Before he was Dr. James Naramore, the 2020 Wyoming Physician of the Year was simply Jim Naramore.
As a teenager in 1960s Gillette, he played football at Campbell County High School and he went to the movies.
Like many teens, Naramore had no idea what his future held.
Vietnam was yet to come and some of the halcyon carryover from the post-World War II United States still resonated.
The country then stood in stark contrast to the one he lives in today. He grew up like many other Americans did then, and still do: young, hopeful but without aim.
Fast-forward almost five decades, a fistful of degrees, a wife, four kids and six grandchildren to the future.
In June, Naramore was named the 2020 Physician of the Year by The Wyoming Medical Society. The award is given each year to Wyoming’s top physician in recognition of the time and personal sacrifice made by the doctor for his or her community.
Young Jim Naramore would not have thought his life would play out like that.
“I honestly didn’t think I was the kind of guy that should go into medicine,” Naramore said.
The award is usually given at a yearly meeting in Jackson Hole. This year, COVID-19 eliminated that, but Naramore is still humbled by the honor just the same.
“I just represent all the other doctors,” Naramore said. “There are other doctors who are incredible, have incredible educations, have incredible skills. I like to rub shoulders with those guys, I like to talk to them.”
With his recent Physician of the Year award, he has received one of the highest honors in Wyoming medicine. It’s a lifetime achievement of sorts.
“It’s kind of like I’m a passenger in the vehicle of life,” Naramore said.
However, his journey to get there wasn’t so straight and as he puts it, the ride is far from over.
“It’s probably wrong when you think you’ve arrived,” he said.
Actually, it was an illness that set him on the path toward a career as a healer. His senior year of high school, Naramore came down with mononucleosis. His spleen and liver ballooned. The doctor he saw, Jerry Hannum, broached the idea of studying medicine.
“He said, ‘If you really want to use everything you have, all the skills, all the energy you have, you should go into medicine,” Naramore said. “Because it’s just demanding.”
His father was a prominent businessman in Gillette and a World War II veteran. Hard work and sacrifice were already familiar for Naramore growing up. Business acumen seeped into him by osmosis. When considering life after high school, he was torn between pursuing business and medicine.
One of many forks in the road
Naramore said he thought back to his conversation with Dr. Hannum, which was the seed. From there, the notion sprouted and by the time he went away to college, striving for a life in medicine was a full-blown, reasonable goal.
While he may not have always known that medicine was the route for him, he had the drive and he loved to learn, a habit that remains with him to this day.
It is not only empirical knowledge, rational facts, data and methodology that he seeks. A lot of the information he has gained he found through personal and professional experience.
As a private practitioner in Gillette since 1980, Naramore has spent a lot of time in front of patients or with his nose in a book.
Continuing education has been a steady part of his life and a testament to his ever-present curiosity. During his commute each day, he absorbs educational CDs through the speakers in his car. With his free time, he often reads.
The 10,000-hour rule popularized by author Malcolm Gladwell in his book “Outliers,” which Naramore read, suggests that expertise is developed, rather than passively acquired, through focused, guided practice — 10,000 hours of such practice.
“If it’s easy, it’s not a good way to practice,” he said. “You should be practicing in a way that you improve yourself.”
Having worked in medicine since completing his residency in the late 1970s, when it comes to practice, Naramore has had about 40 years of it. In his younger years, 80- to 90-hour work weeks were common. At that rate, he would have passed the 10,000-hour threshold in his first few years of being a doctor.
Devoting that amount of time, while worthwhile, did not always come easy.
Time has been a challenge for Naramore throughout his career. Finding time, creating it when necessary and making the most of it when he does have it has been essential to his professional growth.
“Medicine is a demanding sport,” he said.
To manage his time and avoid burning out from the never-ending workload and all-hours calls for emergencies, he learned and embraced variety.
His practice, family medicine, lends itself to that. He has patients of all ages and the array of approaches he takes whether the patient is an infant, teenager or adult keep the breadth of his medical knowledge within reach.
As a generalist, “We get to know the whole person.” he said.
“You can be a broker of information, absorb that for the patient and replay it for them so they understand what is happening,” Naramore said. “And that helps them.”
Naramore offers comprehensiveness to his patients. He has his office go out of its way to contact patients about lab work, whether it’s normal or abnormal. No lab work gets signed off on perfunctorily without analysis. The paperwork on his desk is a near-constant pile.
“It’s easy to sign your name on the chart and not do anything with it,” he said. “The hard part is to connect with people and let you know what they found and know what to do next.”
For patients, he wants them to feel a sense of closure.
“You’ve got to close the circle,” he said. “It loses meaning if you can’t do it in a meaningful way.”
That means that whatever their test result or prognosis, they are never left wondering what their next step is or what their current status may be.
“I think that’s just better medicine, when people know what’s going on and have ownership over their own health,” Naramore said.
Another wrinkle of variance to his days has been the time he spent helping those younger in the medical field or considering it.
