P. Hunter Bolton: Family doctor

The author found more than old instruments in a medical bag he inherited.

By Harold S. Jenkins, MD
Family Practitioner/Madison, VA

"Where on earth did you dig up that relic?" Ellen, my office nurse, sniffed at the worn leather satchel on my desk. "It smells like it's been stuck in some cellar for the last thousand years."

"It's Dr. Bolton's medical bag," I said. "She left it to me in her will, and her lawyer just dropped it off."

I opened the bag, which was three times larger than my own. The inscription on the bronze clasp was faint but still legible: Birmingham Leather Works, Birmingham, England, 1912. I turned the key to expose an interior with a dozen labeled compartments.

Ellen touched the textured leather inside. Protected from decades of wear and weather, it was a rich chestnut brown. "I've never seen anything like it. Have you?"

"No, but I remember this bag." Indeed, I did.

I'm hiding behind the water heater in our kitchen. A shy 6-year-old, I'm as far away as I can get from my mother and a guest, both of whom are drinking coffee.

Mom's crying again. She cries most of the time. It's been worse since my kid sister Angie came back from the hospital last week. She's too sick to go anywhere, so Mom calls the doctor every day.

"She just won't eat anything, Doctor." Mom buries her head in her hands. "She won't even sip Kool-Aid."

In khaki slacks and blouse, the other woman looks like a middle-aged colonel. She flips her lighter open and puffs on another cigarette. Mom's real picky about not letting anybody smoke indoors, but for once she doesn't fuss. The doctor breaks the silence.

"Agnes, this time I came to check on you, not your little girl. You know what the specialists say. They can't do anything more for her leukemia. She's dying, Agnes. You know that."

Mom sobs. Then the other woman reaches into her satchel, grabs a bottle, and pours some yellow pills into an envelope. She pats Mom on the shoulder, tells her to take a pill every six hours, and says she'll be back tomorrow.

On her way out the door, she pulls a grape sucker from her pocket and tosses it to me. She climbs into her olive-green Jeep and bumps down the long farm lane.

"Look at the crazy names on these medicine bottles." Ellen laughed as she scanned the labels: Barbidonna, Achromycin, Declomycin. "I wonder what this stuff is for."

"I'm sure Dr. Bolton knew. She dispensed her own medicines, you know. Most country doctors did that, 50 years ago."

"Well, at least there are a few familiar names—Benadryl, phenobarbital, Compazine, nitroglycerin."

"And we still prescribe digitalis and sulfa—just in different preparations."

"But we don't use these anymore, thank goodness!" Ellen shuddered as she held up a 10cc glass syringe with a glass plunger. The stainless steel needle was three inches long. "I guess she went home and boiled these on the stove to kill the germs."

"She probably did," I said.

It's a long ride to the doctor's office. Ten years old now, I'm clutching my little sister— not the one who died from leukemia. Lynn is sweating and bawling, and I'm pressing gauze onto a jagged cut on her arm. A daredevil, Lynn crashes her tricycle all the time, but this evening she tangled with barbed wire. Mom frowns, tells me to hang onto that bandage, and races down the road.

Dr. Bolton is easy to find because she's always in the same house. She lives upstairs and works downstairs. By the dashboard clock, it's 9:30 p.m.

"So these are the first stitches for our little beauty, right?" The doctor is in khaki again. I wonder if she ever wears frilly dresses like Mom does. I decide that she doesn't. Mom says she's sorry to bother Dr. Bolton after hours. The doctor says that she hasn't gone to bed yet and that it's no trouble. Then she opens a metal cabinet and picks up a glass syringe with a monster needle. Lynn kicks and thrashes, like a bronco sniffing a branding iron.

"Agnes, you hold her legs, and your boy here can manage her head and arms. This really won't hurt much." Lynn howls and glares up at me. I know that it's all over between us and that she'll hate me forever. The doctor finally clips the last stitch, squirts some goo on Lynn's arm, and wraps it in a bandage. She says to come back next week.

"I brought you a few ripe peaches, Doctor. They're not very big this year—haven't had enough rain." The doctor says that dry-weather peaches always taste the sweetest, and I go out to the car for the grocery bag. Dr. Bolton thanks me, the two women thank each other, and we drive away. Lynn falls asleep before we're halfway home.

