Bryson City Tales

by Walt Larimore, MD

  “I will, Tony. I will,” I said, trying to reassure us both. “Hold on now.”

  If my diagnosis was correct, what I was about to do would cure him. If I was wrong, if his shoulder was broken, what I was about to do would not only make things worse, it would put Tony in even more excruciating pain. With him now relaxing, I moved quickly. In less than one or two seconds, I was able to abruptly perform a simple manipulation of his shoulder and arm. Both Tony and I instantly experienced relief as his dislocated shoulder moved back in place.

  Tony’s eyes widened, and he beamed. “Pain’s gone, Doc. It’s gone!”

  I breathed a huge sigh of relief. “Sit up, Tony. Let’s get you to your feet.”

  As he rose, so did a crescendo of applause from the crowd as they saw him swing his recently crippled arm. The stadium erupted. The ground shook.

  The referee stepped in. “Coach, you’re gonna have to sit him out a down.”

  “No problem. No problem.”

  As Tony ran off the field, the stands erupted again. Their hero appeared healthy. Coach and I walked off behind him.

  “Good job, Doc.”

  I handed him two Tums. He smiled and trotted ahead of me. I felt like I needed at least two myself!

  After a quick check on the sideline indicated that Tony had suffered no nerve or blood vessel damage—and after a single play by a scared-to-death sophomore quarterback, executing his first play before his entire hometown—Tony hurried back onto the field.

  His dislocated shoulder was just what he, the team, and the crowd needed. Sylva didn’t stand a chance. The junkyard dog was out of the pen. We scored three times in the last quarter. The opposition never even got close to the goal line.

  It was one of the most joyous nights of my life. I had made a difference. I had become, in one glorious instant, part of the team and part of the community. From that moment on, for the rest of the game, I wasn’t watching their game, I was watching our game.

  After the win the locker room was the scene of an ongoing celebration. Coaches, players, and parents were all slapping me on the back. There were enough cheers going around for everyone. Coach asked me to check on Tony. I did. His shoulder was in good shape. The rotator cuff seemed tight. It was his first and, hopefully, last shoulder dislocation. Fortunately it wasn’t his throwing arm.

  “Should I ice or heat my shoulder, Doc?”

  I looked at the coach. He smiled. “I’d like you to ice it tonight and several times again tomorrow,” I said. “That OK, Coach?”

  Boyce grinned from ear to ear. “Doc, you say it, that’s the way we’ll do it.” He slapped Tony on the back. “Great game, son. Tonight’s part of your legacy.”

  “Thanks, Coach. And, Doc, thanks to you, too!”

  Outside the locker room there were only a few folks left. The lights had been turned off and a sprinkler was already on—preparing the field for next week’s battle with Robbinsville.

  A couple came up to me. The woman spoke first. “I’m Tony’s momma. He gonna be OK?”

  I explained the injury and what I had done. I recommended that they bring him to the office on Monday for an X ray—just to make sure everything was OK. I told them how to care for him over the weekend and suggested that they pick up an arm sling for the next day. It would make the shoulder more comfortable and guarantee plenty of sympathy at church. They smiled and thanked me.

  Preston and Joe Benny strode up. They provided a running commentary on the game, praised me for my first game’s performance, and were effusive in their congratulations. It was all a bit embarrassing. When they went off, arguing about this or that play or call, I headed toward my car. There weren’t many left in the lot.

  I suddenly stopped. At the gate stood Mitch and Gay. I felt a chill go down my spine. Was he angry? Should I have called him to the field? In my haste to care for the quarterback, had I dishonored his position and experience? The questions were rushing through my brain when he stepped toward me, extending his hand. As he shook it, he asked, “Anterior dislocation?”

  “Yes, sir.”

  “Neurovascular bundle OK?”

  “Yes, sir.”

  “Any pain over the proximal humerus after relocation?”

  “No, sir.”

  “Sending him for X rays?”

  “To the office Monday.”

  “Sling?”

  “Yep. Mom’s gonna pick one up in the morning.”

