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JOHN WOOTEN, M.D.
Past Trustee
Past Chief of Staff
Pitt County Memorial Hospital

LAMONT WOOTEN, M.D.
ORTHOPEDIC SURGEON
PITT COUNTY MEMORIAL HOSPITAL

Date: July 19, 2000

Interviewer: Ruth Moskop
Also Present: Harriet Wooten, M.D.

Ruth Moskop: I'm Ruth Moskop and I am here at 1807 Circle Drive on July 19, 2000. I am here to interview Dr. John Wooten and Dr. Lamont Wooten with regard to their association with Pitt County Memorial Hospital. Doctors Wooten, do I have your permission to record this interview?

John Wooten: Yes, you do.

Lamont Wooten: Yes.

Ruth Moskop: Thank you so much for your time. I understand, John, that your family has been associated with hospitals in Greenville actually since the early 1920's.

John Wooten: That's true. My father started practicing in Greenville in the early 1920's and then I followed him and then Lamont followed me.

Ruth Moskop: And where had your Dad been before he came to Greenville?

John Wooten: Well, actually he didn't move very far. He was born in Greene County and went to Trinity College which is now Duke and then graduated in Medicine from Jefferson in Philadelphia and then after that he worked a while in hospitals in Philadelphia and then in Wilson. I think he moved to Greenville because he found my mother over here and decided to marry her and she decided to marry him too and he moved to Greenville.

Ruth Moskop: That worked out well.

John Wooten: Yes it did.

Ruth Moskop: How did he happen to become associated with the hospital? Was there a hospital in Greenville?

John Wooten: No, there wasn't. My father always wanted to be a surgeon. There wasn't any hospital here but they needed a hospital. So, four doctors really got together to build a hospital and it was my father, Dr. K. B. Pace, Dr. Dickinson, who actually lived in Wilson, and Dr. Laughinghouse. They raised $100,000, which was considered sufficient to build a hospital. They started a hospital. In the interim, though, they put up a temporary hospital in the upstairs of a feed store downtown. It was the H. L. Hodges Company which continued on in business and I remember them very well. It was an operating feed store and the upstairs was rented as an apartment. Anyway, that upstairs building down there got a lot of fame because it was unusual to have a hospital on the second floor over a feed store. It served reasonably well for about a year and the other hospital was opened on Johnston Street and it was known as Pitt Community Hospital and at that time was privately owned.

Dr. Laughinghouse got out of it fairly early and my father bought his share of it and then about 1929 my father left Greenville and went to New York where he took some training in surgery, not what we would call a full residency now a days, and he came back and practiced surgery in that hospital for the rest of his life.

Ruth Moskop: At what point did you enter the story?

John Wooten: I was one of the early babies born in the new hospital. I think I was the second, but anyway, it was in 1924 and I guess I don't remember anybody telling me I had to be a doctor but I just sort of assumed I would be and so I went ahead and studied medicine and when I came back to Greenville to practice in what was originally called the Pitt Community Hospital was gone. The Pitt Community Hospital served for a number of years but it was during the Depression and hospitals weren't surviving anywhere in the country. Most of them were going broke and this was no exception. It was broke also. The hospital in the mid-1930 was given to the County and the name was changed to Pitt General Hospital and it used to be Pitt Community Hospital when it was privately owned and then they turned it over. The County didn't make any money out of it either but I suppose they could afford it.

Ruth Moskop: Do you remember anything from your childhood about that hospital on Johnston Street?

John Wooten: Oh yes, I remember all the details of it.

Ruth Moskop: Tell me something of the details. You are one of the few people who does, John.

John Wooten: It was a three-story building. It was built on a block and it had a garage in the back where you could park your car and had a big garden that they used partly to grow food for the hospital. Anyway, it occupied all of that block except for one lot. About halfway through its life it underwent a major expansion and added a few more offices and some more beds. The first floor had xray, the laboratory and offices for Dr. Winstead and Dr. Wooten, my father, who were the two practicing surgeons in the hospital. The second floor had an operating room at one end of the building and the rest of it was patient's rooms. The third floor had an obstetrical suite at one end of the building and then patient's rooms. In the basement, which was not really underground but was called a basement, there was a segregated section for black people - it had four or five rooms and a ward setting down there. Actually it wasn't torn down since I have been living here. It was converted into an office building and an apartment house for a while.

Ruth Moskop: Did you accompany your father to the old hospital or did you just run in to visit and leave again?

