Happy Trails, Raymond Smoker.
"I don't believe in retiring and don't think other people should, too. We're supposed to keep going as long as we can." – Raymond Smoker, August 31, 2012
Jay Paul Maddox, MD, looks off into the distance as he remembers Raymond.
"He was a simple man who made a huge impact on people – more by example than words. He was the kindest, sweetest man who gave me more than I ever gave him."
The stories we tell about others are very often the most revealing about ourselves.
Raymond Smoker was an 87-year-old Mennonite from Pennsylvania who first crossed paths with Dr. Maddox probably 20 years ago. A lifelong bachelor, Raymond left the cold weather of the north in the 1980s to join his sisters in Florida.
He had a small farm near Chipley, which he operated with minimum mechanization. Using huge draft horses, Raymond sustained himself and his animals – critters, he called them – using the agricultural methods of the past. With his rusty equipment, Raymond cultivated, planted and harvested with the most natural of horse powers.
His friendship with Dr. Maddox was reinforced by a mutual interest. Dr. Maddox, who lives on an approximately 330-acre farm with his wife, Linda, was interested in Raymond's methods and wanted to incorporate them on his farm.
Then there came a time when Raymond moved to the Maddox farm.
"A year ago in June, I had a fall and got a pelvic fracture. Doc found me at Southeast Alabama Medical Center," Raymond said last August.
Raymond was, in fact, patching his roof when he fell and at his age, Dr. Maddox didn't think it wise for Raymond to continue living as self-sufficiently as he had. Raymond sold his small farm and brought his horses and horse-drawn equipment to the Maddox Farm near Wicksburg.
"I thought we would be that place where he took care of horses. I never dreamed he would live here," said Dr. Maddox.
As Raymond recuperated, he was uncomfortable sharing quarters in the big house with the Maddoxes. He soon found a place in a renovated area of the barn in the far stables where he was close to the horses and the life he loved.
Raymond lived there and worked on the farm for the last year-and-a-half of his life until a freak horse accident took him home on September 14, 2012.
The day of the accident, Raymond was helping get a team of horses ready for a wedding at a nearby farm. Dr. Maddox was to join him an hour later. But one of the horses reared up, pushing Raymond backward. He struck his head and never regained consciousness.
Dr. Maddox expresses deep sadness over the loss of his friend and teacher. This 5-foot, 100-pound peaceful soul with bushy black eyebrows and a 3-inch beard, who went barefoot more often than he wore shoes, wearing a thin cotton shirt, blue jeans, a weathered straw hat and black suspenders, had made a lasting impression on the physician.
Such a man, who could remember the names, offspring and peculiarities of every horse he'd ever owned, indeed made an impression on a skilled and educated orthopaedic surgeon whose career spans 32 years and is a partner in the largest orthopaedic practice in the region, Southern Bone & Joint Specialists.
"He had the values of simple living. He had an amazing commitment to God, a little boy's heart and a reverence for the land," Dr. Maddox said.
Raymond was also a good judge of character.
He recognized the generosity extended by Dr. Maddox and Linda, who seven years ago began opening up their farm for a trail ride benefitting the Alabama Baptist Children's Homes and Family Ministries. The Maddoxes provide the venue for the annual spring event and spend time preparing the trails. This past year the ride attracted about 1,500 people and raised thousands of dollars for the Children's Home.
It never surprised Raymond, who enjoyed being a part of the activities. "Doc helps others. Life has some quite hard knocks at times. Some people can't see their way through adversity," he said.
Dr. Maddox and Linda were each motivated to do the trail ride by separate events in their lives. When he was about eight years old, Dr. Maddox's neighbor opened his small farm up to him and his little brother, who are the sons of a Baptist minister.
"It changed my whole world," Dr. Maddox said. "We could go to the woods and explore. The things you get to do on a farm! It had a huge impact on us. Our heart has been to let other kids use the farm like that."
When the Maddoxes' four children were growing up, the farm was always open for fellowship and friends, a little guitar picking and sing-alongs. For about 10 years, teenagers from around the Wiregrass met in the barn every Thursday for a student-led Bible study.
For Linda, the childhood memories were not so sweet.
Said Raymond: "Mrs. Maddox's mother died when she was nine. She had the rest (three younger brothers and a sister) to care for. They had nothing in their cupboards. The state came in and took them away. She and her brother were adopted so she has a heart for these children."
A year after entering the Oklahoma Baptist Children's Home with one brother, the two were adopted by a Baptist minister and his wife. Linda learned what love is and that there is a God who is also loving.
She describes the orphanage as a large compound where she never saw her brother. Then came the painful visits.
"When young couples came in to adopt, they lined us all up against the wall to see if they liked us," she recalls.
It was a study in rejection. Older children rarely get adopted because most adoptees want younger children.
"I realized each child who comes here to the farm is precious. This is such a little thing for us to do, to help raise money for something like this. I feel for every child and what they are going through," she said.
Perhaps this is also why Linda takes in the undesirable and rejected wounded, sick or aggressive dogs from Save-A-Pet, rehabilitates them and helps find them a home. She now has about 35 dogs in specially built pens. Dr. Maddox said his wife has easily placed 100 to 150 dogs.
