In Search of the Intensive Care Pessimist

Peter Brindley Circle

By Peter Brindley

In spring I wrote in this venerable blog about travelling to India and hoping to see the elusive tiger.  In summer I subsequently came to Britain expecting to see nothing but ICU pessimists. I saw lots of Indian tigers; I met very few true British pessimists. Despite a UK summer that could be remembered for bombs, knives, fires and anger, your lovely country has endured, despite being injured.  Like much of the world, you have a political and healthcare system seemingly tailor-made to produce burnout and despondency. However, while many of you are “down”, you are definitely, and defiantly, not “out”. In critical care terms, while complaining might be your oxygen, giving up is not in your DNA.


while many of you are “down”, you are definitely, and defiantly, not “out”

If the truth really does set you free then I should come clean: I came to Britain as much to eat your pies and to hike your hills, as to learn, lecture and share. This secular man had experienced a “crisis of faith”, and needed his mother (land). I have left humbled, wiser, calmer, inspired, and above all more grateful. These words matter, after all finding “meaning” and showing “gratitude” is likely more important than any title or achievement. It was nice to be the ICS Fellow; it was necessary to spend time with ICS friends. It is important to me – perhaps even therapeutic – that I say “thank you”. Regardless – and to use a Canadian expression – this “Come From Away” wants you to understand what keeps me coming back despite your inclement weather and flat beer.

When I spent time with the first responders of London, Essex, and Hertfordshire there was no anger or bile 2. Instead there was an enduring sense of looking out for “mates”.3 There was a commitment to be more empathic not less, and to try to reframe “threats” as “challenges”. These folks keep on doing this job because this job matters: period. Resignation – both literal and figurative – is not caused solely by exhaustion, it is when you can no longer answer questions like “what’s the point?” and “whose got my back?” In order for me to truly understand, the only way was Essex.


These folks keep on doing this job because this job matters: period

I spoke in Chesterfield: famed for its crooked spire, but notable for an ICS conference that got straight to the point. Like it or lump it, one of our most pressing, and distressing, issues is “End of Life Ethics”. We got capital education away from London, and tackled these issues through the lens of “ethics”, the “law”, and even “poetry”. This was not your father’s ICU meeting, and we were the better for it. Ditto, in Glasgow 4 and at Bart’s 2 where sports coaches, psychologists and even comedians spoke alongside workaday ICU doctors. In order to fully understand Intensive Care Medicine, you understand that you also need to step outside of it.


We got capital education away from London

My visit coincided with the release of my first book (free to download here or via the link below 5). Regardless, this allowed me to pontificate up and down your great land. I spoke in London where the ICS’s created a novel day to prepare trainees for the transition to Consultancy. After visiting the Palace at Blenheim I also spoke at the Porta cabins of the John Radcliffe Hospital 7. Regardless of the location people freely shared insights regarding the importance of the healthcare team. Just as importantly, this naturally segued into how important it is to have a team whose members are themselves’ healthy. You understand that “to do well you must be well”, and I applaud you for it.

You may well be burnout, but you also appear to be resilient. This matters mightily because it is likely an imbalance of the two that matters most. You also know how to laugh like no nation on earth. I needed that, just as I suspect you do too. The ICS was there for me, and I firmly believe it is there for you too. We should talk more in Liverpool in December at the State Of the Art 8. I can think of no place on earth that I would rather be.

Optimistically yours,


breaker only


breaker only

ICS will be running a Wellbeing seminar 4th September 2017.