John Wooten: I was never a doctor then. My father died about two weeks before I started medical school but I used to accompany him on rounds and used to try to go in the operating room but I failed with such regularity I couldn't do that very well.

Ruth Moskop: I was going to say, in spite of those early experiences you became a surgeon.

John Wooten: Well, I think that going to medical school would get anybody over fainting in an operating room setting, I think. That is not a problem.

Ruth Moskop: You were interested in what was happening there, I assume, as a child.

John Wooten: You know, thinking back on that I have a feeling that he wanted me to come more than I wanted to. I understand that because I have children too and you want to get them interested in what you are doing and maybe they would rather be out doing something else.

Ruth Moskop: What kinds of things would your dad do then that you remember in the hospital?

John Wooten: Well, we lived about five or six blocks from the hospital and he came home for lunch. He worked a lot at night, went out most nights. It got as the time passed and the war started and doctors were taken out of Greenville most of the younger doctors were gone and we were left with a very few people to do what had been done before. So he was busy most of the time and gone a lot. I know we never played baseball together or anything like that. He did help me with my homework. He was a good father.

Ruth Moskop: I'm sure he was. If you were to compare the facilities in that hospital on Johnston Street with the facilities in the hospital that then opened up on Fifth Street, what would come to mind in that comparison?

John Wooten: Of course I came to practice in that hospital we were talking about and thought it was a pretty fine hospital. The operating room where my father practiced first of all wasn't air conditioned and I can remember in the summertime how they wanted to open the windows and get a little bit of fresh air and yet they wanted to maintain the sterility of the operating room and it was sort of a swap off. The people in the operating room consisted of a surgeon and a Mrs. Evans, a lady who poured ether for anesthesia. She was in there and she used a little can of ether and put a mask over your face and poured that while the operation went on. There were two other nurses, one I called the scrub nurse who was really a surgical assistant and handed instruments and the circulating nurse would go and get things and just look after the operating room in general. That was all the people that were there. Now days you have more than that just starting an IV.

Ruth Moskop: What was that like in the old days when somebody would pour ether? What were the signs, I guess it was just how the patient looked and felt?

John Wooten: Oh yes, you can tell by the relaxation, by looking at the pupils and by having done it countless times before. Of course, it wasn't as safe as modern anesthesia. That is the reason they don't do it anymore.

Ruth Moskop: Did you practice at that hospital on Johnston Street?

John Wooten: No, I did not. You know, we are talking about three different hospitals now. There was the Johnston Street Hospital, and then there was the hospital, the red brick one on Fifth Street and that was the new hospital when I came. It had been open only a few years when I came to Greenville and it had undergone a major expansion. In fact, I was quite surprised that Greenville elected to build another hospital. I thought the one we had was pretty much state of the art but, of course, it was not.

Ruth Moskop: How were things different then in the red brick hospital? You had a lot more space?

John Wooten: Yes, we had a lot more space and there was a lot of difference. Of course, for one thing we were air-conditioned. The operating room was clean and sterile and the air was regulated. Xray had progressed tremendously in all kinds of invasive xray procedures were performed there. The surgical group in Greenville had grown from just two or three general surgeons to specialists in all kinds of fields like in my field of orthopedics and urology and neurosurgery and all kinds of medical specialists were here before we ever moved to the present hospital. There was a lot of difference.

Ruth Moskop: At the red brick hospital, the day you went into the hospital to work with a compound fracture and so forth, how many people would you have assisting you then?

John Wooten: Probably there wasn't more than we used to have. That would really be enough. Once we got to be a medical school then the place really overflowed with people. We didn't have any resident staff in the red brick building.

Ruth Moskop: What about the admissions policy in the red brick building? How was that taken care of?

John Wooten: Well, you were supposed to pay your bill but it was a county run hospital and then there was a fair amount of charity work done there. There were people who couldn't pay their bills and didn't because they couldn't afford to. The bills were interesting. I was in that hospital myself for about a week in the 1960's and I have a copy of the old bill and it shows that I stayed there that long and the total bill was only $400.00 and the room was $16.00 a day and the anesthesia was $7.00, not $700.00, but $7.00. There was a tremendous increase in prices and income, largely, coincident with further Government intervention and medical pricing and support of medical facilities.

Ruth Moskop: You said in the Johnston Street Hospital there was a section on the low level of the hospital for African-American patients, did that segregation policy change things?

