Stories, Autobiographical, Interesting, Plaut, Asthma,
It is 1964 and I am in the last year of my pediatric residency at the New York University-Bellevue Medical Center. Johanna is a doctoral student at Columbia University in the middle of writing her dissertation in French Literature. It is time for us to decide where we want to live and work. This collection of ten short stories describes our journey to Whitesburg, Kentucky and some of the people we met there.
THE ROAD TO WHITESBURG
It is the spring of 1964; I am finishing my residency in pediatrics at Bellevue Hospital in New York City. My favorite professor receives a letter saying that a medical group in Letcher County, Kentucky, population 30,000, needs a pediatrician.
Johanna is a student at Columbia University and is in the middle of writing her doctoral dissertation in French Literature. We are trying to decide where we should settle. I want to make a difference in our new community and also would like to work with bright doctors who have some interest in teaching and research.
Johanna and I scan the ads in the New England Journal of Medicine, Pediatrics and The New York Times. We decide to visit five practices north of Washington, D.C. and east of the Mississippi River. The first is a three-man practice in Rochester, New York. The senior man has written many articles dealing with the treatment of strep throat in children. One of his partners co-authored several of these papers and is the president of the Rochester Pediatric Society. When we go out to dinner I learn that the youngest of the three pediatricians in the group likes to make orange marmalade from scratch. The pediatric community in Rochester has a special character. Almost every pediatrician has a faculty appointment at the medical school. Many of them work on projects with the full-time faculty. This would be a good place to practice.
Next we visit Kalamazoo, Michigan. Kalamazoo is the home of the Eli Lilly pharmaceutical company. It also boasts a clutch of Frank Lloyd Wright houses. The routine on these visits is to meet the doctors in their office, check it out, then ride around town, talk about schools, and then go out to dinner with the wives. I met with the senior doctor who has unbounded energy. He has special interests in fluoridation, diabetes, growth retardation, and communication. Eli Lilly sponsored several films that he made to educate doctors. He likes me, my credentials and Johanna and says so. I spend the next hour with his partner who tells me that they have hardly talked to each other in the past six months. He would like me to join the practice to help make it run more smoothly.
The nurses treat both doctors with respect and deference. The nurse who shows me around the office won’t even refer to them by name. When I ask to speak with one of them, she answers apologetically, “I am sorry, Doctor, but Doctor is in the other room talking with Doctor.”
Kalamazoo. Johanna still laughs when she says the name. She cannot take a place with this name seriously. I think about the practice. First, I don’t want to enter a warring partnership. Second, Kalamazoo has plenty of pediatricians. I don’t want to compete with other pediatricians for the honor of giving some baby a DPT shot. I want to make a difference.
Next we go to Madison, Wisconsin. I interview at the Fox Lane Clinic. They are looking for a second pediatrician. I meet my prospective colleague. He shows me around and describes the clinic’s operations. I am expected to see a certain number of patients a day and to refer at least one patient each week for a tonsillectomy (you can always find someone). In addition to my salary, I would get paid 50% of the charge for each blood test and xray that I order. The dinner is good and they put us up in the honeymoon suite of a beautiful hotel on the lake.
Our fourth stop is a solo practice in Columbus, Ohio. This pediatrician spends half of his time seeing patients with diabetes and the rest seeing patients with a variety of problems. He is on the faculty at Ohio State and has published several articles. He wants to reduce his practice time because his wife is seriously ill.
Our final stop is in Kentucky. I interview at the headquarters of the Daniel Boone Clinic in Harlan. That’s where the bloody coal mine organizing battles were fought in the twenties and thirties. The clinic is located in a hospital that was built by the United Mine Workers.
We drive from Harlan to Whitesburg with Bill Potter. He’s a surgeon and one of the founding members of the Daniel Boone Clinic. He drives a sports car, and drives it fast on the winding mountain roads. He is chief of surgery for Harlan and its four satellite hospitals spread out across the coalfields in southeastern Kentucky. He travels every week to supervise the residents (doctors in training) in Whitesburg, Hazard, Owensboro and MacDowell. They are 20-50 miles from Harlan in different directions.
