Bryson City Christmas: What a dying man in the ICU taught me about Christmastime and new beginnings

The morning before the Christmas of 1982, just a year after beginning the practice of family medicine in the small hamlet of Bryson City, North Carolina, I was in the office when the ER nurse called. “I’ve got a patient here with a pretty bad pneumonia. He’s an older man and he’s skin and bones. I think he needs to be in the ICU.”

I agreed and gave Louise the admission orders. “Does he have family?”

“Not that I know of. Just a friend who brought him in.” She and I both knew that this probably represented some sort of end-stage cancer.

When I arrived at the hospital and entered the patient’s room, he looked worse than I could have imagined.
Another man was sitting by Evan’s bedside. As I entered he stood.

“Hi, I’m Dr. Larimore. I’m the doctor on call today.”

“I couldn’t be more delighted!” the man almost exclaimed. “My name’s Richard. Evan and I have heard of you. Many of our customers at our flower shop speak of you.”

“Richard, Evan, it’s good to meet you.” I then turned my attention to Evan, taking a complete history and then doing a complete physical. When I was done, I pulled up a chair.

“Evan, I think you know you’ve got pneumonia.” He nodded.

“But, it’s not a typical pneumonia. It’s atypical. Given your weight loss and fatigue, I’ve got to be honest with you.” I paused for a moment.

Evan reached out and took Richard’s hand and at that moment I realized they were more than just friends. Evan looked fleetingly at his partner and then back to me. “Is it cancer?”

I nodded. “To tell you the truth, that’s my guess. We would need to do tests to be sure. But, that’s what I suspect.”

“Is it treatable?”

“It depends on the type. But, my guess is that it’s probably already widespread. So, we’ll just have to see.”

“When can we start?”

“Well, let’s get the infection under control, and then we’ll talk about getting started.” I was quiet and let them absorb the information. When it was clear they didn’t have any more questions, I left the room.

The next morning, I made early morning rounds— well before our family would wake up to celebrate Christmas. I found Evan alone but awake. I greeted him and sat on the bed. His breathing was labored and shallow.

“Evan, how are you feeling?”

“Not so good, Doc. Didn’t sleep well.” He took a deep breath and continued, “Doc, I’ve been told you’re a man of faith. Because of that, I was worried about coming over here to see you.”

“Why’s that?”

Evan didn’t answer for a moment. Then he looked deeply into my eyes. “Doc, lots of Bible thumpers call people like me and Richard evil things. I was worried you might think the same.”

Now it was my turn to be quiet a moment. I was trying to think about how I might respond to this man’s honesty and transparency.

“Evan,” I began, “my faith teaches me that the most important thing in life is a personal relationship with God. Everything else pales in comparison to that. And, I found that when I began that relationship with God, He was fully able and willing to guide me into doing and thinking the right things. So, the real issue isn’t what I think or what you think, but what He thinks.”

Evan smiled and I saw tears form in his eyes. “When I was a kid, church was important to me. I really enjoyed going—but, never more than on Christmas Eve. But, when I grew up I just grew away from it. Do you think your God would even want another relationship with me?”

For a moment I thought about the Bible verse that says, ‘Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect.’ (1 Peter 3:15)

“Evan, I know God would want to have a relationship with you. The Bible says that God loves us. In fact, He loves us so much that He sent his Son, Jesus, not just to be born in a manger on Christmas, but also to live a perfect life for us, as an example, and then to die a torturous death for us, for all of our wrongdoing. Evan, if you’re willing to believe that, He’s willing to begin that relationship with you—today—but only if you want to.”

Evan looked away, out the window of the ICU. The daylight was just starting to reflect off the new layer of snow. “It would be a good day to start,” he whispered.

I was quiet. The tears began to flow down his face and he sniffled. I reached out and took his hand. He gave my hand a squeeze and then looked back at me.

“Doc, I’ve done a lot of wrong things. Guess you thumpers would call me a pretty bad sinner, huh?” He smiled as he wiped his tears with his free hand.