John Wooten: Yes it did, it was carried over to the red brick hospital and on the first floor on the East Wing it was all black. The facilities were identical but they were still segregated.

Ruth Moskop: How long was it before that policy changed, do you remember?

John Wooten: No, I don't but it was early. To my recollection there wasn't any real problem with it. It changed and we didn't pay much attention to it.

Ruth Moskop: You mentioned something that was interesting to me the other day when we were talking and it had to do with the reason why there is a medical center in Greenville.

John Wooten: That's a personal observation but I think most old timers will bear it out. Greenville medicine was never segregated into various opposing camps. Doctors here always got along and I think it probably started out because any doctor moving to Greenville could own a share of the hospital and was expected to. They had governing rights and policy-making participation and there really was no segregation. In the towns around here and particularly I think of Wilson, Rocky Mount and Washington, N.C. because they were so completely divided. In Wilson there was a big building and there was one group of doctors there and there was another building with a group of doctors there, each one had his own hospital and they competed rather vigorously against each other and I suppose would have a hard time ever organizing enough to go through a political machinations for getting a medical school. In Greenville that wasn't the case. Everybody was everybody else's referral and I don't think there was any grouping. I am not qualified to say whether there is now a medical school group and a non-medical school group but I expect they cooperate pretty well.

Ruth Moskop: Maybe Lamont can address that issue in a little bit. Well, I think one reason why the hospital has been successful because pretty much people have cooperated. Can you think of any other reasons why the hospital has been such a success over the last years?

John Wooten: You can never leave out people like Ed Monroe and Leo Jenkins. They had the esteemed role of moving the medical school through the Legislature and that was an amazing piece of work.

Ruth Moskop: I would like to have been there during that time.

John Moskop: They made a pretty good team I think. Leo thought anything was possible if he was behind it and Ed made it possible by his ability to negotiate and his tenacity in trying to get what he could.

Ruth Moskop: There were other "knights in shining armor" in all of eastern North Carolina pushing for that.

John Wooten: There certainly were. I should have mentioned there were people outside of Greenville that were, particularly politicians outside of Greenville.

Ruth Moskop: In the course of your practice of medicine with regard to the hospital, what do you remember as significant changes, key incidents can you remember? What introductions of new technologies come to mind? What helped you the most in your practice?

John Wooten: I suppose the most comforting thing was to know there were a whole lot of other people around who knew what I knew and more. When I came here to practice in orthopedics what I said was the answer because I was the only orthopedist around and I had to get along by using the other surgeons as my assistants and people who would take call for me and we had a pretty nice arrangement. I wasn't the only person treating muscular skeletal trauma. Several of the general surgeons did and what I did was give them informal consultations and told them that this was what I thought they ought to do or I think you ought not to touch this, or something like that. In exchange for that I got coverage so that I could take a day off and know that somebody was looking after things. When you are practicing by yourself you are on call all the time but I managed to get to the national orthopedic meetings every year. Once I got a partner I only got there every other year so you have to give up something.

Ruth Moskop: You did practice in the present hospital?

John Wooten: Oh yes, I was there a long time.

Ruth Moskop: How were things different there?

John Wooten: Other than being brand new and slick and having lots of room, which we had when we moved in, it seemed to run about the same way in my opinion. We had the best of everything though.

Ruth Moskop: Did that improved technology help you?

John Wooten: Yes it did. The technology of surgery during my career has vastly improved and changed. The many different ways radiation, xrays can be used in diagnosis and helping you in the operating room. That was one big thing. The biggest thing, I think, in my surgical career is the ability to do all kinds of surgical procedures with very little invasiveness instead of a big scar on your knee, most common new procedures can be done through a tiny little hole and, of course, that carries over into general surgery. You can take a gall bladder out through a little hole; all kinds of things have made less traumatic. I think that may be the biggest thing that has happened in my surgical career.

Ruth Moskop: Were you able to participate in that less invasive kind of surgery?

John Wooten: No, not very well. I never got good at it because I never was trained as a resident to do it and if your not good at it you really ought not to do it. Actually my younger colleagues did most of that.

Ruth Moskop: Thank heavens you had the colleagues.

John Wooten: That's right and I had some good ones.

Ruth Moskop: And I'm sure they were grateful to have you to come to.

John Wooten: Thank you. I'll let it go at that.

Ruth Moskop: What about drug therapy, were you able to benefit in your practice from the evolution of pharmaceuticals?

