An Ivory Tower is supposed to be the tertiary referral center where they know everything and can take care of all difficult patients. So why is it when I have a specific need for a higher level of care that one of my local Level 1 trauma centers, University of California, San Diego, balked.

I had a difficult patient. Suffice it to say that I needed someone capable of performing endovascular thoracic stent grafts. I was given contact by the patient’s insurer. I spoke with the Trauma fellow and the classic response was..

Don’t you have a closer Level 1 Trauma Center? Now I later did speak with a Cardiac Surgeon at Cedar’s who was willing and able but in the end the patient’s concomitant injuries were enough to have family withdraw supportive care. Back to the real problem. When I was a resident our Attending Staff only wanted to know the answer to one question.

Do you want to send the patient by ground or by air? As he explained one day. We were here at the university, the ivory tower. We were expected to provide support and assistance to the surrounding communities’ surgeons. It was never a question of whether or not someone had insurance or that they were beyond salvage. We were there the help. In this case, help our fellow surgeons.

I guess in the 11 years since I’ve finished residency a lot has changed. Unfortunately, not for the better.