If you would like to support the Tangier clinic, as written about in this article, click here.

Just last spring, when Dr. David Nichols convinced his friend and real estate developer Jimmie Carter to visit the beleaguered clinic he’d been working in for a quarter century, it was not a pretty sight. Like a jack-o-lantern’s smile, the ceiling in examination room number four was missing several of its aged fiberglass panels.

Those that remained were water-stained and freckled with mold, the result of a three-year-old leak in the roof. The decor consisted of peeling beige wallpaper and faded green wall tiles, most of which were cracked or absent. On the wall hung a tin medicine cabinet, its glass façade broken some sixteen years ago by a doctor who, unable to find its still-missing key, unsuccessfully attempted to force open the lock. The room’s poorly fitted swinging door, propped open by a slab of scrap wood, had no handle. And the exam table, the one piece of furniture intended for the patients’ comfort, wasn’t comfortable at all, just a stationary wooden board padded with cracked brown vinyl.

It’s under these conditions at the Gladstone Memorial Health Center, Tangier’s sole medical facility, that Nichols has cared for the majority of the island’s roughly 600 residents for the past twenty-seven years.

Every Thursday, Nichols pilots his R44 Raven II helicopter to Tangier from his home on the southernmost tip of Virginia’s Northern Neck, where he owns White Stone Family Practice. With singer Josh Groban crooning through the headsets, Nichols and two support staff from his office, physician assistant (PA) Rob Duffer and registered nurse Tess Owens, make the twelve-minute trip to the island’s airstrip, its blacktop fractured into hundreds of checkerboard squares framed by ratty tufts of chickweed.

Nichols first visited Tangier in 1978 while on a boating trip with his parents. He could tell that residents were in poor health, so about a year later he called then-mayor Bobby Thorne to ask if the island could use medical help. Thorne readily accepted the offer. Two months later, piloting a Cessna Skyhawk, Nichols settled into the clinic, bringing with him a nurse and three tackle boxes filled with medical equipment and drug samples. (There’s still no pharmacy on the island.)“It was rough when I first arrived,” recalls fifty-eight-year-old Nichols, a slight man with a palatably gentle bedside manner. “The heat was erratic.

Sometimes we worked with our winter coats on. I remember seeing my breath and the patients’ breath, and they never complained.”

Within the first year, Nichols received a $25,000 grant from the Richmond-based Cabell Foundation after a staff member had read an article in the Richmond Times-Dispatch about his work on the island. With the monies, he purchased several new pieces of equipment, furniture, exam tables, and lamps.

Nichols wasn’t the island’s first imported physician. Half a dozen others had come—and gone—before him, including Dr. Mikio Kato, who lived and worked on the island from 1957 to 1959. “There was a Methodist preacher on the island, Oscar Richel, who raised the money for the clinic—that’s how they could afford to build it. If it weren’t for him, they’d never have one,” recalls Kato, who, unable to make a living on the island, opened a practice in Cumberland, Md. (He’s now retired and living in Crisfield.)

And then there was the medical team from the Nassawadox, Va.-based Eastern Shore Rural Health System, which held hours at the clinic on and off for about fifteen years. In January 2006, the group was forced to halt their visits after the clinic failed to pass inspection by the Joint Commission on Accreditation of Healthcare Organizations (JHACO), an independent national body that oversees the safety and quality of healthcare facilities.

“Doctors came here, and we expected them to stay, and they never did, until Dr. Nichols,” says Betty McMann, a retired nurse’s aide at the clinic and a longtime patient of Nichols’. “It’s a comfort to know that on Thursdays, he’s coming. If he can’t fly in, he’ll get a boat, especially if he’s got patients that need to see him. He’s been very faithful, and he’s gotten Tangier to trust him—and Tangier don’t trust you too easy.”

Although Nichols’ team had been doing the best they could to care for the folks of Tangier, Carter knew it was time for him to help his friend raise funds for the type of medical facility the island had long deserved.

