Bryson City Tales (36 page)

He stormed past us. Mitch came to the door. “Boys, you better come in here.”

I looked at Rick and he stared back. “Do you know what this is about?” I asked.

“Nope,” Rick said.

We skulked into Mitch's office, and he closed the door behind us. I hadn't felt this way since being called to the principal's office during the second grade. That visit resulted in a paddling of my hind end—an act then considered both legally and morally appropriate.

Mitch went around us and sat at his desk. He sighed. “Boys, he wants your hides.”

“Our hides!” exclaimed Rick. “For what?”

Mitch looked at me. “Walt, did you slap a young man in the emergency room?”

I was befuddled. “What are you talking about, Mitch?”

“Mathieson says he has a family he's taken care of for years. Their little boy cut his tongue. They brought him to the office because Mathieson was off. They say you saw him, Rick, and sent him home with no treatment.”

“That's right, Mitch. I remember the kid. White's the name—from up Alarka Creek. He had fallen and bitten his tongue. Bled all over. They rushed him to the ER. By the time they got there, the bleeding had all but stopped. So Louise sent him over to the office. Took a look at him and saw that all the bleeding had stopped. In fact, the edges of the cut were sealed back together. We were trained to not put sutures in the tongue unless the bleeding couldn't be stopped.”

“Sounds reasonable to me. So what's this slapping thing?”

Rick continued, “Well, they got home and the tongue began to bleed again. They called the office. Since we were closing, I directed them to go to the ER. That's where Walt saw them.”

Mitch looked at me. “Yep, Mathieson says the parents brought him to the ER and you sewed him up. Mathieson says that before you sewed him up, you attacked him and slapped him across the face. He says the parents were so worried you broke his jaw that they had to take him to Sylva to get Dr. Dill to X-ray the kid's head.”

Now
I remembered the case—clearly. But it didn't happen
exactly
that way. “I think I can explain.”

“I'm listening.”

“I was on call for the ER, and Louise called me over to see this young boy who had fallen on his chin and cut his tongue. Louise warned me that the family had a particular aversion to doctors and to hospitals. The only reason they even saw Mathieson was because he went to their church, and the only reason they even came to the hospital that night was because they couldn't get the bleeding to stop.”

“What did you do?” asked Mitch.

“Well, I went in to see the kid. He went berserk. His mom and dad looked scared to death. I suspect I should have asked them to leave, but I didn't. We had to papoose the child in sheets to restrain his flailing arms and legs, but it only made his hysteria worse. Louise had to secure his head while I dabbed the briskly bleeding tongue with a cotton swab soaked in lidocaine and epinephrine. The kid went crazy, screaming and yelling. His mom started screaming. While his daddy was holding her back, he started yelling at me to do something.”

“What did you do?”

“Louise lost control of the boy's head, and he began to thrash it back and forth. I grabbed his forehead with my left hand, securing his head, and I got my face right in his. Then I just firmly slapped his left cheek with my right hand—just once and not hard at all. ‘Charlie,' I said to him sternly, ‘You calm down
now.
Your tongue is numb now. You won't feel any pain. I need to fix it.' Then, Dr. Mitchell, in an instant he calmed down. So did his mom and dad. I was able to sew up the tongue without the boy even whimpering. His parents seemed distant but grateful.”

Mitch sighed. “I know that family. Probably not wise to have slapped that kid. I understand why you did it though.”

“Well, Mitch, after they left the ER, Louise told me the same thing.”

“Rick, Mathieson's after you, too.”

“What did
I
do?” asked Rick.

“Did you steal some hospital equipment to treat one of the Larimore kids at their house—and then
make
the hospital nurses go to the house to do treatments?”

“You've got to be kidding me! Is
that
what he's accusing me of?” Rick was red-faced.

“Yep, that's what he said.”

Rick explained the home bilirubin therapy. “But,” he concluded, “I didn't
make
anybody do anything. In fact, the nurses seemed to enjoy doing the home therapy. I felt it was best for the patient, and the nurses seemed agreeable.”

“Well,” explained Mitch, “Dr. Mathieson wants you both brought up on charges. And that's not all. He's angry because you don't use enough penicillin.”

We looked at each other. In unison we exclaimed, “What?!”

For the first time Mitch smiled. “Yep, you don't use enough penicillin.”

“I don't get it,” I exclaimed.

“Well, Mathieson says that when my and Ray's patients—and your patients—come into this office for a cold or a sore throat, they expect to get a shot of penicillin. When you boys think it's a virus, you refuse them the therapy they want and expect. So they just leave my office and drive up Hospital Hill to one of their offices and crowd their waiting room to get the treatment Mathieson feels they should have gotten down here in the first place.”

“Mitch,” complained Rick, “you
know
that most of these people don't need an antibiotic.”

“Rick, I know that and you know that. But
they
don't know that! Them and their parents believe that penicillin is a lifesaver. And sure enough, sometimes it is. They still remember when half the folks who got the pneumonia would die. So they believe it works, and when they're sick, that's what they want. It may be a placebo for them, but they'll demand it till they get it.”

“But,” Rick insisted, “what if they don't need it? Shouldn't we educate them that they just need symptomatic care—along with a bit of time?”

“Probably should. Probably should,” he sighed. “But we don't have the luxury of an audience that wants to learn that. My suggestion is that you boys just dispense a few more shots. You don't have to put much penicillin in the syringe. The needle's the same whether it's 150,000 units or a million units.” He smiled.

I felt myself getting angry and defensive. I wanted to fight this suggestion but knew it wouldn't be wise to do so. I was feeling frustrated and threatened. I took a deep breath to calm myself down. “Rick,” I thought out loud, “looks like we'll need to begin using that ‘placebicillin.'” This was an attempt at humor—and it did seem to break the ice. Both Rick and Mitch smiled. Rick nodded his head slowly.

