A Look Back at My Six-Decade Career in Emergency Medicine

They say luck is when hard work meets opportunity. As I begin my retirement and reflect on my career in Emergency Medicine, I recognize I have been fortunate to have been in the right place at the right time, with my personal career path evolving in parallel with the establishment of Emergency Medicine as a specialty.

Early Career

My admission to medical school in 1961 was likely enabled by the Indiana state legislature creating new  buildings for the Indiana University School of Medicine contingent on a significant increase in enrollment. At 135 students, my first-year class was the largest in the nation. 

In 1965, I selected a rotating internship at Mound Park Hospital (today named Bayfront Medical Center) in St. Petersburg, Florida, largely for the comfort of my growing family. I was fortunate, however, that this location utilized the interns to staff the emergency room every sixth night throughout the year, and I quickly discovered I loved it! The medical staff covered the ER on call. The nurses really ran  the department and trained those of us who had the sense to pay attention.

After I completed my internship, I was recruited by the U.S. Army and ended up in an Infantry Brigade helping to train new medics. We general medical officers also covered the ER at the base Dispensary on rotation. We deployed to Vietnam as a unit, with me in command of a medical company of five physicians, one dentist, and ninety medics. Our role was to receive and stabilize casualties for evacuation to hospitals and to treat the day-to-day ailments of soldiers and thousands of locals. This opportunity enabled a strong foundation on which to build my future Emergency Medicine career.

When I left the Army in 1965, I learned that hospitals had begun contracting with physicians to provide full-time staffing of the emergency room, now being referred to as an emergency department on par with other specialties. One of the mentors I most admired in my internship hired me back to Florida, where I spent the next twenty years. During my time there, I eventually was promoted to Medical Director of the Emergency Department  and served as Chairman of the Department of Special Services of the Medical Staff.

The concept of reaching out to resuscitate heart attacks in the field evolved from teaching first aid to ultimately become CPR as we know it today. Fire departments found they could utilize their ability to reach homes rapidly to get defibrillation to the affected person.

My local fire chief invited me to direct the rescue squad being trained as paramedics at the local community college. I found it was quite similar to what I had done in the Army, sending trained medics out to save lives in potentially hazardous conditions. We were able to make the four-minute response time a goal in developing the system, eventually covering the entire county.

The Evolution of the Specialty 

I was invited to become a charter member of the American College of Emergency Physicians (ACEP), a fledgling organization founded in 1968 to gain recognition for Emergency Medicine as an official specialty. In 1972, just four years after the founding of ACEP, the American Medical Association recognized Emergency Medicine as a specialty and created the AMA Section of Interest on Emergency Medicine. 

Through my ACEP affiliation, I was fortunate to attend many conferences where the knowledge base of the specialty was developed and disseminated to physicians from all over the country. Leaders shared best practices that we could implement in our own hospitals and communities.

I see the emergency physician’s role largely as stabilizing and buying time for the patient to get the definitive care needed. I do not take out the patient’s appendix or repair the ruptured aorta. I do not place the pacemaker or stent the coronary artery. I splint the fracture that can wait until tomorrow in the orthopedist’s office. Of course, we do perform definitive and immediately life-saving procedures—establish airways, correct arrythmias, manage dehydration, fix electrolyte disturbances, repair wounds. But we may have reached out to have those procedures done at the scene by paramedics to our patients’ advantage. Our skill must be rapidly assessing the situation and directing a team. Knowing what must be treated now and what can wait affords our colleagues a good nights’  sleep to be efficient and alert the next day.

I witnessed and played a role in the early development of trauma centers, which were created by using community assets and local surgeons responding to a perceived need. In Florida, a surgeon on the staff of a hospital near I-95 was frequently called in for highway accidents, having to wait for the OR team to come in. He presented his trauma center solution throughout the state, stressing that many facilities already had everything they  needed to provide care—they just required organization and personnel to keep the resources they already had open and ready. The emergency physician and team could manage the patient until the surgeon came from home.

Following his lead in my own community, I lobbied my staff specialists who routinely cared for gunshots and stabbings. The need was brought to the forefront when an undercover detective was wounded in a drug bust and  died after being taken to the “nearest hospital” that could not handle the case quickly enough. 

The hospital’s leadership team realized that a commitment to trauma care could expand the patient base geographically. That eventually led to full-time trauma surgeons and a scene-responding helicopter service, making our Trauma Center a regional referral center.

In my early years as an emergency physician, inpatient care was handled by community physicians who saw their own patients in the  hospital and rounded from their offices. More recently, we have seen the evolution of yet another new specialty as many hospitals are now using hospitalists to care for their patients in the  increasingly complex inpatient setting. Emergency physicians may find themselves handing off the patients they have stabilized at an earlier point. Although hospitalists can rely on our workup, H&P, and bridge orders to allow them to wait until the morning to see the patient, I anticipate that they will soon find themselves expected to be present at all times.

My Advice to the Next Generation

I am proud to have played a role in the evolving field of Emergency Medicine and admire the training new physicians are receiving today as the accumulated experience through past decades has been digested into pearls and best  practices.

Looking back on my career, it has been a privilege to work with physicians of every specialty and to learn from their various approaches to patient care. I have also enjoyed the support of great nurses, technicians, clerks, security officers, and housekeeping staff who make the hospital a pleasure to work in even during chaotic times. I have also had overwhelmingly positive experiences working with local law enforcement  and EMS teams.

Mostly, I will miss the interactions with people from all walks of life who came to me through no real choice of their own at a time not of their convenience who trusted me to care for them. It is these conversations, shared experiences, and interesting stories that have kept me coming back to work each day all these decades.

If I were to offer any wisdom to new emergency physicians, I would first suggest you listen to the nurses. They know their way around the ED, and they are trained professionally to observe and assess changes in their patients. They can enhance your knowledge base, save you from mistakes, and make you a hero. Second, for your own personal satisfaction, I suggest talking to your patients about their lives. I have found it infinitely entertaining, and it may give you some insights that could affect your treatment. And lastly, appreciate the unique privilege you have to care for patients and their families during some of the most challenging times of their lives. Your ability to practice emergency medicine today is afforded by the vision and tireless efforts of physicians decades ago. I wish you all the excitement, innovation, and satisfaction I experienced during my own career. 

November 1967 - Dr. McLane at Schofield Barracks, Hawaii with his wife Carol and four children Jeannie, Randy, Gail and Keith. They had just hosted Thanksgiving dinner for soldiers and their families in the company mess hall. He left for Vietnam three days later. 

Dr. McLane in Vietnam treating an elderly man with a medic and interpreter.

1968: Dr. McLane (seated front row, middle) with fellow officers, including doctors, the dentist, and his executive officer in front of the dental clinic at Duc Pho in Quang Ngai province, Vietnam. The dental equipment required air conditioning, so after hours the clinic became the officer’s club. The majority of the time they lived in tents. 

Dr. McLane (seated front right) at his retirement party April 2021 with several members of the Lakewood Ranch ED staff.