Bryson City Tales

by Walt Larimore, MD

  “On the appointed day the reporter drove up to the house, walked past the Secret Service agents and up to the front porch. She knocked on the screen door. Miss Lillian greeted her and took her into the parlor, where they both sat down. Miss Lillian offered her no refreshments, which would be highly unusual, even rude, in that area of the South.

  “The reporter tried to make small talk. Miss Lillian’s response was to look at her wristwatch and say, ‘You have twenty-seven minutes.’

  “The reporter began her interview with what was to Miss Lillian one of the most offensive questions she could be asked: ‘The president has been quoted as saying that his religious beliefs would compel him to never knowingly tell a lie. You raised the president from the time he was a baby. You saw him grow up. During that time did you know him to ever tell a lie?’

  “Miss Lillian’s cheeks flushed, but she remained cool on the outside. ‘When you say “lie,” asked Miss Lillian, ‘do you mean a white lie or a black lie?’

  “It was the reporter’s turn to flush. ‘What’s the difference?’ she asked indignantly. ‘Isn’t a lie a lie? I mean, just what is a white lie?’

  “Miss Lillian stared right at that reporter lady and said, ‘A white lie is like . . . ,’ she thought for a moment and then continued on, ‘a white lie is like when I met you at the door and said, “‘It’s so good to meet you.”’”

  Louise threw her head back and laughed. I laughed with her. She had made her point.

  From that moment on I began to feel comfortable around Louise. Maybe it was because I relaxed about not being the know-it-all that doctors are often led to believe they should strive to be. Perhaps I was becoming more accepting of the fact that as long as I was to practice medicine, I would need to continue to learn and be taught—by my patients and by my colleagues.

  Louise and I developed a special relationship. Sure, it was a bit bumpy at the start—but, like a fine wine, it mellowed and matured into something very valuable to me. No lie. Not even a white one!

  chapter sixteen

  THE EPIPHANY

  One day during morning rounds the call came over the hospital intercom. “Dr. Larimore, stat to the ER.” I was in the EKG reading room, on the other end from the ER. I quickly ran the couple of hundred feet.

  The patient appeared whiter than the sheets on which she lay, and she was gasping for breath with very rapid, shallow breaths. Even more ominous was a rapidly expanding pool of bright-red blood on the floor under her gurney—at least four or five feet in diameter. Worse yet, there were several waterfalls of blood actively dripping from the edge of the sheet covering the patient.

  “Dr. Larimore, get over here!” Louise shouted. “She’s hemorrhaging from the vagina.” I ran over as Louise continued her history. “She had a positive pregnancy test last week, and her last period was about three or four months ago,” yelled the ER nurse, who was cutting off the woman’s clothes, while Betty, the lab director, was starting an IV and drawing blood for lab samples. Nancy Cunningham had run in to help us and was starting oxygen.

  “Let’s set up for an exam, now!” I ordered. “Louise, get the Gyn tray!” In moments the stirrups were set up and the patient pulled down to the end of the bed, flat on her back, legs spread—we call it the dorsal lithotomy position. I quickly gloved and turned my attention to the woman’s perineum, which had blood coming from the vagina at a remarkable pace. “What’s your name?” I asked her. She didn’t answer but just stared at the ceiling. We were losing her.

  Louise, who knew everyone in town, filled in some of the details. “Her name’s Doreen, she’s eighteen, been married about six months. Just out of Swain High last May. Works down at the plant.”

  “Doreen, I’m going to do a quick exam. I’ll be as gentle as I can. I suspect you’re losing your baby. We’ll do everything we can to help you.” In my heart I was thinking, I don’t want to lose you, Doreen. Fight for me. Lord, I prayed, help Doreen. Help me!

  I went to work, quickly inserting a sterile speculum, and discovered what I was expecting to discover. Doreen’s cervix, the opening to her womb, was about three-quarters of an inch dilated, and hung up in it was a dark clot of material—what medical professionals usually called “the products of conception,” what I called a preborn child who was miscarrying. Around the tiny baby and placenta the uterus was hemorrhaging—and hemorrhaging big-time. The cure would be to remove the little body and placenta as quickly as possible.

