We've had a halcyon year. It was just a wonderful year, with no significant natural disasters, advancing global health and prosperity, and people working together for the common good. Yes, we had a halcyon year. I think it was 1956. It certainly was not 2020.

As I write this in late October, the election looms, with both Democratic and Republican voters believing that democracy is threatened if their candidate loses. Yesterday the CDC reported over 300,000 excess deaths in the U.S. to date, an estimate that includes both deaths from COVID-19 and deaths from suicide, domestic violence, and delayed surgery and primary health care attributable to COVID-19. COVID-19 is surging in Europe, with daily cases increasing more than 10% per day in some countries. A similar surge is predicted for the U.S. Southern states are facing the worst onslaught of hurricanes on record. Western states are battling the most severe fire season in history, triggered by the worst megadrought in at least 1,000 years. Income inequality is rising. Unemployment claims are rising. More than 8 million more Americans now live in extreme poverty.

However, the grim picture has a bright spot: the dedication and sacrifice of health care workers. Li Wenliang, the Chinese ophthalmologist who sounded the alarm about an unknown respiratory illness in December 2019, only to succumb to COVID-19 in February, is a national hero in China. From Lombardy to Istanbul to Buenos Aires to Tamil Nadu, windows have flung open as grateful citizens applauded from their balconies the dedication of health care workers reporting to the front lines of the battle with SARS-CoV-2. More than 140,000 health care workers have contracted COVID-19, and more than 500 have died (see covid.cdc.gov/covid-data-tracker/#health-care-personnel).

We are the lucky ones. We are still here. I approach the end of 2020 with gratitude.

At Stanford, our shared battle against a feared and seemingly implacable new enemy, our tacit acceptance of personal risk to ourselves and families, and an increased respect for each individual has engendered an unprecedented unity of spirit among us. We are newly conscious of the dedication of our nursing colleagues, whose personal risk is significantly higher than ours. We are more appreciative of each other and kinder in our interactions. I think this is a common experience. I am thankful for this change.

I have never been prouder to be an anesthesiologist. Our Surgeon General, Jerome Adams, has addressed COVID-19, Mary Dale Peterson navigated ASA through uncharted waters. As a profession, we have risen to the occasion. On the cover of Time magazine, anesthesiologist Francesco Menchise took a moment away from caring for the dying patients in Ravenna, Italy, to show the world how we face crisis. If you remember that now-famous cover, Dr. Menchise is wearing an industrial N95 mask with an expiratory valve. Italy had run out of proper PPE. He went to work anyway. I'm grateful for his dedication as I am sure are his patients.

Gratitude needs to be expressed. I pray regularly, with no idea if my prayers are heard, simply to express gratitude. I also give regularly, not to assuage guilt for not doing so, but because I am grateful.

This year I am particularly grateful to the American Society of Anesthesiologists. ASA supports five worthy non-profit foundations. Pamela and I are directing considerable support to one of the foundations that is especially meaningful to us. Having survived the trauma of 2020 (at least up to the point of this writing), our support for the important work of an ASA foundation is bringing us a measure of solace.

There are five ASA foundations, the ASA Charitable Foundation (ASACF), the Anesthesia Foundation, the Anesthesia Patient Safety Foundation (APSF), the Foundation for Anesthesia Education and Research (FAER), and the Wood Library-Museum of Anesthesiology (WLM).

The ASA Charitable Foundation (ASACF)

The ASA Charitable Foundation (www.asacharity.org/) was established in 2011 to channel anesthesia resources to natural disasters and health crises. The foundation supports Lifebox and Hope For The Warriors. Recently the foundation initiated the Global Scholars program to bring early-career anesthesiologists from low- and middle-income countries to the U.S. for observerships at prominent teaching hospitals and to attend the ASA annual meeting. To date, 21 Global Scholars have been funded. This year the ASACF will fund the Committee on Global Humanitarian Outreach, the Overseas Teaching Programs in Rwanda and Guyana, and the Resident International Anesthesia Scholarship Program. These important world projects extend ASA's reach and impact.

The Anesthesia Foundation

The Anesthesia Foundation (www.anesthesiafoundation.org) was established in 1956 to provide low-interest loans to anesthesiology residents to complete their education, particularly in response to natural disasters. Currently the loans carry no interest if repaid within six months of completing residency. During the height of the coronavirus pandemic, when many ORs were shut down, the Anesthesia Foundation, aided by a loan from ASA, provided no-interest loans for two years to 116 early-career anesthesiologists totaling $870,000. Following Hurricane Katrina in 2005 and Hurricane Harvey in 2017, the Anesthesia Foundation dipped into its reserve funds to provide grants and loans to residents who were displaced or suffered losses. The Anesthesia Foundation receives no financial support from ASA. Interest from repaid loans is re-circulated to new loans.

Anesthesia Patient Safety Foundation (APSF)

Among the most internationally recognized patient safety organizations, the APSF (www.apsf.org) has been a pioneer in improving the safety of patients. The foundation funds studies into the unique human factors, health system engineering issues, and patient characteristics that impact perioperative patient safety. The grants provided by APSF often support the development of the next generation of patient safety scientists in the specialty. The foundation develops metrics to assess improvement throughout the entire span of perioperative care, provides guidance for best practices and approaches for implementing patient safety programs, and disseminates patient safety information globally. The APSF Newsletter is available in English, Japanese, Chinese, Portuguese, Spanish, and French.

Foundation for Anesthesia Education and Research (FAER)

FAER (www.asahq.org/faer) develops the next generation of physician-scientists in anesthesiology. FAER achieves this by awarding career development grants that place significant focus on mentorship. Mentored Research Training Grants help anesthesiologists develop the skills, preliminary data for subsequent grant applications, and research publications needed to become independent investigators. Research Fellowship Grants are awarded to anesthesiology residents and fellows. Research in Education Grants focus on improving the concepts, methods, and techniques for education in anesthesiology. In 2020, 15 former FAER grant recipients received 17 awards from the NIH, including K, R, and U awards from six different institutes. FAER also supports the research pathway with our Medical Student Anesthesia Research Fellowship (MSARF) program and Resident Scholar Program (RSP). MSARF provides medical students with an eight-week research experience within an academic anesthesiology department. Upon completion, they have the opportunity to present their research to peers and mentors at the annual meeting. FAER has a unique return on investment: studies have shown that every dollar awarded to grantees has resulted in $17 in subsequent peer-reviewed funding.

Wood Library-Museum of Anesthesiology (WLM)

The WLM (www.woodlibrarymuseum.org) strives to live up to its mission to “Advance Anesthesiology by Preserving and Sharing its Heritage and Knowledge.” The WLM holds the most comprehensive collection of anesthesia-related books, documents, objects, and art in the world. It even holds a video from the 1950s of the first application of ultrasound imaging in humans (I know, because I donated it – a story for another editorial). The WLM's collections and exhibitions include the world's largest anesthesia library with extensive archives, research, reference, and online resources. It also supports the annual Wright Memorial Lecture, the WLM Laureate of the History of Anesthesia, the Paul M. Wood Fellowship program, and the publication of hundreds of Reflections in “Anesthesiology.”

There are a lot of outstanding programs to choose from! As I near retirement age, I look back with gratitude at the many blessings anesthesiology has brought to my life. My academic career was launched by funding from the Foundation for Anesthesia Education and Research, as was Pamela's.

We've given generously to FAER this year to express our longstanding gratitude toward our profession. Pamela's and my gratitude are multiplied manifold because we are grateful to escape 2020 more or less intact. We claim no great virtue or altruistic motivation for giving generously. It just feels right this year.

Take a moment to consider what feels right for you.