What I Learned From the Study of Sex Differences in Pulmonary Hypertension: How Following the Data and the Kindness of Strangers Helped Me Overcome Self-Doubt and Imposter Syndrome

The establishment of the pulmonary hypertension center in Giessen, initiated in the late 1980s and further developed over the following decades by the founding team of Friedrich Grimminger, Ardeschir Ghofrani, Ralph Schermuly, and myself, has its roots in research projects on acute lung injury, ARDS. Employing the multiple gas elimination technique (MIGET), we observed severe ventilation/perfusion (V/Q) mismatch with high shunt in the ARDS lungs, accompanied by elevated pulmonary artery pressure levels.

It was a Sunday morning. That was the only time Drs. Pat Daily or Walt Dembitsky could review cases before they operated on Monday. It was 1986, and I was a pulmonary fellow, so my presence at this meeting with Dr. Kenneth Moser (1929–1997) (Figure 1) was as an observer, not a participant. 

In 1988, I had spent over 2 years at the Physiological Institute, working on the competition between skin- and muscle blood flow for cardiac output in man during exercise, when I started my residency in Internal Medicine. There I met Werner Seeger, who was a consultant and was directing the Intensive Care Unit at that time. He enrolled me in his research group, which focused on acute respiratory stress syndrome (ARDS), a condition characterised by a ventilation-perfusion mismatch that results in competition for blood flow between well- and poorly ventilated lung areas, a topic I had previously explored in my scientific work.

From the earliest days of human existence, people have inhabited some of the most challenging environments on Earth, including high-altitude regions. It is well established that chronic hypoxia, the defining environmental feature of mountainous areas, leads to high altitude-induced pulmonary hypertension (HAPH) in individuals who are not adequately adapted. Yet, despite the apparent presence of another environmental stressor, such as cold, its role in development remained overlooked for decades.