h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

16/11/11

I like my research job but I do miss clinical work. Of course I get to do stroke clinic every so often, but it's not the same. I miss looking after really sick people. It was only when I was committed to doing Medicine for the Elderly than I realised that I liked looking after very very ill people. People so ill that they are likely to die before your shift is over.

I hated this when I first qualified, I hated the constant feeling of doom, and I hated the responsibility. I hated the constant fear that I would do something wrong. I wasnever sure if I was making the right decision, so overtime I made a decision I worried and worried that I would make the wrong one. I would ring up to check everything was ok when I was at home.
I do like arriving at work on Monday morning and knowing that my work is exactly how I left it. However badly my systematic review is going it doesn't quietly die when I go home.

As I got more experienced I got more confident in looking after very sick people, and realised that more often than not what I did was the right thing to do. And that I could talk to relatives in very difficult situations and that I could do difficult conversations as well as most other doctors, and a lot better than some.

Then I got a job where I would cover intensive care overnight. I wouldn't say that I enjoyed it, but I found it addictive. There was the joy of going home and knowing that you really had made a difference to someone. There was the fact that it was impossible to be distracted from your job, because what you were doing was doing the most urgent job in the hospital, looking after the very sickest people. Nothing could be more urgent. And I realised that emotionally I could do it. I could look after ITU patients and cope emotionally.

Coping emotionally is a skill that I didn't realise that I had until it happened. People die on ITU, sometimes every day, sometimes 2 or 3 times a week. That's what happens if you get the sickest people in one place. If you work in a field where people don't die you can allow yourself to get upset when they do. You can take a day off work to go to their funeral. But if people die every day you can't do that, you have to get used to it.

You have to care that your patients live, you have to be genuinely empathetic with their relatives. But then you have to be able to go home from work, take your wife out to dinner, have a cheerful and amusing conversation about her boss. She deserves you not to be moping about work the whole time. I can do this, not everyone can.

And sometimes I'm tempted to give up my career path, and train in ITU. I don't because it would be worth starting again, because it would be difficult financially as their would be a pay cut. And because I don't want to give up on something that I'm half way down the line of. And because I'm not sure that it's not because the grass is always greener.

Thanks Z, this is food for thought...

My heartfelt thanks to you and everyone who works in intensive care. I've been on the receiving end.