Dr Peter Keenan was Ireland’s first consultant in paediatric emergency medicine. Appointed in 1984, at Temple Street Children’s Hospital in Dublin, he was immediately thrown in the deep end in an emergency department that catered for around 50,000 attendances annually.

In this podcast episode, Peter recounts how he set about the management of the huge number of patients, which he compares to dealing - afresh every day - with ‘a great military retreat’. He talks about the crucial importance of reducing the number of ‘reflex’ admissions by managing as many cases within the ED itself as possible. He cites the example of self-limiting febrile seizures, and in response to the often stated “You can’t be too careful”, he says, “Yes, you can!”, pointing out that unnecessary admissions to hospital are not only inconvenient, costly and associated with avoidable and sometimes-distressing tests, but they are also a significant factor in overcrowding within a paediatric ED. His antidote? ‘Sensible diagnostic thinking’ with this, as with every other presentation. Beyond bringing some order to a perennially busy inner-city ED, Dr Keenan was also a major mover in Ireland in the once-marginalised area of child abuse. He recalls here how the understanding and management of childhood sexual abuse in Dublin was often based on the accounts of women who attended the Rape Crisis Service at the Rotunda Hospital, just a few hundred metres from Temple Street, as well as the aftermath of the notorious Cleveland Child Abuse Scandal in the UK, in 1987. Sadly, Dr Keenan also reflects on the ‘multi-generational’ nature of such abuse, and how much of it is driven by deprivation and intoxication.

In his own hospital and beyond, Dr Keenan is a much-loved and charismatic paediatrician, famous for his energy, good humour and pride in his ‘Northside’ pedigree. However, he says he owes a great debt to many of his colleagues in Temple Street for their willingness to help out, including Professors Denis Gill, Niall O’Doherty, Niall O’Brien, Michael O’Keeffe and others. And in a particularly moving reflection, Peter talks of how his ability to cope with a series of personal tragedies, including the death of his son, Stephen, in a ‘free-diving’ accident in Egypt, was at least partially and paradoxically eased by the amount of trauma and tragedy he had already faced in his place of work.

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