Bryson City Tales

by Walt Larimore, MD

  I could sense my partner’s concern.

  “Walt, if there’s a problem with Erin and we’re in the middle of a blizzard, I simply won’t be able to get her to the care she’d need or get any necessary care to her.”

  “Rick, what are you saying?”

  “I think I want to refer Barb up to Asheville to deliver. Barb is not now in labor, and her cervix is only two to three centimeters dilated. If you leave now, you can be there in an hour. In case of any problems on the way, the hospital in Sylva is only twenty minutes away and the hospital in Waynesville is only forty minutes away. Also, if you leave now, you’ll beat the storm. I’ve talked to Ray; we’ll cover your patients. I’ve talked to the OB group in Asheville and they not only agree with this course of action, but they’d be delighted to take Barb as a patient.”

  My mind was racing. I had so wanted Erin to be one of the first babies born in our new birthing unit. I wanted our nurses and staff to see that the doctors trusted them and the hospital. That we didn’t have to travel to Asheville to deliver a baby. I felt like a traitor for even thinking of leaving town for the delivery of my own child.

  As though reading my mind, Rick continued, “Walt, there’s not a person in town who won’t understand my sending you all to Asheville. It’s the right thing. If anything were to go wrong, it might hinder our chances to see our dreams come true—to have a great maternity care service right here in Bryson City. I haven’t been here that long, Walt, but, like you, I’m sensing that some of the older doctors might like nothing more than for us to make one big blunder. I think they’d go after our hides in a minute.”

  He was making sense. I was not sure that a majority of the doctors would be supportive if there was a misstep of some sort.

  Rick continued, smiling. “Worse yet, would you want to hear Gary Ayers airing our dirty laundry on WBHN?”

  I smiled. “Guess you’re right. Should we talk to Barb?”

  “I already have. She’s up at the house packing her things and getting Kate taken care of.”

  “OK. I guess this is best.”

  He walked over to me. “It is, Walt. It is.”

  “Thanks, buddy.”

  “Look, you drive safe, OK?”

  “OK.” I smiled and turned to leave.

  “Walt!”

  I turned back. Rick reached out and placed his hand on my shoulder. “I’ll be praying for all three of you.”

  “Thanks, Rick. That’s the most precious gift you could give us.”

  His gesture of faith and solidarity sunk deep into my soul. To have a compatible practice partner was a joy. To have a true friend with whom to work, one who was a fellow adventurer on the pathway of faith, was even more invaluable.

  By the time I got home Barb had an overnight bag packed. She was sitting by our Christmas tree. When she heard me enter the house, she called out, “In the living room!” She stood as I entered. We hugged. “Nancy Cunningham is off today,” she said. “She came to pick up Kate and will keep her as long as we need. I’ve packed for you and me. We can go anytime.” She paused, turning her head to look at our Christmas tree. Then she began to cry.

  “Aw, honey.” I hugged her tight. “Everything’s going to be all right. It’s going to be all right.”

  “I know,” she sobbed. “I’m just so sorry we can’t deliver here. I know how important it is to you. This is our home. This is where we’re putting down our roots. I’m so sorry.”

  I pulled back slightly, keeping my hands on her shoulders. “Honey, your and Erin’s health is far more important to me than anything. I don’t care if we have to drive to Emory or Duke. I just want you and Erin to get the best care—and I want her to be safe and healthy.”

  Barb smiled and wiped her tears away. “I know, Walt. I know. I just wish there was some way to deliver here.”

  “Thanks, honey. I do too.”

  I put the bags in the car, and we piled in. I started up the little Toyota and pulled away from our home—suddenly realizing that I was driving out of our hometown as well. In this hour of uncertainty and anxiety, disappointment and anticipation, I was more aware than ever that our connection with this small town was strengthening and becoming very important to us.

