“Rick, that’s an incredible story. How are Brian and Sharon doing?”
“As worried as any parents could be. Coming here from a larger community down south, they needed to talk to the specialist to be assured that it was safe to keep their son here in our small hospital. And it was helpful that the specialist reassured them that I was well trained and competent. Of course, I would have been delighted to have transferred him, but everyone seemed happy for him to stay here. I just came from there, and the kid’s looking better already.”
“That’s super news, Rick. And it sounds like you did a great job.”
“Thanks, Walt. But I’ve gotta tell ya, I was terrified. Absolutely terrified. And I’m not sure why.”
I was quiet for a moment. I knew this was a special moment for us, since doctors rarely talk to each other about their uncertainties or their insecurities, for fear of being looked down on as weak or fragile.
I felt two conflicting emotions. One was a great deal of gratitude that my friend and partner was willing to open up to me like this; the other was a great deal of embarrassment that I had not been so open with him about my feelings in caring for little Tommy.
“Rick, I know what you’re feeling. And I feel like I owe you an apology.”
“You do?”
I explained how I had felt when I was caring for Tommy. I confessed the terror I experienced when I thought I was going to lose him — and what that would mean to his family, as to well as to me and my family. I apologized for not sharing these thoughts with him and told him how much I admired him for being willing to do what I simply didn’t have the strength to do — to admit that I needed help in my weakness and indecision and that I needed someone with whom I could talk about the same feelings.
He forgave me and admitted that it was a very difficult subject for him to bring up. For the next hour we had one of our deepest heart-to-heart talks.
After that night, a degree of shared trust, vulnerability, and transparency began to be evident in a way it had never been before. Most interesting to me was the fact that in admitting to each other our weaknesses and our limitations, we actually strengthened our respect, admiration, and love for each other.
That Sunday, Pastor Hicks preached on healing. He concentrated on two verses I found particularly helpful. The first was from the apostle John’s first letter and involved a personal relationship with God: “If we claim to be without sin, we deceive ourselves and the truth is not in us. If we confess our sins, he is faithful and just and will forgive us our sins and purify us from all unrighteousness.” The second verse Ken taught on was from James’s letter: “Therefore confess your sins to each other and pray for each other so that you may be healed.” Both verses had more meaning to me that week than ever before.
I realized that my most important relationships in life, starting with my relationship with my heavenly Father, would be the most healthy when they were grounded in transparency, honesty, confession, forgiveness, understanding, and mutual respect. I was extremely blessed to have a wife and partner who desired the same thing. It reminded me of the old proverb that says, “Two are better than one, because they have a good return for their labor: If they fall down, they can help each other up. But pity those who fall and have no one to help them up! Also, if two lie down together, they will keep warm. But how can one keep warm alone? Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken.”
But as I was soon to find out, this cord could be stretched and frayed to the breaking point.
part two
chapter twelve
GOOD FOR BUSINESS
When I saw Dan’s name on the daily schedule Bonnie and I were reviewing first thing that morning, I smiled. I always enjoyed seeing Dan McGill in the office. Like Carl Walkingstick, Dan was a patient who always brought a smile to my face and peals of laughter to me and my staff.
Dan was perpetually optimistic and sported a huge smile. Given that he was legally blind, an African-American, and looked a bit like Stevie Wonder, I always expected him to break out in song. I once told him as much, and he responded, “Aw, Doc, if you heard me sing, you’d realize how good Stevie Wonder really is!” Then the guffaw he let out at his own joke shook the walls of the exam room and gladdened my heart.
When I walked into the exam room that afternoon, I found Dan with his best friend, Samson — a golden retriever guide dog that had been trained in California. Dan had told me he had saved Samson from “the left coast.” Dan’s smile illuminated the room as the dog’s tail banged against the wall. Both appeared delighted that I was there.
“Good to see ya, Doc!” Dan exclaimed, and then he smiled from ear to ear as he added, “Just kiddin’!”
As I bent over to pet the retriever, he licked my hand. I was a great admirer of Samson. Seeing Dan and Samson again brought to my mind a conversation in which Dan had told me about how the dog had been trained to keep on a direct route, ignoring distractions such as smells, other animals, and people; to stop at all curbs until told to proceed; to recognize and avoid obstacles Dan wouldn’t be able to fit through — such as narrow passages and low overheads; to stop at the bottom and top of stairs until told to proceed; to take Dan over to elevator buttons; to lie quietly when Dan was sitting; and to obey a large number of verbal commands.
“What’s even more amazing,” Dan had told me, “is that Samson had to learn how to disobey any command that would put me in danger. I think that’s one of the most amazing things about guide dogs. They call it selective disobedience.”
“I understand that,” I had retorted. “I see it in my son, Scott, frequently.”
Dan had laughed and continued. “Well, Samson only disobeys when it’s likely to protect me. And when it comes to cros-sin’ the street, it’s a pretty important skill. At a curve downtown, me and Samson gotta work very closely together to navigate the situation safely. When we reach a curb, Samson stops, which signals me that we’ve reached a crosswalk. Samson, like all dogs, is color-blind. He can’t distinguish the color of traffic lights, so we’ve gotta decide together when it’s safe to cross the road.”
