Smith Island Winter Day. 2 1985

Part 2. (from notes done in 1985)

I've left Dolphia's house which is set off by itself and I'm heading back to toward the little village.

The houses on Tylerton are closely clustered. I stop at Kaki's house. She is the medical messenger for the village and she lets me know who needs to be seen. She answers the door in her robe and says "Oh my Blessed, I am eating my white bread." I thought she meant she was baking bread but she explained that "eating my white bread" means that the person is loafing. It is commonly applied to the men when they take a break in the interim between the end of oyster season and the beginning of the crab run.

Kaki has one of the most beautiful voices on the Island. When I first met her, she was having some episodes of chest and jaw pain that she believed were indigestion. Although a female under 50, this was a suspicious story and I sent her to Donald Wood, M.D. the Salisbury Cardiologist. Don found  advanced coronary artery disease. Kaki underwent Coronary Artery Bypass Grafting has done well ever since.

Kaki  was born on an another Island about 10 miles south of Smith's called Tangier Island. She is in good spirits today and she offers me breakfast. However, since I've stopped smoking, I'm eating far too much so I turn it down. Kaki reports that there aren't many people wanting visits today. After a cup of coffee, I set out to do the calls.

At Pauline Marshall's I check her skin problem, heart disease and hypertension. She is doing fine but is another patient  confused about her Medicare benefits, particularly the deductible part. I try to say as little as possible in order to reduce possible confusion.

Almost all of the insurance business on Smith Island is Medicare. After seeing a patient, I must submit a claim to Medicare that includes the date of service, the diagnosis, and a code for the exact kind of service provided. These claim forms get mailed off to Medicare where they are processed. Eventually, a check arrives from Medicare as payment for the service.

During my first year on the Island, I tracked all of my Medicare billing. Eventually, I got paid for everything. In a traditional practice, this kind of tracking is done by the clerical staff. I had no clerical staff. If tracking were to be done, I would have to do  it. Given Medicare's good record in my practice, I decided to stop the recording and accounting. I just did the work and sent the claim. Then I forgot about it and trusted Medicare to treat me fairly. It has greatly simplified my life. I only needed to track the amounts received for the IRS.

My next stop is to see Lillian Marshall, no close relation to Pauline. There are only a few surnames on Smith Island. Evans, Tyler, Marshall, Bradshaw, and Marsh are most common with a few Corbins, Sneades, Kellams and Harrisons. When you have a couple of hundred people named "Evans" in a population of 500, you have a hell of a time with most kinds of filing systems. It actually makes more sense to file by first names, something the inhabitants have been doing for years. I wish that I could explain that to Medicare, since I get statements that use the last name and only the first initial.

Lillian is a new patient. She is one of the few Islanders who admits to being a Democrat. I was surprised to find Reagan supporters among the indigent on the Island whose medication benefits are being cut by Reagan policies.  Although I have been on the Island for more than a year, I am still unaware of the many interrelationships that exist. Lillian's daughter lives next door to me in Ewell. I also know one of her sons.

Lillian requires a little more time to obtain a full history and permit her to become comfortable with me. She recounts three previous heart attacks and she has frequent episodes of angina. I make a mental note to come back for the next week or two. She is also an a blood thinner, so I went ahead and drew some blood to send off for a pro-time to check the level of effectiveness for her anticoagulation.

Tylerton is the most charming of the Smith Island villages. There is the usual amount of litter at the waterfront, but the roads are clean. The only vehicle that I have seen is Dwight Marshall's little pickup that he uses for the grocery story. Ewell and Rhodes Point are inundated with vehicles that have no muffler or lose their muffler to the salt air within a few months. The rule there is to buy a rattletrap for less than $1000 and let it rust away until it is unusable and then push it off the road near the dump. The absence of vehicles in Tylertown is a visual relief.

I stop by to see Mary Marshall. She lost her husband, Ullie, about two months ago. Medically, Ullie was a mystery. I first saw him last year. He was suffering from end stage congestive heart failure and had made two recent unsuccessful trips to the medical center in Salisbury. After I became involved in his care, I got close to him and Mary. This past summer, he developed a very painful ulcer of the left foot that became markedly bigger in 48 hours. He had no pulses in his foot and I was afraid he would lose it and I sent him on to the hospital.

Mostly I hope that my heart patients die suddenly and that they not waste away and suffer a prolonged and miserable terminal illness. Ullie seemed destined for the latter and I wasn't too sure that he would return from the hospital.  When he did , the one inch ulcer was a six inch opening over the outside of the foot that exposed muscle and tendons. It seemed preposterous to think it would not become infected. Mary told me that she had been instructed in dressing change.

Then I saw Mary's technique in changing the dressing. It violated many of the rules of asepsis. She wore no gloves. She took the sterile gauze and placed it in the palm of her hand. She used the other hand to apply antibiotic ointment to the gauze, laid the gauze upon the wound and then wrapped the wound. She said that she had been doing it this way for a few weeks. She did use dishwashing detergent to scrub her hands before handling the dressing materials, and there was no evidence of infection. I guessed that 50 years of living together had given them similar immunities and bacterial flora.  The wound never did become infected.

