DR. MICHAEL DEBEVEC, M.D., CONTRIBUTED THE NEXT TWO STORIES

Dr. Michael DeBevec, M.D., is a family physician with a special interest and training in sports medicine. Although he lives in Grand Marais, Minnesota, he works in the emergency room of the hospital in the Minnesota community of Sandstone. Dr. Mike’s first story relates a “house call.” It well illuminates his personality and perhaps, more broadly, the ethos that makes a country doc storied. Let me introduce you to Dr. Mike DeBevec in his own words:

A Date at the Cemetery

“There’s the cemetery, Linnea,” I said, “and now I’m turning around.”

Linnea hesitated a moment, and although she was nearly blind now, she gazed in the right direction, apparently searching for a familiar landmark. “You’ll see a little two-rut road leading past an old apple tree. Maybe a quarter of a mile up,” she said with a lilting Norwegian accent, the final few syllables up and down and up.

I trusted her memory, and spotted the roadbed, now grown over with alder and red osier dogwood.

“I’ll have to reconnoiter, Linnea. Just stay here,” I said. I headed straight into the brush where Linnea had directed me, but couldn’t see an apple tree near the road. Within one hundred feet, I spotted an outbuilding. Painted dark red, it stood in stark contrast to June’s vivid green pervading the forest. Peering to my left, I broke into a big smile and laughed aloud when I spied a rotten, medium-sized, leafless tree thirty feet from the barn. “The apple tree,” I sighed, as if it were I who had once lived there. Just up a little hill, overlooking the tree and the barn, was an obvious foundation, probably of the house that Linnea’s father had built. As I entered the side door of the little barn, I could almost hear the voices of small children, ghosts from Linnea’s childhood. There was a certain peace in that old barn, like that of a country graveyard.

When I returned to the car, Linnea still waited patiently in the front seat, looking out the window as if she could still see her dad and hear her mother calling.

“It’s all there, Linnea. The barn, the apple tree, foundations of the house—just like you described.”

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Ten years had passed since I first saw Linnea Sundholm as a patient. Back then, her husband Hjalmer had decided he didn’t like the health care at the New Linden Clinic. Since we operated a satellite office within a few miles of their rural home, Hjalmer agreed to let his wife “do her doctoring” there. Linnea was eighty-three, losing her sight, but mentally sharp. Hjalmer was a semi-retired commercial fisherman—at the age of eighty-five!—still picking gill nets on Lake Superior from time to time.

For the first few years I took care of her, I would just see her for periodic checkups and to refill her blood pressure medication. We chatted about her colorful past as a wife, mother, and in years long gone, as a public health nurse and midwife. She was open and direct. I loved her stories, due to my interest in the history of the area. We both looked forward to our visits.

Eventually, it became too difficult for Hjalmer and her to get to the clinic, so I offered to make home visits. It was a privilege to see her in her own setting. A cup of coffee and a homemade treat were routine. She gave me lefse for Christmas, along with secrets on how to make it.

I continued the home visits for a few years. She had to be hospitalized once or twice. Her heart. Sight and legs were failing, but her spirit and mind remained vibrant.

Inevitably, the time came when Hjalmer could no longer provide for her basic needs. He pleaded with me not to put her in the New Linden Nursing Home. There was really no alternative, but dealing with his grief and impending loneliness was wrenching.

On the day when Hjalmer capitulated to reality, he made the forty-mile drive from his home to the nursing facility. He first had to meet with the social worker and business-office people. While sitting in the waiting room, he slumped over, dead. Although ninety years old, he had had no active, significant medical problems. Can a man truly die of a broken heart? We decided that the answer was yes.

After a time spent in our local facility, Linnea’s remaining family took her to a nursing home ninety miles away. I could no longer provide her medical care, but I was able to visit her within a few weeks of placement. She looked more pale, tired, and had lost some of her mental acuity. Still, she knew me and we talked about her family. She asked if I could be her doctor in her present nursing home, even though she knew the answer. I politely explained, knowing we were obeying the rules of understatement required for Norwegian expression of grief.

The next time I stopped to see her, she responded to her name but did not know me and was unable to converse. She died a few weeks later.

I still think of her often, even though it has been fifteen years since her death. I glance toward the cemetery on the little hill just outside New Linden each time I drive by, and realize that I have not been to her gravesite. Why? Maybe goodbyes are best said in the spirit.

It had been a month or so after Linnea had entered the New Linden Nursing Home that I had showed up on my day off to take her the twenty-five miles to her original family homestead. It had been a day to tell stories, to see and hear each other. My eyes, her mind. It had been my final gift to her.

Or, was it her final gift to me?

Black Rock Baby

“Contraction!” she said.

