Smith Island Winter Day. 1 1985

(Based on notes from 1985)

I dislike alarm clocks especially at 6 AM. But I am well rested and this morning I won't be rushed. I can even take a few minutes to wrap up in the bedclothes and listen to the rain which I now notice is mixed with snow. The thermometer has been below freezing for a good portion of the last few weeks. The shallows around the islands froze up more than ten days ago. The harbor at Crisfield is also ice-filled, leaving only the Tangier Sound free and clear. The icebreaker has made at least six runs to Smith Island in the last week.

The ice has caused some trouble. One of the ferry boats to Crisfield sank three days ago, an hour after discharging passengers. Last week I was unable to reach Tylerton, the most isolated of the three Smith Island communities. I tried again by outboard yesterday and still couldn't get through the ice-packed two or three miles of creek. I was running against the tide and large plates of ice slipped under the hull and scraped off some of the anti-fouling paint and damaged the lower end of my outboard motor.

The village of Ewell is quiet this morning. Because of the weather, no oyster boats will venture out today. The absence of boat noises permits me to hear a distant buoy horn. It's now 6:15 and I must begin to dress. Downstairs I hear the children's excitement. The first basketball game is scheduled today and despite reports of several inches of snow in Salisbury, they are hopeful of going with their classmates on the 8 AM ferry.

Although I have been on the island for 15 months, I have yet to take the school boat in the morning. I much prefer my own boat since I can come and go when I wish. Today I have no choice. If I'm to reach Tylerton, it will be on the school boat.

It is now 7 AM and from the kitchen window I see two boys standing under the church portico a half a block away. I say my goodbyes to the family and join the growing crowd at the church, They all know me but no one speaks. I realize that it is not a personal thing, just that I am an adult in a place I really don't belong. After a minute or so the children are kind enough to forget that I am there and permit me to eavesdrop on their conversation. By 7:10 the yellow school bus has arrived to take us about a mile down the road to the village of Rhodes Point where the school boat is docked.

Leaving the bus, the mist and rain begin to penetrate my winter jacket. I am foolish for having neglected oilskins. I am getting better at being prepared--since being prepared means the difference between tolerable and miserable whether it is summer flies or winter storms.

The school children from Rhodes Point are already aboard, together with an assortment of other islanders who will be using the school boat as alternative transportation to the ferries. The boat's engines are idling. Captain Alan Tyler checks to make sure all are on board and then slowly backs the Betty Jo into the creek and we were off toward Tylerton to pick up the last batch of school children.

Smith Island has elementary and middle school. The high school is in Crisfield, 12 miles away by water. Our children must make a daily round trip across this open water of Tangier Sound, a part of the Chesapeake Bay. For the kids in the village of Ewell, this means leaving the Church at 7:15 A.M. and returning at 4:30 P.M.  It is a long day and eliminates most opportunities for extracurricular activities. Twenty years ago, island children boarded with families in town during the school week and went home on week-ends and holidays. I think that sounds like a better experience.

I have arrived on Tylerton at 8 A.M. I walk down to one end of the island to see Miss Dolphia but there is no answer. I know she is home but one of the prerogatives of being 80 is sleeping in.

I end up at Harvey Corbin's where Adam needs his Measles, Mumps, and Rubella shot. Adam was just waking up. Harvey has been up and is lighting the oil stove in his workshop. He will spend the day making crab pots and he appears glad for my distraction for a few minutes. I return to their kitchen and Adam comes toddling over to sit on my lap and watch his mother make breakfast.

I hated the thought of ruining Adam's nice smile but he wasn't doing badly to get his shot without going to a strange place. Most island children get their immunizations at home or a short walk from their home.

Adam is a pretty tough guy. No tears.

I called Miss Dolphia from Harvey's. She said she needed 10 minutes. Paved roads are new to the Island. Most trails and paths use oyster shells in place of gravel as does this one. Dolphia lives in a long-suffering house of three sections. It's deterioration appears to go back several years. She uses only two rooms in the winter. She is afraid of the bottled gas furnace and she lights it infrequently while depending on her electric blanket. Dolphia is now 81. She lives alone and is becoming more forgetful. We both enjoy my visits.

