Life lessons after a career in intensive care medicine

I have spent the past 30 years working in intensive care medicine. I was drawn to intensive care as a trainee for several reasons. First, I enjoyed the opportunity to care for the sickest patients in the hospital and to use technology, evidence, and experience to try to save their lives. Second, I enjoyed the interprofessional teamwork that is inherent to high-quality intensive care. I enjoyed being “the physician in charge” and knowing that my expertise was nearly useless without the amazing interprofessional team that works together in the intensive care unit. Finally, whether we could save a patient’s life, I was honored by the privilege to care for patients and their families during this incredibly difficult time in their lives—to find ways to support them in all realms including physical, psychological, social, and spiritual. In fact, this final reason for my interest in intensive care was the motivating factor for my research career: I wanted to find evidence-based ways to communicate with and support seriously ill patients and their families during and after critical illness.

Now, 30 years later, I find myself facing a serious illness. I was diagnosed with bulbar-onset amyotrophic lateral sclerosis in March of 2021. This illness was not part of my plan—just as critical illness is rarely part of the plan for our patients and their family members. I find myself on the other side of goals-of-care discussions now. This illness has caused my family and me great stress and distress. And this illness is also an opportunity to reflect on my life and my career. I write now as part of this reflection on my career and to share, with those who are interested, some of my life lessons (see Fig. 1).

Fig. 1

Life lessons after 30 years in intensive care

The first lesson is to work with people you like and even love. We don’t always have a choice of work partners, but often we do. As I reflect on the past 30 years, it is memories of working with those I really liked, or even grew to love, that has made my career the most rewarding. This includes physicians, nurses, respiratory therapists, researchers, and research staff. It includes bosses, colleagues, people who worked for me, and trainees. I have been able to surround myself, in my work environment, with people I really like. I recommend you do the same whenever possible.

The second lesson is to take sabbaticals. I had the great privilege of spending a year working and playing in Paris for the academic year 2017–2018. It was a remarkable year that will stand out forever in my memory, as well as the memory of my wife and our then 14-year-old daughter. It was a magical year for us in so many ways. I’ll spare you reading about most of these ways, but one was that the sabbatical gave me the opportunity to recharge with time and space to reconnect with why I love what I do and to think truly creatively about my work. In the prior 10 years, I received 25% of the grants I submitted—a reality of the funding climate since the 2007 stock market crash. During that year in Paris, I worked on 8 grants and 7 of them were funded. I believe this high proportion is not a coincidence. Having the time and space to think creatively had a remarkable impact on my work. I realize not everyone can spend a year in Paris. However, everyone can find ways to create time and space to recharge, nourish their creativity, and reflect on what is most important to them about their work.

The third lesson is to prioritize your family. By “family”, I mean those you love most. This could be a biologic family or a family of choice. I believe that making my family a key priority has been tremendously important to my happiness, personally and professionally. Having a fulfilled and prioritized family life has made me a better intensivist, colleague, boss, and mentor. I won’t pretend that I have always put my family first throughout my career—I have had some lapses. But when I have lapsed, I have found it very rewarding to re-center myself and re-orient my priorities to bring my family back to the center. Sometimes, I could do this with a well-planned and truly “unplugged” vacation. Other times, it required a long talk with my wife, daughter, or a trusted friend, or seeing a therapist. Identifying the imbalance and then finding the right way at that time to re-balance has been very important for the longevity and success in my career.

My final lesson, learned more recently, is to live every day as if I have a terminal disease. I don’t mean to glorify having a terminal disease by any stretch of the imagination! I would give almost anything to not have ALS. However, having this disease has allowed me to focus on what is most important to me and to let go of things that are not as important. Focusing on the important has been something I have worked towards for 25 years and with which I have struggled at times. In the past, I would often classify too many things as “important” and find myself unable to really focus on the most important because of too many distractions. Nothing about the physiological effects of ALS has increased my ability to focus. Instead, realizing how limited my time is, I have found the inner strength to focus. I believe I always had that strength, but oftentimes chose not to use it. My advice, for what it is worth, is to find that strength even when you aren’t put in that position by a terminal illness.

These lessons are not intended to be all-encompassing or universal to everyone. They are a few of my most treasured lessons from a career in intensive care. I share them now in the belief they might help others.