Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains (10 page)

Ken nodded and took a sip of his coffee. “One man rejected Jesus, and one pleaded to him for mercy. To the one who begged for mercy, Jesus promised paradise. He would still die on the cross for the evil he had been accused of — but at the same time, he could enter eternal life with God through his Son's pardon.”

“That doesn't seem fair,” Barb stated.

“Why not?” Ken countered. “I mean, if God were fair and gave each of us what we deserved for our own wrongdoing and sin, we'd
all
be in a heap of trouble. The miracle is not that some of us come into a personal relationship with God, but that
any
of us do. So I'm planning to make a pastoral visit to the handyman and talk to him about the divine mercy and love available to him. My prayer is that he'll accept the invitation to begin his own relationship with his Creator. It won't change the horror of what he's done — or the penalty and consequences he'll no doubt have to pay. But the simple truth is that our Lord loves him the same way he does each of us. And Jesus died for him the same way he did for me and you.”

Barb and I were quiet as we pondered what Pastor Hicks was saying. Frankly, even though I had prayed for the handyman the night of the crime, part of me didn't want to accept the premise that the Creator of the universe would and could love a murderer as much as he would love anyone else. Why wouldn't God want this man to suffer for the suffering he had inflicted and the life he had taken? Isn't there a certain amount of evil that cannot be forgiven — that
should
not be forgiven?

That night, after the bedtime stories were finished and the kids tucked into bed, Barb and I had a long talk over a cup of tea, a Bible open on the table in front of us. Having been students of the Bible for about ten years, we knew that looking for life principles in its pages was a fruitful exercise.

We had both felt uneasy about our pastor's approach to this brutal criminal. As we reviewed a number of passages together, however, we were pointedly reminded that the most vile and evil people were offered the same love and grace as anyone else.

As Barb read aloud from the gospel of John, the ancient truth humbled me and penetrated my heart: “For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. For God did not send his Son into the world to condemn the world, but to save the world through him. Whoever believes in him is not condemned, but whoever does not believe stands condemned already because he has not believed in the name of God's one and only Son.” I nodded my head slowly as I was again reminded that God's invitation to every person is the same.

“Pastor Hicks is right,” I commented to Barb. “Even if the handyman is guilty of murder, he really
does
have a choice. He can continue in darkness and be condemned by an earthly judge
and
a heavenly Judge, or he can turn his life and his heart over to the One who is the source of all light and life and freely obtain mercy.”

Barb reached out for my hand, and we found ourselves praying together with a new earnestness and humility that night — both for a woman whose body and heart had been deeply wounded, as well as for her assailant, that he might find healing for his spirit and a salve for his soul.

chapter nine

TOO LATE?

T
ommy was seven years old and had never been in a doctor's office before. His family lived deep in the hills and believed, as did many locals in those days, that doctors and hospitals were only for birthing and dying. And the acceptance of the hospital for birthing was a fairly modern phenomenon, as most of the Swain County
natives over the age of forty had been delivered at home.

Furthermore, Tommy's mom and dad saw no need for preventive medicine, well-child visits, or immunizations. To them it was just an unnecessary cost foisted on unsuspecting folks by the already-too-rich doctors and hospital administrators. Doctors, in their considered opinion, were of use for dealing with trauma or surgery or the rare malady that couldn't be handled by one of the local granny midwives — who also dispensed herbs, vitamins, and a variety of medicinal potions.

I hadn't seen Tommy's parents since helping a midwife deliver one of their younger children at home. Mom and unborn baby were in deep distress, but even with the child's life at risk Donnie and Isabella Shoap had been very reluctant to allow a strange doctor near the bedside. They steered clear of “modern medicine” as much as possible, so when Bonnie told me that Tommy and his dad were coming over to the office, having been sent by a nurse in the emergency room, I was curious, to say the least.

I was seeing another patient when Bonnie knocked on the door.

“What is it?”

“Dr. Larimore, I need you.” The alarm in the nurse's voice was subtle but, to me, noticeable. I quickly excused myself and stepped into the hallway.

Bonnie was holding a chest X-ray. “I thought you'd want to see this.”

I held it up toward the florescent ceiling light. It was a chest X-ray of a child. The heart and ribs looked normal. The left lung had an infiltrate in the lower lobe — indicating probable pneumonia. But the shock was the area of the right lung. The X-ray was completely white, which meant the lung was filled with fluid. My concern was immediate. “Where'd you get this?”

“It's Tommy Shoap's X-ray. He and his dad are in the exam room across the hall. I think you need to see them
now
.”

I handed her the X-ray and stepped across the hall. A deep rattling cough greeted me as I opened the exam room door, but when I actually entered the room and saw the boy, my inquisitiveness transitioned to immediate alarm. He appeared cyanotic and emaciated. His respiratory rate was shallow and at least two or three times faster than normal. His shirt was off, and I could see him rapidly using the normally relaxed accessory breathing muscles to catch as much oxygen as quickly as he could. I instantly knew this boy was in severe respiratory trouble.

I quickly nodded at his dad — who looked appropriately worried — and spoke softly to Tommy. “How ya doing, partner?” Then I turned to Bonnie and as calmly as possible requested, “O
₂
stat! And let's get some help.
Now!
”

Bonnie left, and I put my stethoscope to my ears and began to listen to the boy's chest. As I suspected after seeing the X-ray, there were
no
breath sounds over his right lung. The left lung resonated with sounds that indicated infection — most likely pneumonia. His chest skin was cold and clammy, and he began to shake with a chill. I touched his forehead, which was burning with fever. His eyes were glazed. Other than some clear nasal discharge, his head and neck exams were normal — as were his heart and abdominal exams.