John Wooten: Well, in orthopedic surgery it is not that big a thing. For instance, all the non-steroidal drugs came along during my time as a practicing physician and they certainly were useful. All the drugs for arthritis and the better anesthetics made surgery safer. But, the real drug revolution was not really in my field.

Ruth Moskop: It seems to me that orthopedics is a field which is very dependent on the body to heal itself.

John Wooten: Oh, I don't know. We think orthopedics is the best medicine to be in. It is fun to try to put things that are broken up back together again and generally the outlook is good. Most of our patients get well.

Ruth Moskop: That is a happy situation.

John Wooten: I think it is too.

Ruth Moskop: So, the combination of the hospital and the medical school has been important?

John Wooten: Oh my, yes. I think the medical school and the hospital have merged with very little trouble. Both of them seemed to have profited from their association. The town doctors have accepted and merged with the medical school exceptionally well also. That has been due to careful management on both parts not to offend the other or get in their way. Lamont can probably say a whole lot more about it than I can because I have retired from the scene. All medical school and town doctors don't get along. I think they do very well here.

Ruth Moskop: It's a credit to the whole community.

John Wooten: It certainly is. A lot of people moved here just because of the medical facilities.

Ruth Moskop: With regards to your associations with the hospital, how do you see it doing in the future? How do you see it developing? Have you thought about that much at all?

John Wooten: No, I am not going to say anything much about that. It is still growing. It grows sometimes beyond what I think it has to but I don't say anything about that.

Ruth Moskop: It keeps getting bigger and we keep bringing in new and more sophisticated technology. What do you think about community needs for health care? How has that changed while you have been watching and participating?

John Wooten: When I came here to practice orthopedics I was the only orthopedic surgeon east of Raleigh except there was one in Wilmington and I seemed to take care of the situation reasonably well. Now there are sixteen in Greenville and the reason for that is that we do more for people than we used to. We have a lot more to offer. During my lifetime, the whole area of cardiovascular surgery for instance has been born and there are many other areas not only in surgery but also in medicine that has been created by discoveries and it takes more people to deliver them to the public. I see no reason why it should slow down at all.

Ruth Moskop: What about with regard to access to health care for different groups of people?

John Wooten: I don't know how to answer that, I am not up on it. I feel like that in Greenville you can one way or another get access to just about anything you need but I am sure that is not true everywhere. I really don't feel confident to comment on that.

Ruth Moskop: John, you have helped us a lot and given some insight into the good old days perhaps.

John Wooten: Some of them were good. Well, you have given me the sort of thing that most people love and that is an opportunity to talk about myself and get it recorded.

Ruth Moskop: Well, the way you have contributed to health care in the community. Are there any particularly difficult cases that you would like to talk about; cases where because where there was nobody else here you had to get a patient quickly to the western part of the state or the central part of the state?

John Wooten: I don't know whether I ought to tell you those things-I do remember many years ago before there were any neurosurgeons in town that we had a patient with an extra dural hematoma, that is bleeding inside the skull, where it is producing pressure on the brain and the treatment is to make a hole, at least that was the treatment in those days, in the skull and let the blood out. That has to be done pretty promptly and we elected to do it to this person even though I really had never done an open skull operation. It wasn't too difficult and it worked, I remember that.

Ruth Moskop: Thank goodness. A different sort of orthopedics then.

John Wooten: I could chop the bone all right but I wasn't too good at the brain.

Ruth Moskop: I guess it's a matter of knowing where to just stop chopping.

John Wooten: The level of skill given to the patient was mine was better than my father's was and my son's is certainly better than mine. That is just because we learn new techniques and get better at them and the specialty gets a little narrower and you are not spread quite as widely. It makes for better technical medical practice. I am not commenting on the good old relationship between the doctor and the patient, I think it is probably as good as it used to be but it is not as intimate. The technical matters are far superior.

Ruth Moskop: When you say it is not as intimate, talk to us about that.

John Wooten: Okay, if you go in a hospital and you are going to get a surgical procedure, since I am a surgeon I hate to keep talking about that field but it is something I know something about, you will be shipped off to xray where some really competent specialist will put tubes and things in you and you probably never will have a good look at them. You will probably not have that much of a conversation with them but they are nevertheless producing important diagnostic things to help you get well. If you are operated on, when you are wheeled into the room there will be eight or ten people in there all of them masked so you don't know who they are and you will have experts in anesthesia, experts in putting in fluids and tubes, experts operating on certain parts of your body and you really never do get to know any of those people, perhaps their names. So, it really isn't as intimate and that is what I meant by that.

