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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