  As we pulled onto the four-lane in the middle of the afternoon, it became darker and then began to snow. Would we make it to Asheville? Would Erin be safe? I didn’t know what our immediate future held, but more than ever I felt certain about who held the future. I smiled. I was beginning to learn how profoundly important faith is during a medical emergency—and wondered again how people without faith made it through things like this.

  chapter twenty-seven

  A SURPRISING GIFT

  We arrived at Memorial Mission Hospital in Asheville in a driving snowstorm. I dropped Barb at the emergency room entrance and parked the car. By the time I arrived in the ER, Barb had been whisked up to the obstetrics unit and was already being evaluated by the admitting nurse, who had spoken by phone with the admitting physician—Sedrick Porter, M.D.

  Our admitting nurse, Marie, had been a labor and delivery nurse for her entire career—all of which had been at this hospital. “I am so glad you’re here,” she said warmly. “It’s been unusually quiet. We haven’t had a delivery since yesterday, and you all are our only guests—at least for now.”

  Admission labs were drawn and a detailed history taken, and then Dr. Porter showed up. He struck us as a quiet and gentle man whom we instantly liked and trusted. What I liked the most was his simple explanation of the options we could consider. I was used to physicians telling us what to do, not doctors willing to empower us to make our own decisions. Whether he did this because I was a physician or whether he did this rou- tinely with all his patients, I don’t know. I do know, though, that I was forever influenced by his example. I would go on trying to emulate Dr. Porter’s approach throughout my career.

  “Walt and Barb, there are a couple of options open to you. One, we can wait and watch. You can walk around a bit, Barb, and if labor gets going, hey, that’s great. The advantage of this choice is that we won’t need to start an IV or use Pitocin. The disadvantage of waiting is that, since your membranes are ruptured, the longer we wait the greater the chance of you or Erin getting an infection—which would prolong your hospitalization and increase your costs. Fortunately, the real risk for this doesn’t start increasing until the membranes have been ruptured for eighteen to twenty-four hours.

  “The second option would be to begin Pitocin now. The advantage is that your baby almost certainly would be born sooner. The disadvantage is that Pitocin-induced labors are more difficult than natural labors. But it is indeed an option.

  “Does this information make sense? Does it raise any questions in your minds?”

  We looked at each other. I could see Barb visibly relax. This wise physician was both reassuring and empowering.

  After a moment he continued. “How about this? I need to see a couple of other folks. How about I go see them? You two can discuss the options, and then I’ll drop on by and we can talk some more. OK?”

  We nodded in agreement. He smiled at us both, patted Barb on the leg, and then reached over to give my shoulder a squeeze. “One other thing. I’ll be here as much as you need me throughout the rest of the night, and we’re going to provide you the very best care we can.”

  He turned to leave as I continued to take mental notes on the lessons this experienced physician was teaching me by his example.

  Barb spoke first. “Honey, I think I’d like to walk around a bit. If labor doesn’t start in the next few hours, then let’s go with the Pitocin. What do you think?”

  “That sounds OK to me.”

  When Dr. Porter returned, he seemed pleased with our decision. “Barb, I’ve never been pregnant or had to face this decision myself. But if I did, I think I’d choose what you all are choosing.”

  Then his forehead furrowed. “There’s just one thing I need to tell you. I will only be available t
o you until about 6:00 A.M., and then my partner, Phil Davis, will take over. Barb, I want to tell you about Dr. Davis. He’s been with our group for a number of years. My wife says that if she were young enough to have more children, she’d choose Dr. Davis to be her doctor. If you haven’t delivered by 6:00 in the morning, then I’ll be telling him all about you guys so he’ll be up to speed.”

  He paused for a moment. “Any questions or concerns?”

  We shook our heads no. He smiled and turned to leave. “Marie,” he said to our OB nurse, “I want you to take great care of our new friends.” I’m sure he must have said this to her about every patient he saw, but it sure made us feel special and important.

  After dinner we were up and about—talking, walking, and then sitting. Barb continued to leak amniotic fluid but felt no cramps or signs of labor. During this time Marie came to find me. “Dr. Larimore, there’s a phone call for you.”

  I left Barb to go to the nurses’ station. I thought sure it would be Rick, calling to check on us. Instead, it was Barbara Morris. Barbara had been my intern when I was a second-year resident, and we had continued to work together when I was a senior resident. She was one of the most intelligent and fun-loving physicians I knew. She, Barb, and I had become close, and “Aunt Barb,” as Kate called her, had become a dear family friend. Not only that, but during our last year in Durham she had been our personal physician. She had diagnosed our pregnancy and provided Barb’s prenatal care until we left for Bryson City.