Ruth Moskop: When you practiced medicine say early on in the red brick hospital there weren't as many specialists which gave you more charge of all the different diagnosis?

John Wooten: That's true, we had the major specialties but now a days you say you are going to be a cardiologist and think you are going to be just a guy working on the heart but then you can be an invasive cardiologist or two or three other different kinds. You certainly can in orthopedics. When I started out an orthopedic surgeon I took care of bones and joints and now they have special orthopedic surgeons for the hand, spine, for children, for arthritis, for replacement of joints, so the specialization does make for technically better performance as I said before.

Ruth Moskop: What were some of the most rewarding experiences you had with patient care.

John Wooten: Anybody that goes into orthopedics is rewarded all the time because most of our patients get well. You can have somebody come in with both legs broken and you point them in the right direction and be reasonably sure that under your care in six months they will be doing fine. We still have some conditions we haven't really gotten any kinds of cures for. Arthritis I am afraid is one of them. In orthopedic surgery the replacement of joints is, of course, has been one of the major things during my career. That whole area has developed during that time. We would like to find a way to make that type of surgery less necessary by finding some way to preserve the natural joint.

Ruth Moskop: That sounds good. Are there any questions that come to your mind.

Harrier Wooten: She asked about some of your rewarding cases and I think when you worked at the Health Department you saw the little children and you saw them grow up.

John Wooten: I didn't mention that but there used to be clinics run by various people for various problems and we have had an orthopedic clinic in a lot of towns in North Carolina all of my life. Somebody volunteered whoever was in that neighborhood, to operate the clinic. So we had a clinic that I operated in the Health Department once a month throughout my medical career. They used to be called crippled children's clinics and that is what they really are. That name seemed to have a stigma to it so they got to be called orthopedic clinics and we treated through the clinic and through the hospital a lot of crippled children in this area. That went on all over the country. They had other kinds of clinics over there too. They had a neonatal clinic which Harriet ran for pregnant women.

Ruth Moskop: Where was that Health Department clinic?

John Wooten: In the Health Department building right next to the red brick hospital.

Harriet Wooten: The Health Department is, of course, across the river now.

John Wooten: Yes and it is harder to get to it now.

Harriet Wooten: Yes and it is much less successful. The old Health Department was Dr. Humber's building.

Ruth Moskop: Are there any particular people, administrators or chiefs of staffs that you can remember as having made outstanding contributions to health care in the community or to the growth of the hospital or promotion of good relations?

John Wooten: I think we have had good administrators at the hospital all along as I look even back to Mr. Ward who joined the old hospital over there on Johnston Street and then moved to the red brick hospital and we have had two more administrators since then and I think they have all been quite competent. As far as doctors I think Dr. Earl Trevathan, who is a pediatrician, has done more quietly for good medicine than anybody I can think of. There is never a movement to improve something in medicine that he is not involved in someway or another. He gives freely of his time and talent and has been a wonderful help to medicine and particularly the pediatrics around here. There are several people like that.

Ruth Moskop: That is a wonderful compliment.

John Wooten: It is the truth. I think everybody will agree with me.

Ruth Moskop: Lamont, shall we talk to you for a few minutes. We would like to talk to you a little bit about the Level I Trauma Center at the Hospital and orthopedic support for that.

Lamont Wooten: The hospital here recognized that trauma services might be good business for a hospital. Hospitals are more like businesses, I think, than ever before. It was interesting that the one my granddad started they held stock in it and I guess that was, of course, a privately owned hospital which failed, at least financially. Now ours has been a county hospital and, of course, there was a big change which is a whole other topic of going to a non-profit private facility which as an aside has made no visible change in our practice. You can't tell any difference.

The hospital administrators of the last number of years actually recognized trauma. They even go as far as to call these product lines now which is a curious thing to me but trauma can be a product line in the business sense from an administrative standpoint and it can be due to a bit as a loss leader. Hospitals are competitive against each other throughout the country, a little less so here they are competitive but really I think our local hospital doesn't have any true competition. All the neighboring hospitals are really a tier below.

