The theme of the most recent SAM conference was “finding the joy in acute medicine”. When the conference was over, I went home – as I always do after SAM – feeling reinvigorated and excited about the future of the specialty.

It was eye-opening to hear colleagues I admire talk honestly about the challenges they faced over winter, and about how they found joy amidst the stress and frustration of corridor medicine.

Looking back on my own winter I realised that – for me at least – joy is easy enough to find. I find it in the relationships I have with my colleagues and the help I’m able to offer my patients. I find it when I make a diagnosis and when a patient gets better with the treatment I prescribe. And I find it in the knowledge that I’m not alone, that I’m part of a broader acute medicine community all in it together.

Joy is the easy bit. What I struggle with is energy.

I think back to the busier shifts I worked in our Same Day Emergency Care Unit over winter. I would often come on to find a waiting room full of patients we’d streamed from ED, some well into their 13^th hour in the hospital. In the minutes it would take me to sit down and boot up a computer, even more would have arrived. I would get to work, excited to do my bit, but the list would only get longer as the day wore on.

Worse still were my winter nights as the medical registrar. I think of my long walk past the ambulance queue, which at times stretched most of the way to main reception. I think of the patients who spent hours on a trolley in a public space, struggling despite the inexhaustible efforts of our wonderful ED nurses. We all know how bad things can get.

But still there was joy. As the med reg, I could help some of these people. I could get a lot of them home. I could explain and reassure and navigate them through the mystifying labyrinth of the modern hospital. And even when I couldn’t help, I could at least be a friendly and supportive colleague to the staff I shared those shifts with. At the end of my night, I could leave confident that I’d made some kind of difference.

So why was I leaving feeling so unsatisfied?

Why was I walking to my car feeling drained and empty? Why was I lying awake when I got home, staring up at the ceiling unable to sleep? Why was I spending my zero days listlessly trying to work up the enthusiasm to do that fun thing I’d been desperately looking forward to during those long, long nights?

It’s a fascinating paradox. How can we love a job that leaves us feeling this way?

What I’ve realised is that joy is not nourishing. Practising medicine fulfils me, but it does not fill me up. A car needs to be driven to keep it ticking over, but you don’t fill the tank by flooring it up the M1.

So what does fill my tank? What restores me? What gives me the energy I need to benefit from the joy I find in acute medicine?

I’ve thought long and hard about this and was surprised by what I discovered.

SAM is one of the first things that comes to mind. I think membership of the society is seriously effective burnout prophylaxis. In times of trouble, it is a profound relief to know that other acute medics – some from the other end of the country – think like you and share your struggles. We’ve spoken a lot about the concept of ikigai, the thing that gives us purpose. A purpose shared is a wonderful thing.

Teaching is another fuel source for me. Spending a couple of hours in the peaceful library at the RCP, passionately discussing education theory with like-minded enthusiasts? I step out into Regent’s Park with a different kind of the buzz. I’m the same when I’m giving our resident doctors their first tour of our ultrasound machine or helping one of our IMTs rise to the challenge of being the med reg on-call.

I never thought I’d say this, but service improvement helps too. My brilliant educational supervisor has finally debunked my long-standing suspicion of the audit cycle and pushed me to make changes. The idea that things don’t need to be like this is a really powerful one and I’m enjoying learning how I can change the things at work that put my nose out of joint.

Positive feedback is another crucial source of energy, for all of us. When you’re down in the weeds, a kind word from a patient or a colleague can be an invaluable pick-me-up.

Time with friends and family is an obvious one, but the strangest fuel source to get my head around is “time alone”. I consider myself an extrovert and love being around people. It’s one of the main reasons I picked acute medicine, the team sport of physicianly specialties. But after 13 hours of intense and often fraught socialising as the med reg, I need my time alone too.

Recognising the difference between joy and energy has helped me put everything into perspective. It doesn’t matter how much I love being the med reg, doing it sleep-deprived for 52 hours in 5 days is brutal. It would be strange not to leave with an empty tank.

Balance is everything. I’m convinced the only reason I’m able to continue practising is because our specialty has worked so hard to model sustainable working, not just for consultants but for doctors in training as well. My day a week doing POCUS or med ed or service development is crucial to my wellbeing.

If you’re reading this, exhausted after another ferocious shift, have a think about what gives you energy. It may be very different from me! And it may not be what you expect. Perhaps you find teaching and admin excruciating and need to get back to the shop floor ASAP. The key thing is to recognise your energy sources and seek out that balance.

And if you can’t think of anything else, go and tell a brilliant colleague how brilliant they are. If you can’t make your day, make someone else’s.