Savannah's Hoodoo Doctor

By WJ Crump

A Savannah native approaching retirement from a medical career returns home to write his sabbatical book. An encounter with Mae, a mysterious Gullah woman, takes him into magical adventures covering almost 3 centuries based in the landmarks of his hometown. The sights, sounds, history, and smells of Savannah are irresistible, and qualify th

• Language: English
• Publisher: William Crump
• Release date: Jan 21, 2022
• ISBN: 9781087911380

Book preview

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Table Of Contents

Acknowledgment

Foreword

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

About the Author

Praise for

Savannah’s Hoodoo Doctor:

The Tyranny of Dogma

This inspiring novel by an accomplished physician and medical educator blends medical history, anthropology and introspection in the story of a man reviewing his life’s work and family relationships. The reader accompanies the narrator as he returns to his hometown of Savannah on a sabbatical to reflect and write. The vivid and poignant description of the sights, smells and recollections resonate, and even one who has never visited Savannah (beyond the scenes in Forrest Gump) will be charmed. The descriptions of the street scenes, salt creeks, landmark architecture and ordinary surroundings are elegantly detailed. The reader will be planning their next visit to the Hostess City with each succeeding chapter.

Using the vehicle of magical realism, the protagonist visits early root doctors and subsequently blends examination of Native American and African culture with customs and Western medical dogma. The structure of the story weaves among the present day, childhood memories, and the horrors of a Civil War military hospital set in the actual location in a still existing downtown hotel. The author addresses the historically unique social status of biracial individuals, the frustration of physicians unable to cure many under their care and the subsequent striving for elusive perfection. He carefully acknowledges the important historical role of women lay healers. The end comes when the protagonist accompanies the biracial healer to the final challenge.

— David Bramm, MD.

Director, Rural Programs Huntsville Regional Campus, UAB Heersink School of Medicine

As a literary project, Savannah’s Hoodoo Doctor is long overdue. Hundreds of thousands of words have been written about Savannah in the past two decades as the city has turned itself inside out to exploit the success of John Berendt’s Midnight in the Garden of Good and Evil. At last, a native Savannahian who knows how to weave and throw a cast net — and is experienced in finding the best shrimp in the muddy coastal estuaries of Chatham County -- has written a compelling novel about the city and its people from an informed insider’s point of view.

Alternating between cool rationality and undisguised emotion, Crump explores the influences of family, history, education, environment, race and myth on an aging family doctor trying to reconcile the cold brutality and randomness of illness and death with mystical belief systems grounded in faith and tradition. His protagonist, whose name is never revealed, embarks on a journey to a bardo where wisdom equips him to break free of what Crump decries as the tyranny of dogma. Skillfully woven into the narrative is an unusual close-up look at the internal debates that go through the minds of practicing physicians as they encounter critical life and death decisions.

— Albert Oetgen is the retired Managing Editor of the NBC News Washington Bureau. He was born and raised in Savannah.

Savannah’s Hoodoo Doctor: The Tyranny of Dogma

Copyright © 2021 by William J. Crump, M.D.

All rights reserved.

First Edition: 2022

Photo credit to Pam Carter

Cover and Formatting: Streetlight Graphics

No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Thank you for respecting the hard work of this author.

This book blends historical facts, personal narratives, and fantasy. The engaged reader need not expend energy trying to determine which is which. Any similarities of any of the characters or their actions to real people, living or dead, is most likely coincidental.

This effort is dedicated to my mother who inspired me to reach for the stars to make her proud, my father who beamed his pride in me consistently, and my patients who joined me on the journey.

Acknowledgment

This work incorporates the wise counsel of David Bramm and Albert Oetgen, who have walked many of the same paths that led the author to this work.

Foreword

Physicians are relentless self-critics and their discernment of failures invariably eclipses their pride in successes. As I enter the final years of a four-decade experience as a family physician and medical educator, I find that certain experiences, insights and revelations emerge. The hindsight that can never be applied retroactively to correct or appreciate a practitioner’s judgement of medicine creates a self-verdict which would surprise many.

I have known Dr. Crump since my family medicine residency. Our careers led to different geographic locations, but our reflections took us to similar places. Reading this intriguing work, I am reminded of the very human elements of those of us on parallel paths.

This semi-autobiographical novel by an accomplished physician and professor of family medicine blends medical history, anthropology and introspection in the story of a man reviewing his life’s work and family relationships. The reader accompanies the narrator as he returns to his hometown of Savannah on a sabbatical, to reflect and write. The vivid and poignant description of the sights, smells and recollections resonate, and even one who has never visited Savannah (beyond the scenes in Forrest Gump) will be charmed; the descriptions of the street scenes, salt creeks, and ordinary surroundings are elegantly detailed.