Dr. Potter bought a helicopter to cut down on his travel time. There is a small grassy spot in the middle of the parking lot in front of each hospital. That’s where Dr. Potter lands. A lot of doctors who drive fancy cars are jealous of him. One day, while he is landing at Whitesburg, he gets too close to a parked car and breaks his rotor – the doctors with the fancy cars are pleased.
We drive from Harlan to Cumberland and then over Pine Mountain to Whitesburg. Dr. Potter is speeding along; his low-slung car takes the curves very well. He is telling me about the clinic and the hospital in Whitesburg: one hundred-four beds. It is one of five hospitals in Kentucky built by the United Mine Workers Welfare and Retirement Fund in 1956. John L. Lewis, president of the UMW, took the union out on strike against the bituminous coal operators in 1945. It was a long strike but when it ended the UMW gave the coal operators the right to mechanize in exchange for a 40-cent per ton royalty. This money would go into the Fund to pay health and retirement benefits.
A lot of coal is being mined, so the fund collects millions of dollars. At first they hire local doctors to take care of the miners and their families. There are problems. Many of the hospitals are wooden buildings and not well staffed or equipped. The Fund is not happy when a surgeon cuts open a swelling in the back of a miner’s knee thinking it is an abscess. It isn’t. It is a swollen blood vessel and the man bleeds to death. The Fund is not pleased when they get bills two years in a row for removing a man’s appendix. The trustees of the UMW Welfare and Retirement Fund see their money diminish each summer when doctors hospitalize miners’ kids for two weeks while their parents go on vacation.
We turn left off Pine Mountain Road onto Route 119 into Whitesburg. When we arrive we drive straight to the hospital. It is a tidy looking building made of yellow brick with a lot of windows. The Daniel Boone Clinic occupies one corridor on the ground floor. Johanna and I meet Sally Polly, the clinic manager, Bob Shoffstall, a surgeon, and Helga Muznieks, an internist. John Engle, a general practitioner and conscientious objector, will be coming down in August to do two years of alternate service.
The hospital is located on a hill overlooking the town of Whitesburg, with a good view of the mountains. It is square, three floors high with the ER, admitting, x-ray, lab, record room and operating room on the ground floor. Pediatrics and medicine are on the second floor; obstetrics and the newborn nursery are on the third. Part of the third floor is empty. The pediatric unit consists of one room with eight beds. If more beds are needed, pediatrics spreads into the empty space.
John L. Lewis said that mining coal is too dangerous for any human being. That’s why he agreed to mechanization. The United Mineworkers Welfare and Retirement Fund covers retired miners but it doesn’t cover miners who are laid off. The hospital was full of miners and their dependents from the time it opened in 1956 to about 1960. Hardly any non-union patients were treated there. With mechanization of the mines, the number of miners dropped from 400,000 to 160,000 and the hospital census started dropping. The union set up a black lung rehabilitation center to fill some of the beds. But in 1963 the UMW miners and their families didn’t fill half the beds. The union decided to get out of the hospital business and sold the hospital chain to the Presbyterian Church. The doctors, all full time employees, were not part of the deal. Many of them are Quakers who had been drawn to the area to serve. A number of doctors leave this uncertain situation. The doctors in Harlan and four satellite clinics decide to stick it out and create the Daniel Boone Clinic.
Dr. Potter takes us to the pediatric ward. The head nurse is young, bright and serious as she tells me about each patient. There are only four children on the ward. General practitioners transfer the sickest kids to the pediatricians in Harlan Hospital fifty miles away for care.
After we finish our tour of the hospital, we are invited for lunch in the hospital cafeteria. We are passing through the line, pushing our trays and a positive feeling comes over me. I like this hospital, and I like the people in the community. The nurses, the doctors, the x-ray technician, the record room clerk, and the switchboard operator all welcome me and tell me how much they need a pediatrician.
