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It's Thursday, and the doctor has flown in

Residents of Tangier Island don’t need a written schedule to know when the doctor is available. They know it by heart.

Residents of Tangier Island don’t need a written schedule to know when the doctor is available. They know it by heart. Dr. David Nichols has been flying to the remote Chesapeake Bay island every Thursday for 30 years to provide much-needed medical care. But, if they should forget that it’s Thursday, they can always hear him coming.

“I heard his helicopter come in. I want to see him,” one patient says, calling the island’s Tangier Health Clinic to schedule an appointment even before Nichols lands his Robinson R44 Raven II at Tangier Island Airport (TGI). The residents have grown so attached to him, and the convenience of his regular visits, that some have waited with broken bones, pneumonia, and chest pains until he arrived instead of catching the ferry/mail boat to the mainland for more immediate treatment.

Thursdays involve early mornings for “DR COPTR,” as his car’s license plate reads. He preflights and pulls his R44 out of the hangar that also houses his 1980 Cessna Skylane. The floor is as spotless as a hospital operating room. Nichols announces his departure from eastern Virginia’s Hummel Field (W75) for “a hop” across the Rappahannock River to pick up supplies at his high-tech White-stone Family Practice office.

There, Kimberly Clark, his office manager—and the first employee he hired three decades ago—has medical supplies ready to load, as she’s already talked to the staff on Tangier to learn what the doctor will need that day. After liftoff, it’s only a 15-minute commute to the island. Nichols talks to fish spotters along the way, asking permission to share their chunk of cleared airspace through a restricted area stretching from the mainland to the island. He doesn’t need to use his N number. “Dr. Nichols” suffices: He’s many of the pilots’ trusted aviation medical examiner.

Inez Pruitt, the physician assistant on the island, meets Nichols at the airport in her tan Ford Focus—minus both side mirrors—to help unload the supplies. The roads on the island are so narrow that most people walk, ride bicycles, or drive golf carts. “This is our resident fly-in doctor—he’s saved many lives,” a woman announces proudly to her tour group as they pass Nichols on his way to the clinic.

The island’s health center, built in the 1950s, is nothing like Nichols’ facility on the mainland. The carpet is stained and ripping, and as Nichols points out, there’s a hint of mold in the air. Photos and newspaper clippings of the doctor and his patients, staff, and aircraft are hung with pride. “We have a lab here, which is antiquated, but it works. This is our one bathroom. [The] toilet teeters a little bit,” Dr. Nichols says lightheartedly. “In spite of the facility and the remoteness, it’s still pretty high power. I’ve never had anyone complain about this facility.”

As soon as he steps into an exam room with a patient, he ignores the panels peeling off the ceiling, the missing ceramic tiles on the wall, and the rusty sink that no longer works. “He only focuses on the patient,” Pruitt says.

Nichols makes it a point to sit and chat with each patient so that they don’t feel rushed. He’s even flown from the island to his main office to pick up additional equipment and returned to Tangier the same day to perform a procedure on a patient instead of postponing.

“What we do here couldn’t be done without aircraft,” Nichols says. Commuting by ferry takes four hours round trip, including driving time to the dock. Nichols has had to commute by ferry, on occasion, or personal boats because of bad weather.

A passionate advocate

Because of Nichols’ commitment to the 600 residents of this island, 10 miles off the coast of the Eastern Shore of Virginia, they’ve become some of his biggest advocates.

His staff in Whitestone and Tangier secretly nominated him for “Country Doctor of the Year 2006.” They knew the humble, laid-back doctor who’s happy if he has chocolate, French fries, and McDonalds nearby, wouldn’t have sought the award. But they also knew he’d win. And he did, “for embodying the spirit, skill, and dedication of America’s rural physicians.”

The residents also came through for Nichols when he needed them most. Nichols’ neighbor wanted the private heliport at his house removed. But the islanders wrote letters and took the ferry to attend a zoning hearing to persuade local officials that Nichols’ private heliport was an important asset.

And Nichols is himself the advocate for the residents of Tangier. “People at Tangier don’t have strong advocates, and that’s where I come in,” he says. He works to find affordable healthcare for those who need to see a specialist off the island. In the past, he’s convinced healthcare providers to reduce the price of a $3,000 colonoscopy for his patients—a price that is out of reach for island residents who have an average family income of $27,000 a year. Some do not have insurance. He also understands that taking off work isn’t practical for the residents, many of whom are watermen who work from 2:30 a.m. to 3:30 p.m. They don’t get paid time off.

“It’s so important to treat everybody the same, with respect,” Nichols says. “Treat them like you would a family member.”

Man with a plan

The Manitoba, Canada, native had always been interested in medicine and aviation, and a high school aptitude test revealed that he was best suited for those two career tracks. While he was a medical student in Canada, his parents retired and moved to Virginia, where Nichols first learned of Tangier Island. Visiting the island, he immediately knew where his medical skills were needed. He moved to Virginia to complete his three-year residency with the Riverside hospital system, and he started flight training during the third year.

A year later, with his residency behind him and private pilot certificate in hand, he asked the mayor of Tangier for permission to provide treatment on the island. He went every week on his day off—Thursday—for seven years until another doctor joined his private practice and started alternating weeks with him. Even though he didn’t work on the island every Thursday, he still made the trip to ferry the other doctor by airplane. (He began flying helicopters 11 years ago.)

Many islanders wondered how long Nichols would stay; they’d seen several practices come and go. “He stuck to it,” one patient says in the waiting room, the ceiling fan squeaking as it circulates stuffy air. “Most people quit.”

He rarely misses a Thursday, but if he does, he’s in the office earlier in the week: “You’ve gotta let people know that you’re there [for them].”

Nichols, who has a passion for missions, often thought he’d serve overseas. Turns out, the Chesapeake Bay is his Atlantic Ocean. “I think every medical doctor should serve,” says Nichols. “I didn’t want to just practice ‘country club medicine.’”

“I think you need these people as much as they need you,” Clark says to Nichols back on the mainland, noting the fondness he has for the island residents. That fondness is personified in his mentorship of Pruitt. She was one of Nichols’ first patients on Tangier in 1979—a married 17-year-old who had dropped out of high school. But he saw her potential. He encouraged her to become a nurse and then she commuted by ferry for six years to the University of Maryland on the Eastern Shore to become a physician assistant. Now the island has a resident healthcare provider who can make house calls and open the clinic even in the middle of the night. Despite the long, sometimes unexpected hours, Pruitt says, “I love my job.”

“It’s what I envisioned, and it’s happened,” Nichols says of the practice and Pruitt’s success. His ultimate vision is for Tangier to have its own first-class facility and dependable medical care long after he’s finished practicing medicine. To help reach his goal, Nichols affiliated his practice with Riverside Medical Group in August 2008—the same group where he did his residency—on the condition that Riverside would support the Tangier effort. (Riverside also reimburses him for flying to Tangier.) A new facility is in the works for the island, thanks to the Tangier Island Health Foundation, which has raised $1.5 million for the building. Bids for the new clinic opened at the end of July. Now the foundation is working to fund an endowment that will keep the facility running because the residents can’t afford it.

“This new facility is going to be state of the art,” Nichols explains, showing off the blueprints. Even after Nichols’ dream comes to fruition, Tangier residents will still hear the familiar whir of his helicopter overhead. Someday, “I’ll probably retire from medicine,” he acknowledges, “but not [from] Tangier.”

E-mail the author at [email protected].

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