This is from the first chapter from my best-selling book, Bryson City Tales. I hope that you’ll enjoy going back to Bryson City with me each week, and that if you do, you’ll be sure to invite your friends to join us.
THE MURDER – PART 1
They didn’t tell me about this in medical school. And they sure didn’t prepare me for this in my family medicine residency. Of course, like all well-trained family physicians, I knew how to provide for the majority of the medical needs of my patients in hospitals and nursing homes. Naturally I had been taught the basics of how to practice medicine in the office setting. But I was quickly discovering that physicians who headed into the rural counties of the Smoky Mountains in the third quarter of the twentieth century needed to know much more than these basics.
I don’t remember any school or residency lessons on the peculiar calls I would receive from national park rangers telling of a medical emergency in the Great Smoky Mountains National Park. “Wilderness medicine,” at least when I first started practice, was not in my black bag.
I don’t remember any preparation for the unique medical emergencies faced by the Swain County Rescue Squad. Search-and-rescue medicine wasn’t in my repertoire either, nor were the river rescues I would be involved with on the county’s four rivers—the Tuckasegee, the Nantahala, the Oconaluftee, and the Little Tennessee. And I know for certain that I had no training in caring for animals or livestock—but, sure enough, those calls were also to come to a family physician in the Smoky Mountains.
Although my formal education had not prepared me for these types of medicine, when the need arose to learn and prac- tice them, I felt up to the challenge. Although I was often per- plexed by some of the unique aspects of practicing medicine in a rural—and, I first thought, somewhat backward—community, I didn’t find the demands particularly distressing. My first murder case, however, was a different story.
I had just moved a month before, with my wife, Barb, and our nearly-three-year-old daughter, Kate, from my residency in family medicine at the Duke University Medical Center in Durham, North Carolina, to Swain County, in the heart of the Great Smoky Mountains. The county had only 8,000 residents, but occupied over 550 square miles. However, the federal gov- ernment owned 86 percent of the land—and much of it was wilderness. Over 40 percent of the Great Smoky Mountains National Park is contained within the borders of Swain County, which is also home to the eastern band of the Cherokee Indians, to one of the more southern sections of the Appalachian Trail, and to the beginning of the Blue Ridge Parkway.
The doctors in the county seat—the small town of Bryson City, North Carolina—rotated the on-call assignment. When we were on call, we were responsible for a twenty-four-hour period of time, from 7:00 A.M. to 7:00 A.M. We were on call for all of the patients in Swain County General Hospital’s forty beds, the Mountain View Manor Nursing Home, the Bryson City and Swain County jails, and the hospital emergency room. We also provided surgical backup for the physicians in nearby Robbinsville, which had no hospital, and for the physicians at the Cherokee Indian Hospital, located about ten miles away in Cherokee, which had a hospital but no surgeons. While on call, we were also required to serve as the county coroner.
Since pathology-trained coroners lived only in the larger towns, the nonpathologist physicians in the rural villages often became certified as coroners. We were not expected to do autopsies—only pathologists were trained to perform these— but we were expected to provide all of the nonautopsy respon- sibilities required of a medical examiner. Having obtained my training and certification as a coroner while still in my family medicine residency, I knew the basics of determining the time and cause of death, gathering medical evi- dence, and filling out the copious triplicate forms from the state. Not sure that I was adequately prepared, but proud to be the holder of a fancy state-provided certificate of competence any- way, I thought I was ready to begin practice in Bryson City— ready to join my colleagues as an inexperienced family physician as well as a neophyte medical examiner. It was not long after our arrival that I was required to put my new forensic skills to work.
(TO BE CONTINUED NEXT FRIDAY)
© Copyright Walter L. Larimore, M.D. 2016. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.