SMACC Chicago: Cardia and Dynamis by Michael Lauria

SMACC Chicago: Cardia and Dynamis

In Stephen Pressfield’s book The Virtues of War the narrator, Alexander the Great, recounts his campaign against a massive and intimidating Persian army. As Alexander describes battles in detail, he places substantial emphasis on the cognitive aspect of combat, the art and science of thought and decision making in war. It is interesting to me, therefore, that when he reflects on his great campaign in its entirety, he does not attribute his overall success to superior numbers, equipment, strategy, tactics, or techniques. Instead, he very clearly credits the intangible and immaterial. The ingredient most paramount to success lay inside the individual soliders: “What drives the soldier is cardia, ‘heart,’ and dynamis, ‘the will to fight.’ Nothing else matters in war. Not weapons or tactics, philosophy or patriotism, not fear of the gods themselves.” 

Medicine is, quite certainly, not warfare. I would hasten to add that a reasonable alternative rendering of dynamis might be ‘the will to struggle, strive, push forward, and labor tirelessly.’ However, I think there is an ubiquitous and universally applicable message that echoes in Alexander’s reflection. A critical element to success lies in the unconquerable spirit and unflagging desire of a group to achieve a particular objective. In the world of resuscitation and critical care this objective is improving the quality of care rendered in the ICU, Emergency Department, or prehospital environment. Never has the very essence of cardia and dynamis in medicine been more apparent to me then at SMACC. One of the very first things that stood out to me as I began to meet the diverse and cosmopolitan membership of the FOAM family was the very nature of their commitment to coming to Chicago. Many people came from around the globe at tremendous expense to themselves, unsponsored by their institutions. Speakers received no honorarium to present. Numerous individuals dipped into their limited personal vacation time. There were also many medical students, registrars/resident physicians, nurses, and paramedics: a host of medical providers whose income is substantially less than attending/consultant physicians. Yet, they made the investment to come learn. 

I was also struck by everyone’s openness and how approachable people were. The conference was full of providers from around the world whom I looked up to and sincerely admired both for their ideas and communication prowess. As a flight paramedic and medical student, there was really no real reason for many to give me the time of day. Yet, they did. Many were happy to discuss different their ideas, provide feedback on concepts I’ve presented, and advice on a career in medicine. Whether it was between sessions during the day or at night over beers, people where happy to chat. In my opinion, they did this because they were simply altruistic, because they cared, because they were engaged, and because they wanted to see the momentum of FOAM carried forward in the next generation of critical care providers. The will to change medicine for the better was also evident in the presentations. Virtually every talk was meticulously designed, thoughtfully crafted, and well rehearsed.

 I often think that people underestimate the time and effort that goes into putting together a good presentation. Every picture, every word, and every color scheme are carefully selected. A new presentation might require 18-20 hours of work to refine the dialogue and get the timing just right to effectively communicate an idea in 18-20 minutes. This commitment to excellence in the absence of financial gain is, once again, testament to a deep-seated passion for sharing ideas aimed at improving the delivery of medical care. The effort of the presenters was complimented by the passion, enthusiasm, and participation of a global audience. Nearly every session I went to the moderators were inundated with questions. Even when time ran out, I’ve never seen such a large group of audience members stick around to engage with one another as well as the speakers. People were challenging opinions, sharing thoughts, and exchanging experiences. This dialogue continued through coffee breaks, during lunch, and late into the night. This was far from the average medical conference where people are spoon-fed ideas, rush out the door when talks are over, and happily collect their CME credits. 

Healthcare systems around the word face a litany of challenges and obstacles. The popular media seems to regularly underscore the problems, disappoint, and short-comings of medicine. Even in medical education, some institutions provide constant reminders endemic problems that have reached pathological levels. SMACC was, at least for me, a therapeutic intervention to inoculate against becoming disillusioned, disenchanted, and cynical. It was inspirational and empowering. Intelligent, passionate, and creative attendees from around the world gave me hope that these challenges could, and would, be addressed and overcome. This year was my first SMACC, but it won’t be my last. I learned so much, had an inordinate amount of fun, and left energized. The soul of the FOAM community and the esprit de corps of the SMACC participants reinvigorated me. Furthermore, it tempered by resolve to become the very best provider that I can be, today in the helicopter and tomorrow in the hospital. I will fondly remember many things about SMACC Chicago. Above all else, I will never forget the cardia and dynamis of my friends, colleagues, and mentors in the global critical care community. 

Michael J. Lauria MS2, Dartmouth Geisel School of Medicine Critical Care/Flight Paramedic Dartmouth-Hitchcock Advanced Response Team (DHART) Dartmouth-Hitchcock Medical Center Lebanon, NH 03766 




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