Bryson City Tales

by Walt Larimore, MD

  “Walt,” barked Dr. Mitchell, “enough relaxation. Let’s get to work!” With that, we were off to the OR, which was larger and more spacious than I had remembered from my tour when I’d interviewed here. The equipment was spotless and looked nearly new.

  “Earl and the board keep us well equipped. You won’t find a better OR suite in western North Carolina,” Mitch boasted. He introduced me to the two nurse anesthetists, Alfred Jensen and Kim Hamrick. Kim’s husband, Mike, was one of only two dentists in the county. Mitch also introduced me to the scrub and circulating nurses and the orderly. For a small hospital this was quite the setup. Ray and Mitch operated all morning, five to six days a week. Big-city surgeons often only operate two or three mornings a week!

  That morning I assisted Mitch and Ray with eight surgeries—an elective gallbladder removal for gallstones, a hip replacement, an elective hernia repair, a breast biopsy, the placement of a set of ear tubes in a three-year-old, an upper gastrointestinal endoscopy, and the removal of a large tumor on a man’s back. In some areas, general surgeons won’t do this many cases in a week. But with a referral area of two counties, this OR was kept hopping.

  My confidence in the hospital and in these two surgeons soared. They were good—very good. Mitch’s hands were as fast and as skilled as any I had seen at any hospital in which I had scrubbed.

  Throughout the morning Mitch invited me to do more and more. My adrenaline surged as I sensed the surgeons and the staff closely watching my every move. Did I know how to properly scrub, gown, and glove? Did I know how to assist—to help the surgeon operate more quickly and effectively? Could I sew— and sew quickly? I answered question after question about anatomy, options, techniques, postoperative orders—sometimes almost nonstop. I felt like a medical student or an intern. It was an intense morning, yet I felt I did well, and I sensed Mitch’s unspoken approval. He left the OR after the last operation, while Ray and I closed.

  “Walt, don’t feel bad about all these questions,” Ray said. “Mitch did that to me for weeks. I wish I had done as well as you did.”

  I was pleased that Ray was satisfied. It had been a very good morning.

  When we were finished, I walked over to the house for lunch.

  “Honey, how’d it go?” shouted Barb from the basement.

  “It went super. Great morning.”

  I sat at the dining room table and opened up the Smoky Mountain Times. This small but excellent paper would bring us the news and the printable gossip on a weekly basis.

  I heard Barb running up the steps. When she got to the kitchen, she announced, “Honey, Eudora brought a mess of fresh vegetables and greens. She said that the nurses and staff always bring in extra from their gardens and leave it in the staff lounge so that those without gardens can enjoy the pickings.”

  This was our introduction into one of the major unreported industries of Swain County, namely, hunting and growing your own food. So Barb and I enjoyed our first lunch of local produce—remarking to one another that there was nothing tastier than fresh, homegrown food.

  After lunch, we drove down Hospital Hill and into town for a visit to the Swain County courthouse, where we planned to register to vote. Its gold-painted dome, mounted with a weather vane, sat atop a neoclassical, octagonal cupola. Its whitewashed stucco walls and its pillared, ionic portico made for a very impressive courthouse for a small town.

  Upstairs housed a beautiful courtroom, right out of To Kill a Mockingbird . Downstairs contained some of the county offices, including the voter registration area. There were only three ladies sitting at their desks when we arrived. One of them stood and approached us, “I’m Sarah Robinson. How may I help you?” Registration took only a few moments and went well until Sarah asked, “What party will you be registering with?”

  In unison we answered, “Independent.” We thought this would be wise, given the split politics of the medical staff and until we better knew the “lay of the land.” Instantly we suspected we had made a mistake. Sarah gawked at us with a funny look. The other two women in the room nearly broke their necks snapping their heads up to stare at us, incredulously, as their collective jaws dropped.

  Sarah recovered the quickest. “Independent?” she inquired.

  “Yep,” I said.

  She repeated, “Independent?”

  “Can’t we register Independent?” queried Barb.