  “Ring forceps!” I asked Louise for an instrument I could use to gently extract the fragile mass. It came out intact and I examined it. All I could see was the placenta. This was not unusual, as the tiny preborn child could often pass without being noticed—or sometimes could be absorbed by the womb before the miscarriage.

  “Nancy, let’s give five units of Pitocin IM and add twenty units to the fullest IV bag and slow the flow of that bag to 125 cc’s per hour.” The Pitocin, normally used to induce labor, would hopefully stimulate the uterus to contract, and the contraction of the muscles should then slow or even stop the bleeding.

  “Walt,” Betty said, “I’ll run the usual labs and get some blood set up. Looks like you’ll need it.”

  “Thanks, Betty,” I called out as she headed toward the lab.

  I placed the mass in a formaldehyde container that Louise had opened. Then I quickly removed the speculum. Louise was working in tandem with me as though we had done this many times together. Obviously, for once I was doing what the older physicians would have done in the same circumstances. It felt good.

  Louise squeezed some sterile K-Y Jelly onto my outstretched fingers. “Doreen, we’ve gotten the miscarriage out safely. Now I need to examine you on the inside. Can you take some deep breaths?” She still seemed dazed and incommunicado but did begin to breathe deeply. I did a rapid manual exam. I could feel no other products inside the uterus. Then with my inside fingers I lifted the uterus up toward the abdominal wall. With my outside fingers, I began to push and massage. “Doreen, this may be uncomfortable, but it will help the Pitocin stop the bleeding. Can you bear with me a moment?” She nodded. As I massaged the uterus I could feel it shrinking and hardening. Thank you, Lord, I prayed.

  Nancy asked, “How about a second line?”

  “Great idea. Will do. It needs to be a large bore needle and normal saline. We’ll use that line to transfuse her.”

  “Done.” Nancy had the IV inserted in seconds. This nurse was good, real good!

  The uterus was continuing to contract, and very little blood was now flowing. “Vaginal pack,” I said.

  “Yes, sir,” responded Louise. She turned to get one from a nearby cabinet. I slowly inserted the pack, which is a roll of narrow sterile gauze. Whew, I thought to myself, I think we’re going to make it!

  “Good job, Dr. Larimore,” Louise whispered. She fairly glowed.

  “Hematocrit is ten,” announced Betty as she rushed back into the emergency room. “Blood is O negative. I’m cross matching for six units.”

  Each transfusion of packed red blood cells would increase Doreen’s hematocrit by about three points. A hematocrit of forty would be normal, but if we could transfuse her to twenty-five or thirty, she could build her blood count from there just by taking some oral iron.

  “Betty, bet we won’t need more than four or five units, but let’s do get started as soon as the units are ready.”

  “Yes, sir,” she said, and headed back to the lab.

  I took off my gloves and went to stand at Doreen’s side. I took her hand in mine. “You OK?”

  She turned her head away, tears now flowing freely. She shook her head no.

  “Are you having any pain?”

  “It just feels like menstrual cramps.”

  “Doreen, I’m sorry we had to work so quickly. But we had to stop the bleeding. I’m expecting you to make a full recovery, but we’ll need to give you some blood to replace all that you’ve lost. I’m hoping you’ll be able to go home in a day or two.”

 
; That evening, I dropped by Doreen’s room. She had received fluids and had tolerated the transfusions without reaction. Her hematocrit was twenty-four, and her color and temperament were both improving. She was sitting up in bed and sipping water. A young man was beside her.

  “Hi, Dr. Larimore,” exclaimed an almost chipper patient. “This is my husband, Harold.”

  “Pleased to meet you,” Harold said as he offered his hand. “Thanks for saving my wife’s life.”

  “I’m just glad she got over here in time,” I commented—feeling almost Mitchlike.

  He went on. “We were at the plant, working. I got called to the nurse’s office. Found Doreen layin’ on the bed. Her pants were soaked with blood. I ’bout fainted. Ambulance came to get her.”

  “I suspect that was pretty scary, wasn’t it?” They both nodded their heads in agreement. I was quiet for a moment, and so were they.