The hospital is small, but is staffed by serious, hard working people. Everyone but the doctors is a native of Kentucky. Almost all of the staff, the nurses, lab technicians and x-ray technicians are from the area. The UMW trained all of them. They realized from the start that outsiders would leave, but natives would stay. I think to myself, this is where I want to work: a small but modern hospital with competent staff, a real need for my services and a chance to make a major contribution to the community. This is different from the practices Johanna and I have visited in Kalamazoo, Rochester, Madison and Columbus. No kickbacks for lab tests, no warring partners, no unproductive hustling. Every hour will be well spent and gratifying. Johanna is behind me in the cafeteria line. I turn to her and say, “This is it, Johanna. I want to work here.”
Communication between Dr. Jimmy Gibson and me is not good. In fact, we hardly talk. He has practiced medicine in Letcher County, Kentucky for many years. I arrived just six months ago. Jimmy never put it into words, but he is not happy to have me working at the clinic.
So I am surprised when my nurse wheels ten-year-old Cathy Collins into my office at the end of a long day. “Dr. Gibson wants you to see her. She’s got bad stomach trouble.” I am surprised, because Doc Gibson has never asked me to see anyone. When I walk across the hallway to get his thoughts about Cathy, his office is empty.
Well, I get down to business, talking to Cathy and her folks. She has belly pain that started last night and it is getting worse. She has some fever and her pulse is fast. Her head and her chest are okay. When I start to examine her belly, she gets anxious. I guess Doc Gibson has been there before me. Gently, I listen to her belly. It is a little quieter than usual. Something is going on. Then I press softly and move methodically from her ribs down to her belly button, first on the right side and then on the left. No problem here. I always examine the ‘normal’ areas first and I think Cathy’s problem will be in the lower right part of her abdomen. Sure enough, as I move toward it, she starts whimpering then she cries, and then she screams, “Don’t press there! It hurts!” She tries to push my hand away. I move over to the left side, press down and let up suddenly. She screams. She has rebound tenderness, a definite sign of appendicitis. I am pretty sure of my diagnosis and a rectal exam clinches it. Ten-year-old Cathy has appendicitis and she needs an operation.
I explain this to her parents. Mrs. Collins is holding Cathy. She moves out of the office saying, “I don’t want Cathy to have no operation.” I know I must convince Mr. Collins that this is serious. “Mr. Collins, Cathy needs an operation and she needs it now. For every hour that you wait, she will be in the hospital an extra day. Her appendix might rupture at any time and she could die.” He agrees to the operation and we walk into the hospital lobby to talk to his wife. She sees us coming and can tell by her husband’s face that he has agreed to the operation. She runs out the door with Cathy in her arms.
I call my lawyer and ask him how I can get a court order to bring Cathy back. He tells me to contact the county attorney. The attorney says we should meet with the judge and a stenographer to get the order. We decide to meet at the hospital at 7:00. I go home for supper and then head back to the hospital. The judge and the lawyer are there, but not the stenographer. I take on her job. After half an hour the papers are ready. The judge calls the sheriff and asks him to go find Cathy.
An hour later, I hear that when the deputies visit Cathy’s grandmother, she tells them that Cathy’s parents are driving her to a faith healer in Virginia. The judge’s warrant won’t be any good there.
I go home to get some sleep. I am sad and worry about Cathy. Seven hours have passed since her parents left my office. At 1:00 A.M. the phone wake s me. It’s the pediatric nurse saying Cathy has come back looking pale and doubled over with pain. It seems that when her parents came back from Virginia they visited her grandma. She tells them that Cathy must be really sick because the deputy is out looking for her. Cathy’s parents can tell she is not any better and they come back to the hospital.
It takes me just ten minutes to dress and get to the hospital. I examine Cathy and then I call Dr. Stone, the surgeon, to make arrangements for the operation. “We got her back,” I say. “She’s been to a faith healer in Virginia. When do you want to operate?” “I don’t,” says Dr. Stone. “I was willing to do it this afternoon, but her parents ran out on you and besides, they’re on welfare. Now I don’t want to help them.”
I am upset. Cathy’s parents are ready for the operation and the surgeon will not do it. It’s not right and no one is going to make it right. I admit her to the Whitesburg hospital and treat her with intravenous fluids and antibiotics overnight. In the morning an ambulance takes her to the hospital in Harlan, fifty miles away. A surgeon operates on her an hour after she arrives. Later that year I see Cathy skipping down Main Street.