  “Of course you can,” she responded, “it’s just that no one ever does.” The other two women in the office acquiesced by solemnly shaking their heads no.

  “OK,” said Barb, “that’s what we’d like to do.”

  The clerk bowed her head to stare at us over her glasses. She made one last effort. “Are you sure? ”

  “Yes, ma’am, we’re sure,” replied my less-than-sure-sounding wife.

  We left the office with our new, but temporary, voting cards.

  “That was weird!” we both agreed. We had no idea.

  After dropping Barb off at the house, I drove to the offices of Swain Surgical Associates, looking forward with some trepidation to my first afternoon in private practice. I parked in the staff parking lot at the back of the building and entered the staff entrance. Shouts of “Surprise!” and “Welcome!” startled me and there on the table was a small cake that Sarah Crisp, the receptionist, had baked. The icing on the top spelled out the words, “Welcome, Dr. Walt.” I’m sure I was beaming as I took in the scene—balloons and confetti blanketing the entire staff lounge.

  Helen Gibson had been Mitch’s nurse since before they invented dirt. Gay, Mitch’s wife, was a trained medical assistant and had volunteered to assist Dr. Cunningham, and now me. Reva Blanton worked the front office with Sarah.

  Helen spoke first. “Honey, we’ve got some cake here for you, but first the boss wants to see you. He’s in his office.” I suspected Mitch just wanted to personally welcome me to the practice. I suspected wrong. He was working on a chart, intently scrawling away.

  “Sit down,” he barked, pointing to an old chair with cracked leather upholstery. When he finished, he rocked back in his chair, looking not at me but at the ceiling. This did not look good. Then he rocked forward, placed his arms on the desktop and clasped his hands, looking down at them. This did not look good at all. Then he looked up at me.

  “You stupid?” he asked.

  “Am I what?” I wasn’t sure I’d heard him right.

  “You stupid?” he repeated.

  “I . . . I don’t think so,” I stammered. “Why?”

  “Well, son, you registered Independent at the courthouse. And I’ve got to tell you, in this county, that’s stupid.”

  I slumped in the chair, stunned. “Most folks around here were born and bred Democrat. I consider that a form of ignorance at best, and a genetic disease at worst. But at least folks stand on their beliefs, even if they are wrong. Most of the rest of us, those with brains and the ability to think for ourselves, are Republican. And I tell you what, son; we’re growing into a force around here. I suspect we’ll take some of the elections coming up in a few weeks.”

  He rocked back, looking a bit more relaxed now that he had unleashed his verbal onslaught. He continued, “But, son, Independent is stupid. It says you stand for nothing, you believe nothing. It says you don’t want to vote in the primaries. It says you’re straddling the fence. Son, you need to make a decision. You need to either fish or cut bait.”

  Then he rocked forward again and opened up his desk drawer, taking out two small pieces of paper.

  “Walt, I told the clerk’s office you wanted to revoke your Independent status and change to the Republican party.” He slid the two voter registration cards across the table.

  I was in shock. It hadn’t taken me more than ten minutes to get Barb home. Maybe another five to get to the office. In that time, Mitch had gotten the news from someone and had both the gumption and political clout to reregister us and get the cards sent to his office. I was outraged and didn’t know whether to explode in
righteous indignation or to laugh. I did neither. I guess I really was in shock.

  He continued, “Son, if you want to change these to Democrat, that’s fine with me, but you just can’t be Independent—not around here. It’s stupid. Go on now. The girls have a little party planned for you. I’ll be out in a few minutes.”

  I picked up the voter registration cards. I wasn’t sure what I would do with them. I turned to leave.

  “Please close the door after you.” I did.

  Everyone was busy now. The waiting room was packed. The exam rooms were filled. The office buzzed.

  Helen came up to me with her first of many, many orders. “Your first patient is in room 2. The patient just has a cold but is as mad as a hornet that he can’t see Mitch. I tried to calm him down a bit for you. Let me know if you need any help.”

  I looked over the chart, then knocked and entered the room.

