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The Debut of Emergency Medicine

Forest Kendall, MD, created the Elkhart General Hospital Emergency Services Department, starting with a small room in the basement of the hospital. In spite of his accomplishment, he claims that it was the department secretary, Margaret – now his wife – who actually ran the show.

Back in the early 1950s, if you tumbled off the ladder . . . or wrapped the Desoto around a tree . . . you got yourself to “Elkhart Hospital” and hoped to find a doctor who wasn’t busy delivering a baby or removing an appendix. That was the only way to get quick medical attention. There was no Emergency Room. No team of trauma specialists waiting to patch you up. And the ambulance service consisted of one red Cadillac that belonged to the fire department.

That was the way it was . . . before Dr. Forest Kendall came on the scene.

After serving in Italy during World War II, Forest Kendall, MD, a 1939 I.U. Medical School graduate, opened a General Practice in Nappanee and assumed the classic role of country doctor. Dr. Kendall was the quintessential family physician. Soft-spoken, with a gentle smile, he quickly gained the trust of his patients who came to count on him for their health and wellbeing – any time of the day or night. He stitched up wounds, delivered babies, performed surgeries . . . providing pretty much all of the medical care his neighbors in this rural community required. But as his practice grew, he recognized the need for a better approach to the serious medical emergencies he was seeing every day.

In 1957, Dr. Kendall approached the management at Elkhart General with the idea of establishing a new hospital-based service dedicated to emergency medicine – staffed with physicians the public could count on to be there whenever needed. With the Hospital’s approval, Dr. Kendall recruited two other physicians to join him. The Elkhart General Emergency Services Department was born.

The new “Department” was housed in a small room in the basement of the hospital and equipped with whatever gear the doctors brought with them or “borrowed” from other departments. The three doctors took turns manning this primitive ER 24-hours at a time. Kendall’s round-the-clock shift would be followed by two days of rest while his colleagues took their turns. “Things could get pretty crazy, particularly at night,” says Kendall. “Emergencies don’t always happen one at a time. I’d often have three or four patients lined up, all needing immediate treatment. We learned to make do.”

At first, the emergency department concept was viewed with a certain skepticism by other doctors, Dr. Kendall recalls. “Some were concerned that we were out to take their patients,” he says. “Of course we never did that . . . that wasn’t the idea at all. If a patient was admitted to the hospital after emergency treatment, which pretty much ended our involvement and the patient’s personal physician took over. Before long, we earned the trust of the rest of the staff, and were even able to count on many of them to pitch in when we got overloaded.”

Dr. Kendall remembers another sign of the times – how they transferred a patient to another hospital when the need arose. “That’s when we’d call one of the local funeral homes. We didn’t want to tie up the city’s only ambulance, so a hearse was the only option.”

Among Dr. Kendall’s many accomplishments was the training of the city’s first emergency medical technicians. “With so many of the emergency cases we saw, it was clear that medical treatment needed to be administered in the field, well before the patient arrived at our door,” he notes. “The firemen were good ambulance drivers, but they weren’t equipped to do much more, so I taught them how to provide on-the-spot treatment.” A grin crosses his face as he describes one occasion when “I went on a training run and suggested to the young fellow riding with me that he should practice his intravenous skills – by starting one on me. It was a bumpy ride, and, thanks to his many failed attempts to find a vein, my arm was sore for a week.”

As the Emergency Department grew, so grew the need for administrative support to keep things running smoothly. “We were busy being doctors. We needed someone to run the show,” he comments. It was a job that fit Margaret Smeltzer like a glove. She had worked as a secretary in other areas of the hospital for several years, and had the skills needed to bring order to the fledging emergency department. She quickly became a driving force in helping the department expand and improve its service. “I had enormous respect for what these doctors were accomplishing,” says Margaret. “And I must admit I was particularly impressed with Dr. Kendall.” It’s evident that the feeling was mutual, as the two were married in 2004 and now enjoy a quiet life in their home in Nappanee.

Dr. Kendall, now 95, is revered at Elkhart General according to David Van Ryn, MD, Medical Director of Emergency Services. “To say Forest was a pioneer is an understatement. He had the vision to recognize what was needed, and the tenacity to make it happen. Thanks to his efforts, we now have one of the most advanced emergency service departments in the region, handling about 60,000 visits a year.”