Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains

by Walt Larimore, MD

  Tom stared at Henry with his mouth open. “Well, I’ll be tarred and feathered. You ole coot! That don’t sound very honest.”

  Henry turned to me. “Doc, I had lots of opportunities to take a promotion and go to the east part of the state and chase down big-time moonshine operations. But I preferred it out here. In these hills, what we called the western mountain districts, most of the moonshine operations were small operations, averagin’ fifty- to sixty-gallon capacity. These shiners out here were more appealin’ to me.”

  He added some snuff to his lip and then continued. “Out here the moonshiner has lived out of the mainstream of history for generations. And of interest to me too was the fact that to most of these men morals and religion weren’t quite the same thing. I remember one moonshiner tellin’ me about another and explained that he knew him to be an honest, churchgoing man. ‘How do you know that?’ I asked him. He told me, ‘’Cause I got to know him well when we war in jail together.’ ”

  Both men laughed and Tom continued. “Well, I’ll tell ya this, morals and religion are different in these parts, Doc. But Styles here, he always played by the rules.”

  “The rules?” I inquired.

  “That’s right,” Henry added. “There was a code — unwritten rules, if you would. As long as we revenuers fought fair and square, so did the mountain man.”

  Tom began to laugh. “Styles, you remember the time you war a chasin’ me through the mountains in your old black Ford?”

  Henry smiled. “I miss that old car. It once belonged to a taxicab driver over in Murphy who made the mistake of sellin’ a case of moonshine to one of my investigators.”

  Tom continued. “Anyway, Styles war comin’ up fast on me in his Ford when he didn’t slow enough ’round a curve and put that Ford into the ditch.”

  “Were you hurt?” I asked.

  “Naw. Just had a bruised ego,” Henry responded. “But before I could ponder it much, I heard old Kirkland here backin’ up his old truck. He coulda made a clean getaway, but instead he came over to see how I was doin’.”

  Kirkland laughed. “I remember askin’ you, ‘You hurt, cap’n?’ ”

  Henry added, “He did that just to irritate me, Doc. He knew I’d been a sergeant in the Marine Corps. When he saw I wasn’t hurt none and could back my Ford out of the ditch, he asked me how far ahead he was.”

  Tom laughed. “I remember that, Styles. You said I war only around the curve, but I tolt you it war at least a quarter mile more.”

  “Doc,” Henry explained, “the crazy thing is I knew Kirkland was tellin’ me the truth. You see, that was just the code. And it worked both ways. For example, if I or any other honest agent were to testify in court that a man was runnin’ from us in a car at a hundred miles an hour when I knew he was actually doin’ only eighty or ninety, that wouldn’t be playing fair or square.”

  Tom added, “Any revenuer that didn’t play far and squar, well, he’d be an unworthy competitor. Word’d git ’round, ya know.”

  Henry’s brow furrowed and his head bobbed ever so slightly as he commented, “It ain’t like that too much any more, Doc. In them days people knew the difference between right and wrong. Ain’t like that no more.”

  “That’s shore ’nuff a fact,” Tom added. “Lot o’ the kids runnin’ shine are downright mean. They involved in runnin’ drugs. They involved in runnin’ prostitute rings — and some of ’em involved in devil worship. Son, they’re a mean group.”

  “Devil worship?” I asked, my interest suddenly piqued.

  “Well, most of the kids involved around here talk about ‘Satan.’ Don’t know if that’s the name of the club or the gang or the leader. But I done heard the same that Kirkland heard, Doc. These kids head up in the hills, and while some of ’em are brewin’ their shine, others are doin’ these animal sacrifices; and some are doin’ all sorts of pagan worship. They talk of orgies and all sorts o’ terrible things. It’s right scary to me. Agents out hikin’ in the woods checkin’ for stills come across these sites, and they say it’ll make ya sick.”

  “How do you know this?” I inquired.

  Both men looked at each other as if they weren’t sure I could be trusted. A silent communication of some sort occurred and an agreement was made. They turned back to me.