  The patient took one look at me and exclaimed, “You’ve got to be kidding me. You’re too young to be a doctor , aren’t you? HELEN, WHERE’S MY DOCTOR? HELEN?!?!”

  I thought to myself, with some dismay, Welcome to rural private practice!

  chapter eight

  EMERGENCY!

  Somehow I survived my first week of practice, including my first experience as the county coroner. So far I hadn’t made any major mistakes or caused any fatalities. The sixth commandment of Moses parallels the first commandment of medicine. This is often publicly quoted as “First, do no harm.” However, any first-year medical student knows that behind the lines what is really taught them is this: “First, do not kill the patient”—always wise advice.

  At 6:00 A.M. the clock radio went off to initiate both our day and the broadcast day of WBHN, AM 1590. Each weekday morning, Barb and I would awaken with WBHN and morning deejay Gary Ayers’s country crooning and conservative views about local gossip—uh, news and politics. I immediately grew fond of his broadcasting style and later would come to appreciate his friendship.

  Today I was to be the on-call doctor once again. Each of the seven of us had four or five twenty-four-hour cycles each month in which we were on call for the county. Since the hospital had no emergency physicians and the county had no coroner, the on-call doctor was responsible for every kind of medical need that came up on his shift. Although the variety of this type of responsibility was brand-new to me, it was the way general practitioners in America had practiced for scores of decades. My fellow six local physicians, with over 170 years of combined practice experience, were not planning on changing the way things had been done since the hospital had been built decades before.

  Depending on the time of year, the day of the week, whether it was a payday or not, being on call could be leisurely, slow, and relaxing, or it could be gruesome, grimy, and laborious. Tourist season, running from Memorial Day weekend through Labor Day weekend, as well as the “color season” of October, was usually fraught with the medical consequences of the foolishness or carelessness of visiting tourists. Being September—the summer tourist rush over and the annual color season yet to come—things were lighter now, both in the office I shared with Mitch and Ray and in the hospital ER. So by the time I’d seen the last patient of the day at the office, I was still wondering when I’d face my first on-call emergency.

  I drove home from the office, parked in the old garage behind our home, and enjoyed walking around a bit on the path that ran along the ridge of Hospital Hill. All of the windows in our house were open, and I could see the curtains gently wafting in the evening breeze. I could hear Barb singing in the kitchen. I could feel the stress of the day melting away. I loved to hear Barb sing or hum—it was one of the ways by which I could tell that her day had gone well. Our little Kate was standing as usual at the screen door—waiting for her daddy. This was always the highlight of my day. I loved my daughter dearly, and I loved being a daddy.

  Because of Kate’s cerebral palsy, Barb’s current pregnancy, prior to our move, had been handled at Duke by our family physician as a high-risk pregnancy. Three ultrasound examinations had revealed that the developing child, a little girl, was healthy and growing normally. We had named her Erin Elizabeth. We were looking forward to Kate having a sister.

  I had never wanted to be my family’s physician but was willing to serve as Barb’s maternity caregiver until Rick Pyeritz, M.D., my partner-to-be, arrived later in the fall. Rick and I had been residents at Duke and had decided to practice in Bryson City together. Initially we would share space with Ray and Mitch, but we’d begin our group practice within a year in the new building soon to be constructed. Barb was not due to deliver baby Erin until late January, so my job as Barb and Erin’s doctor, pending Rick’s arrival, should be fairly easy. I was absolutely thrilled with our hospital’s new state-of-the-art, two-bed, LDRP birthing center—a center I had helped design during my senior resident year at Duke. LDRP centers had large, comfortable birthing suites where a family could Labor, Deliver, Recover, and receive Postpartum care all in one room. We laughingly called our center “the smallest LDRP birthing center in the world.” I particularly anticipated having my own child born there.

  Kate’s disability and the hours of therapy she required each day were often draining on Barb and Kate. On top of that, there were still boxes to be unpacked. Nevertheless, as I walked toward our little home that cool September evening, Barb’s singing meant that her heart was light. So was mine. My step quickened. I thought, Maybe this small, old, creaky house in this tiny mountain town will become more than just a little house by the hospital. Maybe it will really become a home—our home.

