Bryson City Tales (9 page)

“That
was
a problem. Nothing worse than to have a patient half-asleep—or, worse yet, waking up during the surgery—or, even worse, to have your volunteer anesthetist go to sleep from the fumes! So I'd usually take my nurse or my wife, who knew how to administer the chloroform—in the early days—and ether more recently. Of course, in the last few years, portable masks of halothane were a godsend. If my wife or my nurse wasn't with me, I'd have to train a family member or friend. Actually, some of the country pastors who'd always show up during my sick calls got pretty good at helping me pass the gas.”

I was quiet—feeling a bit uneducated in spite of having just come out of a prestigious medical school. I couldn't imagine the rush, the fear, the excitement of a kitchen C-section—or a kitchen
anything.

Dr. Bacon continued, “Walt, some of my best surgery was done under these adverse conditions. It's hard to explain, but there was something much more exhilarating about driving through the elements to attend a woman delivering a baby at her home than there ever could be walking across the street to the hospital. Nothing stimulating in
that.
”

I sensed our conversation was coming to a close. The apples were calling my new friend—some needing to be crushed for applesauce, some needing to be cooked, and some needing to be made into cider.

“The chief value, Walt, of the kitchen operations, over those done in the hospital, is that the young surgeon, the inexperienced physician, had no one to blame but himself for a poor result or an infection after surgery. You young guys, if any of these things happen, tend to blame the hospital or the staff or the nurses.

“The second value of the kitchen surgery is that it could be done immediately. Young surgeons don't understand that fear has an adverse influence on surgical recovery. You see, to most people hospitals are scary. They all seem to know people—friends and neighbors—who've gone to hospitals and died. Yet they know no one who's died on the kitchen table. So when the hospital was built and we quit doing most of our kitchen surgeries, we didn't realize the harm we were doing. Instead of seeing people early in their disease, they waited to come in for help. Patients would resist advice to go to the hospital and only come in when in severe distress.

“So, when the hospital first started doing surgery, our morbidity and mortality was unacceptably high. This caused more fear of the hospital and produced a vicious cycle. The more people who fared poorly at the hospital, the longer people waited to come to the hospital, and the worse they did when they got there. When we operated at home, we operated earlier in the course of the disease. The patient's fear factor was
much
lower. And they just did better.

“Walt, even today, I will
not
operate on someone who is deathly frightened. It doesn't matter what causes the fear—I will not operate on a frightened patient. I've seen more than one patient who, prior to surgery, said they had dreamed that they didn't recover—or who confessed that they thought they were going to die and not recuperate—who proceeded to make good on their prediction. Every old surgeon has similar stories to tell from his own experience. When we autopsied these cases, we did not find the cause of death in even one.”

He took a slow, deep breath. “I believe they were literally scared to death.”

He slowly stood. “Been a pleasure chatting with you, Walt, but I bet that lovely wife of yours has Sunday dinner about ready. You get on and I'll bring some cans over later this evening.”

Later that evening Dr. Bacon did bring over dozens of jars and cans. Our root cellar was well stocked with candied apples, apple chips, applesauce, and apple cider—some of the best we've ever had. But the old physician's real gift that day was grounding me a bit in the history of my profession and my community. I may have known more
modern
medicine than he did, but not more medicine—and certainly not more
interesting
medicine!

chapter seven

FIRST-DAY JITTERS

M
onday morning was my first official day of work as a family physician—the culmination of twenty-four years of education. I almost couldn't believe the big day had finally arrived. Today, I would just start making a living—almost eleven years after many of my high school friends had begun their careers.

I arrived at the hospital at 5:30 A.M., ready to meet Mitch for rounds. Mitch was, according to the evening supervisor, uncharacteristically late. I stood nervously at the nurses' station waiting for him. I didn't have to wait long. In he strode, confident and lively. As he entered the station, as though on cue all the nurses stood to attention and in unison said, “Good morning, Dr. Mitchell.” I'm sure my mouth dropped open. Then a nurse appeared from nowhere with a pot of coffee and a clean cup and saucer. “Thank you, Verna,” commented Mitch, without looking up from the pile of charts that had been carefully organized at his chair. This was
not
the way we made rounds at Duke. We were lucky if the nurses even noticed us when we entered the station—that is, unless they needed something.