It is pretty easy to take care of the medical aspects. I am able to carry a little office on my back. I can check blood sugars and hemoglobins and do a reasonable job of physical examination in the home. At the patient's home, I can gather all the current medications;  I can check the refrigerator to see what they are eating; I can assess the level of cleanliness and hygiene.

Knowing Dolphia is a diabetic and seeing the cakes and pie around her house tells me she is not on her diet. Since she is 81, I am not very likely to persuade her to give up her ways but I will factor them into her treatment plan. I accept Dolphia sweets and all. There need not be deception between us.

Dolphia is very tall and I asked her about her father's size. She was glad for the opportunity to tell me about him. Her dad pulled crab scrapes until he was almost 70. "By then his chest size was 48. He was real big." By referencing living men that we both knew, I was able to estimate him to be about 6'3" and 260 lbs, not an extraordinary size for islanders. I had just finished taking care of a frail 110 lb male who died after a long bout of coronary disease and who spent most of his adulthood at 240 lbs.

"In the Spring my Daddy set his nets."

"Did he make his own nets?"

"Oh no. He would order them away. When they came, they were just plain. He would go and take the tar kettle and light a fire out in the marshes to tar the net. Then he would lay it out in the marsh to set. You could smell the smoke from the tar all over the island."

"Did people complain about the smell?"

"Why no. It was like they fumigated everything. It was alright. Then he would take the nets out to the sound and drive a big post and lay out the net. The tar weighted it and kept it some and there were other weights to take the net to the bottom."

I am especially curious about the old medical practices and I asked Dolphia about obstetrics at the time of  her first pregnancy. She related that the midwife came as soon as any cramping began. Her midwife kept the woman walking as long as possible. When the doctor came, the woman was examined. Dolphia didn't remember great detail but described the use of sterile gloves and that "the doctor and midwife were very particular."

She told me that her fourth and last child was stillborn. During the pregnancy Dolphia was diagnosed as having gallbladder trouble for which hot compresses were applied to the abdomen. The doctor told Dolphia that the gallbladder trouble and resulting bile had killed the baby.

This explanation made no particular sense to me and as I began to say something, the fates intervened and twisted my lips together. I realized that Dolphia had accepted the explanation and had lived with it for more than 40 years. Please protect my patients from my big mouth.

Dolphia needed her medications renewed. There were no changes to be made. Because of the isolation, almost all prescriptions need to be called to the drug store in Crisfield and then delivered to one of the ferry boats.

The ferry captains are the middlemen for many transactions and are required to have a large amount of cash to cover the day's business.  For example, when I wish to order groceries from Crisfield, I make a list and then call the grocer and read off the items. The grocer will collect my order, total it and load it into cardboard boxes. Eventually the order will be transported to the ferry. At the ferry, the boat captain will purchase my grocery order. He will transport it to the Island and deliver it to my kitchen. I will be charged the purchase price plus two dollars freight per box. What a bargain!

The pharmacy works in the same way. Unfortunately, it makes me, responsible for medication as well, an additional burden. I also keep a supply of common medications on hand at the clinic in Ewell. I charge $5.00 for most prescriptions. The pediatric suspensions are much more expensive, though.

As I write this we have been without ferry boat service for 48 hours but I have enough variety of antibiotics and other drugs available to handle most problems. Because the pharmacy is not yet open on the mainland, I make a note of Dolphia's needs so that I can call in the prescriptions from a later stop.

I feel a lot of love from Dolphia. The day is miserable and she is glad to have the doctor come. She doesn't understand Medicare or Medicaid. Any attempt to explain increases the confusion. I just tell her that her government appreciates all she has done for the country and that they pay me well for coming to see her. She tells me that I ought to be well-paid because it is a long boat ride and miserable weather.

Mostly I feel better paid than at any other time in my life. As I head back towards the village I wander back over previous conversations with Dolphia, about the way her house looked when she and her husband were young and when the high tides did not come up to her steps. She recalls the days when the south facing beach had not been eroded and the times when there were other islands that have long ago surrendered to the water. Through the mist on the road, I can see a couple of the smaller islands that once held a house or two. Things change, especially the coast line of Smith Island.