Adventures in Practice
Cover Stories
Written by William H. Koch, D.C.   
Friday, 27 January 2006 00:50 Read : 1190 times

W
e have all grown up with the dramas of medical practice, depicted in popular TV programs.  There was Dr. Ben Casey doing brain surgery, and also the fatherly Marcus Welby, M.D., who practiced medicine in a small town, providing each patient with a level of patience, competence and benevolence that everyone would love to have from their doctor.  Who can forget Mash and the battlefield surgical expertise of Dr. Hawkeye Pierce and his team of medical mavericks?  Today we have E.R. and Strong Medicine, as well as medical reality shows in which we can, on any give day, watch actual surgeries ranging from face-lifts to knee replacements and everything in between. The public loves it and it sells well.

Chiropractic may not have the dramatic appeal of the emergency room or the operating theater.  We don’t normally have to deal with blood gushing from severed arteries, nor do we have to run through our offices yelling, “STAT! STAT!” and issuing frantic orders to the staff.  Nevertheless, the practice of chiropractic can, and should be, a grand adventure.

Adventure, comes in many forms.  It is overcoming adversity, solving difficult problems.  It is the excitement and joy of being able to help people when all others have failed.  Life in a chiropractic office might not make for a popular TV program, but it is anything but boring, if you do it right.

For thirty years, I practiced in the tiny village of Water Mill, right in the center of The Hamptons on the eastern end of Long Island, New York.  My patients spanned the whole socioeconomic spectrum, ranging from farmers and fisherman to movie stars and Fortune 500 CEO’s; from star athletes and other celebrities, to the people who cleaned their houses and manicured their lawns and gardens. It was a challenging, fun and exciting practice.

I lived on Shelter Island, a quaint, picturesque little island between the North and South Forks of Eastern Long Island.  The only way to get to my office in Water Mill was by ferryboat.  For years, patients on the island had suggested that I open an office there.  I did, in 1985–but it was not an ordinary office. It was “The Coastal Chiropractor,” a chiropractic office built into a new 44-foot trawler yacht.  She was a big hit.  During the years 1985 to 1989, from May through October, I had office hours aboard her every Monday and Wednesday.  She was berthed at the Dering Harbor Marina.  Deck chairs on the dock served as the waiting room.  It was great fun during the warm months but, in the fall when the days grew shorter and the northers started blowing in, we would have to give it up until the next spring.  The Coastal Chiropractor would have to go to the boatyard to be hauled out for the winter months.

In 1989, I decided to take The CC (as I called The Coastal Chiropractor) south.  It was during that cruise along the Intra Coastal Waterway that I had one of the most remarkable experiences of my career.

I was steaming down the Chesapeake Bay, trying to outrun a storm that was closing in fast from the north.  The weather was already deteriorating by the late afternoon. I had planned to pull into the harbor at Smith Island to ride out the storm but, when I got there, I suddenly had the impulse to go to Tangier Island, about an hour farther south.

Tangier is a small low lying island, the home of a hundred or so fisherman and their families who make their living catching the Chesapeake Bay Blueclaw crabs.  When I entered the harbor, I found there was no marina for pleasure boats. I asked a fisherman who was working on his boat where I might tie up for the night. He directed me to a nearby dock.

I had just finished tying the last dockline when the owner of the dock came up on a motor scooter, riding through high water that threatened to drown the little bike’s motor.  The tide was higher than normal, driven by the coming storm.  In an obvious panic, he asked me if I was a doctor.  I said that I was a Doctor of Chiropractic. He quickly explained that his 15-month-old granddaughter was dying of a seizure.  He went on to tell me that they were waiting for a helicopter to come from the mainland to take her to the hospital in Cristfield, Maryland.

“She’s fading fast. She’ll be gone before he gets here if somebody doesn’t do something,” he said.

I agreed to see if there was anything I could do to help, at the same time explaining that this sort of critical care was not my field of expertise.

“Just do what you can, is all I ask,” he said, “or she’s a goner.”

So, off we went, two big men riding on a little motor scooter, leaving a wake like a speedboat.