  “Doreen, I need to pull out the packing. That will make you feel a whole lot better. Harold, do you want to step out for a moment while I do this?”

  “No sir!” he replied. “If it’s all the same to you, I’d just as soon stay with Doreen.”

  “OK with me if it’s OK with your wife.” She nodded, and I pulled on sterile gloves as Louise got the patient into position. “Doreen, as I pull out the gauze, you should feel some pressure but no pain.” Harold was watching intently. Knowing that people sometimes swoon when watching a medical procedure, I said, “You may want to sit down on the chair there. Sometimes there’s some blood, and that can make a fellow feel a tad bit weak.”

  Harold sat down but didn’t let go of his wife’s hand. As I pulled on the gauze, it slid out without difficulty. But, to my astonishment, attached to the end of the gauze was a three-inch-long fetus. Looking just like a miniature baby, its eyes, arms, legs, hands, and even the nubs of fingers were all discernible. I gently picked up the little one and placed him in my palm. Their eyes were as big as saucers. So were mine. The word fetus seemed so cold, so inhuman. So I said, “Doreen and Harold, this is your little baby.”

  They seemed much more curious than sad or shocked. They looked and asked question after question.

  Harold asked, “Can you tell if it’s a boy or girl?”

  “It’s hard to tell at this stage, but he sure looks normal.”

  “He looks kind of like a real baby,” Doreen commented.

  I smiled and nodded. She was right. “He is a real baby, Doreen. Just real small and real fragile.” I paused for a second, feeling the tears forming in my eyes. I looked at the young couple and felt the first tear fall on my cheek. “I’m sorry he didn’t make it.”

  Their eyes met, and then they grasped each other’s hands even more firmly. Doreen turned back to me, her lower lip quivering and tears beginning to stream down her cheeks. “Can we bury our baby?” she asked.

  I looked to Louise for help—having never encountered this question before. The nurse nodded her head yes. So did I. As Doreen’s tears continued to flow, she reached out to touch her little one and then gently stroked his head. “He’s so soft and fragile.” Then she pulled her hand back and began to weep aloud. Harold moved closer to her on the bed, placing his arm around her and gently patting her back. His eyes were filled with tears. “Now, now, Doreen. It’s going to be OK, honey.” Then he collapsed and they wept in each other’s arms.

  I sat quietly, feeling honored to be able to share this intimate moment with this couple. After they had composed themselves, I suggested, “If you feel like naming the baby, I think it would be a good thing to do.” They nodded affirmatively.

  I wasn’t sure how to phrase my thoughts—I wasn’t even sure if my request was professional or appropriate—but I felt compelled to ask. “Harold and Doreen, your baby is the first baby I’ve delivered here in Bryson City. He’s also the first baby I’ve lost.” I felt more tears streaming down my cheeks. The words were hard to get out, but I stumbled on. “If you don’t mind, and if it wouldn’t be an imposition to you, I’d sure appreciate being able to come to his funeral.”

  Harold and Doreen both nodded. Then as they wept and hugged, I placed the baby on a small 4 x 4-inch gauze and handed it to Louise—whose cheeks were also tearstained. She left the room.

  I was quiet—trying to compose myself. I pulled out my handkerchief and blew my nose. Finally I said, “Doreen and Harold, I was wondering, would you mind if we said a little prayer?”

  This was a new experience for me. In medical school and residency we were never taught to pray with patients. In fact, many of my professors thought that bringing religion into medical care was unethical. But I had long ago come to see my patients as consisting of mind, body, and spirit. I knew a loss like this could affect all three.

  They nodded. “Lord,” I began, not at all sure that what I was doing was appropriate or correct, “thank you for Doreen’s health. We could have lost her today, but did not. Harold and I both thank you for this.” I paused, not sure what to say next. “Lord, thank you for this little baby. I know that he’s now in your arms. We ask you to care for him and love him. And I ask that Harold and Doreen would heal quickly and, if it is in your will, that you would allow them to experience the gift of another child—one they can love and raise. Amen.”

  They continued to hug and cry in each other’s arms. I just sat by, in silence. As they composed themselves, Harold was the first to speak. “Doc, that was very special for us. Thanks.”

