The patients we see today may have a short lived impact on us – just one more case in a sea of injury and illness – but our words, actions and interventions will potentially have a life-long impact on the patient as well as their family and friends. Whilst what we do for our patient today is what we believe is the best thing for them, will the future be kind to us, or condemn us? Is todays ECMO yesterdays balloon pump, or tomorrows defibrillator? History and anecdote, science and opinion, research and theory, technology and labour have all lead us to this point but where will they take us? To understand where we might be heading in the next 30 years it is important to consider where we have come from and the forces, influences and factors that got us to where we are now, not only as a profession but also as individuals.