Ian J. Barbash

I am not just a critical care physician, but a survivor of critical illness. I suspect I was not an easy patient, maybe even “difficult,” especially when I was scared and couldn’t breathe. My wife says I am not a good patient. She laughs lovingly when she says it, but not because it isn’t true. She says it with empathy—empathy that was vital to my recovery.

This is the fifth New Year since the onset of COVID-19 in America. I am a pulmonary and critical care physician who had spent a decade of my life working in ICUs before I became an ICU patient myself in 2025. As a physician, husband, and father of four young children, I had been saving others. But this year, I needed to be saved. Transitions are times for introspection. How do I cultivate gratitude in the face of trauma? How can I be hopeful when the future feels tenuous?

IMPORTANCE: Intravenous fluid administration is recommended to improve outcomes for patients with septic shock. However, there are few data on fluid administration for patients with preexisting heart failure with reduced ejection fraction (HFrEF). OBJECTIVE: To evaluate the association between preexisting HFrEF, guideline-recommended intravenous fluid resuscitation, and mortality among patients with community-acquired sepsis and septic shock.