“I am not on call”, Dr. Brian Stoltz said over a lot of background noise through what must have been the speakerphone in his car.
“I know”, I said. “Cityside ER said there is nobody on call for ophthalmology this weekend. I have a 54 year old woman with intense tearing, discomfort and only 20/70 vision in her right eye.”
“And she’s not a patient of our office?”
“No, she has only had to see an optometrist for glasses. I’ve called every hospital within 50 miles and there is no ophthalmologist on call over the long weekend. You helped me once before with a case of dendritic keratitis when you were on call.”
I also remembered Memorial Day weekend last year, I was in the same situation during my Saturday clinic. A young boy, whose mother had just joined the board of our health center, came in with eye irritation. He had a small rust ring very close to the center of his cornea. I had dug out plenty of them, with a special spatula or even with the tip of an 18 gauge needle, but this was a child, who might not have beeven fully cooperative, and the location was critical for his future near vision.
Cityside Hospital had no ophthalmologist on call for that long weekend either, and all my calls to ophthalmologists in the surrounding area were fruitless. He got in to see an eye doctor the Wednesday after the Monday holiday and it turned out that he actually also had a small metallic corneal foreign body. Everything turned out okay, but the wait was uncomfortable and at least a little risky.
A corneal rust ring, even a foreign body, can usually wait a few days, but if this woman had what I thought, acute angle closure glaucoma, I wouldn’t want her to wait that long to see an eye doctor.
“I think she’s got acute glaucoma”, I said.
He was silent. I continued:
“She’s got mixed injection, no foreign body, no fluorescein uptake and I can see her left fundus clearly but I can’t get a focus on her right fundus no matter what lens I dial in on the ophthalmoscope.”
He was silent again for what seemed a very long time. Then he said:
“I live an hour away, but I happen to be in town. If you have her walk out your door right now, I’ll meet her at my office in, what, 25 minutes?”
“She’ll be there. Thank you so much.”
I haven’t heard yet what he found, and I haven’t wanted to bug him, but I am anxious to hear what the final diagnosis was. I do know that an urgent slit lamp exam was necessary.
One postscript:
When I sent my emergency eye patient off with her office note and insurance information to see Dr. Stoltz, her husband said:
“You’ve done well by us. I came in and saw you once with a cauda equina syndrome.”
I didn’t remember him, but he must have had a critical enough pressure on his lower spinal nerves to also have warranted an urgent referral to a specialist.
Disease strikes at inopportune times.
A Country Doctor Writes: 
true, disease strikes at inopportune times but I am unsure what the purpose of this post is. I hope it is not to point out some high moral ground by the ER doctor. What if the specialist had simply said: “sorry, I’m not on call, this is not one of my patients and I can’t help you”? Would he/she then be lambasted as a selfish, uncaring provider? I am a specialist in a rural area and frequently get called by the ER when I am not on call and have no contractual obligation to answer my pager. I almost always do and am happy to provide advice over the phone but draw the line at coming in unless it is a life or death issue (unless it is one of my patients). The ER providers are usually understanding but several seem to think that I am at their beck and call as some sort of 24/7 mobile resource. I think it is a matter of perspective: those ER providers work shifts and never get paged when they are with family, hiking, enjoying a night out, etc.
The purpose of my post was to illustrate that in rural America you sometimes face the possibility of traveling 100+ miles to see the specialist you need and sometimes you are fortunate to have someone go out of their way to help you even though they have no formal obligation to do so.