“Deep breath,” I said. “Hold it. Push! Push, push, push.”

There had not been much movement of the baby’s head down the birth canal during the past hour. It was still quite high in its mother’s pelvis. I felt a “caput” forming, a swelling of the baby’s scalp over the presenting part of its head as it tried unsuccessfully to squeeze through the birth passage.

Barb and Tim Griffin had two children already and were veterans of the labor experience. Both had the benefit of easy-going, friendly personalities and, luckily for me, neither was prone to anxiety. We had talked easily and freely throughout early labor, which for Barb was typically short, no more than three hours. At present she was already dilated six centimeters (doctor talk meaning that the mouth of her womb had opened by a bit more than half). I knew that things could go rapidly. Or, maybe not.

Father-to-be Tim was in the labor room. “Take a deep breath in. Blow it all out and relax,” I said to Barb at the conclusion of the contraction.

The clock told its story. Barb had been in labor for three hours since she had entered the hospital door. The mouth of her womb was now fully opened up. I had been able to detect that the position of the baby’s head was posterior, not anterior, nature’s favored position, meaning face up, not face down. Meaning that the head has difficulty completing its journey through the birth passage if things continued in the same way. Barb was a tall, big-boned woman—one that an unsuspicious practitioner would assume would allow an easy birth. I now knew different.

I glanced at Tim Griffin. I knew that he read my eyes accurately. Barb, working so hard, concentrating so hard, remained oblivious.

It was time to explain. “Barb, the head is posterior, not low enough to use forceps to turn the baby. Folks, we’ll have to head for Duluth.” One-hundred-twenty miles away.

I told the nurses to call the ambulance crew and gave orders for equipment needed to go along.

I had delivered a few hundred babies by this time in my career, half of them in small rural hospitals, half in a large hospital during residency training. I had been in New Linden for eight years and knew the joys and perils of a remote, full-service family practice. A potential hazard is resuscitating a baby after a difficult labor.

The transfer time from our hospital to one in Duluth was 1.5–2 hours. I had made that trip half a dozen times with women in labor; in each case a healthy baby had been born in Duluth. Still, that is a long trip for a woman in pain and a baby that needed to squeeze out of a tight place and get some air.

Barb continued to have good-quality contractions. She lay patiently on the ambulance cart, strapped down for safety, awaiting loading.

A nurse handed me the baby resuscitation equipment I had requested. “Let’s get going,” I said to the emergency medical technicians (EMTs). I could see that Barb was concerned, knowing that she had to endure at least two more hours of periodic pain.

We slammed the rear door of the ambulance shut, turned on flashing red lights, and left the back door of the hospital. Riding in the ambulance over the next half hour, I reviewed the possibilities. Posterior presentations—when the baby comes through the birth canal face up—can result in two outcomes. No, three, I thought. The baby could stop where it is, requiring surgical intervention; complete birth in its face-up position, no matter the difficulty; or rotate one-hundred-eighty degrees and deliver the usual way, face down. In the last case, labor often then proceeds rapidly and the baby gets its wish. Fine, but the baby might be in distress by that time. Thoughts to comfort a doctor riding in a wailing ambulance, racing through darkness.

We reached Black Rock Bay, forty miles from New Linden on the highway to Duluth. Besides a beautiful view of Big Lake sunsets, there is not much there, save a railroad overpass. It was pitch dark by the time we reached this place, red lights puncturing the darkness, the speedometer needle steady at seventy miles an hour. There is a wide gravel shoulder.

Barb had become more agitated and her contractions had speeded up, become more intense. I rechecked the position of the baby’s head.

“Pull over, boys,” I called to the EMTs, “we’re going to have a baby.” I kept my voice matter-of-fact, belying my gut, which was anticipating all the “worsts” detailed in an obstetrical textbook. I said to Barb, “The baby is rotating, which means its head will be crowning shortly.”

She knew what crowning meant, that first glimpse of baby hair at the vaginal opening. The infant’s heart tones were audible and strong. Barb still had the strength to cooperate with my coaching through her contractions. Once the head finished rotating, the baby came right down and was born. I remember a welcome and amazing calm as I caught the baby. Although light was not the best there in the back of the ambulance, the baby breathed, pinked up and showed vigorous activity right away. I gently suctioned its mouth and nostrils. I placed the baby on Barb’s abdomen and announced, “It’s a boy.” I confess to breathing a sigh of relief myself.

“Well, boys,” I said to the EMT crew, “let’s turn around and go home.”

So far as anyone could remember, Baby Boy Griffin was the only child ever born at Black Rock Bay, and he was the only one I ever delivered in an ambulance. I’m not sure what his parents acknowledged for his birth certificate as “Place of Birth.”

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