At the end of the June, my pulmonary fellowship- which began as a pulmonary/critical care fellowship- is finishing. From here I’ll move to my first job as an attending, a mix of inpatient medicine and outpatient pulmonary, but not before one final weekend working in the ICU. It is quite fitting that things should end as they started, in the same place that took the wind out of my critical care sails. Nearly two years ago I arrived on the unit- bright-eyed, enthusiastic, convinced of my path. Then this conviction, worn from overuse, seemed to break apart into pieces. I went from fierce dedication to burnout, in what felt like the course of a week- although now, I can see that this was building for years. So many of us spend our 20s chugging away in search of meaning and achievement. Somehow we only seem to look to our careers to help us achieve this. For me, it was spending every waking unit either in the ICU, thinking about the ICU, and eventually dreading the ICU, that made me realize this field wasn’t for me and there may be another path for my life.

It’s been a hard decision to make. See-sawing back and forth between my commitment to balance and the ghosts of my former ambition telling me to do “more”. When they haunt me for more, its never to be a better doctor, to be more loving to my family, to be a better partner. No, its always in the pursuit of status, prestige, letters after my name. Somehow, many of us have come to equate this constant striving for true value, ignoring the richness of life that comes from achieving in multiple (and, yes, non-career) areas.

I’ve second guessed this choice for the past year as I wean out of fellowship and into a more manageable career. Occasionally I will have spasms of panic- “what if the major regret of my life if never becoming full professor at a major academic institution?” If I’m lucky, this is rapidly followed by the realization that I’m choosing to devote that time to other pursuits and relationships, and truly not giving up on anything essential to my core values. But it can still be challenging to sit with these “what if’s”.

I was lucky enough this weekend to go face-to-face with the life I’m leaving.  Day one, I fell back into old ways, ICU for me is like riding a bike, and it was easy and satisfying to immerse myself in it again. The old panic arose. Luckily by day two, I had swung back to my commitment to seek a more balanced life. What made the change, and what can I do when my old ghosts come haunting again? These were the things I realized that I hope to be able to remind myself in the future:

1. There is a difference between being good at something and having it be the right thing for me. This has always been the hardest thing to wrap my head around. Having worked in an ICU for extra rotations in residency and for a year before fellowship, it’s the most natural clinical practice for me at this point. But when that skill doesn’t translate to satisfaction in my work, its time to find a new clinical area to develop.
2. It’s not the critical care, it’s the team mentality that I miss. What is it about ICU that I feel so drawn back to? Part of it is certainly the satisfaction of doing something I am good at,  but I expected that to be outweighed by my fatigue with the constant emergencies and ever-present death and dying. This weekend while transporting a patient for an emergent procedure with the nurses, we had a moment of levity trying to maneuver the bed. The shift coordinator found me some Aleve and heat packs when my shoulders were sore at the end of the day. I had multiple team huddles with nurses, consultants, families as the patients’ clinical status changed throughout the day. These episodes made me realize that the ICU has a unique sense of teamwork, and it is this atmosphere, more than the work itself that I will miss.
3. I’m more a physician-healer than a physician-scientist. This is a point that has been hard for me to understand. Some doctors are excited by the research, the molecular mechanism, the ideal-world function of medicine; while others are more fueled by the clinical side, the patient interaction, the real-world scenario. Clearly both sides are important and physicians need to be a balance of both- but I will get more satisfaction if I seek out practice areas that support my practice style.
4. There are other ways to have impact apart from micromanaging physiology. Its easy to lose sight of this in the ICU where every titration feels important, yet runs the risk of losing the forest for the trees. I need to remember the value of forest-focused medicine as well.
5. There’s more to career than prestige. I’ll be honest, I like saying “I work for ‘X’ prestigious hospital.” Many people probably also get career satisfaction from the day to day of working there. But since I don’t, I have to let go of the title.
6. The hospital doesn’t love me. (There’s more to life than career.) Something I constantly tell myself. I can’t keep pouring my best time, energy, creativity into the hospital that gives me so little in return, and leaves nothing left over for my friends and family. Of course, I need to give my all to my patients- but this doesn’t require an 80 hour work weeks and 5 side projects. That energy should be saved for the people I love. Those are the relationships I want to build to sustain me through life, not an academic career ladder.
7. I’m not my best self when working in the ICU. The level of intensity and laser focus required for me to be excellent in the ICU is not something I can easily turn on and off. It leads me to cross-examine my husband when he’s just trying to tell me a story but I need the details in a specific order; or rush around meticulously trying to do everything in the most efficient way possible when I could just be enjoying the evening. Maybe these traits serve me in critical care, but not in the rest of my life.

I hope I re-read this the next time I second guess my career switch. It only took me two days back in the ICU to recall why I left in the first place, and allowed me to celebrate my last ICU day without regret (or maybe just a little).