While Tangier is widely known as a tight-knit watermen’s community, not as commonly known are its residents’ chronic health problems. Because islanders’ diets are low in raw foods and center, instead, around processed and fried foods, there’s an excessive rate of high cholesterol, heart disease, and high blood pressure. Genetic ailments, from cancer to diabetes, play an equally potent role in their health issues, exacerbated by a high incidence of smoking.

In 1960, Dr. Donald Fredrickson, a former director of the National Institutes of Health, discovered “Tangier disease,” a rare, inherited disorder (it’s been identified in only fifty people worldwide) characterized by a severe reduction in the amount of high-density lipoprotein (HDL), or good cholesterol. Those with the disease have a greatly reduced ability to transport cholesterol out of their cells, leading to a HDL deficiency and the accumulation of cholesterol in many body tissues. (Symptoms include enlarged orange or yellow tonsils, enlarged spleen or liver, and an early onset of cardio-vascular disease.) “Seeing one patient here is like seeing three at home in terms of work,” explains Nichols, an intensely focused man with a voice that carries a slight accent from his native Winnipeg, Manitoba. “They have so many problems and medical issues compared to patients at home. If we see twenty-seven people at the clinic, it’s a long day because so many have multiple issues, and they all interrelate.”     

These specific ailments require specific medical equipment (echo-cardiograms, cardiac stress tests, etc.), which are unavailable at the clinic. Nichols must send patients to Crisfield’s McCready Hospital or Salisbury’s Peninsula Regional Medical Center, an additional forty minutes north, for testing. No easy task, since this trip involves coordinating boat schedules to and from the mainland, transportation on the mainland, and sometimes an overnight stay in a hotel—an expensive outing for islanders, the majority of whom are self-employed and without health insurance.

“Not having the right equipment keeps patients from getting immediate care,” explains Nichols, who received his medical degree from McGill University in Montreal. “When you see a patient in Tangier with chest pains, you immediately have to rule out heart disease. You need to have a treadmill for a stress test, but since we don’t, we have to send them all the way to Salisbury’s hospital. That can some-times take days before it happens. And sometimes they’ve already had a heart attack by the time they’ve arrived.”

Walking out of the clinic’s only bathroom, a powder room-size space with exposed corroded pipes and rotted flooring, a patient carefully carries his urine sample down the hallway. Navigating the narrow passage, cluttered with a copy machine, scale, medical supply cabinet, and a seven-foot-long bookshelf, he passes nurses and patients and turns into the makeshift lab. 

“In a modern facility, patients don’t have to do things like that,” comments Nichols, a rumble of shame in his whispered voice as he watches the scene. “There should be a lab window where patients can leave the cup. Like this, it’s humiliating.”

With fair skin and a freckled complexion, Nichols is not someone naturally drawn to island life. But when you consider his Newfoundland roots (his father’s country of origin), you understand his attraction to the equally remote Tangier—and to hard work—a little better. After searching for a retirement location in the rural south, his parents settled in Burgess on Virginia’s Northern Neck. Nichols, too, fell in love with the area on a visit with them. So after his residency at the Medical College of Virginia’s Riverside Hospital in Newport News, he opened his private practice in nearby White Stone. That’s when he discovered Tangier.

“I feel a strong sense of loyalty and responsibility to the people of Tangier,” says Nichols, who rotates Thursday visits with Dr. Keith Cubbage and Dr. Richard Bagnall, both from his White Stone practice. “In many ways, I’m their advocate. And I think I do that job well. I’ve gotten to know these people really well, and they’ve gotten to know me, and I feel very attached to them. I have a saying, ‘When you’re on Tangier Island, you’re a little closer to heaven.’”

The clinic was built by the town of Tangier in 1957 and was named for Dr. Charles Gladstone, the island’s resident physician from approximately 1921 to 1955. Every Saturday evening, Dr. Gladstone went from door to door to collect his payments, which, according to Betty McMann, were “less as a quarter.” “He had good
pills for fever. And he didn’t have office hours. If you needed him, you just went.”

