Bryson City Tales (4 page)

And then, there we were, driving toward the heart of the Smokies for my interview with the board at Swain County Hospital. Barb and I had spent hours and hours reviewing information from each potential practice site—information sent by the local hospital or the town's Chamber of Commerce. The packets would often include appeals from local political officials that extolled the benefits of their locale and why a physician could experience permanent bliss only by choosing to practice in their town or area. Conspicuously absent was any explanation as to why, if their town was so perfect, they were not already overrun with doctors.

Quite frankly, our motive for agreeing to an interview in Bryson City was because we had friends who had camped and hiked there and who had lauded its natural beauty and its relative isolation. So we wanted to see the area, but we were pretty sure we would ultimately end up in one of the many other towns whose public-relation materials were so much more attractive. One by one, however, the towns had been checked off our list. Now only
Bryson City remained. Would this town open her arms to us? And if so, would we feel called to accept her embrace?

As we drove along, I glanced over at my wife of nearly seven years. Barb, my best friend, reclined in the passenger seat, fast asleep on a fluffy pillow. The so-called air-conditioning of our aging Toyota Corolla was laboring to keep the car cool and gently blowing Barb's blond bangs off her forehead. I smiled. I felt fortunate to be married to such a remarkable woman. We had known each other since we were five years old, growing up in Baton Rouge, Louisiana. Voted by her high school class as the most likely to succeed, Barb had earned her bachelor of science degree in English education at Louisiana State University, where she had been both the sweetheart of my fraternity—and of me. We were married during our last year of college, and then Barb had been a teacher in New Orleans, Louisiana, and in Durham, North Carolina—first putting me through medical school and then through family medicine residency. At LSU, she had been awarded a Ph.T. degree—Putting Hubby Through!

Our first child had been born during my internship. I was on an emergency-room rotation—forty hours on and eight hours off, followed by forty more on and eight more off. Barb's water broke five weeks before Katherine Lee was due, and our premature daughter was born on the night before Halloween during one of my eight-hours-off periods. Although I had been a physician for less than a year, in medical school I had delivered several hundred babies in the charity hospital system in Louisiana. I had taken care of many more in the nursery. I had seen babies of all sizes, shapes, colors, and looks. And, speaking quite objectively, I had never seen a more beautiful baby than Kate!

But when Kate was about four months old, Barb became very concerned that our daughter wasn't progressing normally. Our family doctor tried to reassure us, but over the next two months Barb became more and more concerned. Finally we were referred to an elderly, but gentle and wise, pediatric neurologist. After his exam of Kate, he told us that he too was concerned. It was the first assurance Barb had received that her maternal instincts were accurate. The neurologist then ordered a special brain X ray called a CT scan.

I vividly remember when Dr. Renuart broke the terrible news. “Barb and Walt, Kate has cerebral palsy.”

He let the words sink in and then continued. “Two-thirds to three-quarters of her brain has died and has dissolved away. This must have happened at some time during the pregnancy, and I suspect we'll never know what caused it. Maybe it was a knot in the umbilical cord; maybe it was just a kink. But somehow her brain lost oxygen and nutrients and died. On the right side, she has no brain at all—just water. On the other side, she has about one-half of the normal brain mass.”

We were in shock. He continued. “Barb and Walt, Kate will grow physically. She'll probably grow to a normal adult size. She'll be bigger, but she'll never be better. She'll probably never walk, she'll never talk, she'll never think abstractly. You'll just have to take her home and love her the way she is.”

He was quiet. The waiting room was quiet. It was as though the sun had set permanently and the lights had gone out. The room seemed colder, the world crueler.

Our marriage suffered. We suffered. I now understand why over 70 percent of couples with a child who has a disability end up divorced. But with the help of several terrific neighbors and a caring faith community and church, Barb and I got through our first two difficult years with Kate. Our marriage became stronger as Kate became stronger. In her development she was already defying the experts' prognoses. And right now she was snoozing contentedly in her car seat in the back of the yellow Toyota.