I like Billy and his parents. They are down-to-earth people. They are friendly and they do their best to make sure Billy gets medical treatment when he needs it. I have seen him several times this past year.
It is January 1966 and I am dictating a chart when Mrs. Turner comes in with 12-year-old Billy. Mrs. Turner is twenty-nine years old and looks 45. Her light brown hair is stringy, her face marked with wrinkles and when she smiles, I can see more spaces than teeth.
“Doc, I am worried,” she says. “Billy’s hands have turned blue.” I look at them and sure enough, Billy’s palms are blue. I turn his hands over. They are blue on the back too. I am thinking heart trouble can cause blue hands, but when that happens the rest of the skin is blue too. This is because the blood circulating through the body is not fully oxygenated. The rest of Billy’s skin is pink.
Breathing trouble can also cause a person’s skin to turn blue. For example, a serious pneumonia can reduce the amount of oxygen passing through the lungs into the blood. But, except for his hands, Billy’s skin is not blue anywhere else. His tongue is red. That means there is plenty of oxygen in his blood
I look at his feet. The skin is a normal color. I think some more. “Has Billy gotten any new clothes recently?” “Yes, Doc, I bought him a Levi jacket this week.” “Did he wear it yesterday when it was so cold?” “Yes, Doc. We were out of coal and Billy’s teeth were chattering as he walked around the house. He was so cold that he held his arm like this.” She folded her arms and tucked her hands into her armpits. “I think I know how Billy’s hands got blue Mrs. Turner. You probably haven’t had a chance to wash that Levi jacket yet.”
I am sitting at my desk when Mrs. Turner comes in with her husband and twelve-year-old Billy. She is not smiling today. Her face looks worried.
“Doc, ” she says, “Billy has gone blind.”
Billy is standing beside me with his eyes shut. His stepfather is next to Mrs. Turner. He is slim, tan and little stubbles of beard are poking out of his face.
Mrs. Turner continues, “He woke up blind this morning. Couldn’t see a thing.”
I look at Billy. He doesn’t look sick standing there.
What can cause sudden blindness? An idea comes into my head.
I brace my hand on Billy’s forehead and try to raise his right eyelid with my thumb. I can’t move it. I try the other side and can’t move it either. A nerve problem usually causes the eyelids to be slack, not tight. I decide that Billy doesn’t have a physical problem. He probably has hysterical blindness.
I step back and tell his Mom, “I can cure Billy but I want you to leave the room while I work on him.” When she leaves the room, I tell Billy. “You will be able to see in one minute.” I take a deep breath and then stomp on his foot. Billy’s eyelids fly open.
“I can see!” he says.
“Good, Billy, I’m glad you can see again.”
Today Billy comes in with his mother and Mr. Collins, his stepfather. They went to Lexington last month while I was on vacation. Billy is having seizures (convulsions) and a lot of them. They drive 150 miles to the Pediatric Clinic at the University of Kentucky and are seen by Dr. Wilson, an excellent neurosurgeon. One of Dr. Wilson’s residents checks Billy, orders an EEG, and some other tests. When they put everything together it looks like Billy has a brain tumor.
The residents want to operate but Billy’s parents bring him to my office to see what I think. I know Billy. Last winter I diagnosed his blue hands. Early this year when he went blind I cured him. I talk to Billy.
“When do these convulsions come on, Billy? Do you ever get them at night?”
“Do you get them every day?”
“Any special time, like in the morning?”
“Could be any time.”
“Do you get them more when you are feeling sick?”
Now, I know that strobe lights can set off a convulsion. The visual stimulation can start a seizure. Some people have convulsions when they are driving past a series of telephone poles. Others convulse when they read a foreign language or sight-read music. What is it that causes Billy to have a fit? A movement? A smell? A sound?
“Do you know what starts you to have a fit?”
“Yes,” he says. “I get a fit when I see my Dad go for his belt.”
“Well, I just get scared, throw my arms and legs out, and fall over and commence to jerking.”
“Yes, Doc,” says his mother. “Billy jerks for a minute or two, then he lays quiet a while before he comes to.”