Bonnie and Patty Hughes, Rick's nurse, rushed into the room. I could see from Patty's eyes, which visibly widened, that she too was alarmed by what she saw. As the nurses set up the oxygen, Donnie Shoap sat quietly by as I tapped various areas of his son's chest. The dull thuds told me that the chest was probably full of fluid. My hope was that it was full of pneumonia, which typically could be easily cured with antibiotics, but my fear was that it was full of pus between the outside of the lung and the inside of the chest wall. If Tommy had this condition, called empyema, then I knew the pressure of the pus could be crushing the lung and collapsing it. The infected fluid can build up to a quantity of a pint or more, which puts pressure on the lungs, causing shortness of breath and much pain.

When Bonnie called out the young patient's systolic blood pressure, heart rate, and respiratory rate, they were all about 60, telling me his blood pressure was dangerously low, his respiratory rate three or four times greater than normal, and, worst of all, his heart rate precariously slow. Given his critical condition, his heart should have been racing — well above one hundred beats per minute. The fact that it was so slow meant we were in deep weeds indeed.

Once the oxygen was flowing, Tommy's cyanosis decreased, and his respiratory rate began to fall a bit. As he pinked up and began to breathe more easily, he was able to recline a bit on a pillow. He looked famished and exhausted.

“Bonnie, call Don and Billy,” I softly instructed. “We need transport stat. Call Louise and get me an ICU bed.” I turned to Patty. “Let's get an IV started with normal saline. Draw blood for cultures and lab tests.” Both nodded and leaped into action.

I looked down at Tommy and squeezed his arm. “How ya doing, tiger?”

He tried to smile back. “Not so good, Doc.”

“Tommy, I think you've got an infection in your lung. We call it pneumonia. I need to take you to the hospital.”

I could see Tommy's eyes widen and hear his pop's gasp behind me.

“Patty has to start an IV. You'll feel a prick — just like a bee sting — but only for a second. It will allow me to get some blood for testing — just a little bit — and allow me to give you some fluids and then some medicine to get you well. Sound OK?”

I could see his eyes moisten and wondered if his inclination was to shake his head. He glanced over to his dad, and I turned to face Tommy's father.

“Donnie, how long has he been sick?”

Donnie blushed and then looked down as he mumbled, “A couple a weeks.”

I wanted to ask him, “Why'd you wait?” In fact, I wanted to shake him and holler it into his face. But I knew the answer, and I knew that shaming a man in front of his son was one of the cardinal sins in mountain culture.

I walked over and touched his shoulder. He looked up, and I could see the humiliation in his face. He didn't need my criticism. I squeezed his shoulder. “Glad you got him here, Donnie. I think we can fix this. But I'm going to have to do this work at the hospital.”

“That's what the nurse in the ER told me. But I refused. I told her I wanted her to let me bring Tommy over here. I was hopin' you could jest give 'im a shot or somethin'.”

“I think it's going to take more than that, Donnie. I suspect that his right chest is filled with pus. It's like a big ole boil. I'm going to have to lance it and let the poison out.”

His eyes widened, and I could see his concern.

“I'll numb the skin, of course, and then slide a small tube into the chest. The tube will be on the inside of the ribs, but on the outside of the lung. The lung is just like a balloon inside the chest wall. And I suspect it's being compressed by the pus. By washing out all that pus, the lung will inflate and be more likely to heal itself a lot more quickly.”

I knew that the pus was highly toxic to the lining of the lung. The longer it stayed in the chest, the more likely it would be to scar the lung and the lining of the lung. I'd have to wash it out, using the chest tube, and then connect the tube to suction until the antibiotics began to clear the infection.

I sat down next to Donnie and explained the procedure I was about to do on his son in the ICU. It was not without formidable risks but was potentially lifesaving. Bonnie brought in a consent form, and he signed it.

Just then there was a knock on the door. Don and Billy had arrived. They quickly prepared Tommy for transport, transferred him to their stretcher, and scurried out of the office to take him to the hospital.

As soon as they were out of the room, Donnie asked me, “Will he die?”

I lowered my head and nodded ever so slightly as I explained, “He could, Donnie. This is the most serious case of childhood pneumonia I've ever seen. But if we get that pus out, put some fluids in his
system, and then get him some powerful medicines flowing through those veins and into his lungs, my prayer is that he'll do well. But this road is not going to be an easy one.”

“Do I need to take him to Asheville?”

“Donnie, to be frank, I don't think he'd survive the trip. We need to get that pus out of his chest now.”

Donnie nodded as he stared down at the floor. Then he whispered, “He don't have a prayer, does he? That's why yer takin' 'im to the hospital.” Large tears dropped from his downcast eyes onto the floor.

I was quiet for a moment, fighting the urge to rush out the door and over to the hospital to go to work on Tommy. But I fought the urge, knowing that the nurses would need a few minutes to get Tommy in a bed and get the procedure set up.

And then I remembered my own fears before Kate's surgery on her legs — which had been rendered spastic by her cerebral palsy. I remembered how it felt to be completely out of control and to turn my child's fate over to the care of others. My own eyes began to get moist as I saw Donnie's tears falling to the floor.

“You a churchgoing man?” I asked.

He shook his head. “Not very often. The pastor fusses at me.” I could see a small smile on his lips.

“You think prayer makes a difference?”

He slowly nodded. “I reckon I do, Doc.”

“Me too. Mind if I say a prayer for your boy?”