I am one of many who have worked in ICU and then found that it wasn’t for me.
I wasn’t someone who was born with the desire to become an Intensivist. At medical school I happily sampled each specialty but didn’t really find anything I preferred. Then I started internship on a surgical run and was almost immediately introduced to the Intensive Care registrars. They were cool, collected and could solve almost any clinical problem I had – and if they couldn’t, they knew who to call. The more I saw of them, the more I wanted to be one of them, which started me on a pathway towards one day becoming an Intensive Care Registrar. Even after a health scare involving a brief time under the care of intensive care did not deter me. After all, Intensive Care had helped me with my patients and my own health – wouldn’t it be good to be able to pay it forward?
So I set my goals and worked towards becoming like the Intensivists and Intensive Care registrars I respected and admired, and I was offered an Intensive Care registrar position. Off I went, bright-eyed and bushy-tailed and it was amazing. Being an ICU Registrar was everything I wanted it to be. Everything was new and exciting. Seeing referrals? Grand! Running arrest calls? Happy to learn! Week on, week off roster? No worries! Hearteningly, my feedback had been predominantly positive.
However, shortly after this I noticed things beginning to change. I started coming home after every shift either in a towering rage or in tears. I was beginning to become short with people referring me patients, and realised this was going beyond the usual occasional annoyance of someone not having all the pertinent information. I began to resent referrals. I became more distressed after family meetings with family members who wanted to continue “everything, doctor, they’re a fighter!” despite medical advice to the contrary. I noticed I was feeling more and more reluctant to come in for teaching on my weeks off, wishing I could just go away for the week instead. I found I was dreading my return to work on Mondays. I chafed at being the team leader at emergency calls. It felt like nothing I did was enough. One day, I realised I didn’t like who I was anymore.
Initially, I thought it was just a phase. I figured I was adjusting to my new role as a registrar, being barely 6 months in. Or maybe it was the unit I was working in, even though for the most part everyone had been supportive and welcoming. I was due to start my rural rotation soon, which I thought might improve things. I’d heard good things about rural rotations for ICU registrars, it was often credited by seniors as a place where they “came into their own” as a registrar. If I stuck it out, I thought, I’d get better at being an ICU Registrar, I’d start feeling better, this feeling would go away and everything would be fine.
So, I went for the rural rotation and much to my distress, things didn’t improve. Once again, I was in a supportive department, the majority of my feedback was positive and I enjoyed the camaraderie of working with a diverse group of colleagues from many different hospitals. Except this time, I was far away from friends and colleagues whom I knew well and would have asked for advice about whether I should continue training in ICU. While working at the hospital was enjoyable, most of my colleagues would return to the city as soon as they had a day off, so I had many acquaintances but few friends.
It wasn’t until I started a non-ICU rotation that I started to find myself coming home feeling like I’d done a good days’ work. I wasn’t coming home angry or so upset I was in tears anymore. I didn’t dread waking up in the morning and going to work. I wondered if perhaps I was a bit burnt out. Maybe I just needed the break, I’ll go back and it’ll be better.
When I went back to ICU, it wasn’t better.
I was still soul-crushingly miserable. So, I spoke to my Head of Department at my rural rotation about my doubts, and ultimately I decided that perhaps Intensive Care wasn’t for me.
In some ways, making the decision was easy. It was much harder to tell people that I wanted to leave Intensive Care, especially my consultants and colleagues. I was afraid of disappointing the consultant group I looked up to at my home hospital after they had invested so much time and effort to mould me into a functional registrar. One of my senior colleagues said to me “You were one of our better registrars, until you decided you didn’t want to do it anymore”. A junior colleague asked “Why would you want to leave intensive care? Don’t you want to save lives?” Most people were kind. When I gathered my courage and told my Head of Department at my home unit, he smiled and told me that he didn’t expect all the registrars to become intensivists, and if I was happier doing something else then I should. Perhaps tellingly, during the annual recruitment cycle, one of my colleagues asked me while I was reviewing a patient in Emergency “You always seen so miserable doing this job, will you be doing something different next year?”
Did I waste my time as an Intensive Care Registrar? I don't think so. I've found myself using skills I picked up during that time in my current specialty. For one, learning how to put in cannulas under ultrasound is a skill that never goes astray. Still, even if all I learned was that while I might make a competent Intensive Care registrar, I also made a miserable one, the time would have been well spent. Life changes, and we change with it. If, with growth, you find that you no longer fit the dreams you thought you had, that may not always be a bad thing. It is not an easy thing to realise, so if you do notice this, please be gentle with yourself.
In the end, I feel that I made the best decision for myself with the information I had at the time. I still sometimes wonder whether it wouldn’t have been better to have stuck it out and continued down the path of intensive care – to me there was no question that I could do it. Perhaps the best illustration was when I caught up with a friend a while ago, whom I hadn’t seen since my days as an ICU Registrar. As we were about to go our separate ways, they said “You look so much happier now than you ever did when you worked in Intensive Care, I’m happy for you.” Maybe that’s my answer.