Dear Dr. Wilson,
Today I checked 13-year-old Billy Turner to evaluate his convulsive disorder. Turns out he has a fit whenever he sees his father is ready to strap him. This happens pretty often, as much as ten times a day. I have talked with Billy and his parents and see no need for brain surgery at the present time. I’ll write you a follow-up note in six months.
Thomas F. Plaut, M.D.
SHOT DEAD IN NEON BAR
It is my first week in Whitesburg, Kentucky, population about 1000. It is in a coal-mining region and sits next to bloody Harlan County. There were a lot of killings there between union miners and company goons in the 1930s.
I start seeing patients my first day there. The usual stuff, earaches, pneumonia, diarrhea, worms, rashes and a couple of well baby checks. At the end of the day I pick up a newspaper to learn something about my new home. The headline says, “JAMES STRUNK SHOT DEAD IN NEON BAR”.
That is a fine introduction to the area. Neon is the next town over. I want to learn something about the killing and ask couple of neighbors about it. They tell me that James Strunk was drinking and commenced to argue with the bartender. James is angry, picks a bar stool and swings at the bartender’s head. He misses. The bartender pulls out a gun and shoots him dead.
I heard this story from several people so I am surprised that the sheriff can’t find anyone that knows about the shooting. The bar was full but no one saw what happened. No one gets arrested. Then I understand, this is Letcher County.
BUYING VOTES – LETCHER COUNTY, 1964
It is the day before the election, and I am working in the hospital when Bobby Caudill and Billy Adams come into my office. “We saw Johanna in town, and asked her where you were,” says Billy. Johanna and I moved to Whitesburg two months ago. We met Bobby and Billy on Labor Day at the Democratic picnic held at the drive-in. Everybody is there. Billy is the county tax assessor. He is about forty years old, five foot seven and doesn’t have much hair on his head. Jimmy is the county attorney. He has broad shoulders, a large but healthy looking body. Bobby Adams, the county clerk, Judge Isom, who is also president of the Letcher Bank, school board members, teachers, store owners, just everybody. We even meet Congressman Carl Perkins, Chairman of the House, Education, and Labor Committee. I get into a conversation with him and he puts his arm around my shoulder, talking real sweet. When I mention I’m not yet registered to vote his arm slips off my shoulder, and he walks away.
Not that many people move into Whitesburg, Kentucky, population about 1000. Most everybody knows that I’m the new pediatrician in town, and now they know I’m a Democrat. It was a nice picnic, I think, as I see Bobby and Billy come into my office. They walk in together. Bobby pulls his suit coat open and says, “Would you like to come buy votes tonight?” I see a big wad of bills sticking out of his inside coat pocket. “We’re going over to Judge Isom’s to divide the money, and then we’ll go out for a ride.”
“Sure,” I say, “I have heard about buying votes, but I’d never seen it done.”
“We’ll pick you up at your house, about seven o’clock.”
They pick me up. Billy is driving, and we head over to the Judge’s house, over in the Bottom. His front door is open, and he smiles as he greets us. We take seats in the living room. The room is good-sized, has a grand piano toward one side, and about eight chairs. There are three other people in the room, and we start to talk. Seems there’s a problem to be settled. The campaign to elect Lyndon Johnson sent $3000 dollars to distribute. Another $3000 has been raised for the school board race. The question is, should we distribute the school board money separately, or hand it out with the Johnson money? Combining it would be easier. But we would have to trust the school board people to distribute Johnson money and to say the right thing, and they would have to trust us. We decide we are dealing with honest men.
The county has a lot of little towns. There is Neon, Fleming, Blackey, Whitesburg, Jenkins, and McRoberts. The Judge has taken the stack of $6000 and made it into little piles. Most of the county is white, but we get picked to deliver money to black McRoberts, a part of town populated by UMW coal miners. Our first stop is Robert Green’s house. I have seen him at the hospital with his wife, Judy. He is short, slim, has ebony-colored skin and a serious-looking face. She is bigger and has lighter skin and a serious-looking face. She is bigger and has lighter skin than Robert, works in the maintenance department of the hospital and helps keep it clean. He is a miner and a union steward. We drive up to the house and walk up the steps to his porch. Jimmy gives him a large roll of bills and says it is for gas, to drive people to the polls. Robert takes it quietly and puts it under the cushion of his porch glider. Billy says nothing. We talk about the weather for a minute or two then we shake hands and drive off.