When we crossed the Swain County line, a remarkable transformation took place in the geography. The mountains seemed to be higher—and they seemed greener and lusher. There seemed to be more open space and less clutter and development. I breathed in deeply as I took in the vistas looking north, into the Great Smoky Mountains National Park, mountain ridge after mountain ridge as far as the eye could see.

I left the four-lane highway at the Hyatt Creek/Ela exit and found myself on a small two-lane country road that followed a wide, slow-moving river. Suddenly the air cooled and Barb stirred. “Are we there, honey?” she asked through a yawn and a prolonged stretch.

“I think this is it.”

She returned her seat to its full, upright, and locked position and started to look around.

“It's beautiful, Walt,” she whispered.

We were both awestruck at the scenery. It may have been the first moment we knew that this is where we might be for a while. Barb pulled out the directions to the inn where we were to spend the night. It was a Sunday afternoon, and our interview at the hospital was scheduled for the next morning.

Winding up the side of the Tuckaseigee River valley, we drove slowly to admire the fall wildflowers adorning the sides of the road. The leaves were beginning to turn a hundred shades of yellow and orange and red. We came upon a quaint house with a beautiful flower-and-vegetable garden to the side. A small sign by the driveway announced
The Douthits
. I hit the brakes, coming to a sudden stop.

“What is it, honey?” asked my startled wife.

“The Douthits. Isn't that the name of the administrator of the Swain County Hospital?”

“I think so. Why?”

“Do you think this might be their house? Shouldn't we stop in and say hi?”

“Might not hurt.”

I put the car in reverse and pulled into the driveway. I went to the door while Barb gently aroused Kate from her slumber. The small ranch-style house was well kept. The yard was nicely manicured with a variety of fruit trees. The garden at the side of the house was a profusion of color—with flowers and vegetables. Someone in this home both loved the land and knew how to tend it.

After knocking a time or two, I could see what appeared to be the woman of the house approaching the front door. There was a small window in the door through which she peered at me, obviously not recognizing me. However, instead of opening the door, she began to walk away. I was perplexed.

Then I heard her call out, “Judy, one of your little friends is here to see you.”

I felt the color rising in my cheeks. Through medical school and residency, professors and teachers always accused me of looking too young to be a doctor. This was almost always the first comment of any new patient I saw—a source of considerable irritation for me. I wanted to look older, more distinguished. But my youthful appearance wouldn't cooperate with my ambition.

Soon a striking young woman, who appeared to be in her late teens or early twenties, bounded to the door. Clearly she was gleeful about whomever she thought might be at the door. Without looking through the window, she flung the door open. She was in full smile, her shoulder-length dark hair glistening in the sunlight as she playfully tossed it back. Then her eyes met mine and took on the look of confusion. She quickly realized that I was not the eagerly anticipated visitor and that she, in fact, had no idea who I was. The smile melted into a frown, and she slammed the door shut.

I thought,
This is awfully strange behavior!
As she disappeared down the hall, she called out, “Dad, I don't have a clue who that is at the door.” All was quiet for a moment or two. I didn't know whether to knock again or to leave. As I was pondering the options, a man rounded the corner and headed toward the door. Like his wife, he gazed through the window at me and, like her, looked equally perplexed. At least he opened the door.

He was a handsome middle-aged man, executive appearing in looks but dressed in casual slacks and a crisp short-sleeved Oxford shirt. “How may I help you, young man?” he inquired. By now, Barb was walking toward the door, with Kate in her arms. He glanced at her, and then his countenance softened and he began to smile. Before I could answer, he asked, “Are you Dr. Larimore?”

I was relieved to see that we had very likely chosen the right home. “I am! I am indeed.” Barb was now at my side. “This is Barb and our daughter, Kate.”

“Come in. Please come in.”

