The ER nurse, Judy Simpson, walked up to me. “I need you to see another of Dr. Hartman’s patients, if you would.” I could tell her request was urgent.

“Sure, what is it?”

“A sweet little girl who put a small ring on a large finger and can’t get it off. The finger is swollen and uncomfortable. I think we need to get the ring cutter to remove it.”

“The ring or the finger?” I asked, trying not to smile.

Judy gave me an annoyed look as I grabbed the clipboard chart, reviewed it, and walked into the room to introduce myself. The young girl, contrary to her mother’s instructions, had placed a pinkie ring on her ring finger. Now, neither the young girl nor her mother could remove the ring despite many frantic attempts. The more they tried to remove it, the more stuck it became and the more swollen and painful the finger. By the time they arrived, the girl’s situation was desperate—not just physically but also emotionally.

“Don’t cut my ring off,” the girl pleaded. “It’s from my grandma. Please! Please don’t cut it!” She dissolved into sobs.

What came to mind was a trick the older doctors in Bryson City taught me. “I don’t think I’ll have to cut your ring. At least, I’ll try not to.”

She began to calm down. I asked Judy if there was a roll of string or twine available. There was none. “Any dental floss?”

“I have some in my purse,” she offered. “But for what?”

“Can I use it?”

“Of course.”

I explained to the mother and girl my plan, and they agreed to let me try it. The old country doctor’s trick was to wrap the floss firmly around the finger, starting at the fingernail and moving up toward the knuckle row-by-row, leaving no visible skin between each circle. It took several moments and yards of the floss until the digit looked mummified. As I wrapped, the built-up swelling passed under the ring and up into the hand. The theory was that the compression would allow the ring to slide over the sore but “skinny” finger.

The trick worked, to the delight of Judy, the mother, her daughter, and even me. Soon the precious ring was past the knuckle and off the finger. After unrolling the floss, the postprocedure exam showed the finger’s circulation and sensation were normal. I assured the mom that the dental floss impression on the skin would soon disappear.

I stepped out of the cubicle and saw Ken coming out from another one.

“How’d it go?” I asked.

“Got him off to the ICU. One of our cardiologists is taking care of him. I think he’ll make it, but it was nip and tuck there for a bit. Thanks for seeing those patients.”

“Not a problem. It turns out they both were patients of Dr. Hartman’s. I had to use an old country-doctor trick on one.”

After I explained what I had done, Ken asked, “Well, do you have any old country-doc tricks for starting an IV on a dehydrated patient? Judy and I can’t get one started, so I have her setting up for me to do a central line.”

I knew that meant Ken would put a large-bore catheter into either the jugular vein of the patient’s neck or the large subclavian vein just under the clavicle. It’s not a complicated procedure, and ER docs do them all the time, but it’s not without risk. I was curious. “Maybe. What’s the case?”

“A dehydrated drunk with no good veins.”

“I bet you ten dollars that I can start that IV in a vein in his arm on the first try.”

Ken and Judy looked at me, and both smiled. I could see they did not believe me. Ken asked, “What makes you think you can do that?”

“It’s another trick I learned up in Bryson City that works more times than not.”

Ken stuck out his hand to shake. “You’re on!”

We walked into the unconscious patient’s cubicle. The smell of alcohol was heavy in the air. I took the blood pressure cuff off the wall, applied it to the patient’s upper arm, and inflated the cuff. “I’m pumping up the pressure until its 10 to 15 points above his systolic pressure. Then I will hold it there for four to five minutes. This gives a tourniquet effect, and it is very uncomfortable because the arm becomes anoxic.”

“I don’t think he’ll notice,” Judy said.

As each minute went by, the man began to moan from the discomfort. “For patients that are awake, I have to talk them through the temporary pain by explaining that the lack of oxygen relaxes the muscle around the veins, allowing them to dilate and making it easier to start an IV.”

I monitored the clock, and at the five-minute mark, I began to let the pressure off the cuff. “I’ll let it deflate to about five points above the diastolic,” I explained. “This allows the arterial blood to flow into the arm, but it will hold the low-pressure venous blood flow back.” I held my breath, but as we watched over the next sixty seconds, the patient’s arm began to look like a road map of enlarged and full veins.

“Son of a gun!” Ken exclaimed. “I’ve never seen anything like that!”

Nodding at Judy, I said, “Want to try now?”

She smiled and quickly inserted a catheter into a dilated arm vein, securing it with tape as I deflated the cuff.

“Well,” Ken sighed. “I guess I owe you ten dollars.”

Relieved the old trick worked, I countered, “I’ll let you buy me a cup of coffee sometime.”

Just then, I heard Dolly’s voice over the overhead speakers: “Dr. Larimore, stat to L and D. Dr. Walt Larimore, stat to L and D.”

“Saw an orderly pushing a pregnant lady in a wheelchair back a few minutes ago. She looked like she was in active labor, and a man followed with two bags slung over his shoulder,” Ken commented. “Wonder if they’re your patients?”

I jumped up and, once out of the ER, began to sprint.