If you learn anything with age, it’s that clothes help.

Dr. Pierre Cardinal

Division of CRITICAL CARE

When he was younger, Hull native Pierre Cardinal had big plans for a career in the National Hockey League. He had no speed, no coordination and no situational awareness but otherwise he says, he had all the right attributes. This was a tough pill to swallow for a French-Canadian boy who believed that if you worked hard enough at something, you could actually achieve it.

So, while never destined for induction into the Hockey Hall of Fame, Pierre Cardinal still worked hard and managed to distinguish himself as one of the ‘greats’ in the arena of Critical Care Medicine. His unrelenting desire for improvement led him to establish the CRI Critical Care Education Network which, after much national success, was acquired by the Royal College of Physicians and Surgeons. He is the editor-in-chief of Navigating Medical Emergencies, an e-book centred on the approach to the undifferentiated acutely ill patient, used by thousands who want to reference expert opinions, clinical approaches and best evidence. In recognition of his passion for medical education he was given the prestigious Frank S. Rutledge Award for Excellence in Critical Care Teaching. His contributions to the future leaders in the field have been remarkable.

Today, in his sixth decade of life, this founding father of Critical Care shares his views on aging, smoking cigars and spandex. Below, an entertaining account of The Man. The Myth. The Legend.

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Courage is looking at yourself in the mirror, literally!

I think people see me as old. I feel old. I just had my knee replaced so I’m back to being more active but I’m grey haired and I can see the age. I know that soon my career will come to an end. I’m not quite ready yet but I’m at least thinking about it on a regular basis. It will actually be easy for me to retire because I’m super good at holidays – I don’t think of the work at all. I will not be bored. Now I count years backward. I don’t think of myself as 60 but instead think that I have 20 years left to live. I’m lucky to be healthy and I wouldn’t necessarily say the best years are behind me because studies show that people get happier as they get older, in part because their expectations become more reasonable. My expectations from my teenage years are pretty much gone. I know who I am, I know what I can do.

If you learn anything with age, it’s that clothes help.

Sometimes when you’re trying too hard you end up with back spasms. 

The furthest I’ve ever pushed myself physically was yoga, I ain’t meant to bend that way. At my age you’re not supposed to wear spandex or do yoga, but I do. I’m stiffer than I was, and it helps with my flexibility and golf swing. I would never go to a public place; yoga is done in the privacy of my home watching YouTube. And I do wear spandex when I’m cycling because of the padding, I love the padding. It’s purely a utility. And you would never, ever see me wearing spandex in any public place. I put them on inside my house, I go for a bike ride and when I get back the first thing that comes off is the spandex.

The best thing I’ve ever gotten for free is my parents. We were a middle-class family that progressed quite a bit. My Dad started as an office boy at CBC and ended up being a Director, so eventually life became much more comfortable. At first, he was serving us ice cream – but only one scoop. By the time I was a teenager I could get two or three because we had more money in the house. My Mom was a teacher and then stopped to raise three kids. She returned when my youngest sister started school. We were a comfortable family, a traditional family and very supportive and very close. We’re still very close. My Dad passed away a few years ago and my Mom is in a home. She fell twice last week and I’m mentioning this not to say how hard it is but to say how nice it is to have my two sisters nearby. We make a schedule to visit her and help. I’m lucky.

I was raised to be… still alive by age 17. My friends and I would drive like crazy on dirt roads and I remember very, very scary episodes. I wrecked my Dad’s car when I was 16. It was the upbringing in those days. Today I always drive above the speed limit but just enough to not get caught. I’m cheap you know. I don’t think driving fast is more dangerous, I just don’t want to get the expensive ticket.