An encounter with the enigmatic Mae, a Gullah woman, propels the narrator to embark upon a journey of self-awareness which demands penance. A gentle sparrow becomes a challenging impetus to complete the journey. The feminine gender of the bird recalls a maternal equivalent and the protagonist notes that he never came to terms with the relationship with his mother. Chance encounters with actors portraying 19th century characters move the narrator to a further dissonance. These issues are blended with youthful memories and the contribution of social injustice to healthcare disparity, a systemic rather than personal shortcoming. The process reveals the fragility that physicians resolutely conceal, complicated by feelings of unrealized potential. He remembers patients who might have had better outcomes given more insight or perspicuity, or perhaps even luck.

Using the vehicle of magical realism, the protagonist attempts to make amends for himself and his profession by visiting early root doctors, and subsequently blends examination of Native American and African culture and customs with Western medical dogma, an impediment since the time of Hippocrates.

The author is even-handed in his examination of multiple, seemingly disparate topics, including the historically unique social status of biracial individuals, the frustration of physicians unable to cure many under their care, and the subsequent striving for elusive perfection. He carefully acknowledges the important historical role of lay women healers. From midwives to the granny women of Appalachia, they have always held prominence, yet are infrequently recognized because of the profession’s current and often misguided worship at the altar of science. The triumph comes when the protagonist accompanies Mary, the biracial healer, to the final coda.

The structure of the story weaves among the present day, childhood memories, and the horrors of a Civil War military hospital, which in a sense is how cognition operates: fluidly and without temporal constraints. The journey, like life, is complex and filled with setbacks, yet always moves forward. Entering the world of the protagonist, one is inescapably pulled into the feelings of those of us in patient care roles, and emerges with a catharsis which is satisfying yet incomplete. This is an important book for those who have worked in medicine, strive to understand human nature, or simply have an interest in Savannah, medical history and anthropology.

David Bramm, MD FAAFP

Assistant Professor Family Medicine

UAB Heersink School of Medicine

Director, Rural Programs Huntsville Regional Campus

Chapter 1

M

y recent semi-retirement and best

friend’s death left me rudderless.

We had shared all the guy milestones together. His and my children were now parents themselves and settled into their life’s work. Our grandchildren were far enough away that any interactions with them were just visits rather than the daily participation that we enjoyed when most lived in our town. Our wives had found a new mission, his with a small business and mine as a foster mother for medically fragile infants. My life as a teaching physician was my other reason for being, and I wasn’t sure where I stood with that either. Like most physicians my age, I had stopped delivering babies. The physical demands and sleep deprivation required for obstetrics were just enough to tip the balance against the joy and exhilaration of helping to birth babies. The recent pandemic and the oppressive new electronic medical record made it nearly impossible to continue a part-time clinic practice, as I had for more than forty years. I had preached my entire life that you should not teach something unless you do it. I had helped usher thousands of medical students and residents into their next phase of life, and delivered almost that many babies into the world. So, if I was no longer a best friend or a doctor, what was I now?

Was I still a dean? In my current academic position, we had a mature student-managed free clinic that had been operating for almost eighteen years. The students were successful in getting local primary care physicians to volunteer several hours every Thursday evening to oversee the students, and I reviewed all the medical notes and we discussed them twice a month as a group during what we called Dean’s Hour.

The concept of the importance of community engagement by medical schools had been with me many years before it became the current vogue. Community engagement, simply put, is considering the community as your patient rather than the individual. Our students graduate with a clear understanding that, especially in small towns, you are responsible for everyone in your community whether you see them in the office or not. Whether it is covering the local emergency room and taking care of someone’s heart attack because they didn’t have anybody to help them with their diabetes or high blood pressure, or seeing the beloved choir director in your church suffer a stroke for the same reasons, it is easy for a small-town doctor to understand the value of community medicine. There simply is no way to teach community medicine in a didactic classroom fashion. The student has to live it, and the free clinic did it for our students. Making sure this happened was still important to me, wasn’t it?

Our free clinic also provided our students’ first opportunity to be someone’s doctor for almost a year. At the end of that year, the third-year medical students had the responsibility of updating our protocols for diagnosis and management of high blood pressure, high cholesterol, and diabetes. The commitment that the students put into this extracurricular activity was nothing short of amazing. They remembered how, as brand-new third-year students themselves a year ago, these protocols were their lifeline. The soon to be fourth-year students updated the protocols and handed them down to the new third-year students as a precious gift.

As I sat with the students working to update the protocols, we came face-to-face with the tyranny of dogma. Dogma is what results when old beliefs solidify against change. All new information is either ignored or discredited. Uncharacteristically for me, my mind wandered away from our protocol work. This sudden realization of the power of the tyranny of dogma felt visceral. I was transported back to my mother’s untimely death, and began to recall details of interactions with my parents while growing up. I was in the midst of all-out reconsideration of those relationships when a student had to call my name to bring me back to the present to answer their question. I answered, but immediately went back into deep thought, feeling very uneasy. Why had these protocols precipitated this inner journey?

