Tangier Island, Va.TANGIER ISLAND For more than 30 years, Dr. David Nichols has piloted a plane or a helicopter across the Chesapeake Bay on his day off each week to provide medical care to this community of 500 that has no resident physician.
He has tended to the islanders in an old building with a leaky roof and holes in the walls, no hot water and outdated equipment held together in some instances by duct tape.
The island will celebrate the opening of a stunningly modern clinic with an official dedication on Aug. 29. The clinic is the realization of Nichols' dream and the culmination of a remarkable fundraising effort that spread far beyond the island.
But the joy of this momentous occasion will be tempered greatly because as the island gains a new medical facility, it braces for an enormous loss.
The island's family doctor is dying. The 62-year-old physician survived melanoma of the eye six years ago, but he learned in July that the cancer had spread to his liver. He said last week that, based on his diagnosis, he could have about four months to live.
"I actually feel very well, but I know it's coming," Nichols said Monday soon after touching down on Tangier following a short flight from the mainland in the family's single-engine Cessna piloted by his son, Davy. Since his diagnosis, Nichols has given up flying.
"I feel very blessed to have lived the life I have," he said. "Tangier is definitely on my short list of things I most appreciate in my life. The people of Tangier are family to me."
As he walked the island's narrow lanes, one islander after another, seeing Nichols for the first time since hearing the news, stopped to shake his hand, give him a hug, share a tear.
"He's been coming here since I was a little girl," said Jamie Bradshaw, sitting in one of the island's ubiquitous golf carts and wiping her eyes after an embrace with Nichols. "I don't know what we'd do without him. I can't even describe in words what he's meant to all of us."
Near Swain Memorial United Methodist Church, whose majestic steeple accounts for much of the Tangier skyline along with the island's freshly painted water tower, Nichols ran into an old friend: Robert Thorne, who was mayor in the late 1970s when the young physician first broached the subject of bringing medical care to the island, asking if Tangier needed help.
"We sure do," Thorne recalls replying.
But it took a few years for the islanders, a private, skeptical sort, to believe Nichols meant what he said about making a long-term commitment to the close-knit community of watermen. Other visiting docs had come and gone, but Nichols kept coming week after week.
"He didn't do it for his glory," said Inez Pruitt, the island's physician's assistant and Nichols' longtime sidekick at the clinic. "He's done it for the people of Tangier."
Nichols is a gentle, soft-spoken Canadian who came to Virginia after medical school in large part because his parents had retired to the Northern Neck. He set up his primary practice in White Stone, but Tangier became his defining mission.
Practicing medicine on a shrinking island that has been hit hard by erosion and the changing nature of bay economics has always been a money-losing proposition for him. Yet he thought it important to continue because of its history and beauty -- but mostly its people.
"Paradise" is the word that popped into his mind the other day as he flew over the glassy bay and the island came into view. It's the word that always pops into mind when he thinks of this wisp of a place known for its old English dialect, soft-shell crabs and (mostly) car-less roads. "It's a pretty easy place to be enthralled with if you're so inclined," he said.
Medically, though, Tangier is not easy work. Because of genetics, diet and lifestyle, chronic illnesses are common on the island. Residents have to be evacuated by air to hospitals at a rate of once a week, often for heart attacks and strokes.
Education and empathy have been primary tools of Nichols, who has handled everything from emergencies to house calls on the island, showing up in all kinds of weather.
"He's saved so many lives," Pruitt said. "He's just always been here -- someone to depend on for strength, not only physical but spiritual and mental."
In 2006, Nichols was named Country Doctor of the Year by a national health-care company that honors the work of rural physicians. He was nominated surreptitiously by Pruitt because, she said, Nichols never would have allowed her to submit his name.
Pruitt was a 17-year-old high-school dropout when she first came to Nichols as a patient. Pruitt, whose family has been on the island for generations, later went to work for Nichols as a nursing assistant. He taught her like an apprentice and encouraged her to go to college -- in her late 30s, with her children grown -- to become a physician's assistant. For six years, she commuted by ferry to the Maryland mainland to attend classes.
In 2006, she became what Nichols believes is the first native licensed medical-care provider in the island's history.
"I am," said Pruitt, who sees patients daily, "a reflection of him."
Nichols and Pruitt banter like brother and sister, mentor and protégé. They sometimes call each other Wilbur and Homer, from one of their favorite movies, "The Cider House Rules," a 1999 film based on the novel by John Irving. The story revolves around a physician (Dr. Wilbur Larch) at a Maine orphanage who takes an orphan under his wing (Homer Wells) and teaches him obstetrics. Pruitt even has a lab coat stitched with "Homer."
As new equipment and furniture arrived at the new clinic last week, Nichols and Pruitt led a justly proud and good-natured tour of the place, extolling the facility's many virtues and needling each other all the way.
The new clinic is perhaps five times bigger than the old one, which was constructed in the 1950s, and is as bright as the other is dingy. It was built large so it can accommodate many patients at once since Nichols and the physicians who succeed him have only limited time on the island. It is so well-equipped, with gear such as a digital X-ray machine, because in such a remote place medical care often requires emergency action.
"I honestly believe there's not a more modern clinic for family medicine anywhere in this country," Nichols said.
Aesthetically, the structure fits in with its surroundings, looking from the outside like a well-appointed beach house. The immediate neighborhood is what one might expect on a small island where everything is compressed: The clinic is just a few steps from Swain Church, the island's schoolhouse and its water tower. Next door is the house where Pruitt was born.
Much of the equipment and many of the services were donated or provided at discounted prices, a result of a wide-ranging, four-year effort to raise funds and awareness about the island and the plight of its medical center.
The drive started after Nichols took friend and patient Jimmie Carter to the island for lunch. The Northern Neck real estate developer was appalled by the condition of the clinic and vowed to help Nichols raise the money for a new building.
The public-private venture has included state and federal funds, grants from private foundations and contributions from organizations ranging from Rotary Clubs to Girl Scouts, as well as money from more than 500 individual donors, said Carter, who set up the Tangier Island Health Foundation.
"It's been heartwarming to see such an outpouring of interest and support," Carter said. "If there's one thing we've seen, Tangier's got a lot of friends."
The foundation has raised $1.7 million. The first $1.4 million paid for construction of the clinic. The rest will establish an endowment to pay for upkeep of the building and the equipment and make certain Tangier residents have high-quality health care for years to come, Carter said.
Two years ago, Nichols affiliated his White Stone and Tangier practices with Riverside Health System as a way to carry on his work after he retired. He just didn't count on being gone so soon.
"It's the journey that's counted for me," Nichols said, as he sat in the old clinic. "Sure I'll miss being able to do all those things I'd planned to do, but, gosh, this was so rewarding."
He nodded toward the handsome white-frame Swain Church.
"I want to be buried over at that church, at the graveyard," he said. "Just put my ashes there."
That way, he can keep an eye on things. The cemetery is next door to the new clinic.
