I work in a small, rural Emergency Department located near the Redwood Forests of Northern California so we get a lot of tourist travel coming through from Portland and San Francisco. Now, I understand that we don’t have the resources (read none) that some of the bigger tertiary centers have in the Big City, but that doesn’t mean that we can’t handle what comes through our small E.D. And, especially now during the summertime we get a lot of Out-of-Towners who wonder what I can handle.
“No, Ma’am, we don’t have a pediatric plastic surgeon. Yes, I understand that your 2 year old’s pediatrician told you that if she ever cut her face you should consult a plastic surgeon, but I think about 3 stitches on that lac above that eyebrow will make the skin come together nicely. Yes, they will have a small scar. Well, you can drive 5 hours south to the Bay Area and see if a plastic surgeon is on-call at the Children’s Hospital, but that’ll make about 7 hours since the laceration happened, and you’ll wait about 2 – 3 hours there while the surgery intern on-call comes down to sew her face. Or I could do it now, and you’ll be back to your hotel room within about an hour.”
“So you have a fracture of your arm. No, we don’t have an orthopedist in-house. Well, I have one on-call, but you have a simple fracture that isn’t displaced, and we splint those here in the E.D. Yes, I understand your Portland orthopedist would be at your bedside giving you a Perrier and a Valium while their P.A. splinted your arm, but I can offer you a Percocet which will kick in about half an hour after your motorhome reaches the 101. Um, would you like that now or to go?”
“Your husband has a collapsed lung, bleeding in his pelvis, and a blood clot in his brain. I’ve put in a breathing tube, a chest tube, and a central line plus we’ve binded his pelvis. We’re flying him to a trauma center so a neurosurgeon can take care of his brain. Drill into his brain like they did on “Grey’s Anatomy?” No, I can’t do that.”