A frontwards view
Across the miles
by Dr. David Keegan
The emergency room here in Placentia is a small but functional affair. We have space for three stretchers, a couple of crash carts, some cupboards and other storage space, and a nursing station. Into this little piece of the world, a vast array of problems are dropped or hurled. Be they victims of motor vehicle accidents, heart attack patients, or pregnant moms on the verge of increasing their family, the care of these patients falls to the small medical/nursing team assembled on site.
When you're on duty and you've got someone with hypopituitarism and a gastrointestinal bleed in bed one, a screaming three-year-old with a laceration in the second, and an elderly frail lady in frank pulmonary edema in the third bed, it can get kind of crazy. Throw in the pacing relatives of the other 30 patients assembled outside, and the lack of windows and no air conditioning, and the whole thing can be kind of overwhelming.
But a neat magical thing can happen. You need to contact a specialist to transfer a patient to their care. You walk inside the nursing station, close the door behind you (and the drapes to the widows to block the view of the pacers), prop up you heels on the counter and dial the other hospital. There is always this anticipation you feel, wondering who will be on call for medicine or orthopedics that day, particularly if the patient you are transferring has an interesting problem.
And then the operator connects you and for a few minutes you have the luxury of talking to a consultant as if they were in the next room (yes, the telephone still fascinates me) or better still as if you were momentarily lifted away from the maelstrom of activity like in the Calgon commercial. You chat about the patients in particular and touch on some other things ("oh, the sun's been out here in Placentia today, though I haven't seen much of it"), and across the wormhole of technology, you make a connection.
It's nice to have as consultants those physicians you've trained under, as many professional and personable relationships have already been established. There are also many consultants whom I have come to know much better since I started working 130 km away, as I had never happened to be on their team or service but now have occasion to consult with. There are even a few people who I don't know if I could pick them out of a police line-up, but I can identify their voices in a flash. (The most obvious example is Dr. Art Rideout, plastic surgery, whose call schedule appears to mirror mine. As a result, I've consulted him on a good clump of patients, but I've never laid eyes on the fellow.)
But as you talk for a few more minutes, you become aware again of the pressing demands on you and the likely demands on the consultant, and your conversation draws to a close. With a cheery goodbye, you return the receiver to its cradle, announce the patient transfer has been accepted, and get down to writing your transfer letter. The journey has ended, but while the telephone consultation was still work, it was in a strange way a neat interlude, allowing a few moment to refocus and recharge. After all, as my grandmother would say, a change is as good as as rest.
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