Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains (22 page)

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 husband 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!”

As I stepped to the patient's side, while nurses yelled, “Pant!
Pant
! Don't push!
Don't
push!” the patient pushed — and out popped baby #2. I didn't even have time to think about the daddy's shock at watching all this — much less consider any desire he must have had to cut his babies' umbilical cords. I just clamped and cut the cord and rushed little boy #2 to warmer #2 where Rick was waiting.

“Baby #1 is fine,” Rick assured me as he looked down at baby #2. “This one looks great too. Wow, they're big for triplets!”

“You OK, Rick?”

“You bet. Get on back to the mom. I'm fine.”

To my utter amazement, as I turned back to the mother a small eruption of fluid gushed out of the birth canal.

“Ruptured membranes!” one of the nurses exclaimed.

A quick check of the cervix showed that it was still fully dilated and that baby #3 was coming down the birth canal headfirst. I found myself befuddled. How could the cervix dilate when the first baby came out feet first? Later discussions with a specialist in Asheville convinced me that the largest baby, actually the last to deliver, must have been the one closest to the cervix and — whether butt-first breech or head-first vertex — had dilated the cervix. Then, with some sort of fetal gymnastics, the soccer player in the group had kicked open his membranes and made his rapid exit from the womb.

Surprisingly, this baby took several dozen contractions to move down the birth canal, but with one final push he plopped into view for all to hear his cries.

“Three boys?” the shocked father exclaimed.

“Your three sons!” I responded. “Here, wanna cut the cord?”

“Can I?” He grinned wide in wonder.

“You bet.”

After the cord cutting, Rick took boy #3 to warmer #1 and repeated his third baby inspection in ten minutes.

“All boys look great! Vital signs normal. All had Apgars of 8 and 9,” he announced to the mom, dad, and all present. Nurses worked on each child to get him cleaned up, measured, properly identified and tagged, and capped and swaddled.

Fortunately, all three boys were in great shape — as was their mom. The dad appeared to be in shock, but I was certain he'd recover — at least one day. Unfortunately, I had forgotten to tag each of the umbilical cords with a different type of clamp for each baby. Thankfully, as nurses so often do, an experienced and very observant labor nurse saved my hide.

“The long cord is the one the daddy cut. That's the cord for baby #3. And the shortest cord is from baby #1.”

I looked at her in grateful amazement. “Way to go! Thanks!”

She blushed and smiled with pride.

On Thursday, our hospital shined. The entire staff pulled together and participated in a wonderful set of deliveries. Unexpected, to be sure, but — thankfully! — uneventful.

Two days after their birth, the triplets were beginning to become jaundiced, and we didn't have the equipment or staff to care for all three of them. I called one of the pediatricians over in Sylva, who kindly agreed to take the babies in transfer. Because the mom was doing so well, I'd be able to discharge her from the hospital so she could travel to Sylva with her babies. The hospital there had agreed to let her and her husband stay in one of their postpartum rooms until the babies were ready to go home.

Before they left, I asked her if she had named the boys. When she told me their names, I sat down in shock. On Saturday, Richard, Carl, and Stanley — born in that order — left the hospital in an ambulance headed to Sylva. Their mother assured me the names were all family names. She didn't know any of the three men we had lost that week. She said she sensed a leading from the Lord in naming each boy. I believed she had, indeed, been given divine direction.

On Sunday, Rick and I sat together during the worship service. Our singing was a bit more contemplative and our prayers a bit more intense — both those of confession and those of thanksgiving. Ken Hicks's sermon — on forgiveness and thankfulness, on restitution and redemption — was more meaningful than he could have ever imagined.

Sunday worship — it
was
a good way to start a new week. The old and dark washed away; the new and vibrant ushered in. That week, lives were lost, lessons were learned, beautiful births attended, and lasting memories created.

The doctor's life always has been and always will be a strange and mysterious combination of opposites — parallel emotions that weave together into the fabric of practice. I was grateful to have been given the vision to see that, even when the threads of life are worn or stretched, the Master Weaver is still there — compassionately, competently, and carefully overseeing the creation of a beautiful tapestry, interlacing both dark and light threads into the lovingly created masterpiece embroidery he is accomplishing in the life of each of his children.

chapter twenty-one

THE RIFLE

D
r. Larimore!”

I didn't recognize the voice, but her tone was frantic.

“You gotta come over to the birthing room stat! We got a crazy woman here. She's
crazy
, I tell ya!”

By now I was wide-awake and sitting on the side of the bed. The clock said 2:13. “Who is this?” I asked.

“It's Marlene Wiggins. I'm a part-time nurse here at the hospital. The Cherokee Indian Hospital transferred a young woman over here who's in labor. By
the time she got over here — ”

I heard a loud noise and screaming in the background.

“Dr. Larimore! Come stat!” Then the line went dead.

I quickly pulled on my scrubs, jumped into my clogs, and ran out of the house and across the street to the hospital. As I ran toward the birthing suite, I could hear a noise that sounded like someone beating a pot with a spoon.

As I rounded the corner, I saw a metal object flying across the hall, just missing the head of a nurse ducking in the hallway, who I presumed was Marlene Wiggins.

“What in tarnation is going on?” I exclaimed as I ran up to her.