Dr. Todd

From the editors

A small-town West Virginia doctor on what the exam room misses

Smith was born in 1966 and raised in southern West Virginia, where at sixteen he cared more about a paycheck than medical school. His memoir follows him from those mountains into practice, through the loss of a patient, and toward a different kind of medicine. An oil painter, he frames his life as a canvas that only makes sense when you step back.

The strongest pages are the most personal. When his young daughter Kate is badly hurt, he calls a trusted surgeon late at night, then waits outside the operating room. 'There was nothing left for me to diagnose,' he writes, and the short, quiet paragraphs suit the wait.

For patients, caregivers and health workers who want a doctor's candid view from small-town Appalachia.

Perfect for: Healthcare workers and caregivers · Appalachian life stories · Parents who've sat in waiting rooms

What’s inside

1. The Making of a Physician — A blank canvas, hesitant lines, and uncertain brushstrokes begin the story.
2. Becoming a Physician — A card appears quietly on a kitchen counter, marking a beginning.
3. Building More Than a Medical Practice — Returning to practice feels like brush touching canvas, with no turning back.
4. When Medicine Had No Answer — Symptoms, exams, scans, and consultations sharpen illness into something recognizable.
5. What I Could Not See in the Examination Room — Some truths in medicine lie beyond blood pressure, labs, and X-rays.
6. When Success Became Too Heavy — Success grows heavier as the image changes in unexpected ways.
7. Fatherhood — Fatherhood changes the artist’s careful brushstrokes and imagined picture.
8. Finding Balance — Balance means more than working harder when the office grows busier.
9. The Official Turning Point — Ordinary mornings can conceal an official turning point by evening.
10. The Question That Would Not Go Away — Visible recovery can hide unanswered questions beneath the surface.
11. The Weight of Assumption — A mistake leads to a lesson about what was missed.
12. The Eve of Catastrophic Change — A familiar day at Blue Ridge Internal Medicine changes without warning.
13. For Harold — Medicine cannot always stop what is coming, despite knowledge and work.
14. The Cost — The morning after Harold died brings a heaviness unlike before.
15. The Hardest Decision — A quiet evening becomes the setting for a difficult decision.
16. A Different Kind of Practice — The same patients, rooms, and stethoscope mark a different practice.
17. Our Segue — Stories that refuse to leave eventually find their way into writing.
18. Planting Seeds: The Providers — Quiet examination rooms become the place to plant seeds of change.
19. A Conversation with Insurance — Insurance delays treatments patients and doctors believe they need.
20. A Discussion for Hospitals — A hospital wakes before dawn, already busy inside while streets stay dark.
21. A Seat at the Table — A large conference room becomes the imagined place for change.
22. Beyond Politics — Asked what the system should look like, he answers with morality.
23. The Final Brushstroke — Life unfolds in moments, and the final brushstroke reshapes everything.

Read the opening

This book belongs to you, because you gave it its form and its purpose. Since the day you were born, you have been the center of your mother’s world and mine—and you always will be. Your dedication, your strength, and your perseverance have made you not only a remarkable student and a champion equestrian, but something you may not realize: my mentor. In the most difficult of times, you have been the voice of reason that carried your father through, and for that I will always be grateful. Nothing here takes away from your mother, our family, or my patients—every one of them helped make me the Dr. Todd I am today. But everyone who reads these pages will understand: Kate is the focus, and Kate is the purpose. Kate, your daddy loves you, and he always will.

5 What I Could Not See in the Examination Room

The sample pages on this site continue the opening — and the full book is available in print.

About the author

Todd A. Smith, DO

Dr. Todd has practiced internal medicine in southern West Virginia since 2000, caring for generations of families in the Appalachian community that raised him. A graduate of the West Virginia School of Osteopathic Medicine, he built Blue Ridge Internal Medicine from a single examination room into a practice that served his hometown for more than two decades. Along the way he has been a grocery clerk, a pilot, an oil painter, and above all a husband and father.