Next we drive over to a store run by Joe Isom. He is a big man, with a big chest and big arms. He is expecting us. Jimmy gives him a wad of money; Joe puts it under the counter and talks awhile. Billy tells him the money is for gas to get people to the polls. How is he going to know about the school board?
The next day Lyndon Johnson wins.
* * * * * * *
I used Jimmy’s term as the title of this story. No one bought a single vote. They just divided up a small amount of money (forty cents a person) to help people buy gas to get to the polls.
THE MULE THAT HAD RABIES
It is 1964. I am sitting in my office in Whitesburg, Kentucky when the phone rings. “It’s Judge Isom,” says my nurse and puts him through.
“Doc,” he says, “I want you to help me. There’s a bunch of people in my office who have had contact with a mule that has rabies.”
The judge knows that I’m a Democrat. We met at the Democratic picnic on Labor Day. Congressman Carl Perkins was there and so was Bobby Caudill, the county attorney.
Anyway, the judge knows I am a Democrat and knows he can count on me for a favor.
“What’s the story?” I ask.
“Well, the Adams family from over on Pine Mountain has a mule that gets sick and dies. They take the head to the lab in Frankfort. Two days later they hear that the mule has rabies. The whole family needs shots.”
I tell the judge if he pays for the vaccine, I will give the injections for free. He agrees and sends the family down to my office. I will need to figure out exactly who needs the shots since they can cause nerve damage. Half an hour later fourteen people, adults and children, come into my waiting room. They are tall and slim. All the men and boys are wearing bib overalls. Most of the women wear faded print dresses.
I ask Mr. Adams to tell me the story. “Well,” he says, “last week our mule gets to looking sick. He won’t pull. He just stands around in the yard with his tongue hanging out. That mule is apunying. I can see all the way to the back his throat. It doesn’t look right to me. I know I will have to do something if I’m going to save that animal. I get the missus to come out with some rags and a pan of water mixed with Clorox. I wrap the rags around my hand. Then I stick my hand into that mule’s throat as far as I can. I work my hand in his throat, in the back and on each side, two or three times. That mule is so sick he doesn’t even move.
“We decide to keep working on his throat several times that day. The boys each take a shift and so does my brother Al. Well, the next day the mule isn’t getting any better but he isn’t any worse, either. We get some other relatives to help us. That afternoon, little Billy comes running into the house. Says that he’s seen a dead fox. Well, everybody knows that you don’t just see a dead fox on the ground unless it has the rabies. If a hunter kills a fox, he carries it home for the fur and meat. I figure that thefox bit our mule, and then went off and died. Well, later that day, the mule keels over dead. We don’t know what to do exactly, so I call up Doc Maggard, the vet. He says he’ll come out and cut the mule’s head off and ice it so we can drive it up to Frankfort for the rabies test.
“Doc comes over the next morning. He cuts that mule’s head off and puts it in ice. Me and my brother drive off to Frankfort, about 150 miles away. The car just ain’t running right. It gives up completely just after we pull onto the Mountain Parkway. The state police drive by and see that we have car trouble. They say they’ll drive the mule’s head the rest of the way to the state lab. A couple of days later, Judge Caudill gets a call that the mule’s brain shows definite signs of rabies.”
Now fourteen members of the Adams family are in my office for rabies shots. They will need four shots over the next 14 days. This vaccine is better than the old kind. It causes permanent damage to the nerves less often. But I don’t want to give it to anyone who doesn’t need it. The mule didn’t bite anyone, so who is supposed to get the vaccine? I look up rabies in my medical textbook. There is a lot of information about rabies, but none about mules with rabies, and no advice on what to do for a person who swabbed the throat of a mule that has rabies. So I am on my own. I figure that the mule’s saliva would have to touch a cut or broken skin in order to infect someone.