  “Doc,” Henry began, “we’ve probably said too much already. It may just be some secrets are best not discussed — best kept, well, secret, if that’ll be all right.”

  I nodded. “Fair enough,” I said, wanting to know more — but knowing I’d only learn more if and when they were ready. So I switched the subject. “So what happened with the chase?”

  Tom laughed and picked up the story, “We resumed our positions and the chase started over. But Styles here was a beat man. He never caught up with me.”

  “Enough of that story!” Henry pleaded.

  Tom just smiled at his friend and turned back to me. “Next time I seen Styles war in Bryson City one day. He war eating at the café. I walked in and seen him and he seen me. I just tipped my hat to him and asked, ‘How’s yer drivin’, cap’n?’ ”

  I looked at Henry and thought I saw a blush.

  “And,” Tom continued, “he was obliged to answer me with a single word.”

  “Which was?” I inquired.

  “Improvin’!” Henry answered.

  The robust laughter of Henry, Tom, and Carl echoed off the roof of the porch — and I soon joined in.

  As we shared this laugh, I found myself intrigued with these men and their codes of “right and wrong,” “far and squar,” and “moral and religious.” Most of all, I admired their friendship and infectious laughter. I sensed that they had many years left to continue to jab and joust with each other — and to continue their educating of one young flatlander.

  However, Tom and Henry never told me anything else about what they knew about “Satan.” It was a secret they kept undercover. If they had chosen to discuss with me what they knew, I believe it would have saved me far more pain than I could have imagined.

  chapter twenty

  THREE AMIGOS

  Death, despair, and disappointment are the unwelcome callers that come with every family physician’s battle with disorder and disease. These sentiments and sensations are part and parcel of a doctor’s daily diet of patient care. Each day can deliver small portions of each — but on some days the portions can be super-sized and difficult to swallow. Thankfully and mercifully, however, these negative emotions are trumped, and sometimes even trounced, by the more common experiences of hope and happiness that can result in a gratifying sense of accomplishment and achievement.

  In the short history of the Mountain Family Medicine Center, the week ahead was to hold an unusual collection of these ups and downs for my partner and me.

  Lieutenant Colonel Richard Kadel was retired military and one of a growing number of military men and women who trusted Rick and me with their care — choosing to become our patients rather than driving for over an hour to the excellent VA facility in Asheville.

  To have him visit the office was always a pleasure — if for no other reason than hearing him regale Rick and me, our staff, and any kids in the office with one of his many war stories.

  Richard was a highly decorated veteran of the Pacific theater of World War II, and the day he brought in his many medals was one of the finest days of show-and-tell our practice had seen. His medals gleamed from a mahogany case that his good friend, master wood-carver Stanley Kontoot, had built for him.

  Each medal had a story, and he shared them, between patients, for an entire afternoon. He told stories of the war in the Philippines and of surviving the battle for Bataan, becoming a Japanese POW, and then escaping from the Bataan Death March and avoiding capture and near-certain death. He told tales of working with the Philippine resistance to cripple the Japanese while anxiously awaiting the help of General Douglas MacArthur and a U.S. invasion. Again and again the escaped American POWs working with the resistance had sen
t coded messages to MacArthur requesting help. Finally, after the U.S. attacked and was victorious, the general staged his famous and much-photographed arrival on Leyte Beach. The lieutenant colonel claimed he walked up on the beach to what he felt was a grandstanding and much-delayed MacArthur and declared, “General, where the [tarnation] have you been?”

  One day, Richard was admitted by Rick for what started out as a mild heart attack. However, his hospital course was terribly complicated by a bladder obstruction, followed by an unanticipated bacterial sepsis from the bladder catheter and by subsequent kidney failure. The old soldier fought valiantly through these battles, only to face an unexpected stroke and then a massive pulmonary embolus. Rick and the team fought alongside this courageous warrior, but on Monday we lost the good lieutenant colonel.

