Authors: MD Walt Larimore
“Here, here,” exclaimed voices around the table as iced-tea glasses were raised in a salute.
Eloise, a tall, handsome woman, floated around the table serving her guests. She blushed, “Well, my lands! No need to fuss. It's just a little lunch.”
lunch!” exclaimed Jack Lyday. Jack was the county agricultural extension chairman. “If this is a
lunch, then the Titanic was a
rowboat.” Everyone laughed.
“Seriously,” began Earl Douthit, “the board has discussed Eloise's food before. It's one of the reasons we have trouble getting patients to leave the hospital after they're well. Most of them have never eaten so good.”
Jack added, “That's why we got Fred to join the board.”
“Why's that?” inquired the apparently perplexed attorney.
“To protect us from a lawsuit when some fool patient eats himself to death.”
The laughter started againâat Fred's expense. We basked in the warmth of the group. They obviously liked each other and thought the world of their little hospital. We were feeling more and more like we were with family.
Eloise reentered the room with a homemade pie in each hand. One was pecan and one was appleâand both were piping hot, with steam rising off the flaky crusts. Behind her was a kitchen staff member with a container of homemade vanilla-bean ice cream. Behind them walked several men in white coats. It was like a paradeâand it was time for us to meet the local doctors.
Introductions were made between us and the six physiciansâBacon, Mitchell, Cunningham, Mathieson, Nordling, and Sale. Harold Bacon, M.D., was the eldest of the county physicians. Although supposedly retired, he continued to see patients in the ER and in his small office next to the hospital. He had in the not too distant past lit up the gossip lines in a two-county area by marrying a decades-younger divorcÃ©e of one of the circuit judges. Mercedith Bacon was at the top of the social pecking order in town and very active in the local Democratic party.
William E. “Mitch” Mitchell, M.D., had served the United States as a Mobile Army Surgical Hospital (MASH) surgeon. He was a political and financial powerhouse in the county. A general surgeon and general practitioner, he had run the county medical proceedings for the twenty-five or so years of his practice and of late had run the local Republican party. After the death of his first wife, and not to be outdone by his senior competitor, he soon married a much younger woman from Asheville, North CarolinaâGay, whose name matched her propensity to laugh and socialize.
Ray Cunningham, M.D., the youngest doctor of the bunch, had begun his medical career in his hometown only two years before my arrival. He was in practice with Dr. Mitchell in the county's first and only “group practice,” Swain Surgical Associates.
Kenneth Mathieson, D.O., had retired to Swain County after years of private practice elsewhere. Also in his late sixties, he found retirement to be unacceptable, and not too long after his arrival, he started practice.
Eric Nordling, M.D., and Paul Sale, M.D., were both general practitioners in their fifties. Both seemed to be loners; however, I learned that their approach to medicine was as different as night and day. Dr. Sale took care of nearly all of his patients' medical problems right in Bryson Cityâreferring folks to the “big city” only if absolutely necessary. Dr. Nordling had the opposite approach: He referred as much as he could out-of-town. This conflict in practice and philosophy did not bode well for the future of their continuing to practice in the same town.
And yet that day of our first meeting all the doctors and board members seemed to hold genuinely warm feelings toward each other. The laughter was free-flowing. At one time I noticed R.P., Earl, and Dr. Mitchell enmeshed in a hushed and very serious discussion, which apparently ended in harmonyâsmiles and backslapping all around.
After dessert, the entire group, including the physicians, began to excuse themselves. Each of the nonphysicians seemed truly glad we were there. The physicians seemed a bit more reserved, but a few were friendly. Dr. Mathieson seemed irritated that I had come to town. Drs. Nordling and Sale also appeared reluctant to welcome me. But for the moment I wasn't discouraged.
Suddenly Barb and I were alone with Mr. Douthit. “Cathy,” he called to his secretary, “would you bring me the folder with the offer?”
Here we go,
Down to business.
Cathy brought in a manila folder that Earl carefully opened. He began to shuffle through the papers. “Ah, here we go.” He pulled out a single sheet.
“Walt, we're not an affluent county or a rich hospital. Our physicians here are not paid even the national average. If you and Barb are looking to make a lot of money, we're not going to be the place for you all. But if you're looking for the type of environment and lifestyle that Swain County has to offer, then you'll be pleased hereâand your income will be more than satisfactory.” He paused.
“Go on,” I encouraged.
He nodded. “First of all, we would pay for all of your relocation expenses. And we'd want the mover to do all your packing for you.”
“That sounds very generous, Earl.”
“To keep your expenses down, we'll cover all of your professional costs for the first year of practice. I've talked to Dr. Mitchell, and he will allow you to practice in his office, with himself and Dr. Cunningham. He will keep any monies collected for your work. We'll pay him your overhead and any money short on your salary. Any money collected above the cost of your salary and overhead will be split. One-half to Dr. Mitchell, one-quarter to the hospital, and one-quarter to you and Barb.”
“OK,” I stammered, trying to figure out the implications of such a complex arrangement.
“We're offering a first-year salary of $30,000.”
This was less than the university paid their medical residents in training.
“Quite frankly, Mr. Douthit, I had expected a more generous offer. Most of the other counties are offering . . .” My voice trailed off.
Was I being selfish? NO! After thirteen years of primary
and secondary school, four years of college, four years of
medical schoolâall with no income other than Barb's teaching
income, nine months per yearâa teaching fellowship in England
and three years of residencyânot to mention school loansâ
NO, I was not being selfish. This offer just would not do!