“Mitch,” I asked, “what now?”

“Well, Mathieson says that he's going to file a complaint with Mr. Douthit. He wants the medical staff to hear the charges, and he wants your hospital privileges revoked. If he can get that, then he's planning to file an action with the state. He's going for license revocation.”

We sat in stunned silence. “What can we do?” asked Rick.

“Well, we'll fight. I think that, now that I know the facts, Sale and Cunningham will be on your side. I guess it'll all depend on Bacon and Nordling. If they vote with Mathieson, there's going to be trouble.”

“Why?” asked Rick. “It would be a tie.”

“No, not really. Since Ray is the chief of staff this year, he can only vote at the meeting in the event of a tie. If Bacon and Nordling vote with Ken, it'll be three against you and two for you. You lose.”

My mind was racing, searching for options. I thought to myself,
We can't let these guys get away with this
.
This is not
malpractice
.
There were no laws or statutes broken. Oh, maybe
we could have approached these situations differently—but to
be brought up for sanctions! That was crazy. We'd fight, that's
for sure!

“Should we get an attorney?” I asked.

“No, no, no. That would only make things worse. Besides, all the medical staff can do is make a recommendation to the board of trustees—and they all really seem to like you boys. After all, they're building you a new office. So I think we'll win there. But it only takes two of the physicians to file a complaint with the state. Let me work on this for you all. But in the meantime, lay low. Treat the other doctors real civil-like. Be nice to them, even if you don't feel like it.”

He paused for a moment, then continued, “And say your prayers.”

I already was.

We received a registered letter at the office only a week later. It was from Mr. Douthit, and it recorded the formal complaint from Dr. Mathieson. The hearing in front of the medical staff was scheduled, and we were expected to be there at the appointed date and time. Our day-to-day lives were on pins and needles. Neither of us was sleeping very well. Then came an amazing day on call.

I was making my evening rounds. The days were getting longer and the trees were beginning to bud. The gray days were a little brighter and the spring flowers were starting to poke up through the dirt. Nevertheless, my and Rick's mood was still as somber as the winter skies had been that year.

The nursery had three newborns who were doing well—as were our other patients in the hospital. I was sitting at the nurses' station when Maxine Wilson, the evening charge nurse, came over and sat by me.

“Hi, Max.”

“Dr. Larimore, we've got a problem.”

“What's that?”

“There's a three-year-old in the ICU I think is dying.”

She had my attention. “What's going on?”

“Dr. Mathieson admitted the little one, Amber, last night. She's had terrible diarrhea and was real dehydrated. He couldn't start an IV, so he started cleisis.”

“Cleisis?
W hat is
that?
”

“Basically it's an old, old technique. He just places a butterfly needle under the skin of the thigh and runs IV fluids into the subcutaneous tissues.”

“Why would anyone want to do that?”

“The older doctors only use the technique if they can't get an IV started. This child's veins are so collapsed from the dehydration that we can't get an IV going.”

I knew that Mathieson would be livid if he knew Maxine was telling me all this. She was putting her job at risk.

“What can we do?” I asked.

“Can you do a cutdown?” She was referring to the technique where a doctor will numb the skin over a large vein and then carefully cut through the skin, dissect the vein, and insert a small plastic tube for an IV access—which could save the life of the patient.

“I can, but won't Dr. Mathieson go nuts?”

“Normally he would. But he's out of town. He and Mrs. Mathieson have gone over to Asheville and left instructions that if there's
any trouble with his patients, Dr. Bacon is to be called—
not
you. But we can't get Dr. Bacon to answer. So, according to policy, I've got to come to you.”

“Let's look at the kid.”

We walked into the ward. The young couple sitting alongside the child was obviously anxious and pensive. Maxine introduced me to them. I found out that they owned a small business downtown.

I turned my attention to the child, whose breathing was labored and whose pulse was weak and thready. My own pulse quickened. This child was sick—
real
sick. Her eyes were sunken, her mucous membranes dry and parched. Lungs clear, abdomen soft and concave. Then I saw the thigh—it was bloated and edematous, with a butterfly needle taped to the inside of the upper thigh and connected to IV fluids. Fortunately the pulse in the foot was normal.

“Max, get me a cutdown tray, stat. Also, have the lab prepare for some stat lab work.”

I turned to the parents. “Mom and Dad, I'm Dr. Larimore. Your child is, as you well know, very ill. I suspect that she's septic—there's a germ growing in her system that is making her very sick. With your permission, I'd like to numb the skin over her ankle and make a small incision. Through that incision I'll try to place a small plastic tube into a vein that will then allow us to give her antibiotics and fluids. Is that OK?”

They nodded.

“I'll also need to do a spinal tap to be sure that she doesn't have meningitis—an infection around the brain and spinal cord. I'll need to take just a teaspoon of fluid that I'll draw from her back. I'll numb the skin so she'll feel no pain, and I'll draw it from the lower back so the needle can't damage any of her nerves. Is that OK?”

They nodded again.

“I'll have Mrs. Wilson get you to sign the permission forms, and then if you'll wait in the waiting room, I'll come get you as soon as we're done.”

With tears streaking down their cheeks, they turned to leave. Immediately I empathized with them. I remembered Barb and I shedding tears when we handed six-month-old Kate over to the neurologist for her CT scan—the scan that would confirm a diagnosis of cerebral palsy. I remember how alone and frightened we felt as we waited in the waiting room. If we had only known then what we know now about the power and peace that prayer can bring!