Bryson City Tales (24 page)

John Carswell and I quickly greeted each other as he continued the chest compressions and elaborated on the history.

“Doc, when me and my boys got there, the family had started CPR and had put a nitroglycerin tablet under his tongue. I called for backup and for the rescue squad. Normally we'd have called for a chopper out of Knoxville, but the fog was just too bad tonight. Had to transport by road.”

John paused, almost as though he knew that a long transport dramatically reduced the patient's chance of survival. “Doc, when I got to him he had no pulse or respirations, but his pupils were reactive. I started an IV and some oxygen and took over CPR. After about ten minutes we got a pulse, and then a few minutes later he began to cough and to breathe on his own. His BP was 60 systolic, and then he woke up. He was complaining of a lot of chest pain. We gave him another nitro under the tongue and a small dose of IV morphine.”

Don took over the story. “Then we arrived, Doc.” He gave me a brief summary as the team continued its work in ER. “We titrated morphine for the pain, which helped at first. We loaded him into the unit and took off for here. His family should be here soon. His systolic actually climbed to 80, but we could never get a diastolic. Then, about fifteen minutes out, he began having severe pain and became diaphoretic and nauseated. His BP and pulse got really low. I gave him another nitro and some more morphine, but he went into V fib and then he coded on us. Billy was driving and John and I worked on him. We've shocked him twice with the defibrillator, but he never responded. We've been doing CPR for ten minutes.”

During the history, Louise and Carroll were helping to transfer the patient to the ER bed and hook him up to the monitors. Louise flew through a quick and cursory exam. I was surprised to see her doing this—in my training, it was the role of the physician. Was this local custom, or was it insubordination? I didn't know, but almost in amazement I watched her perform the exam with not a single second or motion wasted.

“Pupils eight millimeters dilated and fixed,” she shouted, to no one in particular. “Extremities cool to cold.” She took a reflex hammer and quickly assessed his reflexes and pain response. “No response to deep pain,” she continued. Everyone on the team knew she was describing a dead man.

As Louise did the exam, the other nurses and the respiratory therapist arrived. In only seconds the patient was hooked up to the ventilator. The EKG monitor began to blink to life. It was just a flat line.

Despite television shows to the contrary, rare was the patient, at least in those days, who came into the ER in full code and who later walked out of the hospital. This one didn't either. After working feverishly for forty more minutes, I called the code and pronounced the man dead.

Louise said, “I'll call the funeral home. We'll need an autopsy. The family is in the waiting room.”

“Thanks, Louise. Thanks, all. You all did a great job. I'll go talk to the family.”

As I left the ER cubicle, Louise followed me out. She looked as though she had something to say.

“Louise?”

She dropped her head a bit. “Dr. Larimore, I'd be glad to go with you to talk to the family—that is, if you need me.”

I thought this was an unusually sweet and thoughtful gesture. Yet, just for a moment I became suspicious.
Doesn't she
trust me? Doesn't she think I'm capable—that I may not do it
like an experienced doctor?
Then I thought,
Has she been asked
by the older docs to spy on me? Is she looking for evidence of my
ineptitude?
I quickly abandoned those thoughts. No, I concluded, she just was a good nurse who cared and wanted to help. At that moment my appreciation for her grew enormously.

We walked from the ER to the hospital lobby. We had no ER waiting room per se. Although the lobby is normally full during the day, at this hour it was empty.

I walked slowly, trying to gather my thoughts, rehearsing my lines—lines given so many times during residency, lines so very difficult to render with care and compassion, lines always rehearsed, at least by me, at the same time as prayers for wisdom and strength were silently whispered. These moments are never easy for the doctor—or for the family.

I introduced myself to the family. “I'm afraid I've got some bad news for you.”

Then I paused. This was what the family had been dreading. Now their worst fears had been confirmed. Some cried. Others just looked numb. All were quiet—overcome by shock. I waited for any questions. None came—which isn't unusual at such a dramatic moment.

