Dr Vicente is a Spanish critical care specialist, working full-time at St Bartholomew’s Hospital in London, as a locum on an ad-hoc basis. In this, his first post for our new feature – the life of a locum – he discusses his path to choosing a career in medicine and deciding on a specialty.

First of all, I would like to introduce myself.

My name is Ernesto Garcia Vicente; I’m a Spanish critical care specialist, based in London since June 2012.

It would be a bit hard for me to say when I exactly decided to be a doctor. Maybe I had some influence from my parents (both are doctors, a rehab lead clinician and a dermatology consultant respectively), but nevertheless none of my siblings chose the medical career. Although I initially considered options such as the military or journalism, when I was 15-16 years old I had no doubt whatsoever that I could only be a doctor. However, a much more difficult decision was going to be deciding which area of medicine I was going to specialise in.

Choosing a specialty

Even after six years of medical school, I hadn’t the slightest idea. One thing I was completely sure of is that I wasn’t going to follow the steps of either of my parents, because I disliked both specialties. I can recall an anecdote in particular which took place one day; I was trying to heal a plantar wart that my mother suffered from. I’ll never forget what she said to me: “Son, if that’s the face you pull with your mother’s foot, you’d better choose a different job”. It was clear to me that I had to go my own way, even though I had no idea what that was going to be.

After passing the required exams, I decided to start family medicine training (equivalent of GP in the UK). I was sure that I didn’t want to be a GP in the future, but at least it was an opportunity to gain a general overview of most different specialties and different medical environments. The training program was very good. It was then, through my A&E rotation, that I discovered that I had a desire to help critically ill patients. It was a risk, because the sicker the patient was, often more unusual treatment had to be undertaken. . There was no doubt I wanted to do that, but how?

The answer came up some months later, in the National Family Medicine Congress, in Sevilla, Spain. I was walking with some colleagues and I shared my thoughts with them, outlining my preference for critical care, as well as my love for technology and my passion for advanced procedures. One of them suddenly said “why don’t you do ICU? It combines all that! You’ll love it! I had no idea what he was talking about, but I was so excited that I invited one of the ICU trainees for a cup of coffee. I remember his words “Yes, critical care has all that, but is a very hard specialty, not very well valued, you get the opportunity to treat a variety of patients and issues from every department of the hospital. On the other hand, you have great satisfactions, you do lots of fascinating and challenging procedures, and if you love medicine, you’ll love critical care”.

ICU in Soria

The decision was made despite my parents warnings (“remember that intensivists have a very hard life, they’re burned once passed the 45 years old!”). I took the exams again, achieving high enough to get a post at St Barbara Hospital, in Soria.

Soria is second smallest capital of a province in Spain, a little town lost in the central part of the country, reaching winter temperatures as low as -20C. The city has incredibly unusual reasons for ICU admission, such as mushroom poisoning, snake bites, road traffic accidents caused by deer, cloud-to-ground lightning strikes, CO intoxication, etc. The population has a long life-expectancy, it being usual to find elderly patients surpassing 100 years old, in reasonably good shape.

The hospital and the ICU were very well equipped and the staff very well trained; I don’t regret having received my training there. It was completely individualised, performing procedures that I’d never do in a big hospital, such as permanent pacemaker insertions, surgical tracheostomies, etc. I also had the opportunity of completing my training with a year external rotation at a 1200 bedded tertiary centre.

Working abroad

One of the main landmarks of my career was the time I spent at the University of Pittsburgh Medical Centre, in the summer-fall of 2009. I had had the chance to meet one of the top trauma surgeons in the world, Dr Juan Carlos Puyana, from the University of Pittsburgh Critical Care Department in a prestigious trauma course in Santander, Spain. Completely fascinated by his presentation, I couldn’t help approaching him at the end of it, asking whether there was any chance of visiting his unit. He very kindly agreed and immediately sent an email to his secretary putting me in contact with her.

Once I finished my rotation there, I knew that I wanted to pursue a career in an English speaking country. Shortly after, I read a job advertisement in the Spanish Online Journal of Intensive Care Medicine regarding a post of senior clinical fellow in intensive care at St Mary’s Hospital, in London. I immediately sent my CV and I received an affirmative answer… just two hours after! Two months later, I had passed the interview, and began preparing for the move to London, where I had never been before. Once I shared my joy with my family, I sent an email to one of the good colleagues I left in Pittsburgh, Dr Hernando Gomez.

He replied with these wonderful words: “Dear Ernesto, congratulations. You really deserve it. Life leads us through different paths, often unplanned, but that in the long term turn out to be better”.

And that is when the real adventure began……

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