There are nine people who swabbed the mule’s throat. And there are five swab cleaners, who washed out the towels. I excuse the four swabbers and the five swab cleaners who had no cuts or scratches on their hands. I ask the five swabbers with scratched hands to come back to my office for the vaccine four times during the next 14 days.
It takes up to six months after exposure for signs of rabies to show up. Every member of the Adams family stays healthy.
People in Whitesburg have their own way of treating some medical problems. A yeast infection that causes white spots in an infant’s mouth is called thrash in Kentucky but thrush in the North. When parents see these spots they take the baby to the seventh son of a seventh son and ask him to blow into the baby’s mouth to cure it. The seventh son of a seventh son is thought to have special healing powers.
Maybe this is because the number seven appears frequently in the Bible:
God created the earth in six days and rested on the seventh.
Jacob married Leah after working for her father for seven years. He had to work an additional seven years before he could marry her sister, Rachel.
You plant your fields for six years and then let them lay fallow the seventh.
You forgive all debts after seven cycles of seven years.
The seventh son of a seventh son can be hard to find. It is good that there are other people who can cure the “thrash”. Any person who was born with a caul has that same power.
I am working in the Head Start program in Letcher County, Kentucky. With the help of a nurse and two high school students, we assess vision, hearing, teeth, and general physical status of the Head Start children. We also check for anemia and TB.
My first encounter with worms in Whitesburg is when I am checking a kid from Head Start. He is lying on his belly and I see one inch of a worm sticking out of his butt. It is an ascaris lumbricoides, the most common worm in the area. I pull it out and give his mom some worm medicine (piperazine liquid) for him to take at home.
A couple of months later a mother tells me her son has passed several worms. She is looking a little embarrassed. I don’t want her to feel bad so I tell her I am having a worm contest this week. I give her some worm medicine and tell her she should come back the next day with the worms in a paper bag so I can count them. Well she comes in with that brown paper bag. I count 48 worms, some of them still moving. I had made up the story about the worm contest to save her embarrassment. Now what do I do? I send my receptionist out to buy a pot of flowers. The mother is happy and so am I.
Later that year eight-year old Johnny comes in complaining of a bad stomachache. He has not had a bowel movement in two days and is feeling bad. I examine him from head to toe. Everything checks out fine. But there is obviously something wrong with his bowels. Is it appendicitis? He has neither fever nor tenderness. I decide to order an upper GI series (x-ray of the small intestine). It may show the cause of the blockage. The radiologist gives him a drink of barium. Well, sure enough, Johnny’s small intestine is blocked by a mass the size of a billiard ball. When I look closely I can see white lines running down the center of each worm. The worms have swallowed some barium, too. Johnny takes a dose of piperazine. The next day he passes more than a dozen worms and his stomachache is gone.
People in Letcher County are used to worms. The doctors find they are so common that some give children worm medicine each year to get rid of them. The most common worm is ascaris lumbricoides. The adult female worm is about as long and as thick as a pencil. The adult male is half that size.
People in Letcher County have ideas about worms that are new to me. They say worms cause you to grind your teeth at night, cause you to have a poor appetite, and cause you to have a stomachache. I think about it and decide that if everybody has worms, then they could cause every symptom. Worms could cause a cold, could cause wax in your ears and could cause ingrown toenails.
Why do people have worms in Letcher County, Kentucky and not in New York City? Because these intestinal parasites are spread from person to person through the feces. If you have running water and a toilet, you can wash your hands and flush your feces. A lot of Letcher County folks don’t have running water.
When I arrived in Whitesburg I decided to meet every doctor in the county. There are a dozen in all, and I am the only pediatrician. If someone calls me for a consultation some day, I want to know whom I am talking to.
On this particular Saturday, I go out to meet Ross Acker. He is a general practitioner in the small mining town of Neon. It is about ten miles from Whitesburg where I live. I hear about Doc Acker. A lot of people go to him for care. He sees about 75 people a day including on Saturdays and Sundays. He graduated from a medical school in Boston that doesn’t exist anymore. His wife doesn’t see him much but he did buy her a Pontiac station wagon with a Coke machine in the back — just like the one Kim Novak drove in some movie. I hear he has a daughter about five years old.
