The Emergence of Emergency Medicine

John Wiegenstein spends a life saving lives —and helping establish a medical specialty

“People didn’t believe that one specialty could encompass all the lifesaving techniques you need as an emergency room doctor.” Photo: Anne Cooper

John Wiegenstein (M.D. 1960) trained to be a priest, an engineer and a fighter pilot before ending up at Michigan’s medical school in the mid-1950s, but once he got there, a single life goal soon became clear. Today, Wiegenstein is widely acknowledged as the primary force that made emergency medicine a recognized specialty in this country.

Earning his M.D. with a wife and small children to support, Wiegenstein rarely slept. “You weren’t allowed to have a job while you were in medical school, but I worked 40 hours a week at the information desk at University Hospital and had to duck when one of my professors came through,” he recalls from his Naples, Florida, home. “I worked nights and went to school in the day.”

In his final two years, he got a glimpse of his future, while working as an assistant in the emergency room at Beyer Memorial Hospital in Ypsilanti. “We had the room to ourselves, sewed people up without much supervision. I got pretty proficient with my suturing. We saw a lot of accidents there.”

But Wiegenstein says he didn’t begin to fully understand the deficiencies of emergency medicine until his emergency rotation at St. Lawrence Hospital in Lansing. Emergency rooms, he says, were dismal places, staffed by doctors who couldn’t keep a job: alcoholics and drifters. “One time I had a fellow come in to relieve me — he was a dermatologist — and he told the nurse, ‘I’m going to sleep. Call me if a life-threatening rash comes in.’ Things were bad. People could easily die.

“I was in my first year at St. Lawrence and a nurse called and said, ‘Hurry out to the parking lot. A man is bringing in his child who looks dead.’ I rushed out and this child was blue-black and the father was trying to breathe for him. I looked in the baby’s throat and he had epligottitis, from an illness, blocking his throat. And I thought, ‘I’ve never done a tracheostomy on a child before,’ but it was the only way. I put in a tube and he survived.”

This and many other sobering experiences made Wiegenstein determined to learn, and learn some more, about what needed to be done in that first “golden hour” to save critically ill and injured patients. On his own time, he went to College of Surgeons seminars, orthopedics seminars, and even sat alongside firefighters in EMT courses. “I realized I didn’t know what I needed to know. As it was, the surgeons often didn’t even see patients in the first hour. They would be called in from home and the intern would kind of be twiddling his thumbs waiting to see if someone would come in before the guy died.”

By 1968, Wiegenstein was ready to organize. He called a group of eight like-minded physicians to a meeting in Lansing, put a page of bylaws on the table, and incorporated the American College of Emergency Room Physicians. Its goal: to create a national awareness of the need for qualified emergency care and training, to promote research in emergency medicine, and to develop emergency medicine as its own, board-certified specialty. Soon, physicians across the country were joining in. The first emergency medicine residency was established at the University of Cincinnati in 1970. St. Lawrence — a Michigan State University-affiliated hospital — followed suit in 1973. In 1979, the American College of Emergency Room Physicians was recognized as a conjoint board by the American Medical Association and the American Board of Medical Specialists. Ten years later, the group was designated a primary board.

“It’s become a respected profession, but it took 20 years. We had an awful fight from the other specialties. Surgeons thought we were invading their turf. The internists thought they might lose their resident training opportunities. People didn’t believe that one specialty could encompass all the lifesaving techniques you need as an emergency room doctor.”

Today, Wiegenstein enjoys a busy retirement with his wife, Iris, and says he does not miss the hectic life of the ER. “I needed to have adrenalin as part of my diet through my career until I was 60 and then I didn’t need it any more!” he laughs. Then he recounts one more story that encapsulates the importance of his chosen field, and the distinct satisfaction that has come from a life spent saving lives.

One day in the early 1990s, Wiegenstein was at work as chief of emergency medicine at Ingham County Medical Center, when a young man came up to him and introduced himself as a new orderly. The two shook hands. Then the young man said, “Actually, I met you once before. See this little scar?” and pulled down his shirt collar to point at his neck. They had indeed met before, in the parking lot of a Lansing hospital 25 years earlier. Recalls Wiegenstein, “He eventually asked me to write a letter to help him get into medical school. He became a resident, a graduate of my program and then an emergency room doctor. It’s really kind of great…”

—WH

Wiegenstein will receive the Medical Center Alumni Society’s 2003 Distinguished Achievement Award at Reunion this fall in Ann Arbor.

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The Emergence of Emergency Medicine