“What’s the problem, Dr. Mitchell?”
“Well, you didn’t mark that you wanted any of those privileges.”
“That’s true, I don’t. I’d plan to assist you and Ray with most of these. But I’m not trained to do them as the primary surgeon.”
Mitch looked incredulous. Ray chimed in, “Told you!”
Mitch looked at him a bit sharply and then back at me. “You’re a doctor, aren’t you? You mean them boys at Duke didn’t train you to be a doctor? How can you practice out here if you can’t do these things?”
I smiled. Ray broke the silence, nicely expressing my sentiments. “Mitch, that’s what I told you. I know that in your day doctors were trained to do it all. But not in these days. Family physicians like Walt, just like the ones I trained with at the Medical University of South Carolina in Charleston, are trained to take care of about 95 percent of all the problems they encounter. And they’re trained to assist a general surgeon. But they’re not general surgeons.”
Mitch sighed. “Makes no sense to me. If you can’t help us in the OR, then you’re no more helpful than Sale, Mathieson, or Nordling.”
“That’s not true!” exclaimed Ray. “Walt’s had lots more training than they’ve had. He’s trained in obstetrics and delivering babies. He’s trained to take care of infants and kids. He’s forgotten a lot more dermatology, gynecology, psychology, and neurology than I ever learned. He knows intensive care. And he can help us in the OR. Furthermore, I’ll bet he’s willing to learn some of these procedures—aren’t you, Walt?”
Ten eyes were suddenly fixed on me—including Barb’s. “Well,” I stammered, “sure . . . I’d be willing to learn anything that you’d be willing to teach me.”
Mitch looked at me for a moment, then at Ray. Ray smiled at Mitch, and then they both looked at me.
“OK,” Mitch said, standing up and extending his hand toward mine. “We have a deal.” I shook his hand, not entirely taking in what had just occurred.
On the way back along the river toward the Hemlock Inn we were silent. As we crossed the Tuckaseigee River bridge, Barb spoke. “Walt . . .”
“Yes, honey?”
“Did we just agree to move to Bryson City?”
We were quiet for a few minutes. As we turned onto Galbreath Creek Road, I nodded. “I think so, honey. I think so.”
“Me, too,” she said.
“Me, too,” piped Kate’s voice from the backseat.
part two
FAST-FORWARD:
AWKWARD BEGINNINGS IN THE SMOKIES
chapter six
SETTLING IN
We arrived in Bryson City in September of the next year. Kate was nearly three, and after the many months Barb and I had devoted to doing physical therapy with her, she could stand and, with the help of special braces, even walk some.
We spent our first weekend moving into our little house by the hospital. One of my first duties was picking a location in which to place our newest possession—a wrought-iron park bench. The three of us sat in it together for the first time, gazing out over the Smoky Mountains.
I put my arm around Barb’s shoulder and she snuggled close, with Kate tucked into the crook of her arm. “It fits the four of us just fine!”
For a second, Barb looked confused, and then she laughed as she rubbed her beautifully enlarged tummy. “Only five more months to go!” Barb was pregnant with our second child. We were excited about becoming parents again—and this child would be the second grandchild we would give to our families. Kate had been the first.
“You look beautiful,” I whispered, as I pulled my wife close.
“This will be perfect,” she whispered. “Perfect.”
We had expected to spend the weekend alone, just getting moved in, but were in for a delightful surprise. We were both pleasantly astonished and genuinely warmed as person after person dropped by. All day long, on Saturday and on Sunday, hospital employees, board members, a few doctors, local political figures, and the newspaper editor—most of them accompanied by their families—dropped by to greet us, welcome us, and share housewarming gifts. Our root-cellar shelves were rapidly filling with their gifts of canned fruits, vegetables, jams, and stews.
“I’m not sure I’ll ever have to go to the grocery,” exclaimed Barb.
Sunday afternoon, Dr. Bacon was helping Barb organize the shelves in the cellar. “Well, honey, if you do run out, just let some of Walt’s patients know—and they’ll restock it all!” He chuckled. We were soon to realize that he was dead serious.