Anyway, Ross knows I am coming. He is finished seeing patients today and takes me for a walk around the office. Looks pretty much like a standard office with a waiting room and several exam rooms. In Letcher County some of the docs run their own pharmacies and Ross is one of them.
He takes me into the pharmacy, a small room with a lot of shelves loaded with bottles full of medicine. He points to several number ten cans on the counter. One is full of pink pills. The next one is full of light green pills and a third is full of white pills. “These are all aspirin.” he says. “My patients know which one works the best for them. They might say, ‘Doc, these pink pills work really good for my arthritis. Would you give me some more of them?’ I want them to have the right medicine and they usually know what it should be.”
“By the way,” he says, “thanks for starting that meningitis scare last week. Everybody’s been upset and coming in here for sulfa medicine.” I had diagnosed a child with meningitis and recommended that all contacts take sulfa medicine.
Doc Acker is a hardworking person with a good heart and I suggest that he join the hospital staff. “Not me,” he says. “I’m happy in my office. I’ll send the difficult patients to you.”
Next we go to the house. It is modern and has a toy room designed for his daughter, Tammy. It measures about 20 by 20 feet with shelves of board games, dolls, toys to pull and toys to push — anything you can think of. Doc wants her to have the best.
He leaves the room for a minute. When he comes back he hands me a one-pint Mason jar filled with clear liquid. “Yes,” he says, “it’s moonshine. The sheriff gave it to me.”
We moved from Whitesburg, Kentucky to New York City in 1967 because Johanna is feeling isolated in our town of about 1,000 souls. True, she enjoys caring for one-year-old Rebecca. But I work twelve hours most days and the community does not inspire her. With the exception of Tom and Pat Gish, who publish the Mountain Eagle, and the Caudills (Harry is a lawyer and author. Anne is his partner in every venture), almost everyone we see socially is an outsider who arrived about the same time we did. Coy Franklin, a Presbyterian preacher, and his wife Becky are young, serious types. John Engle and his wife, Ruth, have come to do two years alternative service through the Mennonite Central Committee.
We spend most of our social time with John Engle, who has just finished his internship in family practice, and his wife, Ruth Ann, who now teaches grade school in Eolia. They play the recorder and we get together to play quartet every two weeks. There is one movie in town, the Alene Theater, but we never went. We did make it to the drive-in once in two-and-a-half years to see Hud. The hospital has the best restaurant in town, the bowling alley is second, and the motel is third. Chicken, creamy potatoes, beans, and pies.
Johanna drives over Pine Mountain three times a week to teach French at Cumberland Community College. She is friends with Gurney Norman, who teaches English and wrote Divine Right’s Trip in The Last Whole Earth Catalog. He’s full of stories about his LSD bus trip across the country with Ken Kesey and the Merry Pranksters. And that is it.
Johanna passed her comps (comprehensive exams) in French literature at Columbia University before we came here. She is working diligently on her thesis and making no progress-no library and no one to talk to. Rebecca, our sweet little daughter was born in August 1965. I am still working ten to twelve hours a day and am no help with darling Rebecca. Johanna wants to move back to New York and finish her thesis.
I want to stay in Kentucky a third year. I’m learning a lot of pediatrics and starting to write about my experiences for national journals. My article, “General Pediatrics Is Not Dead,” presents a view opposite that of most academicians. I am also working on “Lumbar Puncture Its Risk and Value.” People have been doing spinal taps for decades, but there are no data on their risk and value in children. I enjoy precepting medical students at the University of Kentucky and talking with the faculty. They respect the work I’m doing and are glad to help me with any clinical or research question that I have;
Finally, the patients are great. Many of them had never seen a pediatrician before I showed up. We have been through a lot—meningitis, brain tumors, convulsions, heart trouble, asthma, kidney infections, and bad diarrhea. The nurses are great, too, and so are the lab and x-ray technicians. I want to stay.
Johanna came to Kentucky in 1964 to support me and my work.. There is no one for her to talk with except for Gurney. Nothing to do. The thesis is hanging over her head. Now she wants to leave. We move back to New York to support her and her work.