  Barbara greeted me warmly. “Walt, I just called your office to wish you all a Merry Christmas and talked to Rick. He told me what had happened and where you were. How are you all doing? How’s Barb?”

  I updated Barbara on our situation. “Walt,” Barbara responded, “if you all and Dr. Porter don’t mind, I’d like to drive out and be with Barb for the labor and delivery.”

  “Barbara, that’s nuts. One, it’s snowing. Two, it’s a four- to five-hour drive. Three, it’s Christmas Eve!”

  “Walt, one, I grew up in New York and I know how to drive in the snow. Two, Barb was my patient and I want to be with her during Erin’s delivery. Three, there’s no way Barb is going to deliver in the next few hours. So I’m coming!”

  I knew I couldn’t dissuade her. “Well, Barbara, let me check with Dr. Porter to see if it’s OK with him, and I’ll let you know.” As I suspected, the doctor, ever gracious, responded, “Walt, I’d be delighted if Dr. Morris would come and join us. It would be a treat.” I called back to let Barbara know and heard the non-surprising news that she was already on her way.

  Late in the evening Dr. Porter returned. Barb was still leaking amniotic fluid and had not had a single contraction. In addition, her cervical dilation had not changed. We elected to begin Pitocin.

  Barbara Morris arrived about 9:00 P.M. and stayed with us through the night. Barb’s labor intensified throughout the evening as a result of the Pitocin. At 11:00 P.M. Marie said goodbye, as her shift was over, and another nurse began to care for us. At midnight we all wished each other a Merry Christmas and were now convinced that little Erin’s birthday would be the same as the Christ child’s.

  By 1:00 A.M. I had been up for nearly thirty-six hours and could barely keep my eyes open. Barb was in a strong and uncomfortable labor pattern and had dilated to about seven centimeters. Dr. Morris had already settled down to sleep in the doctors’ lounge. “Barb,” I pleaded hesitantly, “would you mind too terribly much if I took a little nap?”

  The hospital did not have private labor rooms—all rooms were double occupancy. Since we were still the only patients in the labor unit, I laid down in the bed next to Barb. I didn’t wake up until the nurse shift changed at 7:00 A.M. Shortly thereafter two doctors showed up—Barbara Morris and Phil Davis. Phil, as had been predicted by Dr. Porter, was as gentle and kind as we could have expected. His examination of Barb revealed that her cervix was now completely dilated but that Erin’s head position wasn’t optimal.

  Instead of being what we doctors call OA (for occiput anterior—meaning that when the mom is on her back, the baby’s nose is pointing down, which is the position that is easiest for the mom, the baby, and the birth attendant), Erin was OP (for occiput posterior, or “nose up,” a much more difficult position for the baby, the mother, and the birth attendant). This was not only increasing Barb’s discomfort but prolonging her labor as well.

  “Barb,” counseled Dr. Davis, “there are some studies showing that if we get you off your back, then the baby is more likely to turn on her own. The baby is doing fine and there’s no sign of any sort of trouble. So I’d like to suggest that you try some different positions. You can lie on your side to push. If you want to try some knee-chest pushing, that may be helpful. Also, if you’d like to walk, I’d be OK with that. Either way, I’m not planning to go home and open Christmas presents until little Erin is in your arms.”

  He smiled at us. His reassuring manner filled the room and gave us comfort.

  So Barb tried different positions, but nothing caused Erin to turn. Barb pushed and worked and pushed and worked. Dr. Davis checked her on a number of occasions. “Barb, I think you are making progress. Are you OK? Can you keep going?”

  Barb, ever the trooper, decided to continue. By 9:30 A.M. she had been pushing for over three hours. She was beginning to feel exhausted (and, not that it mattered, so was I).

  “Barb and Walt,” confided Dr. Davis, “I think it’s time to go to the delivery room. If we can push the baby out, great. If not, I can use a little vacuum cup or forceps to help her deliver. Does that sound OK?”