As he quickly thumbed through each chart, he hummed to himself. Then Ray showed up. Same song, second verse. “Good morning, Dr. Cunningham!”

“Good morning, ladies.”

Then another pot of coffee and cup with saucer appeared.

Then Mitch was up and walking. “Let's
go see some folks, Walt.” And we were off to visit the patients. I heard the rustling of charts. I looked back at the station as we headed down the corridor and saw Verna putting the charts into a rolling cart and then quickly pushing it as she tried to catch up with us.

As we saw each patient—each having been awakened by a nurse's aide who preceded us—Mitch asked a few questions, answered a few questions, did a brief exam, and, while doing so, dictated a note that was written in the chart by Verna. Then he would dictate some orders, which she would write on the order sheet—which he would sign—and then we were off to the next patient. The whole process took only a few moments with each patient.

We'd briefly discuss each case. He'd ask what I would do and then briskly criticize each answer. “Son, that's
not
the way we do it here.” Attached to this oft-repeated phrase might be, “That would just cost too much money, and the folks here don't have much” or, “That's the hard way to do it. How about . . . ?” or, “You've got to be kidding! Didn't they teach you . . . ?” I was beginning to doubt the value of
any
of my last seven years of medical education—when suddenly we were done.

“Let's go get a bite to eat before surgery. We've got a full schedule today.” We took the elevator—the first of only two in all of Swain County—to the basement and entered the small but comfortable hospital dining room, Eloise Newman's domain. Eloise, whose culinary expertise had so dazzled us the previous year, had been brought up in the “red meat and potatoes” school of food preparation. If it wasn't fried and fatty, it wasn't worth serving. The spread of available food was impressive. But no yogurt, no fruit, no muesli or granola, no whole-grain foods here! Rather, a veritable smorgasbord of yeast rolls and homemade biscuits, butter, homemade jams, eggs (scrambled or poached or fried), bacon, sausage (link or patty), grits, home fries, and pots and pots of strong coffee. This was a nutritional den of iniquity. But did it all ever taste good!

“Walt,” barked Dr. Mitchell, “enough relaxation. Let's get to work!” With that, we were off to the OR, which was larger and more spacious than I had remembered from my tour when I'd interviewed here. The equipment was spotless and looked nearly new.

“Earl and the board keep us well equipped. You won't find a better OR suite in western North Carolina,” Mitch boasted. He introduced me to the two nurse anesthetists, Alfred Jensen and Kim Hamrick. Kim's husband, Mike, was one of only two dentists in the county. Mitch also introduced me to the scrub and circulating nurses and the orderly. For a small hospital this was quite the setup. Ray and Mitch operated all morning, five to six days a week. Big-city surgeons often only operate two or three mornings a week!

That morning I assisted Mitch and Ray with eight surgeries—an elective gallbladder removal for gallstones, a hip replacement, an elective hernia repair, a breast biopsy, the placement of a set of ear tubes in a three-year-old, an upper gastrointestinal endoscopy, and the removal of a large tumor on a man's back. In some areas, general surgeons won't do this many cases in a week. But with a referral area of two counties, this OR was kept hopping.

My confidence in the hospital and in these two surgeons soared. They were good—
very
good. Mitch's hands were as fast and as skilled as any I had seen at any hospital in which I had scrubbed.

Throughout the morning Mitch invited me to do more and more. My adrenaline surged as I sensed the surgeons and the staff closely watching my every move. Did I know how to properly scrub, gown, and glove? Did I know how to assist—to help the surgeon operate more quickly and effectively? Could I sew— and sew quickly? I answered question after question about anatomy, options, techniques, postoperative orders—sometimes almost nonstop. I felt like a medical student or an intern. It was an intense morning, yet I felt I did well, and I sensed Mitch's unspoken approval. He left the OR after the last operation, while Ray and I closed.

