Bryson City Tales — Emergency (Part 1)

This is from the eighth 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.

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EMERGENCY (PART 1)

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!

(TO BE CONTINUED NEXT FRIDAY)

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© 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.