When I decided, upon the completion of my infectious disease fellowship in 2009, to pursue another year of training in critical care medicine, I was perceived crazy given the rigor of such a fellowship and the fact that I was (and still am) an ID addict. (Plus, I had also completed a combined residency in Internal and Emergency Medicine).
My answer to those who questioned my motives was that I didn't want to be an ID physician who steps back once the patient becomes critically ill and requires ICU care. Critical care physicians are trained to be adept at almost everything and often need little to no consultative help from other sub-specialists, leaving the ID physician with little to add. The ICU is also the place where infectious disease often reach their culmination--particularly infections I am very interested in such as emerging infectious diseases and influenza--and I like the unique challenges of managing all aspects of the patient's care, which is the role of a critical care physician. I have a similar sentiment regarding Emergency Medicine, where all these diseases initially present.
Last night in the ICU served to reinforce my sentiment.
Overnight I admitted two patients with severe infectious diseases, one of which required extraordinary interventions to keep alive. That patient, transferred from a rural hospital with likely influenza pneumonia, progressed throughout the night from requiring moderate amounts of ventilator support to ultimately, after a series of rescue interventions, being placed on ECMO. Trying to halt the onslaught of the infection and the resultant failure of multiple organ systems was extremely challenging.
It is these challenges, inherent in working in an ICU, where the melding of infectious disease and critical care medicine reaches its apotheosis and its what I like to do.