It had something to do with dogma, it seemed. We have known for a long time that high cholesterol is associated with an increased risk of heart attacks and strokes. Thousands of well-designed medical studies show that the higher the level of bad cholesterol, the more likely you are to have a dangerous cardiovascular event. When I was a student, there was little we could do for this besides suggesting alterations in diet to decrease total cholesterol and exercise to increase the good cholesterol. Then along came the statins, a truly revolutionary intervention. Like good scientists in the Western tradition, we thought it was obvious that if a little statin helped cholesterol a little bit, more statin to decrease cholesterol even more would be better. In the United States, this more must be better conviction has nearly bankrupted Medicare, and causes all of our goods to cost far more than they should because of the generalized cost of health insurance for the workers who construct our modern marvels.

For many years, debates raged on many consensus panels as to the appropriate goal for the bad cholesterol number. Further, there was the growing realization that once someone has had a cardiovascular event, nature has labeled them as high-risk, so we should lower their bad numbers even more. Next came the heated argument about what is called primary prevention. For at-risk patients who have not yet had a heart attack or stroke, how much should we lower the bad cholesterol if it means increasing the side effects of the statin?

A series of articles was published in the midst of this conflict that shook the pillars of dogma. They supported the finding that any dose of statin made a significant difference, and increasing the dose really didn’t decrease the risk much more. This was a serious threat to the dogma of the day that each person needs a goal number for their cholesterol. Americans like clear goals, and if these can be couched in numbers, even better. Then our molecular scientists discovered that statins are in fact powerful anti-inflammatories. The emerging concept that coronary artery disease was at least partially due to inflammation came out at the same time. It may be that the effect on cholesterol is a mere bystander, and the anti-inflammatory effect of any dose of statin is all that really matters. That is still the debate today. The inertia of medical dogma is impressive. So, what should we do about the target cholesterol numbers staring back at us from our free clinic protocol?

The dogma about the management of high blood pressure is also crumbling. Many well-designed studies show that high blood pressure creates a risk of heart attacks, strokes, and chronic kidney problems. It is also proven that lowering the blood pressure decreases the risk of these events. On that there is no disagreement. The debate is at what level of blood pressure the risk increases enough that it is worth beginning a medication or taking a higher dose. In the 1970s and early 80s, we had a standard low-potency diuretic pill that was the mainstay of treatment. It was thought to be fairly safe, and if a little was good, then more must be better.

There was a series of joint consensus panel recommendations that came out every five to seven years, summarizing what we knew at the time. During my residency in the early 1980s, my host university participated in the landmark study that compared aggressive treatment to lower the blood pressure more, to see if it was better than standard treatment that might just lower it a few millimeters. This was based on the most recent consensus panel statement that recommended aggressive treatment using what was called stepped care.

I can still remember helping to load copies of charts into boxes with the name of the study printed in bold letters on the side. Up on the bulletin board in the workroom was the diagram of a series of steps like those in front of a library. At the bottom was the low dose of the medicine we had used for many years. With each step, higher and higher doses were used, and eventually even a second or third drug might be added to lower the blood pressure as much as 20 or 30 mm.

We knew that higher doses of this medication could wash out some of the body’s potassium, as well as very slightly worsening the cholesterol picture and raising levels of the substance in the blood that was responsible for causing gout. This seemed a small price to pay for the promise of further decreasing the risk of stroke, heart attack and kidney failure. But all of the experts were wrong. The patients treated more aggressively with higher doses of this medication actually had more cardiovascular events and had a higher mortality rate. The study was stopped fairly abruptly after it showed that low potassium levels had led to a higher risk of rhythm problems in the heart, some of which were deadly. Patients were actually dying at a higher rate because we were acting the way we thought wise, aggressive advocates for them should do. The large-font headline of the medical journal editorial that summarized the initial results of this study read, in bold letters, What Have We Learned? Stepped Death. I had felt a wave of nausea as I read that editorial. As I tuned in and out of my students’ current protocol discussion, I felt that again.

All tyrants are difficult to bring down, and it took almost two years for this new dogma to be accepted. Since then, we do not exceed a low dose of this medication, and we have discovered many more that are much more effective and safer.

And then the key memory came rushing back. When my mother was admitted to the ICU with her first and only heart attack that ultimately proved fatal, I got home from my first faculty position as fast as possible. I had been busy with medical school and residency, and my parents really didn’t discuss their medical issues with me much. But when I went in to my parents’ house and found the bedside stand where her medications were kept, I saw that she was on a high dose of that drug. There was also a piece of the rhythm strip