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288 pages
Oct 2004

Bryson City Seasons: More Tales Of A Doctor's Practice In The Smoky Mountains

by Walt Larimore

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chapter one


It was one of those sweltering summer afternoons in the Smoky Mountains that are unknown to outsiders and a distinct surprise to first-time visitors—humid, sticky, and unyielding. The heavy air lay over us as though it didn’t want us to even move.

“You didn’t tell me, Walt,” my bride of nine years complained. We were heading toward our tenth wedding anniversary that fall, and I had already begun scheming, behind her back, with the help of our friend Sally Jenkins, to give Barb a bedroom makeover and a special trip out of town.

“About what?” I asked, trying to feign innocence but suspecting she had somehow found out about my shenanigans. One thing that was almost impossible in Bryson City, North Carolina, was having a secret remain a secret. Somehow news wafted through our town as easily as mountain breezes.

“About this heat!” Barb exclaimed. “If I had known it was going to be this hot in the mountains, I might have just stayed in Durham and let you come up here by yourself!”

Barb turned to smile at me—one of those “you know I’m kidding” smiles I loved. She turned back to face the mountains. “At least I would have asked the hospital to put an air conditioner in the house!”

We were sitting on the park bench we had placed in our backyard when we moved to Bryson City, North Carolina, over a year ago. It looked out over an exquisite view across Swain County Recreational Park, then up and into Deep Creek Valley, and finally over nearly endless ridges all the way to the most distant mountain ridges—deep in Great Smoky Mountains National Park—that separated North Carolina from Tennessee.

“Maybe I could call down to the Bryson City icehouse and have them send over a block or two for us to sit on.”

“You mean that old building down by Shuler’s Produce next  to the river? It doesn’t look like it’s been open for years. How about you go get us a glass of ice water?”

I nodded and ran into the house to get a glass for each of us—being quiet so as not to wake up our napping children—and then tiptoed to the back screen door and out to Barb.

The view was mesmerizing, and we had now seen it through each of the four seasons—my first year as a practicing family physician—since finishing my family medicine residency at Duke University Medical Center.

“I didn’t know it would be this hot,” I commented. “But then there were so many things we didn’t know about this place until after we settled here, eh?”

Barb threw back her head and laughed. My, how I loved her laughter!

“True enough!”

We both fell silent, reflecting on the beginning of our medical practice here. I had left residency so full of myself. Indeed, I had been very well trained—at least for the technical aspects of practicing medicine. But when it came to small-town politics and jealousies, the art of medicine, the heartbreak of making mistakes and misdiagnoses—all piled on the difficulty of raising a young daughter with cerebral palsy, dealing with one very strong-willed, colicky little boy, and transitioning a big-city girl into a rural doctor’s wife—well, the task was not only full of unexpected events, it was downright daunting.

Barb turned her ear toward our house for a moment. I could tell she was listening for the children. Kate and Scott were napping, so we had the windows open—both to capture any passing breeze that might happen along and to hear the children if they were to awaken.

My thoughts turned to our small hospital—a sixty-mile drive west from the nearest medical center, which was in Asheville. In the early 1980s, Swain County was still a slow, small, sheltered mountain hamlet. Most of the folks were natives, as were their parents and their parents’ parents. Most all of the physicians, and the nurses for that matter, were in at least their third to fourth decade of practice. They had their way of doing things and didn’t “hanker to outsiders”—whom they called “flatlanders” if they liked you, or “lowlanders” if they did not. They especially resisted any “newfangled” ways. “Be careful if you say anything negative about anyone, son,” Dr. Bill Mitchell, or Mitch as everyone called him, warned me. “It’ll get back to them—and me—lickety-split.”

Rick Pyeritz, M.D., my medical partner and also a classmate in our family medicine residency at Duke University Medical Center, was on call this day for our practice and for the emergency room. In Bryson City, the on-call doctor was on call for hospital inpatients, the emergency room, the jail inmates of the Swain County Sheriff’s Department and Bryson City Police Department, the National Park Service, the coroner’s office, the local tourist resorts and attractions, and the area rest home and nursing home.

The fact that one of us would cover all the venues in which medical emergencies might occur made it very nice for the other six physicians not on call that particular day.

“When the kids get up, how about we all take a stroll up Deep Creek?” Barb asked.

“Sounds like a great idea!” Deep Creek was the southern wilderness entrance to the Great Smoky Mountains National Park. The creek was wide, tumbling, and ice-cold—a great place to go tubing or to just hike in the solitude of the park.

We looked across the valley. I looked at Barb as a small breeze caught her hair and blew it across her forehead. She swung her head to flip it out of the way. “But until the kids get up,” I inquired, “maybe their parents need a nap?”

 "Just what do you mean by nap?” Barb wondered out loud, tossing a suspicious look my way.

It was my turn to smile and silently look up at the ancient creek and across the ageless mountains.

Suddenly we were startled by a loud sound. We turned to see a car screeching around the hospital and heading down Hospital Hill toward town at a rapid rate of speed.

“Wasn’t that Rick?” asked Barb.

“It was! Wonder where he’s going?”

In a small town it doesn’t take long to find out almost anything.


Even though on call that Saturday afternoon, Rick had found some time to lie down on his couch for a nap. Living in houses owned and provided by the hospital, we were just across the street from the hospital. We had been friends since our internship year at Duke. Our varied backgrounds, interests, and character traits—he a New Englander and I a Southerner; he a single man and I a married one; he a backpacker, naturalist, ornithologist, jogger and I a sedentary family man; he an introvert and I an extrovert—drew us together like opposite ends of the magnet. However, we shared a love of family medicine and a desire to serve the families that honored us by choosing us to be their family physicians—and we were both equally attracted to this rugged wilderness area.

During our days in training at Duke, Rick and I became best friends—while Barb became Rick’s surrogate sister, confidante, and friend. The three of us did many things together, and during the third year of residency, we decided to go into practice together. I arrived in Bryson City a few months before Rick, and during those months, I’d been learning the ropes of private practice, settling into this mountain community and gaining, ever so slowly, a sense of confidence in my own style of practice. And with Rick’s arrival I ...