I hope you are reading this letter in a relaxed environment, a beach, a resort, or at the airport waiting to board for a family vacation far away. I also hope unlike me last week, reading on quarantine, because I got Covid! Yes, indeed, I didn’t get it at its peak in 2020 nor 2021, and not even this winter. I wonder what I did wrong because I did not let down my defenses: I wore masks, washed my hands, used a paper towel when opening doors, and wiped my cellphone. My easy, anecdotal conclusion is this strain of the virus is more transmissible. It felt like a bad flu, with myalgias, rigors, low-grade temp, and the worst, coughing! Have you watched Val Kilmer as Doc Holliday in Tombstone coughing from tuberculosis? It felt like that! So, please be careful as Covid is obviously still around, the vaccines and the boosters help you to pass through with mild to moderate symptoms, but it is not fun! And some people can still get very sick…
As I mentioned in my July letter, the Nomination Committee put forward the name of the new Secretary of the Society, who was approved by the Board. It is my pleasure to introduce a good friend and colleague who I have known for many years and with who I share common interests in brain death and beyond: David M. Greer!
David earned his BA in English literature from Williams College and his MD from the University of Florida. He trained in Neurology and NCC at Mass General where he served as faculty for several years, before moving to Yale as Clinical Vice Chair of the Department of Neurology. Five years ago, he returned to his beloved Boston as the Chair of the Department of Neurology at Boston University. David has also served as an NCS Board and Executive Committee member, has chaired many brain death workshops, and created the Brain Death Toolkit. He is a prolific academician, a consummate clinician, and most importantly a practical, down-to-earth leader with a great sense of humor. I am more than certain that as an Officer, he will guide NCS to sail through the rough waters ahead of us.
In my July letter I also mentioned the ongoing efforts to create an NCS Position Statement on Criminalization of Care. It required a lot of work, emails, discussions, legal advice, and concessions. Sarah Livesay, Mona Kumar, the Women in Neurocritical Care (WINCC) subcommittee and our headquarters staff, all have been instrumental.
It reads: “The Neurocritical Care Society (NCS), as an international society, is committed to quality patient care based on scientific knowledge as well as compassion and respect for patients worldwide. NCS has always been concerned by laws and court decisions that criminalize the provision of healthcare and criminalize unintended medical errors, thereby threatening the relationship between healthcare providers and their patients. The delivery of safe health care, for all, is predicated on the confidential relationship between patients and their providers. Laws that restrict the provision of medical and nursing care based on best scientific evidence is in direct conflict with NCS’s Mission and Vision, especially when these rulings impact those in minority or otherwise underserved populations. NCS will continue to advocate for the right of healthcare providers globally to deliver care based on their training, to act based on the best available evidence without threat of criminalization and to support patients to make healthcare decisions based on this advice.”
These five sentences capture our beliefs as a multidisciplinary, open and transparent Society, with members dealing with life and death situations every day. These experiences bring maturity and wisdom to all of us and make us better human beings and health care providers.Although state laws and Supreme Court decisions affect all of us, and each one may have a different opinion, NCS as a 501(c)(3) entity cannot take political positions. However, we felt we could not stay mute on changes that specifically affect the care of the population we treat in our Neuro-ICUs and, in a more general sense, affect all health care providers beyond the neurocritical care world. We do not work in the medical field, but to provide care to all people equally. And we should not be penalized for trying to help them, while sometimes even putting our lives at risk…
Socrates is an almost mythical figure from the ancient world. He is known through his followers, especially Plato and Xenophon and is considered the first moral philosopher, influencing the thinking of almost everyone that followed in the Hellenistic, Roman, Christian, and Islamic worlds. Despite his major impact during the eons that followed, during his times he was considered a very controversial figure by his contemporaries. Eventually, he was tried in ancient Athens for “corrupting the youth and worshiping false gods” and was sentenced to death. He rejected his followers’ suggestion to escape and died in prison by drinking “κώνειον” -poison hemlock. It is very difficult to pick one of the myriad quotes attributed to Socrates. But for the purpose of this letter, I found this: “Εν μόνον αγαθόν είναι, την επιστήμην, και εν μόνον κακόν, την αμαθίαν” - There is only one good, knowledge, and one evil, ignorance. Interestingly, in modern Greek “επιστήμη” means science, but in classical times it meant knowledge. Nothing new to us, as health care providers, who base our everyday management of patients on the knowledge of scientific evidence. Not based on our personal beliefs, which may be full of biases. But based on objective data. This is also relevant to our discussion above on the criminalization statement. Our responsibility to every patient is to treat him or her equally based on the best science of the day. Socrates also said the famous “Εν οίδα ότι ουδέν οίδα” – what I know is that I know nothing. True. Even scientific dogmas change with time, as new information proves many of them false. So, we do need to approach medicine as a live, vibrant, changing field. Although in 2022 this is the best we know and the best we could offer to our patients based on science alone, we should also need not be rigid, keep always a question in the corner of our minds, be inquisitive and be ready to have a Socratic dialogue with the forces of change…
Panayiotis (Panos) N. Varelas, MD, PhD, FAAN, FNCS
President, NCS Board of Directors
Professor of Neurology and Chairman, Department of Neurology
Albany Medical College