I glanced at my wife and saw that she was trying to hide her disappointment. “Now, I can tell by the looks on your faces that the salary
inadequate. However, we feel the
offer may be of interest to you.” He paused and then continued. “On top of what I've mentioned, we will offer you, at no charge, the home that Mrs. Gunn showed you earlierâfor as long as you wish to live there. The hospital will cover the cost of any and all repairs and of all utility bills and phone bills. In addition, you are both welcome to dine at the hospital at any time at no cost.”
I looked at Barb again. She seemed a bit more interested.
“We will also pay for all of the costs incurred by you both when Dr. Larimore has to travel in order to obtain his continuing medical education. We would just ask that you preapprove these expenses with me prior to traveling.
“We will also provide for all your insurance needsâmalpractice, car, home, medical, dental, life, and disabilityâwhich should save you considerable funds.”
This was starting to sound better.
“In addition, we want to build a brand-new office building. Our current physician office facilities are not what we would like. So the board has had conversations with the North Carolina Office of Rural Health and with the Duke Endowment. We would like you to help us design a family medicine center, to be located within walking distance of the hospital. We'd like to begin recruiting other family doctors who could join you in this building as our older physicians begin to retire. This building will not cost you any money, but just the effort to help us design a wonderful facility for our clientsâyour patients.”
This was starting to sound
“Last, but not least, we want you to help us design our new in-hospital birthing center. We'd like to take the old delivery rooms and make them into two comfortable and attractive birthing suites that will be the envy of any hospital in the state.”
He sat back and took a deep breath. “Walt and Barb, I don't expect you to decide overnight. Please take this information, think about it, and let me know your decision when you're ready.” We agreed.
As we left the hospital, offer in hand, my mind was swirling.
There is so much that seems attractive, almost charming, about
this town and its medical community. Yet neither Barb nor Ihave
ever lived in such a small hamletâso far from family and, Barb
reminds me, a mall! We'll need time to talk, to debrief, and to pray.
“Walt,” pleaded Barb, “let's find a place to walk and talk.” We decided to drive up the Deep Creek Valley. At the northern end of the valley was the border of the Great Smoky Mountains National Park. We parked and strolled up the wide walking path beside the creekâit was smooth enough to roll Kate in her stroller. During the summer the creek would be filled with the shrieks of kids tubing over the white-water rapidsâbut today it was peacefully quiet. Within a short time we were aloneâjust the rustling of the wide rushing creek, the singing of the birds in the thick overhead canopy, and the joyous sounds of Kate singing and humming.
Thick mountain laurel and rhododendron bushes hugged the path. We passed two waterfalls and sat, overlooking each, simply to discuss our impressions and concerns. Maybe it was the sheer beauty of the placeâor the warmth of her peopleâor the hospital's overwhelming need for updated medical skills and technology. Maybe it was our need to feel neededâto make a difference. Whatever the reason, our hearts were in agreement. Barb leaned over to me as we sat by Indian Creek Falls and pronounced, “Walt, I think this
the place!” I smiled in agreement.
We left the park and drove west from town out to the Nantahala River, where we watched fly fishermen and kayakers at play. We soaked in the quiet, marveled at the lushness of the hills, and breathed in the clean mountain air. We spent the afternoon driving around the small townâand up the valleys and dales surrounding herâand into some of her larger hollows. It was a warm afternoon and the sky was a crystal blue. Our peace and confidence only grew. Eventually, as dusk began to descend, we drove back to town for our scheduled dinner with the partners of Swain Surgical Associates.
We parked and walked up to the gracious manor where we were to dine. What was then known as the Frye-Randolph House was originally a small Victorian lodge, built in 1895 by Captain Amos Frye. The captain later expanded it to an L-shaped plan, complete with lovely gables and a stone-pillared porch. Captain Frye and his wife, Lillian, lived in the house while the captain's palatial Fryemont Inn was being constructed just up the hill. After the captain's death, Lillian, by then the first practicing female attorney in western North Carolina, continued to practice law and run the inn until her death in 1957.
Dr. Mitchell and Dr. Cunningham were sitting outside with their wives, and they stood as we approached. Introductions were made all around. Gay Mitchell and Nancy Cunningham were the kind of sparkly people everyone instantly falls in love with. Their smiles were gracious and their laughter was infectious. We immediately liked them bothâGay the louder and more buoyant, effervescent, and outgoing; Nancy the more quiet and reserved. Unlike their husbands, both had been raised elsewhere, but they were quick to share with us their newfound love for the mountains and Bryson City.
The dinner bell rang, and we were escorted into what appeared to be a beautifully kept private home. Only the tourist brochures on one wall gave away the purpose of the Frye-Randolph house. We were shown into a private dining room where rich linens covered the table and candles glowed warmly. Our five-course meal was accompanied by light, friendly conversation. The proprietor and his wife, Bill and Ruth Adams, were in and out of the roomâobviously great friends of our hosts and most hospitable to Barb, Kate, and me.
After dinner we were shown to the sitting room. A small fire was burning in the fireplace, and as Ray lit his pipe, the room's aromas were heady and warming.
“Walt,” said Bill “Mitch” Mitchell, almost sounding stern, “Ray and I think you'd be a great addition to our medical staff. And we'd love for you to join us in our practiceâat least until your new medical office can be built. But I've just got one concern I need to discuss with you.”
“What's that?” I asked. My curiosity grew as Gay pulled out a folded sheaf of papers from her purse.