"We've picked up a lot of people over the years," Linda said, including Hurricane Opal and Katrina victims, a man they found sweeping up at a gas station, a family with four children and others.
Linda said she and her husband believe in giving back. "The things we have don't belong to us anyway. They belong to God. But I believe the more you have, the more you should give."
Dr. Maddox puts in a lot of hours and has a lot of long days on the farm. Throughout his life, it was evident that Raymond valued and loved work as well. Raymond proudly stated that "Doc rolls up his sleeves too and is not a bit scared of work."
"To him work was honorable. He valued that in people and in horses," Dr. Maddox said.
As Dr. Maddox recounts memories of Raymond hitching up a plow behind powerful Percherons and Clydesdales. He tells the story of his sifting through a cardboard box of photographs dating back to the 1940s. Raymond pulled out a blurry picture of a horse and delivered the history of the animal from temperament to foals. Then he picked up another picture and another, each time telling the life story of the photographed horse.
Many stories later, Dr. Maddox passed the box of memories back to Raymond.
"You keep them," Raymond said.
"I couldn't believe he would give me those photographs but he insisted," Dr. Maddox said. "I realized he was giving us his life in pictures. I asked him why and he said, 'So you can tell people.'"
Raymond's decades-old farming practices have been embraced on the Maddox Farm and are evident in fields, fences and gardens. These visible signs are part of this devout Mennonite man's legacy. His photographs and memorabilia will also be preserved in a museum to be established at the farm. In addition, the annual trail ride will be renamed in honor of Raymond.
Southern Bone & Joint Specialists
Twenty skilled physicians provide complete orthopaedic care in sports medicine, trauma, total joint replacement of the hip, knee and shoulder; spinal surgery; hand and finger surgery including treatment for carpal tunnel syndrome; and foot and ankle disorders. At Southern Bone & Joint, the specialty trained physicians are devoted to treating the entire musculoskeletal system including bones, joints, ligaments, muscles and nerves.
For an appointment, please call the office at 1500 Ross Clark Circle at 334-793-2663. SB&J is open Monday through Friday from 7:30 a.m. to 5 p.m.
The Family Connection
Some men and women have a hereditary tendency toward developing various types of cancer due to a genetic mutation.
Given five generations of family history, Jean Stokes of Ozark, clearly was at risk for breast cancer with multiple family members who tested positive for a genetic mutation in genes BRCA 1 and 2 (breast cancer type 1 and type 2).
Jean's mother, grandmother and uncle all developed breast cancer.
At age 73, Jean was diagnosed with breast cancer. Because of the strong family history, her radiation oncologist, Steve Stokes, MD, of Southeast Cancer Center, ordered genetic testing. She tested positive for Hereditary Breast and Ovarian Cancer Syndrome.
Since then, several other family members have also tested positive, including a son, a granddaughter and her first cousin's daughter.
Mutation of good DNA-repairing genes that suppress tumors is a strong indicator of heredity breast and ovarian cancer. The risk of developing breast, ovarian and prostate cancer is greatly increased through inheritance of this mutation. That's the reason Dr. Stokes says families must share the information.
"It's pretty rare to see this many in one family," he said. "I am thinking Jean's grandmother must have been positive as well. They just didn't know."
Though she has always had annual mammograms, Jean said she could have been more proactive. "Nothing has been uncared for. With all this cancer, I didn't connect the dots at all. I just had my regular appointments. If I had the test run and had learned earlier that my risks were higher, I would not have waited a whole year for a mammogram."
In fact, this genetic predisposition was not known by the family until after Jean had surgery, chemotherapy and radiation for cancer in her right breast in 2007.
"My cousin in Atlanta who had cancer has a daughter married to a surgeon. He wanted my cousin tested. She was positive and she passed the mutated gene to her oldest daughter, who also had a mastectomy," she said.
Having her cousin's medical records in hand, Jean was tested. After a positive read, she took her records to her children and grandchildren.
"Having my cousin's paperwork was sufficient for me to go have it done and my paperwork was enough for other family members to have it done. My oldest son is the worrier so he was tested. He is positive. His oldest daughter went to Birmingham a little over a year ago. She was positive and had a double mastectomy and reconstruction.
"My grandmother passed it to my mother, who passed it to me. I passed it to my son, who passed it to his daughter. Dr. Stokes was amazed – there are so many of us with the abnormal mutation."
Jean is overcome with emotion talking about this family legacy.
"I look at them and worry. It's a hard, hard feeling to think that you are the carrier, that you handed that down," she said. "They try not to make me feel that way. I couldn't help it and my mother never knew she had the mutation. I got it from her, but she never knew that.
"Getting tested has made me feel better though, knowing it could save their lives in the long run. They are now aware of it. We have all done really, really well."
Today there is no sign of cancer in Jean. She has taken the drug Arimidex for nearly five years and has a breast MRI and mammogram every six months.
"I take extra precautions. There are several doctors who examine me. I see them all twice a year. There are only two or three months a year when I am not examined," she said.