“Walt, don't feel bad about all these questions,” Ray said. “Mitch did that to me for weeks. I wish I had done as well as you did.”

I was pleased that Ray was satisfied. It had been a
very
good morning.

When we were finished, I walked over to the house for lunch.

“Honey, how'd it go?” shouted Barb from the basement.

“It went super. Great morning.”

I sat at the dining room table and opened up the
Smoky
Mountain Times
. This small but excellent paper would bring us the news and the printable gossip on a weekly basis.

I heard Barb running up the steps. When she got to the kitchen, she announced, “Honey, Eudora brought a mess of fresh vegetables and greens. She said that the nurses and staff always bring in extra from their gardens and leave it in the staff lounge so that those without gardens can enjoy the pickings.”

This was our introduction into one of the major unreported industries of Swain County, namely, hunting and growing your own food. So Barb and I enjoyed our first lunch of local produce—remarking to one another that there was nothing tastier than fresh, homegrown food.

After lunch, we drove down Hospital Hill and into town for a visit to the Swain County courthouse, where we planned to register to vote. Its gold-painted dome, mounted with a weather vane, sat atop a neoclassical, octagonal cupola. Its whitewashed stucco walls and its pillared, ionic portico made for a very impressive courthouse for a small town.

Upstairs housed a beautiful courtroom, right out of
To Kill a
Mockingbird
. Downstairs contained some of the county offices, including the voter registration area. There were only three ladies sitting at their desks when we arrived. One of them stood and approached us, “I'm Sarah Robinson. How may I help you?” Registration took only a few moments and went well until Sarah asked, “What party will you be registering with?”

In unison we answered, “Independent.” We thought this would be wise, given the split politics of the medical staff and until we better knew the “lay of the land.” Instantly we suspected we had made a mistake. Sarah gawked at us with a funny look. The other two women in the room nearly broke their necks snapping their heads up to stare at us, incredulously, as their collective jaws dropped.

Sarah recovered the quickest. “Independent?” she inquired.

“Yep,” I said.

She repeated,
“Independent?”

“Can't we register Independent?” queried Barb.

“Of course you
can,
” she responded, “it's just that
no one
ever does.
” The other two women in the office acquiesced by solemnly shaking their heads no.

“OK,” said Barb, “that's what we'd like to do.”

The clerk bowed her head to stare at us over her glasses. She made one last effort. “Are you
sure?
”

“Yes, ma'am, we're sure,” replied my less-than-sure-sounding wife.

We left the office with our new, but temporary, voting cards.

“That was weird!” we both agreed. We had no idea.

After dropping Barb off at the house, I drove to the offices of Swain Surgical Associates, looking forward with some trepidation to my first afternoon in private practice. I parked in the staff parking lot at the back of the building and entered the staff entrance. Shouts of “Surprise!” and “Welcome!” startled me and there on the table was a small cake that Sarah Crisp, the receptionist, had baked. The icing on the top spelled out the words, “Welcome, Dr. Walt.” I'm sure I was beaming as I took in the scene—balloons and confetti blanketing the entire staff lounge.

Helen Gibson had been Mitch's nurse since before they invented dirt. Gay, Mitch's wife, was a trained medical assistant and had volunteered to assist Dr. Cunningham, and now me. Reva Blanton worked the front office with Sarah.

Helen spoke first. “Honey, we've got some cake here for you, but
first the boss wants to see you. He's in his office.” I suspected Mitch just wanted to personally welcome me to the practice. I suspected wrong. He was working on a chart, intently scrawling away.

“Sit down,” he barked, pointing to an old chair with cracked leather upholstery. When he finished, he rocked back in his chair, looking not at me but at the ceiling. This did not look good. Then he rocked forward, placed his arms on the desktop and clasped his hands, looking down at them. This did not look good at all. Then he looked up at me.