  He was quiet a moment.

  “Good job, son. Good job. Don’t know if I’ve ever enjoyed watching a game this much.”

  He slapped me on the back as we headed out the gate.

  “Should I have called you to the field, Mitch?”

  “You stupid?” he asked, smiling. He paused for a moment and then laughed. “No, no. Absolutely not. Figured if you were in trouble, you’d call. Folks around me in the stands were yelling for me to go down, but I told them to just hush up. I told them there was a mighty fine physician down there. Glad you didn’t let me down.”

  “Thanks, Mitch.”

  “Thank you, Walt. I’m glad you’re here. Good night.” They turned to leave.

  “Night, Mitch. Night, Gay.”

  As they walked away I headed toward the car. Then something caught my eye. The scoreboard was still lit up: SWAIN COUNTY 35 VISITORS 14. And in the lights below the scoreboard, in the message section, it said, “Thanks, Doc Lattimore.” My first home victory. Although my name was misspelled yet again, it was sweet indeed.

  chapter twenty

  FISHER OF MEN

  L ouise and I were completing our paperwork on a minor emergency we’d just handled in the ER when we heard someone moving quickly up the hallway toward the nurses’ station. Carroll Stevenson, the head technician of our radiology department, came into view and announced urgently, “Louise, the rescue squad’s bringing in a full code from Fontana Village.”

  Don and Billy soon appeared, with a heart attack patient in tow. As the gurney came through the door, I saw a stocky man alongside the rolling stretcher, performing chest compressions on the patient.

  “Louie,” Don shouted, “John had this controlled with nitroglycerin and morphine before we arrived, but now the patient’s not responding.”

  John Carswell was the head of security at the Fontana Village resort and a trained paramedic. He handled most of the resort’s medical emergencies until the county rescue squad got there—nearly a forty-five-minute drive down the winding road on the south shore of Lake Fontana, a deep lake that began at Fontana Dam and ended where the Tuckaseigee River flowed into it at the western outskirts of Bryson City.

  Don continued the patient’s history as he and Billy guided the gurney into an ER bay. “His name is James. He’s sixty-four years old. According to the wife, he has a known history of coronary artery disease, is status post two MI’s, and has mild congestive heart failure and stable angina. No hypertension or diabetes. He’s never smoked. Strong family history of heart disease. His last MI was one year ago. Takes Lanoxin 0.25 milligrams a day, Inderal 40 milligrams every eight hours, Isordil 10 milligrams every eight hours, and sublingual nitroglycerin PRN. He’s had no cardiorespiratory symptoms in months, was at Fontana for a family reunion. After supper he had a sudden bout of severe chest pain, broke out in a sweat, vomited, and then fainted. Carswell was first on the scene.”

  John Carswell and I quickly greeted each other as he continued the chest compressions and elaborated on the history.

  “Doc, when me and my boys got there, the family had started CPR and had put a nitroglycerin tablet under his tongue. I called for backup and for the rescue squad. Normally we’d have called for a chopper out of Knoxville, but the fog was just too bad tonight. Had to transport by road.”

  John paused, almost as though he knew that a long transport dramatically reduced the patient’s chance of survival. “Doc, when I got to him he had no pulse or respirations, but his pupils were reactive. I started an IV and some oxygen and took over CPR. After about ten
minutes we got a pulse, and then a few minutes later he began to cough and to breathe on his own. His BP was 60 systolic, and then he woke up. He was complaining of a lot of chest pain. We gave him another nitro under the tongue and a small dose of IV morphine.”

  Don took over the story. “Then we arrived, Doc.” He gave me a brief summary as the team continued its work in ER. “We titrated morphine for the pain, which helped at first. We loaded him into the unit and took off for here. His family should be here soon. His systolic actually climbed to 80, but we could never get a diastolic. Then, about fifteen minutes out, he began having severe pain and became diaphoretic and nauseated. His BP and pulse got really low. I gave him another nitro and some more morphine, but he went into V fib and then he coded on us. Billy was driving and John and I worked on him. We’ve shocked him twice with the defibrillator, but he never responded. We’ve been doing CPR for ten minutes.”