“Where’s the new doc?” came a call from upstairs.
I bounded up the stairs to see a handsome young man who, when he saw me, stuck out his hand. “Howdy, Doc. I’m Gary Ayers, the morning deejay at WBHN. We’re the local radio station—AM 1590.” He paused. “In fact, we’re not hard to find on the dial. We’re the only radio station that can be heard in these parts,” he observed with a chuckle. “Just wanted to come by and meet you—especially since you guys are a great source of information for the morning news!”
For a moment I thought he might be kidding. But he was not. Gary, as I was to learn, was the source to the county not only for world and national news, but he was also the mouthpiece for most of the better community gossip.
As Gary left, Dr. Bacon and Barb came up from the basement. “Be careful, son,” warned Dr. Bacon. “If he likes ya, he can make life pleasant indeed. If he doesn’t, look out!”
“What about the newspaper editor?” I asked.
“Oh, you mean Pete Lawson?”
“Yep. He was by earlier today.”
“Nope. Not to worry. Pete’s as good a newspaper journalist as there is. Plays his stories straight to the facts. I like Pete. A lot!”
And I liked Dr. Bacon. I asked him if he’d give me a personal tour of his orchard, located between our house and his.
“You bet!” he agreed. “Do you want to help with the harvest? I’d be glad to trade a few jars of canned apples, applesauce, and apple cider for your efforts.”
“I’d be delighted.” I smiled as I accompanied him outside, where we strolled through the rows of trees and eventually sat under the large fir tree in front of his house, gazing at the mountains. Dr. Bacon began to share a bit about his past and about the medical history of the county.
“Walt, I’m glad you’re going to bring the babies back to our county. I was so disappointed when the younger docs and the hospital decided to let Sylva take away our babies.”
“Did you attend births yourself?” I inquired.
He looked at me as though I had four eyes. “Did I attend births?” He chuckled. “Why, I’ve delivered hundreds and hundreds of babies in my time. I’ve even delivered scores of babies of girls I delivered. Now, that’s when you know you’re getting old—when you deliver your second generation. I’ve even delivered a few of what I call third-generation babies—where I delivered the baby, the mom, and the grandmom. Now you know for sure that I’m ancient.” He threw his head back and laughed. I wondered if I would ever have the amazing privilege to attend the birth of a woman whose own birth I had attended.
“For years and years,” Dr. Bacon continued, “before the hospital was built, why, I’d do all the deliveries at home. Remember taking the Model-T out into the hollows. Sometimes I’d have to push her across the creek bottoms, sometimes get stuck in mud. Would get to the house and stay until the baby was born. Sometimes that’d be hours and sometimes a day or two. Had some basic rules I’d always go by. First of all, I’d get all of the men out of the house. Something about men. They just seemed to get in the way and women always labored better without them.”
“Wouldn’t you allow a daddy to see his child be born?” I inquired.
“Oh my, yes. But he’d only be in the way during labor. He could come in for the birth—if he wanted and if she wanted. But if she didn’t want him there, he’d just have to stay out. They seemed to understand—especially in those days.
“What I rea
lly wanted at the house was women—especially women who had had babies. Walt, there’s not a man in the world that can care for a woman in labor like a woman who has gone through labor. I can’t explain it, but a woman caring for a woman just seems to make the labor go faster. If there weren’t any ladies present when I got there, I’d send the husband off to get some. It would give him something useful to do.
“I’d also always bring a bundle of fresh newspaper from town.”
“Newspaper? For what?”
“Walt, newspaper is sterile. Perfectly sterile. I’d use the paper as drapes and to keep the bedsheets dry and clean. Also, once I knew the mom and baby were OK, it gave me a chance to sit back and catch up on the goings-on in town.” He chuckled.
“Good obstetrics requires a good portion of patience. I’ve always said I needed a good cigar and a rocking chair to enjoy while I’m reading that paper. Just let things go their natural way. Almost always came out all right. In over forty years I only lost one baby—and that was from a knotted cord. And,” he emphasized, “I never lost a mom. Not one.”