“How do you decide?” I had asked him.
Dan’s response had been fascinating. “Well, I gotta listen to the traffic to decide when the light has changed. Then I tell him to go ‘forward.’ If Samson sees and senses there is no danger, he leads me across the road. But if he sees a car approachin’, he’ll refuse to go until it’s safe. So we gotta work together to get from place to place. Samson don’t know where we’re goin’, so he depends on me. The other side of the coin is that I can’t see the obstacles along the way that he can see. So we depend on each other.”
Putting the flashback behind me, I turned to Dan and asked, “So what can I do for you today, Dan?”
“I got no needs today.”
I was taken aback for a moment. “Then why are you here?”
“Samson’s here for a checkup.”
“Samson!”
“Yep.”
“I’m not a vet, Dan.”
“I know that, Doc. But the closest vet to Bryson City is over there in Sylva. I don’t have a car. And if I did, you wouldn’t want me to drive over there, would you?”
He grinned as I responded. “Point well taken, Dan. But couldn’t someone take you?”
“Could,” he replied, “but Doc Mitchell’s always done Samson’s checkup. It’s required by the organization that placed Samson with me. They want his eyes and heart checked, as well as his general health. Then you just sign this card, and I send it in to the association. Doc Mitchell would do it every year. But since I’ve started coming to you, Samson has taken a shine to you. I told him I was gonna bring him up here for his exam, and he seemed awful happy about it.”
“How about this, Dan? I’ll do the exam this year. But starting next year, Samson needs to see a veterinarian who’s trained and experienced to care for him. If he had the early stages of an easily treated illnes
s, you and I would feel terrible if I unknowingly missed it, wouldn’t we?”
Dan thought for a second, and then his radiant smile dawned once again. “OK, Doc. I see your point,” chuckling at his joke. “You got a deal.”
I reached over to my writing desk and picked up the ophthalmoscope. “All right, Samson,” I commanded, “on your feet!”
Samson obediently stood, and I found his retina and lenses to be normal. “No signs of cataracts or eye problems, Dan.”
Replacing the ophthalmoscope in its holder, I picked up the otoscope. Samson cooperated as I examined his teeth, gums, and tongue and then turned my attention to his ears. “All’s normal with his head, ears, nose, and throat, Dan.” Samson was more cooperative than most of my younger patients.
Next I turned my attention and stethoscope to Samson’s lungs, which were clear, and the heart, which sounded completely normal. No arrhythmia, no murmurs, no gallops. Then I examined Samson’s abdomen — which also sounded normal through the stethoscope. A quick exam of Samson’s paws, nails, joints, and hair showed equally normal results.
“Dan, this dog is as healthy as a horse.”
Dan’s smile got even wider — as if that were possible. “Thought you weren’t a vet, Doc — so how would you know he’s as healthy as a horse?”
I laughed. “Good point, my friend.”
I took the card Dan had brought and signed it. I also took a prescription pad out of the pocket of my white coat, dated the front sheet, and wrote “Samson McGill” on the name line. Where I would normally write the prescription order, I wrote, “physical and eye exam normal.” Then I signed the note and handed it to Dan. I wanted the organization to know that Samson had been examined by a people doctor, not a professional veterinarian.
“Here you go. Let me know if they need anything else filled out.”
I stood to open the door as Samson and Dan headed to the checkout. Of course, Samson had to stop and receive love and affection from the nurses and Dr. Pyeritz.
I smiled to myself as I turned to a chart at my dictation station. Dan’s merry laughter filled the nurses’ station. I knew he came to the office early and often stayed in the waiting room for a while after a visit. He and Samson enjoyed the attention and fellowship, and our patients loved them. Every doctor and every doctor’s office needs at least one Dan McGill. They serve to remind us of the joy that’s behind every corner and around every curve — if we only know where to look for it.
Dan and Samson are good for business, I thought. Even more important, they were good for me.
chapter thirteen
BABY’S FIRST WORDS
Late that same afternoon, Dean Tuttle, our office manager, walked back to my dictation station, where I was working on a chart.
“Dr. Larimore, I’m sorry to bother you.”
“No bother at all, Dean. What’s up?”
“I just took a call from Clem Monteith. He’d like you to drop by the farm this afternoon.”
“Something wrong?”
“Yeah. He says Doris is having a problem that he needs you to come by and check out.”
Home visits were a part of our practice in Bryson City. I always enjoyed visiting patients in their homes. I learned so much more about them and their families than I ever could by seeing them in the office.
I had first been taught about the art and science of home visits while studying in England in 1978. While a teaching fellow at the Queen’s Medical Center in Nottingham, I studied with Derek Prentice, M.D., a general practitioner. His early morning and late afternoon each day were reserved for seeing patients in his surgery (the British term for the doctor’s office). The middle part of each day was spent visiting patients at home — typically involving about a third of his day.
One day an elderly woman had come in to the surgery. Derek had asked me to spend twenty minutes taking a social history, which I had done. He hadn’t told me anything about her or allowed me to see her chart. I had been surprised when he didn’t ask me about what I had learned with regard to this woman’s story and health. The next day I found out what he had been up to.