“Evan, that puts you and me in the same exact crowd.”

He cocked his head and looked at me. “Dr. Larimore, are you … ? Are you like me?”

“I am.”

“You are?” he asked.

“Yes, but let me explain. The Bible explains that the sexually immoral and idolaters and adulterers and homosexual will not inherit the kingdom of God. But, Evan, it also says in the same verse that the greedy and slanderer and swindler will not either.”

Evan was quiet in his thoughts, so I continued. “You are homosexual. And, more than I’d like to admit, there are times when I’m greedy and a slanderer. Sometimes I’m far more selfish than I should have been and I’m certainly guilty of gossiping more than I should. So, according to the Bible, you and I are in the exact same crowd.”

Evan smiled and squeezed my hand.

“Evan, the Bible has a lot of names for Jesus. My favorite is that he was known as a friend of sinners. All he requires from us, if we want to have a personal relationship with him—if we want to be his friend—is for us to simply admit that we’ve missed the mark—that we’ve sinned and done wrong.”

“I guess I would qualify.”

I smiled. “Me too, Evan.” I paused to let him think a moment.

“I think I’d like to be his friend. That would be nice— especially on Christmas day,” Evan whispered, between labored breaths. “How do I start?”

“Actually, Evan, it’s pretty easy. You just talk to God— what us thumpers call prayer. Let him know you’re ready—invite him into a relationship with you, into your heart, and he’ll come in. First you have to realize that you’ve done wrong. Then, you have to be willing to trust him with your life and your choices.”

Evan nodded and closed his eyes. “Lord,” he whispered, “I begin.”

I smiled. It was the shortest and sweetest prayer I had ever heard. “Evan, the Bible says that when we admit to God our wrongdoing—just agree with him that we’ve missed the mark—that he will instantly and eternally forgive our sins. And, based upon that forgiveness, he’s willing to become your friend and your Lord and to reserve a room for you in Heaven.”

The tears were still flowing down his cheeks. He nodded.

“As of this minute, there’s a room with your name on it. The Bible says, ‘To as many as received him, he gave them the right to be sons of God’.”

Evan smiled, “I guess that makes us brothers, doesn’t it?”

I smiled. “It does.”

He smiled, nodded and squeezed my hand.

I left to go to the X-ray reading room and on my way back to the ICU I saw one of the nurses running toward the unit. I walked quickly into the ICU and arrived just in time to see Evan surrounded by nurses.

“What happened?”

“He just had a respiratory arrest. OK to get him on a ventilator?” I nodded my assent and we went to work.

But from there, things went downhill fairly quickly. Evan’s pneumonia quickly evolved into ARDS—a severe form of respiratory disease that is very difficult to treat—and then he went into kidney and liver failure. He died late that same afternoon.

The autopsy report confirmed the pneumonia—but blamed it on a bacterium I had never treated before— Pneumocystis carinii. The report also confirmed multi-organ failure and a form of skin cancer—Kaposi’s sarcoma—but said the cancer was confined only to his skin.

Evan had not died of cancer. I now know he had died of a disease that was then unnamed—HIV/AIDS.

Evan was my first patient with this horrible disease. But, he was also the first patient with whom I shared my personal faith so forthrightly. Looking back over a long career in family medicine, Evan’s case and his decision represented one of my most memorable moments.

But, what his autopsy did not show—and could not show—was that Evan died a new man—spiritually. He had become a friend of God. He had been born as a son of God on the day we celebrated the birth of the Son of God. And, his life actually began the morning of the day it ended.

During that Christmas, at the beginning of my family and professional life, I learned a valuable lesson: all
Christmases can be a time of beginning and a time of renewal. A time when we each commit or recommit our belief, our devotion, our service, our gifts and our very lives to the baby born in that manger, who was sent to be a perfect model of love. He humbly sacrificed his life on our behalf that we could have eternal life starting here on earth by becoming sons and daughters of our Father in Heaven.

Amen and Merry Christmas.

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