As a matter of fact, our hospital is not just Pitt County Memorial Hospital, it is the University Health Systems and they, of course, own a number of the hospitals surrounding, Bertie Memorial in Windsor, Heritage in Tarboro and others in Ahoskie and now they are going up around Manteo so its becoming a large corporate structure and they recognized that becoming a Trauma Center may bring in a lot of other things such as the Heart Center has done as well.

People come here for their bad car wrecks. Their families and neighbors will recognize that this is an area with a level of higher expertise and therefore may come here for a hip Replacement or for their other more routine things so the hospital has figured that out and therefore we promote our trauma services to enhance the hospital's position. This is not necessarily a negative thing because it is clear that delivery of trauma care is better done in a concentrated area. Even though the hospital may look at this in a business aspect it is also clear that in parallel it is better for the patient. A patient with local trauma who goes to a smaller hospital where there is not an organized team like we have here is going to fare much worse. So again, that leads to the concepts of subspecialization so there is no question if you are in a neighboring county and you have a bad car wreck your mortality and morbidity will be less if you are in a Level I trauma center such as ours and there are no Level I trauma centers near here. As a matter of fact, Chapel Hill recently lost their Level I designation due to not being up to muster. Wake Forest, I think, even temporarily lost theirs, lost their accreditation. So, you have to prove yourself to keep this.

In conjunction with developing a trauma center there are particular difficulties that our center faces in that we don't have an orthopedic residency here. The trauma service is mainly manned by the general surgery staff and the general surgery staff does have a cadre of residents who do the lion's share of the day to day work in taking care of these patients.

In the orthopedic service we do not have residents. They are all private practitioner orthopedists who did not elect to be part of an orthopedic trauma service. Most of us were general orthopedists but we acquired a great deal of expertise just taking care of all the trauma that is here now. It is not without challenges. A typical orthopedist career when you are young and in residency in maybe your first five to ten years getting up in the morning and operating all night and coming in the next day to run your regular practice is acceptable. But as the careers age in our practice the older physicians find that more and more difficult to be constantly ready in coming in at any time and dealing with trauma.

Our challenge, as its unlikely we are going to have an orthopedic residency here for national reasons, is to provide the level of service that the patients need in a Level I Trauma Center without the support of residents so we have done this a lot through our private orthopedic practice in hiring physician assistants at our corporate expense as well as specialized orthopedic techs who help us in our service. So, we have four or five full time employees that we have in the hospital helping us to respond not to just trauma but to other things. The hospital has not until now been able to provide for us so they perform the functions of what an orthopedic residency program would do. A residency program is typically funded by the hospital and most Level I trauma centers have orthopedic residency programs so we are one of the relative few that have this high volume of trauma without having the service of fifteen to twenty orthopedic residents.

Ruth Moskop: That is quite a challenge to work on.

Lamont Wooten: So, it is not without discussion as we have been discussing it over the last five or six years about how best to do this. The hospital has taken a lot of responsibility in this in that they hired a number of general surgeons recently who fortified the general surgery portion of the trauma service and who are pretty much the leaders of the trauma service and do a lot of the work. As of yet we have not had that same type of support for the orthopedic area and probably one in three or one in two of the trauma patients that come in have orthopedic problems that we are intimately involved in. That is a challenge and we are having regular meetings with the hospital administration, with the trauma service and general service in how best to fulfill that need that the hospital has decided should be served here for all the trauma victims in eastern North Carolina.

Ruth Moskop: I hope it evolves and is well resolved, as it is important.

Lamont Wooten: People with bone fractures, we can usually operate on them within twenty-four hours and stabilize them, the fixation of their fractures and, of course, the open end is that we do that right then, other procedures we try to do within twenty-four hours. As long as the patient is stable enough to do it we have been able to provide orthopedic surgery manpower to get the job done.

Ruth Moskop: That's when it helps to have a group practice, isn't it?

Lamont Wooten: Oh yes. We don't actually have sixteen, I wish we had sixteen. There are twelve as actually several people just retired and it is difficult to slow down in this type of practice. We so far had to make all the orthopedists take call as if we let several of them not take it the remaining group is too small to cover it. We are sort of in a position where you work hard and then you quit. It is difficult to taper off but we are trying to change things where somebody later in their career can slow down and not have to bear the brunt of a Level I trauma call.

Ruth Moskop: How do you recruit people now? You say you have two people retired and it sounds like you have a gap to fill.

