Tangier residents rely on doctor's 'island calls'

Marian Pruitt, 78, was waiting in the white clapboard health clinic when Dr. David Nichols arrived on a recent Thursday.

Miss Pruitt sat patiently on the edge of the examining table while the doctor unpacked his supplies, checked his appointment schedule and donned a white lab coat.

Like other residents of this island in the middle of the Chesapeake Bay, Miss Pruitt is used to waiting -- at least for medical care. Tangier Island, a 3-mile-by-1-mile spit of land that is home to about 700 people, has had no permanent physician since the late 1960s.

For medical emergencies, residents go by boat, airplane or helicopter to the mainland of Maryland or Virginia.

But for routine illnesses and injuries, the islanders wait for a doctor to come to them.

For a decade, thanks to Dr. Nichols, that wait seldom has been more than a week.

On Mondays, Tuesdays, Wednesdays and Fridays, Dr. Nichols operates a family practice in White Stone, on the shores of the bay in Lancaster County. But every Thursday, Dr. Nichols -- or his partner, Dr. Robert J. Newman -- flies to Tangier to provide medical care to the islanders.

Realizing the need for medical services on Tangier, Dr. Nichols began making the weekly flights 10 years ago. A licensed pilot, he flies a single- engine, four-seater plane he bought for the 25-mile trips.

When Dr. Newman joined Dr. Nichols' practice three years ago, the partners began alternating the weekly trips. Because Dr. Newman doesn't have a pilot's license, R. Frederick Baensch, administrator of Rappahannock General Hospital, provides free shuttle service in his plane.

Dr. Newman and Dr. Nichols -- along with an assistant from the White Stone office -- have braved all types of weather to get to Tangier.

"People count on you," Dr. Nichols said. "I've had people wait four or five days with a broken arm."

Miss Pruitt's recent visit was for a routine checkup. She began seeing Dr. Nichols regularly several weeks earlier, when she developed a persistent case of shingles, a painful inflammation of the nerve endings.

"It's like a heavy weight on my head," she told Dr. Nichols as he gingerly examined her. He told her to continue taking her medication.

He also offered his condolences on the death of her sister, with whom Miss Pruitt had lived for 75 years. Just two weeks earlier, Dr. Nichols had made a house call to see Miss Pruitt's sister.

Her sister also had shingles, which led to other complications. She died shortly after Dr. Nichols' last visit.

"She's at peace now," he said as he gave Miss Pruitt a gentle pat on the shoulder.

Dr. Nichols, 41, is a soft-spoken man who dispenses advice and reassurance as readily as he dispenses samples of prescription drugs.

To Lisa Crockett, who came in recently with her fussy, feverish 20-month- old daughter suffering from a sore throat, he said: "Take care. I hope you get some sleep tonight."

Then he said to the young mother, "It's a thankless job, isn't it?"

Dr. Nichols, a native of Canada who attended medical school at McGill University there, believes in developing a rapport with his patients, many of whom he calls by their first names.  High-technology laboratory and diagnostic tests are not available in the sparse setting of the Tangier Health Center.

"But 75 percent (of diagnosis) is what the patient tells you," he said during a conversation between examinations recently. Heart disease and high cholesterol are among the major health problems on Tangier, he said.

Escorting a visitor into the clinic, he described the building as from the "old-time Norman Rockwell days." Dr. Nichols himself could be a character from one of the artist's paintings.

He carries his supplies to Tangier in a fishing tackle box. The X-ray machine he uses is of World War II vintage.

Another relic of the past also is evident at the clinic -- cash payments for services rendered. Tangier Island has no bank, and, unlike their mainland counterparts, few residents there have private health insurance.

Sometimes, the payment Dr. Nichols receives is in the form of hugs and kisses.

"We're certainly not in it for the money," he said of the island practice. "Lots of days, we end up losing money. If you're looking at dollars as the bottom line, my time could be better spent elsewhere."

Occasionally, when the weather has turned bad during the day, the doctor and his assistant have been stranded overnight.

"I could probably write a book (about our experiences)," said Elizabeth Somers, a medical assistant in the White Stone family practice who has been making the weekly trip to Tangier for six years.

"Sometimes, when we've gotten to the airport, I've been sweating bullets," she said.

What keeps her coming back?

"I love the people over here," Ms. Somers said. "Some of my favorite patients are Tangier patients."

Dr. Nichols added, "Here, people are very appreciative."

Many of the islanders remember well what things were like in the days before Dr. Nichols. Before 1957, the medical needs of islanders were met by an elderly physician who lived on the island and practiced out of his home.

The Richmond-based Virginia Council on Health and Medical Care, now the Virginia Health Council, intervened and began publicizing the need for a doctor and a health clinic on Tangier.

As a result, the clinic was built to serve as base for three different full-time physicians, none of whom stayed for more than three years.

 "They're never going to get a full-time doctor here," Dr. Nichols said.

"It's a tough life here. You get island fever very quickly."

About five years ago, the Virginia Department of Health began dispatching one of its Eastern Shore doctors to the island once a week, and a pediatrician began including Tangier in his rounds once a month. A dentist comes from Tappahannock every Wednesday.

Yet, none of the doctors is as consistent as Dr. Nichols and his partner, said Dewey Crockett, Tangier's mayor, undertaker, teacher and assistant principal. A forecast of rain, for example, kept the health department doctor from coming to Tangier recently.

With his faithfulness and dedication, Dr. Nichols has won the respect and confidence of the islanders, said Crockett, whose wife, Jean, is the only registered nurse on the island.

Mrs. Crockett keeps tabs on patients and calls Dr. Nichols if a problem develops during the week.

Lisa Crockett, the mother of the infant who came to see Dr. Nichols recently, said: "I wish a doctor lived here. That would be ideal."

Short of that, she added, Dr. Nichols and Dr. Newman provide "great care. . . . I don't know what people here did before those doctors started coming."   As he ate a sandwich at a bayside picnic table during a short lunch break, Dr. Nichols reflected on his 10-year relationship with the people of Tangier.   Asked whether he entertained any thoughts of ending that relationship, he was emphatic.

"No," he said. "I plan to do this as long as the people of Tangier want me here."