Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains (12 page)

“That's some heavy stuff, I'd say!” Rick exclaimed. “Maybe you and I should go through that Bible study.”

I nodded as I turned the pages to another verse. “Here's another one: ‘In this you greatly rejoice, though now for a little while you may have had to suffer grief in all kinds of trials. These have come so that your faith — of greater worth than gold, which perishes even though refined by fire — may be proved genuine and may result in praise, glory and honor when Jesus Christ is revealed.' ”

“So do you think God causes trials and suffering?”

“I don't know the answer to that, Rick. I mean, I know God allows trials. Remember the story of Job, where God let Satan put Job through various trials. And God allowed that. But does God cause suffering? I guess I'll have to study on that some more — or let Tina and Barb share the answer with us when they learn it.”

Rick smiled.

“But I'm convinced of this — God can and will use the trials we go through in such a way that they will eventually turn out for good. To me that's heavy stuff that's actually pretty good news.”

“I think I agree,” Rick commented. “Speaking of heavy stuff that turns out good, I about got my pants scared off this afternoon.”

“How's that?”

“Louise called me to the ER. Brian
Kelly had brought in one of his kids.”

“Brian Kelly the builder?”

“Yep.”

“He's the guy whose wife broke her arm in several places when their family was camping, and you had to set and cast it, right?”

“One and the same. Turns out Brian came to the ER carrying his little boy. The kid couldn't even walk.”

“Trauma?”

“Nope. Had a cold and a low-grade fever — no big deal — other than he just started getting weaker and weaker. First he couldn't stand and then he couldn't even sit up. His pop rushed him to ER. His cranial nerves were fine and his reflexes all intact, but he had almost no muscle strength — and all of his muscles were tender to the touch.”

My mind was swirling with possibilities. This was a very atypical case, whatever it was. “Guillain-Barré syndrome? Polymyositis?” I asked, thinking of the disorders where viruses can attack and disable the neurological system.

“At first I thought that. In fact, I did a septic workup and a spinal tap and admitted him to ICU. I started broad-spectrum antibiotics, and then I got some shocking lab results.”

“White blood cell abnormality? Meningitis?” I guessed.

“Nope. Not that simple. His CPK was over 10,000!”

“Whoa!” I exclaimed. The CPK is an enzyme that escapes from muscle or brain tissue when it is damaged. Normal levels are far less than 100. This result represented over a hundredfold increase. “Did you recheck the value?”

“The lab did. It was accurate.”

I shook my head in astonishment. A doctor can tell which tissue is damaged by asking the lab to run what are called isoenzymes. The CPK-BB comes from brain tissue, the CPK-MB comes from heart tissue, and the CPK-MM comes from skeletal muscle tissue. “I hope it wasn't BB or MB,” I muttered.

“Nope. That was one piece of good news. It was 100 percent MM.”

“Rhabdomyolysis,” I commented, thinking of the group of disorders that results in the dissolution of muscle tissue. “I've never seen a case in a child.”

“Me either, Walt.”

“Any evidence of trauma, poisoning, snakebite, or anything like that?”

“Nope. Just the sudden onset this morning of fever, chills, dry hacking cough, and runny nose. His mom and sister had the flu last week, which should have given me a clue. But I had no idea what I was dealing with and began to worry I might lose this kid. Walt, I've gotta admit — it was terrifying.”

I nodded, understanding completely what he had been feeling.

Rick continued. “I immediately began running IV fluids mixed with sodium bicarbonate to prevent all the protein from his muscles from blocking up his kidneys. Then I called Tom Dill, the pediatrician in Sylva, but he wasn't available. So I talked to an infectious disease specialist in Asheville. And I'll tell ya this — am I ever glad I did!”

“What'd he say?”

“He said they've been having a peak in their influenza cases over there, and they had seen a couple of cases that sounded identical to mine. He explained that the most common viral illnesses to cause rhabdomyolysis are influenza A and B. He said they think the virus actually attacks the muscle directly and that the virus also makes some sort of muscle-specific, muscle-melting toxin.”

“I never knew that.”

“Me either, partner. But I sure was relieved to hear it. Then he told me there were other viruses, like the Epstein-Barr virus, the herpes viruses, and the chicken pox virus that can also do this.”

I shook my head. “Wow, that's amazing! So what'd he say to do? Transfer the kid? Or what?”

“Nope. He said that as long as the CPK levels drop over the next twelve to thirty-six hours, and as long as the kidneys and electrolytes stay stable, we could watch him here. In the meantime, I need to keep his urine output strong and the urine alkaline.”

“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

W
hen 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 illness, 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.