“But, Dr. Bacon,” I quizzed, “what if you got in trouble? Did you go to a hospital?”
“Nope. In those days we did what was called kitchen surgery.”
“You did the C-sections at home?” I was incredulous.
“Of course. Why not?”
I paused. “Well, the lack of sterility could cause infection and death, and what about the lack of help and proper equipment?”
He laughed. “I guess you’ve never been exposed to ‘kitchen surgery,’ have you?”
“Nope, that’s for sure!” I replied.
“Walt, in our kitchen-surgery days we had to be content to work with no luxuries. We had to learn what essentials we had to have and how to work quickly. This is more than most modern surgeons know. Our system involved small incisions and rapid surgery. I tell you, this minimizes more infection than all the modern face masks and head covers combined. We seldom had any wound infections in our kitchen surgeries. The most important factor was prompt surgery. Small incisions. Minimal unnecessary trauma to the tissues. Expert surgical technique. Minimal exposure of any internal tissue to the air. Rapid closure and good dressings. These were the tools and trade of the kitchen surgeon.”
“Was lighting a problem?”
“It could be at times. Indeed. Lantern light is hard to use for surgery. The best light was a car headlight.”
“What did you do—bring a car battery and light into the house?”
He laughed. “No, no. Just have someone drive the car up to the door or in front of a kitchen window and leave the headlights on—pointing into the kitchen. Then a family member would use a looking glass to reflect the light into the wound or onto the perineum. There was no better light than this—just as good as any operating room light!”
I was fascinated. “What about anesthesia?”
“That was a problem. Nothing worse than to have a patient half-asleep—or, worse yet, waking up during the surgery—or, even worse, to have your volunteer anesthetist go to sleep from the fumes! So I’d usually take my nurse or my wife, who knew how to administer the chloroform—in the early days—and ether more recently. Of course, in the last few years, portable masks of halothane were a godsend. If my wife or my nurse wasn’t with me, I’d have to train a family member or friend. Actually, some of the country pastors who’d always show up during my sick calls got pretty good at helping me pass the gas.”
I was quiet—feeling a bit uneducated in spite of having just come out of a prestigious medical school. I couldn’t imagine the rush, the fear, the excitement of a kitchen C-section—or a kitchen anything.
Dr. Bacon continued, “Walt, some of my best surgery was done under these adverse conditions. It’s hard to explain, but there was something much more exhilarating about driving through the elements to attend a woman delivering a baby at her home than there ever could be walking across the street to the hospital. Nothing stimulating in that.”
I sensed our conversation was coming to a close. The apples were calling my new friend—some needing to be crushed for applesauce, some needing to be cooked, and some needing to be made into cider.
“The chief value, Walt, of the kitchen operations, over those done in the hospital, is that the young surgeon, the inexperienced physician, had no one to blame but himself for a poor result or an infection after surgery. You young guys, if any of these things happen, tend to blame the hospital or the staff or the nurses.
“The second value of the kitchen surgery is that it could be done immediately. Young surgeons don’t understand that fear has an adverse influence on surgical recovery. You see, to most people hospitals are scary. They all seem to know people—friends and neighbors—who’ve gone to hospitals and died. Yet they know no one who’s died on the kitchen table. So when the hospital was built and we quit doing most of our kitchen surgeries, we didn’t realize the harm we were doing. Instead of seeing people early in their disease, they waited to come in for help. Patients would resist advice to go to the hospital and only come in when in severe distress.
“So, when the hospital first started doing surgery, our morbidity and mortality was unacceptably high. This caused more fear of the hospital and produced a vicious cycle. The more people who fared poorly at the hospital, the longer people waited to come to the hospital, and the worse they did when they got there. When we operated at home, we operated earlier in the course of the disease. The patient’s fear factor was much lower. And they just did better.
