Sundown, Texas is a town not known to many people outside the Texas South Plains area and former residents of the town of about 1500 people southwest of Levelland, Texas.  I remembered the town during much of my medical career because of a house call I made with Dr. Clarice Phillips, a GP in Levelland and one of my preceptors during my senior year in medical school.

About 7 weeks into my 12 week stint in Levelland that cemented my desire to be a country GP Dr. Phillips informed me., “We’re going out to Sundown today, Elwood to see Mrs. Smithson,”

He took along his doctor’s bag and a wrapped autoclaved set of tools for our visit.  We passed by many fields of cotton and maize and a few oil wells pumping away, and reached a farmhouse just on the edge of Sundown.

We got out of the car with me carrying the instrument package and Dr. Phillips his bag.  Mrs. Smithson was sitting in a rocking chair on her porch.  She had grossly swollen feet and legs and a protuberant abdomen. 

I was introduced to Mrs. Smithson and Dr. Phillips and she chatted about the weather, the lack of rain, how the cotton and maize had fared this crop year and a bit about how she was feeling.

Dr. Phillips examined her, used her lap blanket to partially cover her, and exposed her distended abdomen to us.

“We’re going to need to drain you again, Emma.  Where’s the basin?” he asked.  “Usual place,” she said.

Dr. Phillips went into the house and came out with a large, enameled basin and placed it on the porch floor between her legs.  He unwrapped the instrument package on a chair placed near her, pulled on sterile gloves, and put some iodine-like liquid on her lower abdomen.  All the time he kept up a running conversation with Mrs. Smithson with asides to me as to the cause of her ascites (the term for the accumulation of fluid free in her abdominal cavity) and the swollen legs. He placed a little anesthetic in the skin of the lower abdomen right in the midline, took a scalpel and made a nick in the skin and then picked up the trocar (in this case a metal hollow tube about twice the circumference of a pencil), attached a piece of rubber tubing and ran it to the basin.  Then he plunged the tube into her abdomen and the fluid began to flow into the basin.

The conversation resumed and after about 20 minutes it stopped with the basin nearly full and the flow finished.  Dr. Phillips removed the trocar, put a gauze pad over the wound and some adhesive tape.

“Emma, where do you want me to put this stuff this time,” he asked.

“Oh, I think they both need some today,” she said.

Dr. Phillips took the basin to the porch railing, leaned over and poured a measure of that nutrient rich fluid into the luxuriant rose bushes on each side of the steps.

Shortly we took our leave and returned to Levelland for afternoon clinic.

In subsequent years I was in situations where it was necessary for me to perform a paracentesis (the medical term for the procedure I described above).  I always remembered that first time on the porch in Sundown, Texas, and followed the guidelines Dr. Phillips had laid out for me.

Eventually medical advances in treatment and the availability of specialty trained physicians took away the need for me to perform the procedure.

However, one day in Yuma, AZ, some 30 years and 850 miles away I was seeing a new patient in my office. During the interview I noticed his “accent” and asked him where he had been raised.

“West Texas”

“Where in West Texas”?

“A little town called Sundown”

I told him I knew where Sundown was and recounted the above story.
“I think that was my grandmother.  She always had the prettiest roses and my mother said it was because granny had a special water she put on it, but I never knew what it was.”  We discussed his age and the recollections and there is no proving that Emma Smithson (a pseudonym) was his grandmother, but it was likely true. I like to think so.