  He had survived everything a horrible world war could throw at him. And he put up a strong and heroic battle against the land mines Father Time had lain in his path. But he finally had to raise the white flag and surrender for the first time in his life — and to the finest form of peace, freedom, and security. He was buried with full military honors and, we hope, was received in glory with the same.

  The first time I met Carl Walkingstick was when he was rushed to the hospital on a Friday morning in a diabetic coma. Dr. Mitchell provided his initial care and then turned his patient over to me when he checked out that evening.

  Carl survived that crisis, and over the next three years he began to take better care of himself. Both the frequency and length of his hospitalizations decreased. Carl, who lived alone, and the friends who were often over at his house all learned to cook and eat better. He began an exercise program, learned how to monitor his sugars and adjust his insulin, and lost a significant amount of weight. Nevertheless, he still was not as compliant with his diet and monitoring as he could have been. This noncompliance led to the foot ulcer that caused him to lose his right foot. And it led to the gangrene that eventually developed in his left foot.

  In this case, the gangrene was not from an ulcer but from a loss of circulation common in diabetes patients. Because of the damage to his nerves by the diabetes — what we doctors call diabetic neuropathy — he couldn’t feel the pain of the slow strangulation of his foot. And because the diabetes had damaged his vision, he couldn’t see the remarkable color changes. By the time I saw him, the foot and ankle were, for all practical purposes, dead. What brought him to our hospital the last time was a final and fatal diabetic coma — this time induced by an overwhelming infection originating from the gangrene. He never woke up.

  Even though Carl’s brain waves had ceased, what I had to do that day — turning off this mountain of a man’s respirator — was one of the hardest acts of my early career. Some doctors will ask a nurse or respiratory therapist to turn off the machine. I never did. I always considered it my job — and it never got easier. I don’t think it was ever sadder for me than on that day.

  On Tuesday, I said good-bye to this remarkable friend. Like Richard Kadel, Carl was a hero and the recipient of multiple war medals, having lost his left arm in the Vietnam War. He was cared for by a family physician who not only admired and appreciated him but who had grown to love him. He was my first Cherokee patient. He taught me many of his people’s ways and beliefs. Many of his friends and acquaintances became patients at our practice because of the praises he sang of us. We all attended the funeral when Carl Walkingstick was buried with the full honors of two grateful nations — one predominately white, the other Native American.

  Stanley Kontoot was one of the masters — at least that’s what other Cherokee artisans told us — and given their skill in the art of carving, painting, and weaving, they should know.

  The wood-carver lived in a small chalet-like cottage, perched high above the Tuckaseigee River, right next to the road between Bryson City and Cherokee. It looked more like it should be in a meadow in Switzerland than in Swain County. Next to his cottage was his workshop where he would ply his craft, alone, for many hours every day. Each of his furniture masterpieces and custom hand-carved picture frames were one of a kind. And his small delicate carvings of birds and animals looked alive. He carved a tufted titmouse for Dr. Mitchell that looked ready to take off in flight.

  Stanley wasn’t much of a socialite, but he had become a close friend of Dr. Mitchell. When Mitch was at his farm along the river, he’d often discover Stanley walking the banks, taking mental notes of the glory of each season, or picking up driftwood that would be used in his next creation.

  Rick admitted Stanley to the hospital one week when Mitch was away. Stanley had suffered both a major heart attack and major stroke at the same time. Somehow he was able to crawl to the phone and call 911. Millie got Billy and Don to him fairly quickly, but Stanley coded on the way to the hospital. Don, riding in the back of the rig, was able to provide CPR and get his heart restarted, but Stanley’s ride through the ICU was long and arduous.

  On Wednesday, Rick discharged Stanley. His right side was nearly paralyzed, and his heart was in a weakened state as well. But Rick assured him that with proper therapy he’d be back at his workbench soon. Unlike his ICU bedmates, Richard and Carl, he had beaten the odds and left the hospital alive. But unseen by us, his spirit was critically discouraged and defeated. We didn’t realize it until it was too late.