Jean said she has had enormous support from family and friends, especially the congregation at Ozark Baptist Church and her Agape Sunday school class. Her middle son even shaved his head when his mother lost her hair during treatment.
"There was no way I was not going to be fine," she said. "I had wonderful prayer warriors. People from 10 different states were praying. I turned my cancer over to God. I couldn't do anything about it. I was totally helpless."
Every Saturday in the fall, Jean dons her Alabama wardrobe – shirt, socks, earrings, the works – and settles down with family to watch the Tide. Life as she knows it is certainly changed, but she relishes the time God has given her.
"Cancer is a mean, mean disease. You've got to always be watching out for it. I knew I was in a battle for my life. I fought and I won. No matter how hard it gets, you can beat it. And when you do, there's a new life waiting for you. You will be able to see things differently."
She finds solace in Romans 12:12: "Be joyful in hope, patient in affliction, faithful in prayer."
WHAT YOU CAN DO:
• Have regular mammograms and do self-breast checks. Get involved with Buddy Check 4 by reminding friends to perform their self-breast exam. Visit samc.org to sign up.
• Know your family history.
• If there is a strong family history, talk to your doctor about genetic testing. Through our affiliation with the UAB Cancer Care network, we offer web-based genetic counseling.
MANAGING HEREDITARY BREAST AND OVARIAN CANCER RISKS:
Many patients with the BRCA1 and 2 mutations choose to take preventative action after a positive testing, including surgery, while others limit their risk factors, increase their number of screenings and watchfully wait. You may:
• Perform monthly self-exams starting between the ages of 18 and 21.
• Have annual or semi-annual clinical breast exams starting at 25 to 35.
• Have annual mammograms beginning between the ages of 25 and 35.
• Begin annual or semi-annual ovarian cancer ultrasound and testing between the ages of 25 and 35.
• Drugs such as tamoxifen have been shown to reduce the risk of breast cancer in high risk women.
• Oral contraceptives may reduce the risk of ovarian cancer in women with BRCA 1 or 2 mutations.
• Preventive mastectomy significantly reduces the risk of breast cancer in women with the mutations.
• Preventive removal of the ovaries after child bearing significantly reduces the risk of ovarian cancer and breast cancer in women with the mutations.
Patient's Best Friend
The human-animal bond is strong. The love we receive from our pets is unconditional and the comfort incomparable.
Dogs might be man's best friend indeed. The heartbeat inside that furry chest might actually keep your heart beating, according to studies which have found that the presence of a pet might just boost the survival rate of heart patients.
Research has shown that owning a pet can reduce stress, lower blood pressure, boost mood, enhance social interaction and add years to your life. With that in mind, SAMC has launched the region's first dog therapy program featuring certified and specially trained dogs, and their handlers, who visit patients at the bedside.
Lisa Gunn, a registered nurse at SAMC, is the first pet handler to join the Pawsitive Therapy program, begun by SAMC's Volunteer Services department. Gunn works the night shift and volunteers during the day with her Labrador Retriever, Lily.
They are one of about a dozen handlers and their dogs who are participating in the program.
"The dogs are calming and generally soothing to our patients," Gunn said. "Our visits have been very positive."
The Pawsitive Therapy program helps patients express their feelings and offers comfort during a stressful experience. The dogs and their handlers receive special training customized for the hospital setting to ensure patients receive the maximum benefit from the visit.
Pawsitive Therapy began in pediatrics and has expanded to the cancer floor, neurology and behavioral health. Visits are made based on handlers' availability, but usually several dogs visit weekly.
On the day of a pet visit, nurses ask patients if they'd like a visit with a therapy dog. Just before a visit, volunteers confirm the patient is up to it. Then Lily and Gunn make their way from room to room.
A sheet is placed on the bed for patient safety and comfort. The dog is gently positioned on the bed and the petting begins. The visit usually puts a smile on patients' faces as they recall their own dogs, cats and other friends. Hand sanitizer is used before and after a pet visit.
On the pediatric unit, Lily finds a soft spot on top of the bed next to 5-year-old Jaycie Palmer of Hartford, who was being treated for a broken arm. Jaycie's mother, Ciji, said the visit helped brighten her daughter's stay in the hospital.
"She has a black cocker spaniel at home named Charlie," Ciji said. "This visit has meant a lot to her."
Animals have been used as therapy in hospitals as early as the 1700s in Europe because of their calming influence. The relaxing effect of touch is also beneficial. And, pets in behavioral health facilities are thought to give patients a useful purpose while teaching both self-control and caregiving.
It is also believed that pets contribute to longevity by providing a daily purpose, especially for seniors living alone. Pet owners often feel needed and responsible, stimulating survival instincts. That effect can also be felt at the hospital bedside.
The SAMC Foundation contributed funds for pet therapy/training, handlers' uniforms, general supplies, sending pets/trainers to community events, a brochure and community education materials. In the upcoming year, Foundation funds will be used to train more dogs through customized obedience classes.
Is your dog a patient's best friend?
To find out more about certification classes and training, contact Volunteer Services Director Jamie Weeks at 334-793-8122.