During home visits that next afternoon, we had pulled up to a row of ancient brownstone homes in a run-down section of central Nottingham. “Dr. Larimore, I have an assignment for you,” he said as he turned off the car. “When we walk into the home, I’m going to give you three minutes. I want you to walk around the flat. At the end of three minutes, I want you to tell me everything you can about this family. Are you up to it?”
“I am,” I had replied.
“Tally ho, then!”
Once I had entered the home and been introduced to the elderly gentlemen who owned it, Derek set the plan in motion. “Ready? Set! Go!”
For three minutes I observed and absorbed — furnishings and books, pictures and diplomas, the outside porch and garden, the kitchen and the pantry. To tell the truth, I had been amazed at how much I learned in a very short period of time. At the end of three minutes, we sat in the living room, where I then spent nearly ten minutes sharing the surprising amount of information I had picked up. As Derek and the old man nodded, I basked in a bit of pride at my newfound skill.
“Well done!” Dr. Prentice had exclaimed as the old man applauded. “So Dr. Larimore, yesterday I had you spend twenty minutes with a woman who lives in this same neighborhood. Would you say you learned more about her, or more about James here?”
I know I blushed when I heard that. The intent of his lesson had become clear to me. “No doubt there,” I replied. “I’ve learned much more here in the home.”
“I don’t want you to ever forget today, Dr. Larimore,” Derek had counseled. “In America, home visits are a forgotten part of the art of medicine. I hope you won’t forget how important it is to see patients in their homes.”
Then Derek had flashed a grin at our host and said, “All right, James. What say we call her down?”
The old man had nodded his head and then shouted, “Claire, come on down.”
I had heard the footsteps coming from the upstairs bedroom. All three of us were watching as the walking sounds reached the bottom of the stairs and then shuffled toward the back room. I had sensed something was up but had no idea of the shock I would receive.
When Claire had turned the corner, her smile beaming, Dr. Prentice and James had broken out in laughter. I can still see Claire clapping and laughing as she saw my mouth drop open. She was the woman I had seen at the surgery the day before and with whom I had spent twenty minutes.
In no way had I connected the two. I had missed every single clue. Lesson learned: a doctor simply cannot learn as much about a patient in the office as in the home.
As my mind returned to my own office and manager, I said to Dean, “Let Clem know I’ll be out to see his wife as soon as I finish rounds at the hospital.”
“Yes sir.”
As Dean walked away, my mind wandered again — this time back to nearly three and a half years earlier when Clem had called me. It was my first night on call in Bryson City during the first week of my medical practice. He had demanded that I come to his farm for a home delivery — of the couple’s child, I had presumed. When I arrived, I had found instead a white-faced heifer locked in breech with her first calf. So my first delivery in private practice had been a small calf — which Clem and Doris had named “Walter.” They still owned Walter, and I would visit their farm from time to time to visit the only being I ever delivered that was named after me. Even though I’ve delivered over 1,500 newborns in my career, few of those deliveries were as memorable as the birth of Walter.
The drive to the farm was far calmer and more relaxed than my first drive there in the middle of the night. As I pulled up to the house at the end of a quiet mountain cove, I felt the same sense of peace I experienced every time I came to this small piece of paradise. The Monteiths kept their small farm clean and pristine. Their house, nestled at the base of a small forest and beside a stream, looked like it should be on
a Southern Living magazine cover.
“Howdy, Doc!” I turned to see Clem coming from the barn. He quickly walked over to me, and we shook hands. I could see that his left hand was bandaged.
“What happened?” I asked, pointing to his hand.
“Maggie accidentally stepped on it when I was shoein’ her. It’s gettin’ better, but since I’m left-handed, that’s why I called you.”
“Dean said you needed me to come see Doris. She in the house?”
Clem looked at me like I had two heads. “In the house? You kiddin’ me, Doc?”
I’m sure I looked confused. “No, I don’t think so. Why?”
“Well, she’s in the barn.”
Now I knew I looked confused. “Why’s Doris in the barn?” I asked.
“Well, Doc, that’s whar she stays.”
“Your wife stays in the barn?” I couldn’t believe what I was hearing — or saying.
All of a sudden Clem threw his head back, and his laughter echoed off the walls of the cove. I had no idea what he found so funny.
When Clem caught his breath, he looked at me and began laughing again. I waited for the paroxysms of laughter to calm down, hoping Clem might explain. When his snickering finally slowed, he sputtered, “Doc, I see what was confusin’ ya. You was thinkin’ of my wife, Doris. But I called you up to see one of my cows. In fact, she’s Walter’s mother. Her name is Doris. She and Buttercup are sisters, and they’re my two most prized cows. Ain’t that something?”
All of Clem’s animals had names and were considered valuable family members, as the couple had no children. Indeed, Clem’s herd and his wife were his family.
“Clem, you called me up here to see a cow? Mitch can care for bovine patients, but you know I’ve just got no training and very little experience in these matters.”
Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains Page 9