  As I walked up to the door, Kate squealed. I picked her up to give her a big hug and then went inside to help Barb with the dinner preparations. Although I kept my ear cocked toward the phone, no call came for the new doctor in town. All was quiet throughout the evening, and Barb and I wrapped up the long day by sitting outside on the bench, watching the moonless sky sparkle over Deep Creek. When we got in bed that night, I promptly fell fast asleep. Then the call came.

  “You the new doc?” twanged the voice on the other end of a phone that had shattered my serene slumber.

  “Yes, I am. I’m Dr. Larimore.” Before the next words came out, I smiled and thought of my internal medicine professor at Duke, Dr. Gene Stead. He taught us, “Never, never, never ask a patient, ‘Can I help you?’ Of course you can help the patient! If you can’t help them, you’re in the wrong business. Instead ask, ‘How may I help you?’ That’s what a physician is there for—and that’s what your patient needs—a physician.” So, almost sensing Dr. Stead sitting on the bed next to me, I asked, “How may I help you?”

  “This here’s Clem Monteith. You better get up here to my place—and I mean now!” exclaimed the distressed voice.

  “Get up where?” I inquired, now fully awake.

  “Doc, I’m not kidding. She’s about to deliver. You better get up here!”

  Now the picture was clearer. Because the physicians in Bryson City often made home visits and because almost all the county’s residents had been delivered at home—at least prior to 1950, when the hospital opened, and some still did so—a few of the long-established families still desired and expected home care. However, being a well-trained, highly technical birth attendant, I shared the delusion of many of my obstetrical colleagues that deliveries were best performed in the hospital setting.

  Nevertheless, I was a trained professional and knew how to defuse a tense situation. So, now sitting up on the side of the bed, I took control. “Sir, it might be best for you to bring her to the hospital now. I’ll meet you there.” Furthermore, not unaware of the abject poverty in the county and the fact that many residents did not have transportation, I added, “Do you have a car?”

  His answer was peppered with colorful language, not fit to repeat word for word, but he said something like this: “No, I don’t have no blasted car, son.” He paused to take a deep breath, then exclaimed, “I got a truck! But I’ll tell you what, there ain
’t no blasted way I’m gonna get her in that blasted truck!! Now listen here, she’s about to deliver and you better get up here—quick!”

  I knew I needed to get up there. At least I could calm him down and assess the situation. Furthermore, I could have the paramedics from the Swain County Rescue Squad meet me at the house. They would have any of the equipment I might need, I thought altruistically. A selfish thought also entered my mind. I mean, if the paramedics could see me do a great home delivery—only if necessary, of course—I thought, humbly, that would be superb.

  The reputations of the older physicians in town—at least the ones who were respected—had been made in their first few heroic cases, now ingrained in the nearly legendary and historic mythology that exists in any medical staff. Ah, I thought modestly, tonight the Larimore epoch begins!

  While I was fantasizing, Clem Monteith’s anxious voice erupted into my ear. “She’s gonna deliver and you better get up here! The front-porch light is on.” He paused, then exclaimed, “Oh my, I can hear her pushing. Get here quick! I don’t want to lose her!” Then the line went dead.

  That pretty much settled things. I would just have to go to his house, where I could calm him down and assess the situation. But, Oh no! I thought. I hadn’t asked him how to get to his place. And that meant calling Millie, the courteous and helpful dispatcher. Surely she’d know the way. I quickly called dispatch and heard a snarl, “Swain County Dispatch.”

  “Millie, this is Dr. Larimore.”

  After a pause, she responded with her condescending, “Yes, I know.”

  Now was the time to let the cat out of the bag. I cringed as I pleaded, “Millie, where is Clem Monteith’s place?”

  Millie heaved a big sigh into the phone. “Son, you thought about investing in a map? They’re not that expensive, and on a doctor’s salary you might could even afford a case.”

  Cute, I thought. “Yes, I’ll try to remember to get one, but I need to get up there—now.”