"Check this out." Ellen pulled out an 18-inch steel pipe that looked like a vacuum cleaner attachment. A small electric bulb clung to one side, and a red rubber hose ran out the other. "What on earth?"

I said that it was a prehistoric proctoscope and I wouldn't be needing that. No door-to-door endoscopy for this doc, even if my malpractice attorney comes along for the ride.

"So you're off to college, huh?" Dr. Bolton checks boxes on my physical form. "Rheumatic fever, no. Diabetes, no. Asthma, no. Agnes will miss you this fall when she's picking those apples."

"I'll be coming home on weekends."

"So what are you going to study?"

I gulp, stare at the floor, and mumble that I've signed up for premed.

"Arthritis, no. Mental illness, probably no. Syphilis, definitely no. This is a damned stupid form—I'll bet you've never heard of syphilis, much less know how to catch it."

I blush, and Dr. Bolton laughs her hoarse laugh. She says I'll learn all about it in medical school.

"Well, here's one of her medical records." I handed Ellen a yellowed index card, 8 by 5 inches. On the front were the patient's registration data, physical findings, diagnoses, and treatments over a 10-year period. On the back was the financial record—the fee, the date paid, and the balance—a commendable zero. An office visit was $6, a house call, $15, and a complete physical, $22.

"That's incredible!" Ellen arched her eyebrows. "Why, an office visit back then cost less than what I just paid for my chef's salad."

I said something medieval about the good old days—pre-Medicare, pre-Medicaid, pre-HMO.

"I wonder if she was as rushed as we are," Ellen said. "She certainly didn't waste any time on paperwork. Look, this entire office checkup is on one line."

In the twilight, I hurry up the flagstone steps, lift the antique knocker, and let it crash against the brass panel. The door swings open, and a uniformed nurse says that my patient just woke up. On the morphine drip, she sleeps a lot.

"Hello, Dr. Bolton." In the lamplight, I step toward the wiry woman who is dwarfed by a four-poster bed. Her white hair bristles in all directions, and her face is as wrinkled as a dried-apple doll. Under an embroidered quilt, her left foot quivers. Her right one is gone, amputated last month when gangrene complicated her heart failure.

"Who the hell are you?" The patient fumbles with her horn-rimmed glasses.

"I'm Dr. Jenkins, the guy who checks you out every evening."

She frowns and shakes her head.

"I'm Agnes' boy, remember?"

In her faded eyes, a smile flickers. "Oh, her boy. Why didn't you say so the first time?"

I apologize, and Dr. Bolton squeezes my fingers. I can feel every bone in her thin hand. I listen to her failing heart and lungs, check the greedy ulcer on the remaining foot, and ask about the morphine pump.

"It's working okay." Trembling fingers grope on the bedside table, find a pack of Lucky Strikes, and light up. "Got time for a cigarette?"

I say no thanks, I don't smoke. She cackles and says that Agnes was a damned good mother, God rest her soul.

We talk about old times while she knocks out two more cigarettes. Her brown satchel rests beside her pillow, and she strokes it over and over again, left to right, like a favorite cat. I check her pillbox and say I'll be back tomorrow. She yawns.

Out in the hall, I study a set of family pictures on the wall. A Victorian couple in a black suit and dress must be the doctor's parents. The four older people would be grandparents. There are no brothers or sisters. In one gold-leaf frame, crocheted roses twine around a name—Primrose Hunter Bolton. I grin. Little Primrose, huh? What a howler!

"Dr. Bolton certainly had a following back when she was in practice." Ellen replaced the chart note in its leather compartment. "Her patients just worshiped the ground she walked on."

"Why do you suppose patients loved her so much?" I ask.

"I don't know." Ellen shrugged. "Probably the usual stuff—she had a good bedside manner, she didn't use the bum's rush, she was on the spot when people needed her."

"Bullseye!" I said. "That was her, to a T."

"And her medical bag is wonderful. It needs a good scrubbing, but it's a real treasure. You'll donate it to a museum, won't you?"

"Oh, after a while, when I retire." I touched the satchel and thought about the countless times that its first owner had done the same. I locked the satchel and put the key in my desk drawer. "Until then, it stays right here on the shelf to remind me of stuff that's easy to forget. I have a hunch that's what Dr. P. Hunter Bolton would have wanted."

 

Harold Jenkins. P. Hunter Bolton: Family doctor. Medical Economics 2002;21:77.