“I want you to know that he did not suffer. He didn't have any pain when he went to sleep. We did everything we could have done.”

James's wife, Grace, smiled. Softly she said, “Doctor, thank you. Thank you for trying.”

I briefly explained what had happened and how hard we had tried to save his life. I suspect that this part of the conversation was almost always one-sided—more for the doctor's benefit than for the family's. It was the doctor's way of confessing, of emoting, of rationalizing to himself and to the deceased's loved ones that the doctor had done all he could do, all he knew to do—that the passing was not
at
his hands, but
out of
his hands. It also gave the family some time to get ready for what would come next.

I then explained the legal and practical details. Under North Carolina law an autopsy would have to be performed, but it could be done, most of the time, without removing the brain. Grace seemed to accept this. Louise and I answered her and the family's questions.

Then Grace asked, “Can I see him? Be with him a moment?”

“Of course,” I said. “Of course. If you would allow us a few moments, Louise will come back and get you. Is that OK?”

She nodded.

Louise and I walked back to the ER. James was covered with a blanket to his neck. He looked peaceful. The nursing staff had cleaned him up and replaced his cover sheet with a fresh, clean one. Don and Billy were doing paperwork. John was sitting by the outside door. After checking to see that all was in order, Louise announced that it was OK for the family to see James.

“Louise, if it's OK, I'll go escort them.”

“Of course,” she said.

I went back to the lobby to escort them in. Like most families, they wept. They gently stroked James's cheeks and touched his head. His boys—he had two of them—bent over to kiss him good-bye. It was my custom to stay with the family during these private moments. To be still and respectful and available. Often families will use this time to share a story or two. Sometimes they'll ask more questions. Sometimes they'll be
very quiet. I would be there with them and, if possible, try to bring some solace into a dreadful situation.

The last thing I was expecting was for James's wife to comfort me.

After she kissed his cheek and held his hand, Grace looked at me. Her eyes were puffy, but she seemed unusually calm and peaceful.

“Doctor,” she explained softly, “my James has had several heart attacks. His father died at the age of forty-five of a massive MI. His dad's dad and granddad both died before the age of fifty from heart attacks. He's sixty-four and has lived longer than any other man in his family. He was a great dad to our five kids and a wonderful husband to me—my best friend.”

She stopped to wipe away the tears. Then she went on. “I am so grateful to have known and loved and lived with this beautiful man. And the Lord has given us so many more years than I ever expected. But, Doctor, best of all, because of his faith in the Lord, I know for sure that he's in heaven. I know for sure that he'll never feel pain again. And I know for sure that I and the kids will see him again.”

She paused. I was overwhelmed by her faith, her peace, and her gentleness. Even in my short career, I had seen many grieving families. Yet, in my experience, it only seemed to be those with a deep and unshakable faith in God who were able to face death with such grace and assurance.

“Doctor,” she continued, “although professionally he was an attorney, he really called himself a ‘fisher of men.' He didn't really lead people to God, like so many clergy or missionaries try to do. James just loved people wherever they were at—warts and all. He didn't try to force them to God; he just gently and lovingly introduced people to his Lord. And more often than not, they would see his life and his example and his character and his giving spirit, and they would want a relationship like he had. He saw so many begin a personal relationship with God because of what God did through him. Now it's time for him to go home to the Lord he loved and served. I'll miss him so much, but he loved me so much. He loved others so much.”

She bowed her head and gently wept. I found myself having some very selfish thoughts. Instead of thinking about James or about Grace, I found myself thinking about me. I wondered what others would say about me when I would walk the same path that James walked. I felt that I knew God. I'd had a personal relationship with him for nearly ten years. But did I know God the way James knew God? And could others see God's love at work in my life? I didn't know.

