie, Jamie, not Cedric, and I said, I'm in? She said, yep, you're accepted. I heard the entire office in the background clapping. But I went from number 104 to accepted because I communicated. They knew my name because I communicated. For one of the first times academically since college started, I wasn't a number. I had communicated, and then I formed a connection that other numbers most likely had not. The great thing about that year before medical school is I got to spend the last year of my grandfather's life with him. Of course, I didn't know it at the time, but my grandfather was a heavy smoker. As a young man, he was, and in the early 80s, he rolled around with an oxygen tank. You can see the nasal cannula here, and he never left the house without his inhaler zip bag. My goal was to understand what all of those inhalers did, which is probably why I'm a pulmonologist. But granddad couldn't make the white coat ceremony, but he saw the pictures, and in late October of 2005, which was his first year of medical school for me, he was admitted to the hospital with a small bowel obstruction. He had surgery, made it through the surgery, but due to his significant emphysema, he was tough to wean from the vent. I don't know what any of that crap meant back then, but I didn't know anything or nearly enough to communicate with my family. I knew nothing. I didn't know what to say. In late November 2005, my family had elected to palatably extubate. I obviously understand those terms now. And on 11-27-05, my grandfather, my dad, died. I find comfort knowing that he wrote me the last thing he ever wrote anyone, and he just wrote, like, his words were, just remember to call me and be nice, right, and he wrote those words down. But I wasn't there, and I never went home to see him. I never went home to say goodbye. My mom, my uncles, my aunts encouraged me not to go because I was in med school and studying, and I thought you went home for other people. I thought you went home to be with your family. I didn't realize that you go home for you. I didn't realize that you go home to say goodbye and let go. And I try to communicate this to lots of people during end of life in the ICU. People don't realize how special that moment is to be able to be next to your loved one at that time. I went to his grave for the first time a couple years ago with my wife and two daughters, and I cried. I needed to, right? But because I didn't go home, I'm constantly chasing a bedside I'm never going to catch. And this event was the single source of my motivation to practice medicine and rush to the bedsides in the ICU, rush to the bedsides on the floor. I always want to communicate with these family members. I want to explain everything because I want family to understand because I didn't. Communicating with family members is just as difficult, perhaps more, as learning how cells and the body communicates. But just as communicating with family is extremely important, to be a successful health care provider, understanding cellular communication is essential in diseases we see, COPD, interstitial lung disease, idiopathic pulmonary fibrosis, EGPA, sepsis, heart failure. Mastering this knowledge and coupling it with superior communication skills is crucial. I think of pulmonary critical care physicians as the alarmists of health care. We are the damage-associated molecular patterns. We are the cytokines. We must learn cellular communication and how it pertains to disease. And more importantly, we must also become comfortable teaching these lessons to family, friends, and patients because our communication directly impacts how families receive bad news, good news, interpret it, and disseminate it to other family members and friends. And those collective interactions, our ability to communicate, dictates how society views health care, and that impacts further patient interactions, and that falls on us. I know we wear a lot of hats, but when shit hits the fan, it's us doing the caring. Look at the pandemic. Who needed to communicate? We did. Pulmonologists and critical care doctors. It's a heavy responsibility, but it's what we signed up for. My remarkable grandparents had four kids. My mom is the baby sitting on the lap of her mom. That's my uncle, my aunt, and my other aunt. Their children became a social worker, a lobbyist, a lawyer. My mom, she's here in the audience. You can stand up if you want, Mom. And her twin sister, who is a journalist. She's being too shy to stand, but she's not really a shy person. At age 50, my grandmother went completely blind, secondary to retinitis pigmentosa, something that's easily treatable now. But she never saw me. That was when her writing career took off. She wrote more than 30 published books, most of them Harlequin romance. You should see the things that she wrote. I was like, Grandma. Anyway. Damn. Her first book was a memoir. It was called The Trouble With Being a Mama, now titled When We Recolored a