  During the history, Louise and Carroll were helping to transfer the patient to the ER bed and hook him up to the monitors. Louise flew through a quick and cursory exam. I was surprised to see her doing this—in my training, it was the role of the physician. Was this local custom, or was it insubordination? I didn’t know, but almost in amazement I watched her perform the exam with not a single second or motion wasted.

  “Pupils eight millimeters dilated and fixed,” she shouted, to no one in particular. “Extremities cool to cold.” She took a reflex hammer and quickly assessed his reflexes and pain response. “No response to deep pain,” she continued. Everyone on the team knew she was describing a dead man.

  As Louise did the exam, the other nurses and the respiratory therapist arrived. In only seconds the patient was hooked up to the ventilator. The EKG monitor began to blink to life. It was just a flat line.

  Despite television shows to the contrary, rare was the patient, at least in those days, who came into the ER in full code and who later walked out of the hospital. This one didn’t either. After working feverishly for forty more minutes, I called the code and pronounced the man dead.

  Louise said, “I’ll call the funeral home. We’ll need an autopsy. The family is in the waiting room.”

  “Thanks, Louise. Thanks, all. You all did a great job. I’ll go talk to the family.”

  As I left the ER cubicle, Louise followed me out. She looked as though she had something to say.

  “Louise?”

  She dropped her head a bit. “Dr. Larimore, I’d be glad to go with you to talk to the family—that is, if you need me.”

  I thought this was an unusually sweet and thoughtful gesture. Yet, just for a moment I became suspicious. Doesn’t she trust me? Doesn’t she think I’m capable—that I may not do it like an experienced doctor? Then I thought, Has she been asked by the older docs to spy on me? Is she looking for evidence of my ineptitude? I quickly abandoned those thoughts. No, I concluded, she just was a good nurse who cared and wanted to help. At that moment my appreciation for her grew enormously.

  We walked from the ER to the hospital lobby. We had no ER waiting room per se. Although the lobby is normally full during the day, at this hour it was empty.

  I walked slowly, trying to gather my thoughts, rehearsing my lines—lines given so many times during residency, lines so very difficult to render with care and compassion, lines always rehearsed, at least by me, at the same time as prayers for wisdom and strength were silently whispered. These moments are never easy for the doctor—or for the family.

  I introduced myself to the family. “I’m afraid I’ve got some bad news for you.”

  Then I paused. This was what the family had been dreading. Now their worst fears had been confirmed. Some cried. Others just looked numb. All were quiet—overcome by shock. I waited for any questions. None came—which isn’t unusual at such a dramatic moment.

  “I want you to know that he did not suffer. He didn’t have any pain when he went to sleep. We did everything we could have done.”

  James’s wife, Grace, smiled. Softly she said, “Doctor, thank you. Thank you for trying.”

  I briefly explained what had happened and how hard we had tried to save his life. I suspect that this part of the conversation was almost always one-sided—more for the doctor’s benefit than for the family’s. It was the doctor’s way of confessing, of emoting, of rationalizing to himself and to the deceased’s loved ones that the doctor had done all he could do, all he knew to do—that the passing was not at his hands, but out of his hands. It also gave the family some time to get ready for what would come next.

  I then explained the legal and practical details. Under North Carolina law an autopsy would have to be performed, but it could be done, most of the time, without removing the brain. Grace seemed to accept this. Louise and I answered her and the family’s questions.

  Then Grace asked, “Can I see him? Be with him a moment?”

  “Of course,” I said. “Of course. If you would allow us a few moments, Louise will come back and get you. Is that OK?”

  She nodded.

  Louise and I walked back to the ER. James was covered with a blanket to his neck. He looked peaceful. The nursing staff had cleaned him up and replaced his cover sheet with a fresh, clean one. Don and Billy were doing paperwork. John was sitting by the outside door. After checking to see that all was in order, Louise announced that it was OK for the family to see James.

