This is from the thirty-second, and last 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 and family to join us.
HOME AT LAST (PART 1)
Labor Day weekend was over. Kate was heading toward her fourth birthday and Scott his first. Barb and I were approaching our ninth wedding anniversary. Our marriage and our children were a joy. I was so happy to be a daddy and to be so in love with my best friend.
Our new office building was under construction. The contractor was predicting occupancy in just a few weeks. Rick and I had hired our new staff members, and they were already at work beside us at Swain Surgical Associates, learning the ropes. Dean Tuttle, wife of my football buddy Preston, was going to be our office manager. Beth, the daughter of Bryson City police chief Carl Arvey, was going to be my nurse, and Rick had hired Patty Hughes from a practice in Sylva to be his nurse. Diana Owle was also going to work in our front office. These four women knew everyone in town, and we felt so blessed that they wanted to work with us.
I had completed a wilderness medicine certification course and was doing more and more consulting work with the Nantahala Outdoor Center, the National Park Service, and the Swain County Rescue Squad. I was planning to begin kayaking lessons in the fall and couldn’t wait to get out on some of the county’s rivers—both for boating and fishing. Rick and I had also been invited to become assistant professors and to teach the family medicine residents in Asheville, which we gladly did once or twice a month.
We were seeing increasing numbers of maternity patients and delivering more babies each month. The Shulers were pregnant with their first and had chosen us to attend the birth. Greg’s dad was doing worse medically, and I would make a home visit to see him weekly. Rick was seeing Katherine fairly frequently, and her summer at the Fryemont Inn had gone very well. This budding romance in the professional community was being followed closely in the various town gossip circles. Rick was leading bird-watching hikes for both the Fryemont and Hemlock Inns.
The man charged with first-degree murder in Bryson City had been convicted and sentenced to death. However, Fred Moody appealed the case, and the verdict was overturned—to one of second-degree murder. The appropriate prison sentence— with the possibility of parole in the distant future—was not appealed by the district attorney, who decided not to run for the state senate. Barb and I remained Republicans, while Rick registered as a Democrat. We would care for members of both parties on each side of the aisle of our new building.
The Larimore’s root cellar was packed with canned vegetables, fruits, honey, jams, jellies, and a variety of canned meats. We had enough food for two winters. And I had also gone ahead and purchased a lifetime North Carolina fishing license.
The spring football practices had gone very well. Tony Plemmon’s shoulder was fully healed, and the two-a-day football practices of August had come and gone. The local team was predicted to be number one in the state that fall. Even Boyce Dietz had come by the office for an appointment for a “preseason evaluation” and a refill of a prescription of the oral antacid, Tagamet—enough to last the season. Expectations for the fall were high indeed.
The tourists were gone for now—at least until the color season began in October. The air was still warm but would begin turning cool this month. I had finished my first year of practice— and what a year it had been. But the most memorable medical event of the year was yet to occur. It began, strangely enough, at the Bryson City Presbyterian Church.
Rick was in Pittsburgh visiting his brother and parents. Usually we would attend church together. Barb and I would teach the Sunday school class for sixth, seventh, and eighth graders while Rick, who was now playing the piano for the service, would rehearse.
The small church was covered with whitewashed clapboards. The steeple and steep roof, highlighted by a well-manicured lawn and overflowing flower gardens, had, to us, an almost New England look. There was an air of dignity and stability to the small building that most of the churches in the area seemed to lack.
We felt comfortable there from our very first visit, about a month after we had moved to Bryson City. We were greeted at the door by a couple and their three children. “Hi, we’re the Claxtons. We’re glad to meet you, welcome to our church. Is this your first visit?”
We immediately felt welcome. We sensed that we were neither an imposition nor outsiders. We conversed with the Claxtons for several minutes, liking them more and more.
“Since you all are new,” said Mark, “why don’t you join us in our pew? We can show you the ropes.” This was indeed unique, and we accepted gladly. They escorted us to their pew, introducing us to several of their friends on the way. We had originally decided to visit the church primarily because Mitch and Ray attended there. But by the time the service began, we already felt at home. We already felt a part of the family. We continued to visit there throughout the year and eventually joined the church.
Presbyterian services had a prescribed liturgy. After the organ’s call to worship, the ceremonial entry of the pastor and choir began. The members and any guests would be welcomed by Pastor Ken Hicks, who himself—as of this fall—was also completing his first year in “private practice.” After a few brief announcements, he began the service with prayer, followed by the singing of a hymn. It was during the third stanza of the first hymn that it happened.