“Walt, even today, I will not operate on someone who is deathly frightened. It doesn’t matter what causes the fear—I will not operate on a frightened patient. I’ve seen more than one patient who, prior to surgery, said they had dreamed that they didn’t recover—or who confessed that they thought they were going to die and not recuperate—who proceeded to make good on their prediction. Every old surgeon has similar stories to tell from his own experience. When we autopsied these cases, we did not find the cause of death in even one.”
He took a slow, deep breath. “I believe they were literally scared to death.”
He slowly stood. “Been a pleasure chatting with you, Walt, but I bet that lovely wife of yours has Sunday dinner about ready. You get on and I’ll bring some cans over later this evening.”
Later that evening Dr. Bacon did bring over dozens of jars and cans. Our root cellar was well stocked with candied apples, apple chips, applesauce, and apple cider—some of the best we’ve ever had. But the old physician’s real gift that day was grounding me a bit in the history of my profession and my community. I may have known more modern medicine than he did, but not more medicine—and certainly not more interesting medicine!
chapter seven
FIRST-DAY JITTERS
Monday morning was my first official day of work as a family physician—the culmination of twenty-four years of education. I almost couldn’t believe the big day had finally arrived. Today, I would just start making a living—almost eleven years after many of my high school friends had begun their careers.
I arrived at the hospital at 5:30 A.M., ready to meet Mitch for rounds. Mitch was, according to the evening supervisor, uncharacteristically late. I stood nervously at the nurses’ station waiting for him. I didn’t have to wait long. In he strode, confident and lively. As he entered the station, as though on cue all the nurses stood to attention and in unison said, “Good morning, Dr. Mitchell.” I’m sure my mouth dropped open. Then a nurse appeared from nowhere with a pot of coffee and a clean cup and saucer. “Thank you, Verna,” commented Mitch, without looking up from the pile of charts that had been carefully organized at his chair. This was not the way we made rounds at Duke. We were lucky if the nurses even noticed us when we entered the station—that is, unless they needed something.
As he quickly thumbed through each chart, he hummed to himself. Then Ray showed up. Same song, second verse. “Good morning, Dr. Cunningham!”
“Good morn
ing, ladies.”
Then another pot of coffee and cup with saucer appeared.
Then Mitch was up and walking. “Let’s go see some folks, Walt.” And we were off to visit the patients. I heard the rustling of charts. I looked back at the station as we headed down the corridor and saw Verna putting the charts into a rolling cart and then quickly pushing it as she tried to catch up with us.
As we saw each patient—each having been awakened by a nurse’s aide who preceded us—Mitch asked a few questions, answered a few questions, did a brief exam, and, while doing so, dictated a note that was written in the chart by Verna. Then he would dictate some orders, which she would write on the order sheet—which he would sign—and then we were off to the next patient. The whole process took only a few moments with each patient.
We’d briefly discuss each case. He’d ask what I would do and then briskly criticize each answer. “Son, that’s not the way we do it here.” Attached to this oft-repeated phrase might be, “That would just cost too much money, and the folks here don’t have much” or, “That’s the hard way to do it. How about . . . ?” or, “You’ve got to be kidding! Didn’t they teach you . . . ?” I was beginning to doubt the value of any of my last seven years of medical education—when suddenly we were done.
“Let’s go get a bite to eat before surgery. We’ve got a full schedule today.” We took the elevator—the first of only two in all of Swain County—to the basement and entered the small but comfortable hospital dining room, Eloise Newman’s domain. Eloise, whose culinary expertise had so dazzled us the previous year, had been brought up in the “red meat and potatoes” school of food preparation. If it wasn’t fried and fatty, it wasn’t worth serving. The spread of available food was impressive. But no yogurt, no fruit, no muesli or granola, no whole-grain foods here! Rather, a veritable smorgasbord of yeast rolls and homemade biscuits, butter, homemade jams, eggs (scrambled or poached or fried), bacon, sausage (link or patty), grits, home fries, and pots and pots of strong coffee. This was a nutritional den of iniquity. But did it all ever taste good!
Bryson City Tales Page 6