Except for a new roof, a gas furnace, and electric heat in each exam room, the facility remains unaltered, including the electrical wiring and plumbing, which has in the past served up bacteria-contaminated water, infamous for its putrid smell and ability to trigger a two-day dose of diarrhea in those who dare drink from the spigot. “If you saw a place like this on the mainland, you would think that the doctor is not too good if they work in a place like this,” says patient Danny McCready. “It’s most definitely outgrown itself.”

“People would like a better clinic a whole lot, but they rarely complain,” says Anna Parks, a native of Tangier and registered nurse who’s been working in the clinic for the past five years. “I guess it’s always been like this, and it’s what they’re used to. They’re happy to have what they have, and they look beyond the look of the building and look at the quality of the healhcare they receive here.”

It was on a whim that Dr. Nichols flew Carter over to the island for lunch that spring afternoon. After the two downed crab cakes at The Chesapeake House, Nichols took Carter on a tour of the clinic. “I was appalled,” recalls the Irvington-based builder, who, along with project manager Nancy Thorsen, is spearheading the movement for the new clinic. “My response to get involved in planning a new clinic was immediate. We all look for something important to belong to, and this was something I could get my arms around. It’s the island’s first line of defense, and they need a better structure. We’re not trying to build the Taj Mahal, just a modern health care facility.”

Many Northern Neck residents have volunteered their professional services in the organizational efforts, including Gloucester, Va., accountant Nancy Dykeman, Irvington-based architect Bill Prillaman, and Irvington attorney B.H.B. Hubbard. The most powerful support has come from Eric Finkbeiner, a lawyer with Richmond-based McGuireWoods and director of the firm’s Virginia government relations team.

Finkbeiner has offered pro bono lobbying, research, and legal services to acquire funding from the state of Virginia. He estimates that if the legislature allocates room for the clinic in their budget, funds could be distributed by July 2007, with construction completed as soon as December 2007. “I think everyone we’ve talked to within the governor’s administration, as well as key legislative leaders, see the need,” says Finkbeiner. “No one has yet said that it’s a bad idea. We feel very confident that we can get something done here.”

The proposed 3,500-square-foot facility, which will cost an estimated $1.1 million to construct and equip and require a $100,000 annual maintenance budget, would include four exam rooms, two procedure rooms, lab, waiting area, laundry, three bathrooms, and small kitchen and overnight area for mainland personnel forced to stay overnight. Replacing the circa-1981 X-ray machine, which is held together with duct tape and doubles as the lunch table/work desk for staff, would be a digital machine that sends images over the Internet. As for those miles of handwritten patient records stored in the hallway, an electronic medical records system would allow Nichols and his associates access to his Tangier patients’ histories via computer while at the home office.

Also about to change is the island’s dependence on Nichols. Beginning this December, Inez Pruitt, whose family has lived on Tangier since the 1700s, will become the island’s very first full-time resident PA, able to provide residents with health services that, historically, Nichols would personally have to administer, including gynecological exams, minor surgeries, and filling prescriptions from the mainland. “I used to get so frustrated when someone would call and need a refill, and it couldn’t be authorized because there’s no doctor here,” says Pruitt, a 2006 graduate of the University of Maryland Eastern Shore’s physician assistant program, who started as a receptionist in the clinic on Christmas eve 1987. “People are suffering health wise because of their remote location. Tangier deserves better.”

It’s the end of the day at the clinic, and the steady stream of patients who occupied the lobby’s mismatched couches and leafed through the wrinkled copies of Seventeen has all but stopped. “Sometimes it’s intense, but I love the people,” says Nichols, standing next to a faded photo of a Coast Guard cutter slicing through icy Tangier waters during the winter of 1977. “They’re all so familiar to me now and appreciative. They give me hugs and kisses and food. They’re fiercely independent people who don’t beg. They’re always appreciative of people doing things for them. I just hope we can provide them with a better place for healthcare. No mater what, I plan to keep doing this as long as I’m needed.” 

For more information, visit http://www.tangierclinic.org.