Everyone from curious high school students to full-fledged medical residents have spent time observing, shadowing and learning from him.
“I feel like a lot of doctors and a lot of people took their time to train me,” Naramore said. “It’s part of the culture to train younger people so that they will have a passion for doing medicine and do it the right way.”
Although the old guard does its best to pass on the tradition of medicine, Naramore recognizes a change that is coming within the profession and the health care industry as a whole.
“It’s just hard work, and that’s how I’ve kind of seen it. It’s not romantic or whatever like it’s portrayed, “ he said. “It takes a lot of time and effort and listening.”
For Naramore, listening is key.
His wife may disagree, he said, but he long ago learned the importance of simply listening. Some listen but don’t hear and others hear but don’t listen. He does both, very conscientiously. But it wasn’t always like that.
As a young medical student, it was one of the lessons bestowed upon him during his early years of residency in Nebraska.
“The skill we were told we needed to learn most was to listen and to really hear what people were saying and when they came in to see us, to find out what the chief complaint was,” Naramore said. “Talk to them about it, engage them and let them know what you’re thinking.”
Even still, with all the patients he’s seen, colds he’s diagnosed, good and bad news he’s delivered in his 40 years as a private practitioner in Gillette, connecting with patients is still a central tenet of his approach.
“I don’t necessarily want to retire, I just want to slow down and do less and not hurt anybody,” he said.
Over the years, he has gradually transitioned his schedule to a more even-keel work-life balance.
No more 80-hour weeks or late night calls to deliver babies. He works close to standard office hours now, a change that came with time and may help when he further transitions into a more reduced role, or eventually retirement.
“I’m working on a succession plan,” Naramore said. “There’s a huge panel of patients here. If I just close the doors, it’s going to be a big mess.”
Even he could not have predicted his path from “Jim” to Dr. James Naramore.
The decisions made and paths taken in his past, as inconsequential as some seemed to him at the time, have led to where he is now: Wyoming Physician of the Year.
But he doesn’t consider it a destination. He’s slowing down but hasn’t stopped.
“You never arrive,” he said. “In life, you never arrive.”
There were a significant increase in pronghorn deaths in northern Campbell County this year from mycoplasma bovis, a rare disease that the population continues to battle.
Like last year, the disease started taking hold in February and then declined at the end of April. The pronghorn death count rose from 50 midway through February to more than 100 toward the end of March, according to the Wyoming Game and Fish Department.
In total, about 350 carcasses were discovered that likely died from mycoplasma bovis. But wildlife biologist Erika Peckham said the true number could be closer to 500.
Peckham commended the public for playing a big role in reporting carcasses. She and other game wardens responded to those reports, which were documented by combined efforts on the ground and with aerial flights.
“In response to these documented mortalities, we reduced pronghorn doe/fawn licenses in Hunt Area 17 by 150 this year,” Peckham said.
Last year when the first cases were found in local antelope, Game and Fish officials hoped the disease was a “one-off” and might not be seen again, said disease specialist Terry Creekmore.
But that doesn’t appear to be the case. Last year there were 75 confirmed deaths from the disease and about 25 more presumed cases, a number that has possibly risen all the way to 500.
“While mycoplasma bovis is not a new disease, mainly seen in livestock. This is a case of a pathogen jumping to a new and potentially previously unaffected species,” Creekmore said.
“This is the second year where an outbreak has occurred. The number of mortalities was higher and it occurred within about 10 miles of the location last year,” she said.
“We don’t know how the disease overwintered and are unsure if M. bovis has become established in this population of pronghorns.”
The disease has been around since 1967, Creekmore said in March. But last year was the first time it was found in pronghorn. Gillette is the only area in the world that it has happened (pronghorn only live in the northwest United States).
Mycoplasm bovis is a pathogen that attacks the lungs of animals, causing pneumonia and, in some cases, “pretty spectacular lung lesions,” Creekmore said.
Infected animals have been noted to fall behind the herd before lying down and dying away from the rest.
“Only a small portion of their lung is working when they die,” Creekmore said.
From the size of the lung lesions, which cause the lungs to be almost solid, the pathogen must have been present and growing for at least a week in some cases, Creekmore said.
Game and Fish officials believe the disease starts taking effect during early to mid-February, which also was the case last year, but so much about it is still unknown.
“Because this is only the second time the disease has been documented in pronghorn, we will continue to closely monitor the population next winter,” Peckham said. “If the disease resurfaces next year, reports from the public about dead or dying animals will again be important in assisting us to determine its impact and geographic distribution.”
Mycoplasm bovis has not been associated “with significant mortality in other wildlife populations in Wyoming,” the Game and Fish Department has reported. Nor has it been found to affect domestic animals like horses, dogs or cats.
Mycoplasma bovis should not be confused with mycobacterium bovis that causes tuberculosis in cattle. They are two unrelated bacteria that cause very different diseases, according to Game and Fish.