To compete in life, you’ve got to want to. Growing up, studying was not a word I knew. My image would have suffered. To be seen as somebody who was into books would have made me a nerd. In those days to be too smart was not well seen. My image was more of a guy who didn’t like authority, who was loud and got kicked out of class. I was fun. This changed when I got to Cégep. I finished high school when I was 16 and when I went to the counsellor and said, ‘I like people, I like science, is there any job for me?’, and he said, ‘have you thought of becoming a doctor?’, I asked him if he thought I could do it. I had good marks and was well ranked, and he thought I was smart enough, so I said, ‘okay, that’s what I’ll do’. That was it. I knew if I wanted to get into medical school I had to study more and then I worked.

To become good at anything you have to suffer. I’m from the old generation where it’s seven days a week. There’s no such thing as a balanced life; that’s foreign to me. The one thing I recognize now is how tired I’ve always been, especially when I had young kids. ICU is grueling but as physicians we’re proud, and it’s this pride that convinces us that we can do it – we can, but at a price. It’s a bit easier now. When I first started, I’d be on for 12 days straight first call! And then I’d go out and party – that might have had something to do with my frontal lobe still not being fully developed.

Let It Be is a song that is guaranteed to start my day off right. It’s a bit of a sad song but it’s a beautiful, beautiful song. And it’s a little bit about how I see the world and how we should be… you know ‘just let it be’. These types of songs do not make me sad, I know that life is hard. Do you know the difference between an optimist and a pessimist? The optimist knows that life is hard, the pessimist rediscovers it every day. Well I don’t need to rediscover it every day.

Having a cigar is life’s greatest luxury. After a busy day I’ll go home and open a bottle of wine, go outside with my wife and light up a cigar and just sit. We have a nice place with gardens and a beautiful view. Perhaps it’s a little like meditation – you control your breathing and I don’t inhale. I like to have them while I barbecue and at certain times of the year it’s the best way to get rid of bugs!

The afternoon of my dreams would include a nap.

The room in my home that I spend the most time in is where the fridge is.

I’d eat ice cream all the time if it wasn’t for my health. We usually don’t eat much carbs at home but we had the family over this weekend and so we bought ice cream. They didn’t eat that much of it so tonight I want to kill it. I’ll get rid of it, so it won’t be in the house.

I prefer to stay at home and cook because I can’t have my cigar in a restaurant.

The thing that makes me go insane the fastest… is my wife. Let me explain. I’m extremely rational and my wife Lissa is totally emotional. So, if we get into an argument there is absolutely no point in trying to reason with her. I’m not good at dealing with emotions, so when there is conflict, and by the way it’s not that often, I will end up saying things to her like ‘what you just said is actually factually incorrect’…Then I take a deep breath try to understand, only to realize, again, that the disagreement had nothing to do with facts!

Dr. Gwynne Jones always makes me laugh. He’s just the funniest guy. He has all these one-liners… these Gwynnisms. He’s got so many jokes; many, many of them are just awful which is perfect for me considering my upbringing; they were in vogue at that time. And of course, Gwynne can say them with total impunity because he’s such a nice man. He doesn’t have an ounce of malice in him. And then there’s his accent, that helps.

The dirtiest place I’ve ever been in is my office. I don’t clean it because I don’t care. We’ve been demoted in terms of offices over the last few years and I’ve basically developed an ‘I don’t care’ attitude. I’m still lucky to have a place to put my boots and my coat but I don’t have to live here.

The best ritual of my daily life is censored.

I do my best thinking when I least expect it.

I think the people who are the best leaders have a certain confidence, not only about themselves but about what’s going to happen. And in times of crisis, they have the ability to step back and look at the big picture calmly and exert this calm influence on others. Often these people start by leading informally but then get pulled into these leadership roles because they have it. I would not classify myself as one of these people. With my patients yes, I’m very calm and don’t get flustered by too many things but in the administrative world, with all the politics, I get frustrated. It’s always the same problems and sometimes there are no solutions for them.

