Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains (13 page)

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

L
ate 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.”

“Well,” Clem countered, “you shore did a good job deliverin' Walter, eh?”

I tried to look like I was irritated, but Clem looked so innocent that it was hard to pull it off.

“OK, Clem. What do you need?”

“Come on with me.” He turned to walk to the barn, and I followed. Over each stall was a name: Daisy, Buttercup, Doris, Walter — and others. We walked up to Doris's stall, leaned against the wall of the stall, and peered in. Doris was facing the far wall, contentedly eating from her hayrack. At her side a newborn calf was suckling. Both mother and child looked healthy and content.

“So what's the problem, Clem? Mom and baby look fine.”

Clem opened the gate and entered the stall. He lifted up Doris's tail, and then I saw it — an umbilical cord hanging out of her introitus. “She's got the placenta trapped in her uterus, Doc.”

“Clem, you know how to remove a trapped placenta, don't you?”

Clem smiled and held up his bandaged hand. “Didn't want to chance gettin' this hand
or
her uterus infected. And you and I both know it's easiest to remove a placenta on the first attempt. So I wanted you to give it a go. Thought it'd be best for all involved.” He looked down at a pail of water on the floor. “Got ya some soap and Betadine water ready.”

I smiled and stripped off my shirt and tie. “Clem, I'm gonna talk to the chamber of commerce about recruiting a vet to town.”

“We've done without one for decades. You human docs don't do too bad a job.”

I entered the stall and scrubbed my hands and then my right arm.

“OK, Clem, hold her tail.” I looked at Doris, who was contentedly chewing. “And Doris, remember that there's a law somewhere that says you
can't
kick the doctor. You hear?” Doris kept chewing. “Remember the word ‘steak,' Doris!” I threatened.

Clem held up the tail, and I grabbed the umbilical cord with my left hand and pulled it taut. Sliding my right hand up the umbilical cord, using it as a guide, I found the correct horn of the uterus. I knew a cow had two uterine cavities, which are called horns, and that the placenta had to be in one of them. The umbilical cord would lead me to the prize.

I found myself considering what I might find. The simplest problem would be a placenta separated from the uterus and just caught at the cervix. Next in difficulty would be an undetached placenta, which could usually be peeled away rather easily from the lining of the uterus — at least in humans. The worst would be a placenta that had grown into the wall of the uterus. This last option would require a veterinarian surgeon, for sure.

As my arm slid deeper and deeper, my fingers finally felt the edge of the placenta.

“The placenta is still attached, Clem.”

I felt around the edge of the placenta and found an edge that had lifted free of the uterus. Slipping two fingers under the edge, I slowly advanced my fingers as the placenta ever so gently separated from the wall of the uterus. I held my breath, as I did when I performed this same procedure in human moms. The placenta is very fragile and can be easily torn. If a fragment is left behind, it can lead to continued bleeding or, worse yet, postpartum infection and even death.

Slowly but surely the placenta completely separated. I curled my hand behind it and gently pulled it out. Doris let out a contented bellow as I breathed a sigh of relief.

“Where do you want the placenta, Clem?”

“Just drop it on the ground.”

“The ground?”

“Yep. Doris here will eat it once we're gone. It's full of iron and protein, and it's good for her.”

I grimaced at that thought as I washed my slimy, bloody arm in the bucket of water and put on my shirt. Clem closed the stall gate behind us, and we walked over to the stall of my namesake.