  I was relieved to realize that my spiritual treatment could be as, or maybe even more, effective than my medical treatment—certainly that they could complement each other. I offered to call their pastor, and they thought that’d be a good idea. Then I left to make the call and to finish my rounds.

  After dinner at home, the phone was quiet, but my spirit was not. Although I was still on call, I decided to go out to the bench and sit for a spell. The view of the mountains and the cool evening air were both refreshing. I knew that the experience of the loss of a child was as old as the hills around me—and I knew it would never hurt less. And yet I recognized the blessing I had experienced—the blessing of being invited into a young family’s emergency and into their loss and grief, to have been summoned into their intimacy, having never even met them before, just by the nature of my profession. I think it was the first time I realized, at the very core of my soul, the wonderful opportunity that had been given me as a physician.

  I thought of all the things a patient allows a doctor—even one they’ve never met—to do or say. They would, without challenge, disrobe at my request; they would tell me things they wouldn’t tell anyone else; they would put their very lives in my hands; they’d even make major lifestyle changes based on my recommendations.

  Then I realized something that truly gave me pause. These men and women who honor me truly honor me by allowing me to care for them. Most of them were granting me credibility before I had even earned it. In essence, they trusted me before I had earned their trust.

  As I gazed on the moonlit, misty vistas, I was filled with a sense of expectancy—a realization that God was whispering to me through every clinical encounter, as well as through every moment spent on this bench. A yearning welled up inside of me: I wanted to hear more. And then I had the most powerful realization of my career: I am meeting people in whose lives the God of the universe is working—working in profoundly powerful ways. It was, for me, an epiphany that would forever change me, my marriage, my life, and my practice.

  part three

  PLAY: MAKING BRYSON CITY HOME

  chapter seventeen

  BECOMING PART OF THE TEAM

  I had just finished seeing the last patient on a Monday morning when Dr. Mitchell walked by, reading a chart. He suddenly stopped and whirled around. “Hey, Walt. You going to the game this week?”

  “What game?”

  He looked astonished and then began to smile. It was a smile I was growing to recognize and despise—a near-sneer of amazement that I was so ignorant as to not know a b
asic fact of medicine or of town history or of life itself. “You’re kidding me, aren’t you?” he would always ask, adding his classic, “You stupid?”—sometimes verbally, sometimes just implied.

  “No, sir,” I would always reply with a sigh. “I’m not,” meaning but not audibly saying, I’m not kidding and I’m not stupid.

  Then he’d shrug his shoulders, resigning himself to the fact that his young protégé was indeed, as he called it, “city stupid.”

  “Well, son,” he began, as he did with all of his lectures to me, “I’m talking about the football game.” He paused. I waited. There was no way I was going to ask the question that was on my mind: What football game? Fortunately he continued the lesson. “Swain County’s going to be playing Sylva Friday night. ’Bout as good a rivalry as there is around here—although the Robbinsville game is always a battle too. Anyway, ’bout ev’ryone in town goes.”

  My mind flashed back in an instant to the impact that football had had on my life. The peak of my personal football career was my sophomore year in high school. I started as a defensive cornerback on the Robert E. Lee High School junior varsity team. The other cornerback, Chris Stuart, and I could read each other’s mind just by looking at each other. We were, in my opinion, a great team. I loved playing alongside him and being his friend. It was my best year.

  The last two years of high school ball saw me on the sidelines, insisting on trying to be a star wide receiver when in fact I had no offensive talent whatsoever. My pride overshadowed the simple fact that if I ever wanted to see time on the field, I needed to return to the defensive side of the ball. To my permanent chagrin, I simply never swallowed my pride on this matter.

  So it only made sense to me, as it does to most physicians who are somewhat pathologically frustrated athletes, to become involved in sports medicine—as I had done during my training at Duke. Suddenly my mind flashed back to a discussion I’d had with Mr. Douthit almost exactly one year before: “Folks around here take their football real serious. But none of our doctors have been particularly interested in being the team physician. Only a couple, Dr. Mitchell and Dr. Bacon, will even go to some of the games. But they prefer to sit in the stands. . . .” Sit in the stands? I thought. That was anathema.