I have been reading Dr. James Roberts' articles since he first started writing in the late '70s or early '80s. I was grandfathered into the specialty and received a lot of good training at the Medical College of Pennsylvania and by some of his early residents, including Scott Ulin, MD. I covered for his residents' training periods at the Frankford and Torresdale hospitals back then. I had a happy successful career in emergency medicine for 30 years, and now, at 72, I do urgent care.
I was always treated as a second-class citizen in the ED through all of those years because I didn't complete an ED residency program. I was fully trained at Thomas Jefferson University Hospitals in anesthesia, and have several years' experience as a staff member at Pennsylvania Hospital at 8th and Spruce. I wasn't accepted by anyone in the late 1970s and for years after.
Reading Dr. Roberts' column on ketamine made me think about how I had been using ketamine since 1974 for all sorts of anesthetic requirements, including in pediatrics at St. Christopher's Hospital for Children. (InFocus: “Ketamine an Ideal Treatment for Excited Delirium,” EMN 2015;37:10; http://emn.online/1NqiEKX.) Most people in the ED accused me of being too unconventional when I wanted to use ketamine. No physician in a U.S. emergency department had my type of experience. I even did rapid endotracheal intubation at JFK Medical Center in 1978, using Pentothal, succinylcholine, and curare. Many so-called intellectual doctors told me to take my anesthesia ideas elsewhere, except, ironically, on the one occasion that involved an emergency OR case in which they pulled me from the ED to help start the case.
It definitely underscores the point about how long new ideas take to evolve. Interestingly, I presented several case reports to Guenter Corssen, MD, a professor at the University of Alabama who helped develop the drug in the earlier stages. Perhaps I did the first rapid endotracheal intubation in a U.S. ED. I've done some other firsts, including intubating a coding patient on the floor of a SEPTA bus at rush hour. I also did a residency in physiatry at Penn and wanted to be an ED joint specialist, but my ideas in 1987 were considered unconventional. Anyway, I wanted to thank Dr. Roberts for all of his years of writing most prolifically.
George Dirago, MD