SITTING on a boat in San Francisco harbour on an unseasonably hot autumn day, Dr Peter Maguire took stock of his 23 years in the NHS and decided it was "time to go".
Fears about Brexit, a "toxic" work environment and a successful stint at a hospital in the Republic had led the high-profile Co Down consultant anaesthetist to question the role he once loved at one of the north's busiest hospitals.
The collapse of Stormont and the 'erosion' of the Newry man's nationalist identity - he is a fluent Irish speaker and runs a bi-lingual clinic for patients in the south - were also troubling him.
Since May 2016, the award-winning medic has been working part-time in a Co Monaghan hospital as part of cross-border project funded by EU money - which he describes as an "uplifting experience" where things run like "clockwork".
He is also one of four top consultants in the Republic with advanced paediatric life support training and has taught 40 young doctors across Dublin, Cavan and Galway how to save babies and children's lives, a position he says is an "honour".
But it is Dr Maguire's full-time job in Daisy Hill Hospital in Newry - where he has been based for the past 16 years and is the most experienced in his team - which he says has become increasingly difficult due to the management culture and bureaucratic constraints.
"I never clocked in or out in my life - patients come first," he said.
"With Brexit, I was predicting last summer we would have chaos, which is exactly what we have. I knew with the expectation of chaos, there will be a lead-in time for me to have to make my mind up one way or other.
"I could also see that my Irishness and nationalism was getting violated by the lack of an assembly. It's come to the stage with a Brexit, with the chaos, with no progress on anything over the past 18 months, that Northern Ireland was not a place for me any more.
"When I first went to work in Daisy Hill, I was a local lad who had come back to work in the community in a unit where it was reasonably well-run – where I could come in and do my job, where I felt valued and could work in what I was trained to do.
"Today I did not know if I would be able to do my job because I didn’t know if there would be beds or not. What's more, I knew there would be an incredible amount of red tape - which means there's less time to deal with patients."
Working in a team of seven consultant anaesthetists, Dr Maguire said he is lucky to have some of the most "amazing colleagues" and nursing staff.
But he was scathing of how the system is run - saying he believes a special measures 'hit squad' should be brought in as the "managerial culture is so bad".
"If anyone asks me about applying for a job here, I would highly recommend that they don't," he said.
The tipping point came in early October last year, when Dr Maguire's 74-year-old mother, Geraldine, had a fall and required surgery.
The medic put in his first ever request for emergency leave to take her home from Craigavon hospital. She is a widow and lives alone.
"Everything fell apart for me when I was refused leave to look after my sick mother. I am an only child and she is my life. I have never been more emotional," he said.
"I wanted to bring my mum home and put her to bed. I wanted to go and get her some basic groceries and make sure she was looked after and to phone her friends and tell them she was all right.
"For me, it was time to say enough is enough. I took sick leave."
A fortnight later and just two months short of his fiftieth birthday, Dr Maguire travelled to San Francisco to attend a medical conference and "reflect".
"It was October 16 last year and it was a wonderful, hot sunny day. I was on a boat in the harbour where my view was the Golden Gate Bridge and I thought 'It's time for me to go. I am going to claim my pension and go'," he said.
"Once that decision was made I felt it was a one-way street afterwards. A very happy one-way street."
Unsure as to whether he would continue in medicine, the consultant's skills were called on during his flight home when a young American passenger in his twenties suffered a severe asthma attack.
"I saved a life crossing the Atlantic coming back from San Francisco. I’m very proud I did that," he said.
A week following his return, Dr Maguire wrote to Southern health trust chiefs about his planned retirement, saying it was a matter to which he had given "deep thought". He gave five months notice with an end date of March 31.
Senior bosses did not contact him about his decision - despite the hospital having a shortage of consultant anaesthetists and turning to expensive locums/agency medics to provide cover.
"There's seven in our team of consultant anaesthetists who I share a roster with. One of the things they talk about is valuing staff. The trust should be making a charm offensive to retain staff but I never heard anything back since handing in my notice," he said.
"I am the most experienced member of the team and I know we need three extra people in our department. What happens is that when we get agency or locums it can be unpredictable."
Having graduated from the Royal College of Surgeons in Dublin in 1993, the former St Colman's College pupil has maintained close links with the Republic during his NHS career.
Uncertainty over Brexit and how it will affect cross-border healthcare has been one of the factors in hastening his departure from the north's health service, which has the worst waiting lists in the NHS.
"We have to remember that healthcare in Ireland is a two-way street. The people of Inishowen go up to Altnagelvin Hospital in Derry for treatment and patients in parts of Armagh and Tyrone go to Monaghan. So this is really important and must continue," Dr Maguire said.
"A hard Brexit would mean controls would go up between the north and the Republic. That removal of free movement would be a complete affront to Irish nationalism. It also reduces our Europeanism and it is something that we didn't vote for."
The consultant's experience of working in the Monaghan hospital has also convinced him of the benefits of being based in the Republic post-Brexit.
Modern anaesthetic drugs which consultants have to "beg" for in northern hospitals are more accessible in the Republic and allow the patient to be treated in a "different way with a quicker recovery time", according to the Co Down doctor.
"Not everything is perfect in the south but when I drove across the border to Monaghan one day last month, it was the most uplifting experience. I knew I had seen the patients in a pre-op clinic beforehand and I knew they will be fit for surgery. I knew I was going in to do a good day's work to change a number of people's lives. I knew it was going to run like clockwork and it did. I felt so valued, so appreciated," he said.
A passionate Irish language speaker, his cross-border work has allowed him to operate his first bi-lingual clinic.
Dr Maguire believes an Irish Language Act should be introduced in the north "with immediate effect".
"By working in Monaghan another thing for me as an Irish nationalist is that I had the absolute ability to use my Irish language skills. When Brexit is going so awfully... I think it’s time to go and work somewhere where I can be bi-lingual," he said.
"But I'm not one of these people who would drive the Irish language down anyone's throat. It’s absolutely lovely to be able to offer it. If someone doesn’t want it in the clinic, we do it in English."
Another new 'opening' in the doctor's career has been providing night-shift cover at Irish music festivals including the Electric Picnic in Co Laois.
"This needs consultant anaesthetic cover because you have tens of thousands people and some will get sick. These are avenues I would never have thought of - I had to resuscitate several people's lives at these festivals through drugs essentially. There were lives at risk that were salvaged."
Dr Maguire is currently travelling in Asia as part of a long-awaited trip to celebrate his 50th birthday and in the wake of his "tough decision" to leave his job.
Malaysia's capital city Kuala Lumpur was the setting for his party on December 20.
He said he has no plans to leave his profession - just the north's health service.
"When I told my mother about my decision to leave she was happy for me but made me promise I wouldn't give up medicine as I had trained so hard," Dr Maguire said.
"I thought - you're dead right. Why don't I go and get away from this awful, toxic environment and I will go and make my life my own. I will continue with service and teach young doctors... I am going to keep doing good."
