By DAVID SALCIDO
As I begin this, I am currently in the capitol of Slovenia, Italy’s well-forested neighbor to the East, for a conference on resuscitation. Many people, frequently including myself, cannot spell resuscitation, and lovely though it is in appearance and likely in etymology, I suspect the same is true for Ljubljana. So, it seems like an almost poetic choice for locating such a conference. Anyway, this evening wandering up the hill to the castle with a colleague, herself a Fulbright Scholar visiting Pitt for a year, gave me some time to reflect on a few things.
First, I recalled my first interaction with the Senate. In 2016, my colleague Lenny Weiss, an emergency physician and all-around incalculably good human being, and I were able to secure a grant to bring a citizen CPR system to Pittsburgh called PulsePoint. Basically, if someone calls 911 and reports a cardiac arrest, PulsePoint can tell you on your smartphone exactly where they are so you can run to the rescue. Cardiac arrest, particularly the kind that happens outside of hospital settings, is a special kind of nightmare. Your heart stops, often with little warning, and your brain is left dying while you are helplessly unconscious. For at least 350,000 Americans a year, a sudden cardiac arrest is the final punctuation on their lives; only about 10 percent who have one survive on average. As you might have gathered by my location, this nightmare is not uniquely American. And, for something so lethal, the first line treatment — CPR — is relatively unimpressive, so much so that a 10-year-old can probably do it. No offense intended to 10-year-olds. You just have to admit, the list of medical treatments you would trust a 10-year old to manage is fairly short. But such is CPR. In my first-ever visit to the Senate, I was trying to reach anyone who would listen to advance the case for CPR by spreading the word about PulsePoint. Frank Wilson, who was then Senate president, generously gave me the floor for a couple of minutes, and I was impressed enough with the warm response that I kept coming back.
Second, perusing the plush, green landscape, I recalled the current movement toward socially responsible investment (SRI) at Pitt. At its heart, socially responsible investment acknowledges that Pitt is a large, impactful institution, and that its actions, including management of its multibillion-dollar endowment, have consequences and moral burden. The endowment, you may know, is ultimately a complicated thing. Less than a war chest, it is more of a lake behind a hydroelectric dam. Technically it is true that it does not matter where the water comes from; the turbines will turn. Technically. And technically it does not matter where the water goes after the dam ... Actually, I encourage you to explore that metaphor on your own a little bit: fish, downstream villages, icebergs, potential energy storage, the whole thing. But suffice it to say, management and maintenance of the endowment is critical to Pitt’s continued existence, impactful to the general spirit of this institution, impactful to the world outside of Pitt, and the Senate must play a significant role. The full expression of that role will not begin until Senate appointments to Board of Trustees committees can vote, although progress on an SRI policy is a good start.
Third, as we crested the hill, looked out over the city and wandered through a curious outdoor photo exhibition, I reflected on the fact that I am humorously out of shape and my colleague, though plucky and athletic, recently had a blood clot (see deep vein thrombosis) on a long flight to Europe. We had made an agreement at the bottom of the Castle Hill that one would resuscitate the other in the event that one of us collapsed on the way up. She would seem to have been getting the short end of the stick. I am just a scientist; she is an experienced physician. However, if either of our hearts had stopped on the way up the hill’s footpath, the only real recourse would have been CPR until paramedics arrived by foot. Luckily, it never came up. Even so, one of us collapsing on the footpath is as real a metaphor for out-of-hospital cardiac arrest in general and the rationale for CPR training as anything. Far from a hospital, the imperative is to not standby while your research collaborator dies. And considering this, it is unfortunate, and I believe irresponsible that Pitt does not train all of its students in lifesaving.
With a little reflection you can understand why this hasn’t happened. It would cost money, time and conviction. It would be logistically difficult. It would not generate research dollars or intellectual property. It is not important enough in the grand scheme of things. If you have been in the Senate long enough, you would recognize this one: “The other AAU institutions don’t waste time and money on it.” That one is my favorite. It’s institutionalized peer pressure, but at least it’s pragmatic and data-driven. It’s hard to argue with data, unless arguing with data affects the endowment, perhaps. Then we have to tread carefully. Our survival depends on the endowment after all. We will never really know whose survival depends on CPR. Could be no one. Could be a colleague.
Walking back down the hill, we searched for the Dragon Bridge briefly but in vain. Truffle fries got in the way. Meanwhile, my colleague and I discussed where she might go after Pitt. In the resuscitation science community the word “Pittsburgh” evokes an unsettling amount of authority. I fully admit I have nothing to do with that, but I reap the benefits. And she may as well. Her affiliation credit at the conference read “University of Pittsburgh,” which was well earned. And this made me wonder about our lack of University-wide CPR training and the slow process of examining and refining the University’s impacts on the world. What does it mean that a world authority on resuscitation does not send its own out into the world with Peter Safar’s lessons? It is at most a failure of principle — but that is difficult to prove — and at the very least, a failure of effective branding, like many things. But that is why we have a Senate.
Join us in the Senate and see what we can all do together.
Oct. 16 is World Restart a Heart Day and a Senate Council meeting day (3 p.m., 2700 Posvar Hall).
Your University Senate Vice President, David Salcido, is a research assistant professor in the Department of Emergency Medicine in the School of Medicine. He is free Fridays at noon to talk in the normal way or over racquetball.