Well I was a sociology major in college and now I'm a PICU attending...
- The PICU is kind of like being an general pediatrician on steroids - almost any childhood condition can advance far enough to needing the skills and expertise of a pediatric intensivist and PICU nurses. The typical things we see include - Respiratory failure from viral bronchiolitis or pneumonia, trauma patients, diabetic ketoacidosis, prolonged seizure activity, severe asthma, severe infections/sepsis, cancer, severe anemia, ingestions, kidney failure, strokes, GI bleeds, organ transplants, congenital heart disease both pre and post op and pretty much anything that needs a machine to assist organ function (at least in the initial/acute phase). It's also common for the PICU to be where any patient that makes other services uncomfortable gets put, as we have all the tools and experience to make sure things go okay. The nursing care in the PICU is also higher, so sometimes patients end up there because it's better or safer to be someplace where each nurse only has 2 patients instead of 4 or 5, even though I as the intensivist may not be doing much to aid in their care.
- While in the adult world, Critical Care is frequently paired with pulmonology, that is not the case in pediatrics. They are separate fellowships and it's not super common to do both. If someone is going to be dual trained in PICU, it's most commonly with cardiology so that they can be superspecialized in managing congenital heart disease patients in specialized Cardiac ICU's. Peds pulmonology tends to have a larger focus on outpatient management of things like asthma, cystic fibrosis, and patients with tracheostomies/home ventilators among many other things.
- Things that drew me to the PICU: first I knew I wanted to be a pediatrician. That has to form the basis of being an excellent intensivist. Other things I liked were the variety of pathology that the PICU saw, rather than focusing on just one organ system. Being able to put physiology into action at the bedside is one of my favorite parts as well. I also realized in medical school that I liked managing multiple organ systems. The procedural aspect was also a draw (intubations, lines, chest tubes, etc) however as I've gone through training and being an attending that is less of a thrill at this point and more just a set of tools I have at my disposal. I also liked that I was able to help kids when they needed it most. Not having outpatient clinic responsibilities was a huge draw, I love being in the hospital and by the end of residency was completely over clinic in every form and fashion. The PICU also is very collaborative, you have to include the nurses, respiratory therapists, pharmacists and other physicians to meet the needs of most patients.
- Things I don't like about the PICU: you see the worst things happen to kids, often by the people that are supposed to love and protect them - child abuse and neglect are hard to get over even after you've been seeing it over and over and over. You have to deal with death, giving terrible news, and seeing parents make decisions for their kids that only prolong their suffering. You have to work nights and weekends and holidays, all of which are hard on your family. I personally get burned out with having non-medical people fawn over you and what you do, either as if you're some sort of saint, or that you're odd for wanting to be in the midst of so much badness.
- Pathway to being a peds intensivist: Do well in college course work, shadow, get leadership positions ->do well on MCAT -> get accepted to medical school -> do well in course work -> do well on Step 1 -> do well in clinical clerkships -> match into pediatrics residency -> focus on being the best general pediatrician you can be -> make sure people know you want to do PICU so they can help you match into fellowship -> PICU fellowship -> get a job.
All that said, keep an open mind about any and all specialties. Very few pre-meds have any idea what inpatient medicine is like, so it's something that can be very divisive where either you love it or you hate it. As an entirely inpatient existence, PICU is not a good fit for everyone. So while it's awesome you even know about this field as a college freshman, something else may catch your passion along the way. You could start by volunteering at a children's hospital in general and seeing if you can spend time in the PICU (although because most PICU patients are intubated and sedated, they often don't need the volunteers as much).
Let me know if you have any more questions
