Bryson City Secrets: Even More Tales of a Small-Town Doctor in the Smoky Mountains by MD Walt Larimore

quickly.
    By the time I arrived, most of the commotion was settling down. When Tommy’s dad arrived, he had been sent to the admissions office to fill out paperwork. In the meantime, the hospital had sent word to Isabella, Tommy’s mom, and she was on her way to the hospital. I found Tommy alone, and he looked scared.
    I sat on the edge of the bed and took his hand in mine. I squeezed, and he squeezed back. I smiled down at him. “It’s scary in here, isn’t it, buddy?”
    He nodded.
    â€œLet me tell you a quick story,” I began. “About seven years ago, I had to have some surgery on my lung. You have pus around your lung, but I had air. It really hurt. I bet your chest hurts, doesn’t it?”
    â€œOnly when I breathe,” Tommy responded. When we realized what he said, we both smiled. His smile was wiped away by a painful, chest-punishing spell of coughing. When it had subsided, I continued.
    â€œWell, the doctor had to put a chest tube in me. And, Tommy, I’ve got to tell you something. Looking at that tube and the big ole container it was connected to ’bout scared me to death.” As I said this, I pointed to the equipment that Vernel and Maxine had set up next to his bed.
    â€œBut you wanna know something?”
    â€œWhat?”
    â€œOther than the small shot they gave me to numb the skin, I didn’t feel any pain at all. And I’ve got a trick that will keep you from feeling even that.”
    Tommy smiled, and then I explained, step-by-step, what I’d be doing. I could see his curiosity grow and his concern subside a bit. “Can I watch, Doc?” he asked.
    It was my turn to smile. “Well, it will be hard to see most of it, because I’ll be working on your side just under your arm, but you watch all you want to.”
    â€œCool!” was his considered response.

    I softly pinched Tommy’s skin just before sticking the needle on the syringe of lidocaine through the skin. As was usually the case when I used this technique — one Louise had taught me in the ER — the patient didn’t feel a thing.
    â€œMan!” Tommy commented. “I was watchin’ you, and I still didn’t feel nuthin’!”
    I smiled and then slowly advanced the needle, infiltrating the tissues with lidocaine as the needle advanced until I felt the softest of resistance give way — telling me I was through the chest wall and into the chest cavity. I injected another few cc’s of lidocaine and then aspirated a sick-looking, thick, yellow-green pus. I knew it was coming from the space around the lung, and it confirmed my diagnosis.
    â€œMan!” Tommy exclaimed. “That’s gross.”
    Vernel and Maxine joined me in laughter as I removed the needle and handed the syringe to Betty, who immediately injected the pus into a culture bottle. In forty-eight hours or less, we hoped to know both the name of the bacteria causing the problem and the best antibiotics to treat it.
    â€œYep,” I concurred with my young patient, “that is gross. But, my young friend, as they say, you ain’t seen nuthin’ yet.”
    His eyes became as big as saucers.
    After prepping his side with the dark-brown Betadine antiseptic and draping the area with sterile drapes, I palpated the ribs, knowing that my incision and the course the tube would subsequently follow needed to go just above a rib — as an important nerve, artery, and vein ran just below each rib.
    A quick, small incision gave me room to insert a trocar, which is a sharpened and tapered rod of stainless steel, through the skin and into the chest cavity. As I advanced the trocar, I looked up at Tommy, who was watching my every move. “Tommy, you’ll feel pressure and poking, but you should feel no pain. OK?”
    He nodded as I slowly twisted and pushed the trocar. As it advanced, it dilated a tract for the tube. I felt the pressure give way as the trocar