Mother's Story. I didn't really like the title change, but whatever. But it's about how it doesn't matter if you're black or white, mothers are mothers. You guys can Google Eva Rutland. You can read the books. Grandma was pretty cool. In the 40s, she had a very large styroid goiter. She went to Atlanta, where she knew all the black doctors, but none were trained to do the surgery she needed. So a white doctor was brought into an inadequate black hospital to an unfamiliar operating room without his usual nursing staff. He made a mistake. He severed a recurrent laryngeal nerve. You guys all know what that means, right? Vocal cords are paralyzed. For years, my grandmother struggled to breathe. But during the birth of my mom and her twin, Grandma obviously needed to take those big, deep breaths to push. The doctor at the time put a tracheostomy in. She was 26. After the birth of her twins, Grandma looked up at the doctor and said, leave it. I can breathe. She breathed through this, one of these tiny, old-fashioned metal tracheostomy tubes. Every night, she would cough for hours, cough up all the mucus when I would spend the night at my grandparents' house. I remember this like it was yesterday. And when I'm rounding in the ICU now, I see people get trachs, and they're complaining about coughing, I always tell them, my grandmother had one of these for 70 years that wasn't cared for by a physician. You're going to be fine. She wore that from the age of 26 to 95 until she died peacefully in her sleep. Imagine that, 26 years old. Not only a poor outcome, but one directly related to what we will see. Patients who have had horrible experiences with doctors. Some will be anxious, scared, dismissive, even combative. But we need to offer them an olive branch and try and connect. Because it isn't their fault what happened to them. And it's our job to communicate to them in a way that gives them a sense that we care. They matter, and that they have control of their decisions. Towards the end of my first year of fellowship, I was rounding on the pulmonary service with somebody you guys are going to recognize here in a minute. He was one of my favorite attendings. I went to KU Med for a pulmonary critical care fellowship. And of course, we had attendings that tried to make things really hard. Dr. Satterwhite. And this is SQS, Dr. Simpson. We went to the KU basketball games together. But he was one of those attendings that always said you could do anything. He was very open, always wanting to discuss things. We were walking down the hallway, and I was with this liberal pony-tailed man. And we were discussing a 70-year-old black female patient who was in the CBICU. Apparently, she was being non-compliant. And due to her significant oxygenation, Normally, traditionally, you guys all know this, I would go first. I was the fellow, and I would go present to Steve. But Steve was kind of cool. He was like, hey, let's just go together and just knock this out. So we walk up to the room. We go through the doors in the CBICU. And I can kind of see her being a little unreasonable and screaming. And I was like, Steve, like, relax. Let me go talk to her. I walk up to her, and I'm like, Steve, what's going on with you? And she's like, well, I don't know. I walk in the room. You judge kind of what's going on. And I was just like, Mom, let me tell you what's up. Let me tell you what's going on and why you're in the hospital. I don't think we've done a good job explaining. And I'm here to explain it. It's not always this easy. But in this case, it just was. I told her everything that was going on. I drew pictures on the whiteboard. I made sure she understood. She was calm and accepted what I told her. Steve and I walked away down the same hallway we were in on the way there. He turns to me and he says, how did you know to call her Mama? You just know. And I just knew. But I also know that same trick wouldn't work on my mom or my very proper grandmother, and especially my aunt, who probably edited that line into my speech. We're not all the same, right? Black people aren't all the same. But I always knew I could communicate. And when I was challenged to think about how I arrived here, I looked within. I'm trying to teach individuals like my grandparents in times of need. I understand my purpose. And I'm not going to allow life to make me forget why I do what I do. And I don't think you should either. I will always learn more. But the goal is to connect dots, not collect them. The relationships that I've developed with companies allow me to communicate or educate the masses, people like my grandparents, in times of need. Being able to do that has led to stronger relationships with academic leaders across the country. This has led to multiple media opportunities. But my purpose remains the same, to educate. I feel there are two ways to become a leader amongst our wonderful field of pulmonary and critical care. You can publish papers or speak from