As we entered, he called
out, “Margie, it's the Larimores!”

He showed us into a small but comfortable living room with a picture window revealing a spectacular view of the Alarka Mountains, which lay south of town. There wasn't a building or structure in sight. I was mesmerized by the striking panorama.

“Please. Please make yourselves comfortable,” Mr. Douthit said. “I knew you were coming in tonight. The Shells are expecting you at the inn.”

As we took a seat on a plush couch, a friendly and pleasant-looking woman appeared from the kitchen carrying a tray of iced tea and drinking glasses.

“Dr. and Mrs. Larimore,” our host said, “this is my wife, Margie.”

As she placed the tray on the coffee table, her smile was radiant, and we could see where Judy's smile had come from. “It is so good to meet you,” she declared as she shook our hands. “Please make yourself at home. I've brought some sweet tea, and I'll bring some cookies in a moment.” She glanced over at Kate, resting in Barb's arms. “And who is this?” inquired Mrs. Douthit.

“This is Kate,” Barb answered. “She's almost two years old.”

“Earl and I can't
wait
to be grandparents, but I'm afraid that's a few years away. James and Judy are both in college and haven't found their spouses just yet.” Margie's friendly chatter put us at ease, and we leaned back in the couch and began to enjoy an unhurried visit with the Douthits.

Earl had been the administrator of the hospital since its inception, he told us. It was chartered as a not-for-profit community hospital in 1948 with one idea in mind: offering top-quality medical care to the people of Swain County and the surrounding areas from conception until death. Swain County Hospital opened its doors two years later, in 1950, with twenty beds, and had expanded several times to its current capacity of forty beds. Earl smiled as he related the rather difficult childhood the hospital had endured. Now, as a growing young adult, the hospital was administered by an all-voluntary community-based board of trustees. I smiled at his analogy.

Earl suddenly looked very serious. He gazed out the window for a moment and then back at me. “Dr. Larimore, I want to be honest with you. We've had a lot of doctors come and go, so we want you to see our town up close—the good, the bad, and the ugly. If you like it, if you feel called here, then we can definitely use another physician. But if it's not your style, I don't want you or Mrs. Larimore to be embarrassed to tell us so. We're not just looking for
a
doctor; we're looking for the
right
doctor. Someone we like, and someone who likes us.”

This was definitely a unique approach. Most of the other hospital recruiters we'd met were intent on
selling
their community to us. They wanted us there—period, no matter what. This man seemed different, and I appreciated his candor and found it refreshing. For the next hour, he told us about the town. He explained the background and personality of each of the town's current four general practitioners and two general surgeons. He laid out the hospital's plans for expansion to a more modern facility and the board's desire to have new physicians who were well trained in family medicine—who could care for patients in the intensive care unit or the emergency room, who could care for children and families, who could deliver babies and provide surgical services. He explained that they were looking for well-trained generalists—not specialists.

This was music to my ears. Physicians who practice general medicine typically are entirely different creatures than those who specialize. They are trained differently, they think differently, and they practice differently. The specialist has to know everything about a narrow field of medicine—especially the rare and uncommon disorders within their area of focus. The generalist must know the common—the breadth, if you would, of medicine. The specialist cares for a single organ system, age-group, or gender—the generalist the entire family within his or her community. I recalled the observation of the famous internist Sir William Osler, who was reported to have said, “A well-trained, sensible family doctor is one of the most valuable assets in a community.” The more Earl talked about what the local hospital was looking for, the more I knew that this town could be exactly what we were looking for.

Suddenly he stood, subtly indicating that our visit was over. “Well, I've kept you two far too long. We'll have plenty of time to visit tomorrow. You ought to get up to the inn. John and Ella Jo can't wait to meet you.”

He then approached me and almost whispered, “John and Ella Jo have really been behind the move to bring some new young doctors into the area. Not everyone agrees with them, especially some of our older doctors. But they can tell you more about this.”