Soon, we arrived at the gravel clearing that served as the island’s airstrip.  Here, there was an old ambulance surrounded by most of the residents of Tangier, all obviously very upset. Many of the women were crying.  The old man announced to the crowd, “ This here doctor just come in on a yacht.  He’s gonna look at her.”

I was quickly escorted into the old rusted ambulance.  In it were the child, her mother, the mother’s sister (who was a registered nurse), and the pastor of the church.

The condition of the little girl was truly alarming.  She was convulsing violently.  Her eyes were widely dilated and fixated, giving the appearance of big black marbles.  Her chest and abdomen were heaving as she gasped for breath. Most alarmingly, she was severely cyanotic.

My initial impression was that she was extremely large for a 15-month-old. I was even more amazed by the very large size of her head.  When I placed my fingers on her neck to check her upper cervicals, I found her axis so extremely subluxated to the right that it seemed it might poke through the skin.

As I examined her, I questioned the mother and aunt about the circumstances leading up to the seizure. I was told that she had begun having seizures within weeks of her birth.  She had been tested and retested many times, most recently just the previous week. Four thousand dollars’ worth of tests were all inconclusive. The doctors didn’t know what was wrong with her, and the drugs the neurologists had prescribed were ineffective in controlling the seizures.

The family went on to tell me that, earlier in the day, she had fallen and the seizure began shortly thereafter.  Never before had she had one so severe or violent.

I gave them my evaluation of her condition.  I told them that I found the child’s upper cervical spine to be severely misaligned, and that I suspected that, due to her size—particularly her large head—her birth had probably been quite traumatic.  I explained that the birth trauma had probably injured her cervical spine, causing pressure on her brainstem, which resulted in the seizures.

“YES!!” the child’s aunt/nurse exclaimed.  “I’ve said that from the beginning. I was there for the birth. I think you are right. I even told the doctors what I thought, but they said that the hard birth couldn’t have caused the seizures.”

“OK,” I said, “I might be able to make an adjustment on her neck to reduce the pressure on the brainstem, but I can’t promise anything. She might die anyway.” There was no sugar coating this situation. It was, indeed, dire. This was no time to mince words. Naturally, I wanted their assurance that I wouldn’t be held responsible should the child pass away. 

In unison, the mom and aunt said, “Go for it!  It’s our only hope.”

I said a silent prayer.  “God help me and her.”  I then set up and adjusted the offending axis.  That release sounded like a shot from a .44 magnum.  Suddenly, the child went from violent convulsions to very, very quiet. 

My heart almost stopped.  Soon her marble-like eyes began to move.  Normal breathing resumed and she murmured a weak, “Mama.”

It was only then, after my own breathing resumed, that I realized every nose on the island was pressed against the windows of the ambulance.  A short time later the small helicopter arrived.  The pilot, attired in helmet and flight suit, ran to the ambulance.

“What should we do?” the mom asked.

“You go ahead and have her checked out at the hospital,” I advised. “ Let them examine her and tell them what happened here today.”

We exited the ambulance to the cheers of the audience.  With rubbery knees, I accompanied the family to the helicopter.  Only the mother and child could fit in the small cockpit with the pilot.

Suddenly, the grandfather reappeared. “You did it, Doc,” he said. “I ain’t never seen anything like that before.”

“Neither have I,” I replied, still stunned by the entire episode.

“Come on, I’ll take you back to your boat.” He gestured to his motor scooter.

When we got back to the dock, the wind was blowing a gale, and the tide was even higher than before.  Soon the old man’s son, the child’s father, arrived with a big Samoyed dog.  “We’re gonna take my boat over to Cristfield,” he said. “I want to see what they have to say.”

His big 42-foot Chesapeake deadrise skiff was tied on the other side of the dock from The Coastal Chiropractor.  Soon, the grateful grandfather fired up the big turbo-charged 892 Detroit diesel, let go the dock lines and roared off into the teeth of the storm. “I’ll stop by and see you when we get back,” he said to me.

Shortly after midnight, I heard the distinctive sound of the big diesel coming into the harbor at full speed. He cut a sharp right turn in front of the CC and slid into his slip, stopping the big boat with a quick blast of reverse throttle as his son lassoed the dock pilings like a rodeo cowboy, and the big dog jumped onto the dock.