  “Louise, if it’s OK, I’ll go escort them.”

  “Of course,” she said.

  I went back to the lobby to escort them in. Like most families, they wept. They gently stroked James’s cheeks and touched his head. His boys—he had two of them—bent over to kiss him good-bye. It was my custom to stay with the family during these private moments. To be still and respectful and available. Often families will use this time to share a story or two. Sometimes they’ll ask more questions. Sometimes they’ll be very quiet. I would be there with them and, if possible, try to bring some solace into a dreadful situation.

  The last thing I was expecting was for James’s wife to comfort me.

  After she kissed his cheek and held his hand, Grace looked at me. Her eyes were puffy, but she seemed unusually calm and peaceful.

  “Doctor,” she explained softly, “my James has had several heart attacks. His father died at the age of forty-five of a massive MI. His dad’s dad and granddad both died before the age of fifty from heart attacks. He’s sixty-four and has lived longer than any other man in his family. He was a great dad to our five kids and a wonderful husband to me—my best friend.”

  She stopped to wipe away the tears. Then she went on. “I am so grateful to have known and loved and lived with this beautiful man. And the Lord has given us so many more years than I ever expected. But, Doctor, best of all, because of his faith in the Lord, I know for sure that he’s in heaven. I know for sure that he’ll never feel pain again. And I know for sure that I and the kids will see him again.”

  She paused. I was overwhelmed by her faith, her peace, and her gentleness. Even in my short career, I had seen many grieving families. Yet, in my experience, it only seemed to be those with a deep and unshakable faith in God who were able to face death with such grace and assurance.

  “Doctor,” she continued, “although professionally he was an attorney, he really called himself a ‘fisher of men.’ He didn’t really lead people to God, like so many clergy or missionaries try to do. James just loved people wherever they were at—warts and all. He didn’t try to force them to God; he just gently and lovingly introduced people to his Lord. And more often than not, they would see his life and his example and his character and his giving spirit, and they would want a relationship like he had. He saw so many begin a personal relationship with God because of what God did through him. Now it’s time for him to go home to the Lord he loved and served. I’ll miss him so much, but he loved me so much. He loved others so much.”

  She bowed her head and gently wept. I found myself having some very selfish thoughts. Instead of thinking about
James or about Grace, I found myself thinking about me. I wondered what others would say about me when I would walk the same path that James walked. I felt that I knew God. I’d had a personal relationship with him for nearly ten years. But did I know God the way James knew God? And could others see God’s love at work in my life? I didn’t know.

  I walked over to Grace’s side and reached down to take her and James’s hand in mine. My tears were now as obvious as hers were. I wanted in some way to return to this kind woman the same kind of gift I sensed she had just given me. I thought back to my prayer with Harold and Doreen, and how they had appreciated a doctor praying with them. I felt compelled to offer the same to this precious woman.

  “May I pray with you?” I asked, with slightly trembling lips.

  She gently, almost imperceptibly, nodded her affirmation.

  I said a prayer of thanks for James and for his rich life. I prayed for his wife and his children. I prayed for myself—that my love for God and for others might someday look a bit like James’s.

  After the prayer, Grace gave me a hug and looked into my eyes. “James would tell you to be strong in the Lord. He would have encouraged you to come to know the Lord more deeply, to spend time with him every day, and to make him known to others. He would have been thankful for all you did. I know I am. Thank you, Doctor.” Then she and the family turned to go. Their last family outing with James was over. But his impact on me would be eternal.

  I whispered, “No, thank you.”

  After the family left, I walked over to the nurses’ station and started to do my paperwork, but I paused and put my head in my hands—my tears and silent sobs obvious. I had witnessed death before—many times—but had never been touched by a death like I had been by this one. I cried for my own inability to save James—and for my own lack of faith, compared to this man’s. I knew I wanted to make a difference with the patients I saw and cared for. I was learning that this would be possible only if I could be competent both clinically and spiritually. I wanted to be able to care for the body, mind, and spirit—to care for the whole person as part of a family and as part of a community.