a podium or media chair. I forced myself up to the podium by taking an unpaved path to become a leader. I'm going to continue to foster my relationships and teach others how to do what I did loosely unintentionally, but now with intention. I will continue to lead and teach with a purpose, owning my time, knowledge, and the dedication I have put forth to carry out my goals and create my own personal vision of success. I hope you have or you will find your own personalized life balance too. It has been well-earned or is well overdue. Find your purpose. Communicate with not only your colleagues, but with your patients, their family, and their friends. Own your time and do all of this with a smile. Thank you for your time and your attention. I'm Jamie, a pulmonary, critical care, internal medicine, physician, producer, educator, content creator, daddy, husband, son, and brother. Thanks for the gift of allowing me to communicate. There are so many things that you could take from today's presentations. One that I would encourage you to remember is that we're stronger together. We're all here for a shared goal, providing better care for our patients. Whether it's through learning or reigniting your passion for medicine, when you return home, you'll be better prepared to care for those who need it most. Throughout this meeting, I encourage you to embrace this common goal and join together to enhance your learning and your chest experience. We're so glad you're here, and we look forward to seeing you at the chest reception on the Great Lawn. To close this session now, we're going to welcome back to the stage Clifford Naoli for a final message. The last value, kukui. One more time, kukui. The kukui, kukui means to be enlightened. Many of you have probably been to Hawaii before, and you've gotten this type of necklace, not knowing what it's about, and maybe hanging in your closet. But what this nut represents, there's an oily substance inside, and when a red coal is put to it, poof, it ignites, and it lightens up the room. This is why, again, another thing of nature is adopted under this position, that of being enlightened. The lei, a circle, it is not complete until put upon the shoulders of its recipient. The beauty is even more at that point in time. When we put this lei upon the shoulders of the recipient, we raise them to another level. We honor them. So I encourage you today, if you have a kukui lei, and you want to raise somebody up, bring the sparkle in their eye, exchange the lei with them. Honor that person, and make sure you understand that you are indeed enlightened. I hope every day that you get up, your lei will be in a display of prominence, so you can touch this nut and be the first seed on your lei of the day. And every person that you speak to, your clients, your patients, your colleagues, friends, family, whomever you touch, enlighten them with something, so they, in turn, can pass it forward and enlighten others. So at this time, ladies, I would like to present this lei to you. And you will honor each other for what you do and what you have accomplished. So please. I am honored to be here to do this for you. I am honored to be here as a patient of yours, but also to, as I say, do a transplant of fresh air into your lungs and to your heart as to who we are. So congratulations on what you do. Thank you. So now we're going to pani kapuka. We're going to close this session. But I want to leave you with two thoughts. Number one, what kind of ancestor will you be? What will your legacy be? Number two, that age-old question, is a glass half empty or half full? For the pessimist, it's one thing. For the optimist, it's another. For the great thinkers, the glass is always full. Why? Because half of it is filled with ha, ha, the breath of life, the first thing we gasp for when we are bored, the last thing we surrender when we transition. The bottom half is filled with a liquid called vai, the ability to make our bones and our muscles fluid that we can move about. And the rim of the glass represents the plane between the physical and the spiritual. So whenever you think about that glass, all you have to say is, Hawaii. It is always full. It is right there in front of you all the time. Just say, Hawaii, Hawaii loa. Maikai? All good? I hope that you learned something today. I will be out on the lawn asking questions of you. I have my brio ellipter on one side and my albuterol on the other. So at this time, I want to bring out my cousin, Nakia Naiole, who will sound the pu and will release the energies back into the universe. He is the younger generation of my family, Naiole. I am the hiapo. I am the firstborn of the firstborn of the firstborn of the firstborn. And this is why I use this, the tongue, the ability to speak on behalf of our family. We wear the traditions of our kupuna, of our ancestors. So therefore, what kind of ancestor will you be? Kanikapu.

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