“They couldn’t find a darned thing wrong with her, just like before; but we know, don’t we, Doc?” he said, giving me a wink as he turned to leave the dock. “I’ll see you in the morning.”

The storm raged on for another day, so I gave myself a day off, spending it visiting with the good folks of Tangier Island .The next day, when I announced that I had to get going, the grandfather said, “I don’t advise it; the bay is still mighty rough.” Several other fishermen nodded in agreement. I explained that I was already behind schedule, because the weather had been bad since my second day out of Shelter Island.  Now I had only a few days to get to Hilton Head, South Carolina. So, off I went into a very rough Chesapeake Bay, heading the CC south, chased by a 10-12 foot following sea.

The message I hope that this story conveys, especially to younger chiropractors, is this:  Listen to your instincts; they are there to help you and your patients. Never underestimate the power of the vertebral subluxation to cause serious, even life threatening health problems.  Likewise, never underestimate the power of the right chiropractic adjustment, delivered in the right place and at the right time. The emphasis being on the right chiropractic adjustment, not just any old snap, crackle or pop. The subluxation is a very specific entity, the correction of which requires equally specific adjustment.

We chiropractors are privileged, more than any other kind of doctor, to work directly with the healing powers of the body. At the same time, we must have ultimate respect for the delicate balance of the neurological and structural components that affect the body’s ability to heal. Chiropractic is very much like the profession of diamond cutting.  The best results are obtained when applied with precision.

The Adventure Continues

The rest of the cruise down the Intra Coastal Waterway was pleasant and uneventful.  Thanks to my cell phone, I was able to continue the radio program I normally did from my office every Monday, Wednesday and Friday morning. It was really fun to share the trip with my regular listeners—to tell them about the vast unspoiled wilderness areas, the variety of wildlife along the way, alligators in the Carolinas, wild horses on the Sea Islands of Georgia, the frequent escort of dolphins playing in the bow wave of the CC, and manatees and more gators in Florida. It’s always nice to travel in good company!

When I left Shelter Island, my idea was to cross the Gulf Stream from Palm Beach, Florida, to The Bahamas, using those islands as a jumping off point to the deep Caribbean and, ultimately, to Central and South America.  It is only about 60 miles as the crow flies from the Palm Beach inlet to the Little Bahamas Bank but, in many ways, it is another world. You go from the cosmopolitan world of first class shopping malls, mansions, Mercedes, crowded highways and waterways, to crystal waters, pristine coral reefs, blue unpolluted skies and powdery, white sand beaches.

Abaco is the northernmost region of the island nation of The Bahamas. It includes Great Abaco Island and many smaller outlying cays (little islands), some with small settlements, others uninhabited.  About 24 hours’ sailing time after leaving Palm Beach, I arrived at my destination, Man ’O War Cay. I had to fly home for a while, and had made arrangements to leave The Coastal Chiropractor at Edwin’s Boatyard until I could return to continue cruising south.  At least, that was the original plan.

Within moments of arriving at the dock at Edwin’s Boatyard, an enthusiastic islander named Andy Albury pulled up in a Boston Whaler.  “The Coastal Chiropractor!”  he exclaimed. “Are you really a chiropractor?”

When I said, “I am,” he asked, “When can I come see you for an adjustment?”

The word spread quickly. “A chiropractor done reached Abaco.”  That was the beginning of my practice in The Bahamas. It was January of 1990.

My plan was to return every three or four months to continue cruising south.  Although I did get a bit further south, I didn’t get into the deep Caribbean or South America.  I was always drawn back to Abaco, by both the beauty of its waters and by its people.  Each time I returned, I was greeted warmly and with shy requests for help for a wide variety of health problems.  I was amazed by the awareness these people had of chiropractic, and by the number of them who made trips to Florida just to see chiropractors.

Each time I returned, it seems my reputation had spread and more and more people sought my services.  So many, in fact, that I became concerned about the legality of what was becoming a part-time practice.

I arranged a meeting with two heads of government, the Commissioner of Abaco and the regional Member of Parliament.  Both were very supportive of my serving the people of their islands and, in turn, referred me to the Ministry of Health with a request for a work permit and license to practice.