A young woman in the first row of the choir suddenly sat down. The congregation and choir dutifully kept singing, and the choir director, Peggy Ashley, one of the nurses at the hospital, kept leading. A couple of women beside the stricken woman looked down, concerned, but kept on singing.
Suddenly the woman careened off the chair and fell hard to the floor. The choir stopped, but the substitute pianist, her back to the choir, just kept playing for a few more moments. Almost instinctively and to the accompaniment of the piano, I leaped from the pew to run up front, only to find myself following Mitch.
When we arrived at the front, Mitch positioned himself at one side and Peggy at the other. I knelt down to be available for whatever might happen. They quickly evaluated her. Mitch gently slapped her cheek. “Susie, Susie, you OK?” There was no response. He pulled on her eyelids. I heard him mutter, “Oh my!” as he noticed that the inside of her lower eyelid, instead of being pink, was nearly white.
“Her pulse is over 140 and thready, Mitch. Skin is cold and clammy,” Peggy calmly reported.
Mitch’s hands quickly and instinctively went to the patient’s abdomen. As he quickly palpated her tummy, he pushed his fingers deep into the flesh just above the pubic bone. Susie moaned.
“Heavens,” he blurted out. “It’s a ruptured ectopic!”
My mind was racing. How could he diagnosis a ruptured ectopic pregnancy with his hands? I would have needed a positive pregnancy test and an ultrasound showing a mass in one of the fallopian tubes. Or, I quickly thought, a culdecentesis, a procedure in which a doctor would pass a very long, thin needle through the wall of the vagina and into the abdominal cavity to see if there was blood—which can come from a ruptured tubal pregnancy. While I was considering this, Mitch went into action.
“Gay,” he called to his wife and medical assistant, “get a coat or a blanket so we can keep her warm. And get her legs elevated. Let’s keep what blood’s left in her heart and head. Then monitor her vitals, and let me know if there’s a change!”
“Yes, sir,” Gay answered calmly, as she would have in the office.
He stood, like a commander in control as he continued his triage—a skill developed not only in his military service but also over years of practice. “Tina!” he bellowed at Tina Hicks, the pastor’s wife and a choir member. “Call the rescue squad, stat. Tell them to get here, and now!”
He continued, “Nancy, Peg,” he called out to Nancy Cunningham and Peggy Ashley, “get to the hospital, now! Nancy, get the OR ready for a laparotomy. Peggy, let the lab know I’ll need six units of universal blood ready when we get there, and then you and Nancy scrub. Kim, we’ll crash her as soon as she’s in the OR.”
Kim Hammrick shouted, “My car’s out front. Let’s go!” The three nurses turned to run out of the church, and members of the congregation, now crowded around the altar, separated to let them pass.
Although it seemed like only seconds since Tina had run from the sanctuary, I could begin to hear the siren of the ambulance heading toward the church—which was only about a half mile from the station. Mitch continued to look around, evaluating who was available, what skills they had, and what still needed to be done. Our eyes met.
“Walt and Ray,” he continued, almost without a pause. He seemed calmer now, almost in a groove—the instincts of experience, concern, and training all flowing together before our eyes.
I hadn’t even noticed Ray at my side. “Get up to the OR and get scrubbed now. Once Kim has Susie out, you guys’ll have to get into the pelvis as fast as you can. Ray, clamp the bleeder, then fill her tank. I’ll stay here and ride up with the ambulance.” We could hear the siren outside and the squealing of wheels.
As we turned to run from the church, the crowd again separated. I could hear Mitch instructing the pastor as we left, “Ken, get the folks back in their pews, and let’s begin to pray for Susie. She needs our prayers.”
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1); (Part 2)
- Fly-Fishing (Part 1); (Part 2)
- Something Fishy (Part 1); (Part 2)
- A Good Day at the Office
- An Evening to Remember
- Another New Doc Comes to Town
- ‘Twas the Night Before Christmas (Part 1); (Part 2)
- A Surprising Gift
- The New Year (Part 1); (Part 2)
- The Home Birth (Part1); (Part 2); (Part 3)
- The Showdown (Part1); (Part 2); (Part 3)
- The Initiation (Part 1); (Part 2); (Part 3)
- Home at Last (Part 1); (Part 2); (Part 3)
© Copyright WLL, INC. 2017. 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.