Why I Do ICU

Dr Jennifer H.

Jennifer is an Intensive Care Registrar in her first year of training. She is currently working in a suburban Melbourne hospital.

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This year, I began my first year working as an ICU registrar.

Since the day I was accepted into medical school I felt pressure from people both within and outside of the medical industry to choose a speciality. I always thought I would take a very long time to figure out which. There are so many options, medical school hadn’t clarified a direction for me and I enjoyed nearly everything, though nothing really held my interest after a 10 week rotation.

It surprised me when after just a few days of my first resident and first ICU rotation – having finished internship only 3 weeks beforehand – that I realised I’d stumbled across the speciality I wanted to do for the rest of my career. I spent the next few years working to get where I am now, and I was so happy when I was offered a position as a registrar.

But why is it that I do?

This is a big and broad question so I’ve tried to break it down as if it’s a job interview.

First: why do I like ICU?

This one is easy!

I like ICU because it’s a team-focused, generalist speciality with a fascinating case mix of critically ill patients with trajectories ranging from complete recovery to palliation. There’s a mix of procedures, medicine, and complex clinical/social/ethical situations. The variety keeps things interesting and the human connection makes it meaningful.

On top of this I enjoy the flexibility of shift work, the teaching I get to do both in the unit and on the wards, and the prospect of reasonably well-paid and fulfilling part-time work in the future. As a relatively new speciality, there are also emerging areas of research and opportunities for leadership. Currently my main (very broad) research interest is qualitative research into how we can improve the patient/family experience before, during and after ICU admission, given how innately traumatising it is.

While I have enjoyed rotating through other medical specialities, I usually liked the idea of specialising in them more than I enjoyed the work. The bar was set very low before my first ICU rotation – I imagined it was a scary place with lots of beeping machines where most people went to die. The beeping machine part is true (though in reality they aren’t that annoying). I discovered quickly the team environment and leadership displayed by senior medical and nursing staff helped with the fear, and the death rate was substantially lower than expected. I also discovered the style and content of the work to be so appealing that despite the negatives – 6 years of specialist training, exams, time-pressured scenarios, poor patient outcomes, difficult conversations with families and unsociable hours – the reality of working in ICU is far better than I ever anticipated.

Second: why am I a good fit for ICU?

It is probably clear from the first part of this post that I enjoy working in ICU, which is the single most important factor. I also believe I have number of attributes and emerging skills that match what is required of an ICU trainee; willingness to work and study hard, dedication to learning to communicate well, and the manual skills to be able to learn “minor” procedures. Additionally, I am detail-oriented to the point of perfectionism, I find clinical and ethical dilemmas utterly fascinating, and I appreciate patients’ humanity even when they’re almost unrecognisable as human beings with lines and tubes everywhere.

There’s more to it than what I’d put on a CV though, and it’s the feeling I have when physically present in ICU. To me, ICU feels like an island separate from the rest of the hospital, with incredibly skilled healthcare staff around at all times including senior doctors, nurses, physios and visiting teams. I can joke with my colleagues and enjoy the day-to-day aspects of working, much like any job. At the same time, I recognise that every patient that comes through the doors has run a gauntlet and I have the privilege of helping them when they're at their most vulnerable: to create emotional space for their families, comfort them in their last days, or celebrate with them as they recover and make it back into the real world. I feel safe when I’m in ICU, and I do my best to help others feel safe there too.

Has working in ICU lived up to my expectations?

Honestly, so far it has exceeded them.

That’s not to say it’s been without challenge, or that my gender hasn’t compounded those challenges. My sense of imposter syndrome is at an all-time high and I don’t think it’s a coincidence given the typical working conditions of a cis-female doctor. Most of the time things are ok, but there are days where male doctors exclusively make eye contact with other male doctors, visiting consultants ignore me, families patronise me or patients mistake me for a nurse twenty times. The three-time-introduction method seems to be working well to reduce the latter (ie: My name is Doctor Jennifer, I’m one of the intensive care doctors and I’m one of the doctors taking care of you today).

I’ve seen positive developments in gender equity in my short career, such as open discussion of burnout and imposter syndrome amongst my consultants on ward rounds, increasing numbers of female trainees across all specialties, and points being given for taking parental leave in college applications to make up for time not being able to perfect the CV. Change is very slow and the fight for change can come at great individual cost, but I do think it’s happening. I try to focus on small gains and look for evidence of change over time, rather than being overwhelmed by the huge ongoing systematic problems within medicine and how the gender bias reflects on our society as a whole.

Finally: Why do I do ICU?

I acknowledge the challenges inherent in a role caring for the critically unwell in a society and healthcare system that is far from perfect. Despite all that, I find ICU training to be professionally and personally fulfilling in a way that no other medical speciality has been for me, and I wouldn’t choose to be anywhere else.