Nearly a year later, I received a very cordial letter on government stationary, thanking me for my request, but stating that, regretfully, no such permission or license could be granted, because chiropractic was not licensed in The Bahamas.

Throughout the years I made numerous requests for permission to practice. At one point, the Member of Parliament hand carried a personal letter from me to the Prime Minister and, with it, a presentation about chiropractic, complete with video. Again, I was politely told that my request could not be granted. This put me between a rock and a hard place. Each time I returned to Abaco, more and more people wanted to visit The Coastal Chiropractor. Yet the Government denied me permission to practice.

I continued to visit Abaco several times a year, enjoying cruising the beautiful warm turquoise waters, fine white sand beaches, clean air and blue skies. And the patients continued to come, eagerly seeking me out whenever I was there. It didn’t make any difference where I was, whether at a marina or anchored out in the lee of a remote cay trying to be invisible. They would find me, and were willing to get into a boat and come to wherever I was. They never wanted to impose on me, were always considerate and appreciative. And how could I object? How could I turn them away? The fact is, if people are really hurting and are willing to go out of their way to come to wherever I am, I cannot turn them away, and I never find it an imposition to take care of them. It is, in fact, an honor. With each visit to Abaco, I felt a greater affinity for the place and its people, and looked forward to my return.

The Final Adventure?

Back in New York, in June of 1996, while making a relatively easy adjustment on a 120-pound woman, an incredible pain jolted me in my own back.  It actually brought me to my knees.  I knew something serious had happened, so I set myself up in front of the X-ray machine and had my receptionist make the exposure. When I read that film, what I saw almost made me sick to my stomach.  There were compression fractures and facet damage of my T-7,8,9 vertebrae.  The years of high volume practice and ignoring my own telltale pain had caught up with me.  I really wasn’t ten feet tall and bulletproof, as I had thought.

Barely able to stand, I had my receptionist drive me to the office of my own chiropractor, Dr. Brian Barrett. We reviewed my X-ray together and he very carefully adjusted my cervical area and what he could in the areas adjacent to the damaged vertebrae. I then went to the emergency room to see my old friend and patient Dr. Paul Andrews, who gave me a prescription for Percodan.  I took the rest of the day off and returned to work the next day.  Though not what I would have advised one of my patients to do, I worked through that summer with the help of the Percodan, but with so much pain that I only got 2 or 3 hours of sleep each night. I also began the search for a young chiropractor to take over my practice. In April of 1998, I turned my practice over to Dr. Robert Merrihew and, like it or not, I became a retiree.

I was, however, a dismal failure as a retired chiropractor.  I missed my practice and patients terribly.  Even though I was spending time in The Bahamas, The Hamptons, and Palm Springs, California, I was very unhappy, and in pain physically and emotionally.

On one of my visits to Abaco, I was talking to one of the local medical doctors. I told her how much I missed practice. Her reply really surprised me. She said, “Why don’t you work part-time with me?”

I was delighted by the idea, but expressed concern as to how we could do this, after my many failed attempts to get licensed in The Bahamas. 

She said they had recently passed a new chiropractic licensing law and were in the process of creating the Regulating Board.  She said that, at first, I would have to work from an established healthcare facility, and offered to sponsor me for a work permit.

This was the beginning of a new chapter in my life and career—the one in which I would become “The Out-Island Chiropractor.”

To be continued...

Dr. William H. Koch grew up in the old whaling village of Sag Harbor on the eastern end of Long Island, New York. He is a 1967 Cum Laude graduate of Palmer College of Chiropractic. He earned certification in Spinal Biomechanical Engineering from The Pettibon Biomechanics Institute in 1977, and conducted post graduate seminars in the Pettibon proceedures.

Dr. Koch began practice in The Hamptons in 1967 and later added an office aboard the motor yacht The Costal Chiropractor on Shelter Island,N.Y.

He is the author of the book Chiropractic, the Superior Alternative. For 18 years, he hosted a daily radio program, For the Health of It.

Dr. Koch and his wife Kiana currently live in Abaco, Bahamas, where he practices as “The Out Island Chiropractor.” You may contact Dr. Koch at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


 
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