  Indeed it did. I hated for him to have to use an operative delivery, but if it ensured our daughter’s safety, we were all for it. Dr. Davis offered to Dr. Morris the opportunity to scrub in and assist with the birth, but Barbara declined. “It was just real important for me to be here with Barb and Walt. I’ll just be the assistant and the photographer, if that’s OK.”

  Once we were in the delivery room, Dr. Davis scrubbed and got into position. Then Barb began pushing. As Erin’s head began to show, I would alternate moving from up next to Barb’s head—as her coach and supporter—down to her perineum watching my little girl’s head begin to crown. The experience was surrealistic. It was almost as though I passed through a time warp at Barb’s belly button. Above the belly button I was Walt—Barb’s husband and best friend, her ally and helper. But below the belly button my medical eyes and ears kicked me into my doctor mode.

  Finally, at 10:35 A.M., out popped Erin’s head, nose up. She was beautiful. Dr. Davis suctioned out her mouth and nose, and she grimaced. Then, with a little push from Barb and pull from Dr. Davis, with Barbara Morris poised to capture the miraculous event on film, out came our daughter, followed by a large gush of previously dammed-up amniotic fluid. Dr. Davis began to vigorously dry Erin off—and then I noticed it!

  My worst fears suddenly gripped my chest. I saw the deformity. Although the rest of her body appeared beautiful, perfect, spotless, and flawless, there was a deformity in Erin’s perineum. For a moment my doctor mind went through its instinctual differential diagnosis—macroclitorus, macrolabia majorum, genital tumors of various sorts, ambiguous genitalia . . .

  I looked at Barb, who was sitting up on a special birth pillow, with an angelic look on her face—that postbirth look of accomplishment and satisfaction, a look that no man will ever experience, much less reflect. She showed no concern, but only contentment.

  I looked back. She must not see the deformity. What is it?What is wrong? My mind was reeling and boggled. I gasped, almost to myself, “What’s that between her legs?”

  The nurse and Dr. Davis at first looked shocked. Then they giggled at each other. It took Dr. Morris to bring me into reality. “Well, Dr. Larimore, I guess you’re going to have to go back and retake your anatomy course. That’s a perfectly normal appearing penis and scrotum between his legs.”

  While I was feeling more boggled than ever, Dr. Davis, who had clamped and cut the cord
, handed the precious newborn, our son, up to Barb, placing the baby on her chest. “Congratulations, Barb and Walt. You have a little boy.”

  The nurse covered him up with a fresh and warm baby blanket. “Merry Christmas,” she said.

  “Merry Christmas,” crooned Barb as she pulled our newest family member to her breast. “Merry Christmas,” I whispered to her, to him, and to myself. “What a gift! What a miracle!”

  When we were alone, Barb asked, “Walt, would you be willing to say a little prayer—a prayer of thanks?”

  For just a moment I was taken aback. What a wonderful request! I thought. After all, could there be a more natural time to pray—and to express thanksgiving—than after a safe birth? Why hadn’t I thought of this before? Especially with my own patients?

  “Of course, Barb. Of course.” So we had a brief prayer together—my wife, our newborn son, and I. This, I thought, should become a tradition at each delivery I attend.

  Later, in the recovery room, both Dr. Davis and Dr. Morris dropped by to share some special thoughts. Dr. Morris said good-bye and left to drive back to Durham. We were so appreciative of her being there with us.

  Then Barb and I finally had some time together with our son. He had been dressed in a gown that looked like a Christmas stocking and a head cap that looked like a Santa cap. The volunteer who brought it in was so proud. This was the hospital’s first Christmas baby of the year! Barb and I were both in shock. We had expected Erin Elizabeth. At least three ultrasounds had shown that he was going to be a she. Instead, she was a he, and for three days he went unnamed. He could easily have been—maybe should have been—Aaron. Instead, he was named Scott Bonham—the latter a family name, the former the only name that freshly boggled parents could come to consensus about.

  chapter twenty-eight

  THE NEW YEAR

  After driving home from Asheville through the snow-covered mountains, we went straight to Ray and Nancy’s to introduce them to the newest Larimore and to pick up Kate, who was absolutely ecstatic about her new little brother.