  Stanley Kontoot never made it back to the office for a follow-up visit. Rick had scheduled to see him on Monday and had even made arrangements for a rehabilitation hospital in the region to schedule him for intensive therapy. The director of admissions knew of Mr. Kontoot and his work.

  “We can’t wait until he gets here,” she told Rick on the phone. “We have others here who carve and do woodworking. He’ll be able to show them all his tricks of the trade.”

  On Friday, Patty pulled Rick out of a patient’s room so he could take the tragic call from the sheriff. Stanley Kontoot had been found dead in his workshop. He had shot himself in the head, and a neighbor had found him the next day. The scrawled note he left behind said he could not live with his handicaps. Despite the hope we held for him, we had somehow failed to pass it on to him. We had completely missed his hopelessness and his depression. We could only speculate about the thoughts that had gone through his mind since he was admitted to the hospital. We couldn’t imagine the despair that led to this one last desperate act.

  That night, after Rick had gone to Stanley’s workshop to complete the coroner’s investigation, he came by the house. He and I talked late into the night. It was one of the darkest nights in our young careers. There is no more bitter experience than looking back on a difficult case and debating whether it should have been handled differently — and if so, how. Yet, this type of evaluation is part and parcel of becoming an excellent doctor. Looking back at cases that didn’t turn out as they should have provides unseen benefits down the road of future practice.

  After a very dark night, our gracious and merciful God gave us a wonderful and encouraging gift — a message, if you will, that he was still in control and that he could still use two young discouraged doctors.

  The birth of Swain County’s first triplets was completely unexpected — at least by us. Their mother, who knew she was carrying triplets, was receiving her prenatal care in neighboring Jackson County, the county to our east, where she was being appropriately and ably cared for by the area’s only obstetrician-gynecologist. Likely she was going to deliver early; therefore, when her contractions began at home, the doctor recommended that her husband get her in the car and transport her, at a safe speed, but as soon as possible, to the closest hospital, which was Swain County General.

  It was remarkable that she had made it to thirty-five-weeks gestation. Most triplets and many twins don’t get that far before being delivered. Unfortunately, one of the three water bags ruptured at the Bryson City exit of the four-lane, and within minutes her husband had screeched to a halt at our emergency room entrance. I was in the ER when they pulled up, and I got the story from the h
usband as the patient was rushed to our small birthing unit.

  Thankfully, a quick bedside sonogram showed that all three babies were healthy and had good heartbeats. However, her cervix was completely dilated, and one of the babies was coming down the birth canal as a double footling breech — meaning that both feet were in place to come out first during delivery. I instantly knew there would be no way to transfer this mom; and, although the children were small enough to probably deliver safely vaginally, there was no way I was going to take that risk.

  Dr. Mitchell was called, and the OR set up for a stat Cesarean section. Dr. Pyeritz was paged to come help me with the newborns. Extra nurses were summoned into the birthing suite. Fortunately, all were immediately available; unfortunately, we only had two warmers for newborns, so we’d just have to double-bunk two of the babies.

  A call was made to the hospital in Sylva to let them know our situation. Our charge nurse talked briefly with the obstetrician, who agreed with our plan to go to immediate Cesarean. She also talked with the pediatrician on call who agreed to be available to take the babies if a transfer was needed. She also reminded us that one or more of the babies could be transferred by helicopter to a neonatal ICU in Knoxville or Asheville if necessary.

  Alas, no one told the babies they needed to stay put. While preparations were being made to take the mom to the OR, baby #1 came splashing out — double footling breech or no double footling breech — with a loud cry. I remember thinking, You’re not supposed to do that! But he did, and I quickly placed baby #1 under warmer #1. The baby boy appeared to be wonderfully healthy and looked to be just over three pounds in weight.

  Rick arrived just in the nick of time, as in unison a nurse called out, “Dr. Larimore, get over here. Now!” and the patient called out, “Another one’s coming!”