I virtually never have any conflicts at work. In part because I’ve been here for so long and I have built very good relationships with my colleagues, I respect them a lot. And I nurture these relationships by going out of my way to talk face to face with people. For example, I go out of my way over to walk over to talk to interventional radiologists instead of talking over the phone. This way they remember me and probably also remember all the times that I have helped them when it is they, who were in trouble, and needed help. Most of the time when we have a conflict it’s not an emotional thing. If we disagree about how to manage our patients, I will take the approach that they know what they’re talking about and I’ll try to understand their point of view.

A book that has had a lasting impression on me is “The Road Less Traveled”. Problems do not go away; they must be worked through.

I come from a family of teachers; my mother, my grandfather and my sister. I think we probably have it in our blood. I also enjoy interacting with residents immensely, especially small groups. I don’t know where the passion comes from to do all these things but once I identify a need, I just say I’m going to do it. Because I’m determined, I’m not going to stop until it’s done. Those are just the right ingredients, I guess. Then sometimes you just end up being lucky…

A phrase I most overuse is ‘let me play with your brains’. I like to teach, but not so much about knowledge, rather about how people think – the cognitive errors and biases which are well known and predictable. So, I will purposefully frame the students or residents into looking at a problem the wrong way, but I warn them in advance by saying ‘I’m going to play with your brain’. And the majority of the time they still end up giving me the wrong answer. It teaches them to be very, very careful because our brains make predictable errors that, sadly, are hard to avoid.

Best movie of all time is Groundhog Day. I like the idea of improving – trying to become a better person. To me it’s a movie that gives someone a chance to do it over and over again until they become better. I like the message there, and Bill Murray is so funny.

I’m not a writer and I don’t write with great ease. It’s become easier as I’ve been doing more and more of it. And, if it needs to be done, I’m gonna spend the time and write something that is good enough. The book I’m most proud of is Navigating Medical Emergencies: An Interactive Guide to Patient Management. We’ve basically developed this by interviewing experts across Canada. The ebook is a good reference but also serves as a knowledge repository upon which different forms of simulations, are built. The problem with experts is that a portion of their knowledge is unconscious. So, it took a lot of work and many focus groups to extract that knowledge from the brains of our experts. However, having completed this work, we now are in a much better position to develop a multi-model curriculum that integrates well and is cohesive. It’s very practical. If you want to assess somebody for x, y, z, it tells you what you should do, the reasons why, and provides the evidence. It’s been a lot of work, but it’s been very well received.

Right now, I’m involved in a big project for Canadian Blood Services. We’re developing an education program on organ donation. Millions are invested in this program and it’s 3 or 4 years of work. So, when it’s complete and somebody comes and says, ‘we like how you’ve done things, would you like to lead this project and here’s so many million dollars’, I might say yes. If I think it’s worthwhile.

My most prized childhood possession was a sound system. When I was a teenager, my grandmother’s house burnt down and so she moved in with us. I moved into the basement. The beauty of moving to the basement was that I had the entire space for myself. I’m sure at times the house was shaking because of rock ‘n roll music being listened to by a young teenager. It had to be very loud.

A present I will always be happy to receive are my granddaughters.

The most money I’ve spent on something really stupid is hockey equipment.

The closest I’ve ever come to death was wrestling with the wheels of a moving truck. I was a resident at the time. I was cycling to work, and I did a stupid move where I tried to be a little more athletic then I truly was by jumping over a curb and I ended up falling into the middle of the street. A truck was rolling my way and its wheel hit me, but just enough to push me, not roll over me. I ended up with a broken arm.

I would never do well in an ICU bed. If life is good to me, I’ll learn that I’m going to die from something that won’t take that long. I’ll stay at home and die there. I’m not going to come here with tubes in every orifice, unconscious, no control, staying here for months in bed. I’ve seen it, there’s a lot of suffering. It’s worth going through all that suffering when you’re very young, when you have your life in front of you, but I’m not interested in that at all. Luckily, I’m not totally DNR material yet!

The one non-monetary thing I have the highest hope of obtaining in life is to be killed at the age of ninety by a jealous husband. My wife would not feel threatened by this answer. She’d say, ‘I’ve heard it a million times before.’