Lamont Wooten: Yes, it is somewhat difficult, as there are a lot of impediments. Greenville is a nice town and you could have an orthopedist who would love to practice here but their wife may not think that this town has enough going to keep them interested as compared to Atlanta or the North or some others. So, one, if you find somebody who is local that is a big help. It is interesting that in our original practice, our practice recently merged, most of our physicians were local. Not only were they local but their parents were physicians in Greenville. Going back in our original practice of Eastern Orthopedics, it was started by my father, his father was a physician here, and then Sellers Crisp, his father was a family practitioner here in town, Ed Bartlett's father, Steve Bartlett was a surgeon here in town, Tally Lassiter's father was a physician in little Washington which is close enough to keep you here and, of course myself. Deeana Boyette, her uncle was a physician in Belhaven. Most of the people in our practice not only have local ties but also had physician parents. Recruitment is sometimes difficult but once the people come here they generally don't leave. The history of orthopedics in Greenville is there has only been one physician who left and he left to go to San Diego to do just wrist surgery. He could not sustain a practice in just wrist surgery in Greenville but contrast that to say the school of medicine where the physicians are pretty much constantly coming and going all the time. We have had a very stable group of orthopedists.

Ruth Moskop: I know that helps you.

Lamont Wooten: Yes, once you get them here they generally stay as they realize it is a nice place to work.

Ruth Moskop: Lamont, you are kind of in the middle of your career, going strong and lots to come, but can you think of any particular experiences you have had in the practice of medicine that have been very rewarding to you emotionally?

Lamont Wooten: Certainly probably the trauma patients you see, particularly younger trauma patients who have much more percentage of their life ahead of them. They are twelve-year-olds or sixteen-year-olds that come in gravely damaged, near death, with multiple fractures and to see them recover. I had one about eight years ago go temporarily paralyzed with a bad spine fracture and ruptured spleen and she was I about sixteen at the time. They fixed her back, took out her spleen and she recovered and just recently, well actually four years ago, saw her and she was a nurse up on the trauma unit. I think they were driving a car fast as a kid and very reckless but through her experience at the hospital I think it had some influence on her chosen career to go into nursing and then subsequent to that she is just about to finish nurse anesthesia school. I am in the operating room where she at one time was on the table and we were working on her and now she is at the head of the table putting other folks to sleep. To make the transition from being on the table to being at the head of the table was interesting and rewarding.

Ruth Moskop: Your dad told us the story about the skull, now what challenges have you seen so far?

Lamont Wooten: Well, parallel to that there was a time here where we didn't have any practicing plastic surgeons even during my career. We had gaps in our coverage for plastic surgeons. So as far as doing things that you normally don't do, in times of necessity I had a lady who I get a postcard every Christmas from now who I think is over in Rocky Mount. She was walking down the sidewalk and a car jumped over the curb and ran over her and she had terrible open fractures with major muscle and skin loss to both legs, which is not that uncommon but now a days we pretty much fix the bones and the plastic surgeon will do the muscles and grafts but we didn't have one at the time so I did all her skin grafts which were very extensive and she went back and became employed after that and she sends me a Christmas card every year and she is still walking. That is something that now days we would have a consultant do that.

Ruth Moskop: Do you frequently look for consultants from outside of Greenville or do you ever send people elsewhere? How does that work?

Lamont Wooten: Well, when I first got here the bad pelvic and asatabular fractures we saw as a result of car accidents we used to send to a fellow in Chapel Hill but we were seeing so many of them here as being a concentrated trauma area that actually I went off with one of my partners and studied with a fellow who is now deceased who was sort of the father of modern asatabular surgery and came back and began doing those type of surgeries here so there is very little that we send out. The only thing in orthopedics that we really send out is still primary orthopedic tumors. They are so uncommon as opposed to lung cancers and such that for any one person to gain any experience he has to cover pretty much a statewide area so we don't have an orthopedic oncology surgeon here. Those cases are so rare they still need to be concentrated in various areas.

Ruth Moskop: Where do you send those?

Lamont Wooten: It used to be there was only one around, Dr. Harrelson up in Durham at Duke. He is actually almost retired and he has a junior partner there who is doing it. Now there is one in Wake Forest and there is one in Chapel Hill. There are actually three in the state which means each of them get one-third of the experience that Dr. Harrelson used to get so it is not as concentrated as it used to be.

Ruth Moskop: Thank you so much. Is there anything either one of you would like to contribute at this point? Anything that sparks your memory? Thank you both very much. I hope we will have the opportunity to do it again.