I walked over to Grace's side and reached down to take her and James's hand in mine. My tears were now as obvious as hers were. I wanted in some way to return to this kind woman the same kind of gift I sensed she had just given me. I thought back to my prayer with Harold and Doreen, and how they had appreciated a doctor praying with them. I felt compelled to offer the same to this precious woman.

“May I pray with you?” I asked, with slightly trembling lips.

She gently, almost imperceptibly, nodded her affirmation.

I said a prayer of thanks for James and for his rich life. I prayed for his wife and his children. I prayed for myself—that my love for God and for others might someday look a bit like James's.

After the prayer, Grace gave me a hug and looked into my eyes. “James would tell you to be strong in the Lord. He would have encouraged you to come to know the Lord more deeply, to spend time with him every day, and to make him known to others. He would have been thankful for all you did. I know I am. Thank you, Doctor.” Then she and the family turned to go. Their last family outing with James was over. But his impact on me would be eternal.

I whispered, “No, thank
you.
”

After the family left, I walked over to the nurses' station and started to do my paperwork, but I paused and put my head in my hands—my tears and silent sobs obvious. I had witnessed death before—many times—but had never been touched by a death like I had been by this one. I cried for my own inability to save James—and for my own lack of faith, compared to this man's. I knew I wanted to make a difference with the patients I saw and cared for. I was learning that this would be possible only if I could be competent both clinically
and
spiritually. I wanted to be able to care for the body, mind,
and
spirit—to care for the whole person as part of a family and as part of a community.

I felt a hand rest softly on my shoulder. Louise whispered, “What you just did, Dr. Larimore, it was . . . beautiful.” I felt her lean over to kiss the back of my head.

“Thanks, Louie,” was all I could say. But no words could reflect the depth of my appreciation for her at that moment. From that moment on, to me she wasn't “Louise,” she was “Louie.” But
never
in public.

I finished dictating my notes on James. The report contained all the necessary clinical details. It began, “This sixty-four-year-old married white male . . .” This was the usual and customary dictation technique, yet this was
not
the usual and customary case. I had been deeply and indelibly marked by this man whom I had never really met, had never known. Yet, to this day I carry his imprint on my soul.

My involvement in the ministry of medicine—incorporating faith into medical practice—in many ways began with this man, a loving man I never knew.

chapter twenty-one

FLY-FISHING

A
fter completing the dictation about James's case, I stepped back into the ER. Don, Billy, and John were waiting. I again thanked them for their hard and competent work.

“Doc,” commented Don, “me and John and Billy seen a lot of docs come and go around here. We've worked a long time with them that's stayed. But you're about as good as any of them. And that's sure enough the truth.”

I didn't know what to say. Obviously they hadn't yet heard of the “skintight cast” fiasco. I had no doubt that they would. Equally certainly it would bring their opinions back to earth. All I could mutter was, “Well, thanks, guys, but you really did all the work. I'm just sorry we couldn't save him.”

“Doc,” said Billy, “I don't think Saint Peter hisself could have saved that man. He was gone when we got there. I knew it. Sometimes you just know these things.”

We all nodded in agreement. Then John turned to me. “Doc, if you're ever interested, I'd like to invite you to come out to Fontana Village. I'd love to show you around a bit. Maybe we could take some time to go fishing out by the dam. It's mighty fine fishing down thar.”

Don, not to be outdone, said, “Doc, Carswell here don't know how to
really
fish. I mean, he can lake-fish, but if you really want to learn how to fish, I need to take you fly-fishing.”

Carswell broke in, “Doc, you go with him, all you're gonna catch is some little skinny trout. I want to teach you how to catch some real fish. In
my
lake we have monsters compared to the babies in the streams. We got bass, walleye, pike, muskie, perch, sunfish, and crappie. Fontana's a fisherman's heaven. You come on the lake with me, and you'll do some
real
fishing. And the lake fish are about as good a eatin' as you can find!” He rubbed his protuberant belly as he smiled and licked his lips. Obviously this man liked to fish as much as he liked to eat.