Ullie was fun. "You know, doc, every man is king in his own home. The trouble with hospitals is that they don't realize that I'm a king." However, he began to fail quickly in mid September. He was not eating so it seemed too dangerous to give him insulin. He looked so frail, that I thought it  better to reduce medications that might be attacking his appetite. So the family and I decided to stop all medications for a while. When asked by other Islanders how Ullie was getting along, I encouraged them to visit him before it was too late.

Amazing. One week after stopping all medications, Ullie was out of bed. Two weeks later he made a boat trip to Czirsfield to visit his automobile, a 1975 Chrysler that was his pride and joy. He also went to a restaurant and visited is friends. It seemed a miracle at the time. At the height of his improvement, Ullie asked me if should go up to Baltimore and spend a week at Hopkins, I pointed out that he would return with the same medications as before.

As Ullie's appetite improved, he began eating peanuts and chips and anything else that he wanted. His sodium consumption was through the roof and his congestive heart failure responded by oozing excess fluid out of his foot round. Finally, he went to sleep and was not arouseable for 48 hours. I made a trip over to see him only to find him awake, alert, and talking.

The family decided that they were not going to restrict his food--he had been a 240 lb man in his prime. Over the next two weeks, he slipped into a deep sleep, became unable to arouse and died. All in all, he had managed to squeeze in few pretty good weeks at the end.

Mary has not been doing well since the death. She had nursed him night and day for several months. After the funeral, there was little for her to do and she developed problems sleeping. She is her own worst enemy. She went to court last Spring at the age of 70 for assaulting the woman next door. It must have been quite a sight to see two elderly women duking it out in Tylerton. I'm certainly sorry that I missed it. Mary has not been out of the house except to the store and post office since the funeral. She really has no friends on Smith Island. Both she and Ullie were loners.

There appears to have been a long-term feud in the Marshall family between brothers Ullie and Paul who is still living but has been confined to a wheelchair since a stroke eight years ago crippled his right side. The stroke eliminated what was becoming a very lucrative business as a wildlife carver. Neither Paul nor Ullie would openly admit bad blood. Each was a proficient bird hunter and had been able to use wild fowl as a major source of protein in their diet. Mary served me many kinds of duck for lunch during visits and I have no idea about the numbers that may have been illegal.

Paul says that he has a cigar box full of duck leg bands, "those little rings the city fellers snap on the ducks that you're supposed to send in. Damn if I'm going to send them in. They've got no business being here in the first place, no damn business buying up this Island and restricting hunting."

One of the sources of friction between the two brothers was the punt guns that Ullie received from his grandfather. Each is ancient. In fact one had been in the water and cleaned up more than 100 years ago. A punt gun is the kind of technology that the Smith Islanders can relate to--it allows you to shoot several geese or ducks with a single shot. It is really a cannon that is mounted in a small skiff (or punt). The operator lies on his stomach in the bottom of the boad and uses hand paddles to slowly maneuver the skiff into the middle of a flock of ducks, geese, or swans. The gun might hold a several ounces of powder and almost anything was used for shot, including pieces of chain. After getting to where the ducks were estimated to be, the gun was fired.

Upon his death, Ullie left the two guns to his sons. When Ullie received the guns from his grandfather, they came with the admonition that they were not to be sold except in cases of life or death--for food or medicine. Knowing Smith Islanders, it is a cinch that Ullie's grandfather would not have included tax payments as a matter of life and death.

Civilization has brought changes to Smith Island. The purchase of the northern parts of the Island for use as a game reserve has removed some of the best grounds for duck and goose hunting. The Islanders were not permitted the same latitude given Native Americans in certain areas, exempting them from some hunting laws. For Smith Islanders, hunting was necessary for winter survival. In the fall, fish was salted out and stored. Some of the fish was traded for potatoes and these were stored in barrels of sand or between layers of dried seaweed. Fowl were a respite from a very boring winter time diet of salted fish and potatoes.

Salted fish is still eaten sparingly by the Islanders but today the fish is not "put up" locally. It is salted cod imported from New England and consumed during the winter months--more a remembrance of the past. To prepare it, the fish is soaked overnight and the water changed at least 3 times. Then the fish is boiled with potatoes while bacon and raw onions are fried in a skillet. The fish and potatoes are eaten with the bacon drippings and onions as a gravy. Leftover potatoes and fish are used to make fish cakes. I liked both meals.

Part of the Islander's heritage is duck trapping--an activity that is now illegal even during hunting season. Trapping made a good deal of sense because it was possible to improve the diet of the birds before slaughter and reduced the chance of biting down on a piece of birdshot at the dinner table.

Glen Marshall is the younger son of Ullie and Mary. He was educated as a computer programmer in St. Louis but decided that he wanted to run a ferry boat instead. He and Clarence Tyler are partners in the Captain Jason, one of the two ferry boat services on the Island. They own three boats and make a run twice a day from Tylerton to Crisfield. As might be expected from one of Ullie's sons, he is believed to be one of the Islanders who continues to keep alive ancient traditions.

I find him to be very moody. He is always dressed in a winter coat or a jacket, even on the hottest, most humid days. The word is that he carries a gun at all times. Given the amount of money that the captains must hold in order to do business in Crisfield, it probably good sense to carry a gun or for people to believe that you do.

Glen was recently convicted on Federal charges for trapping ducks. He flat out told the judge that duck trapping was a part of his heritage.

Some time ago the county decided that Smith Island needed a modern sewage treatment center. Previously, the septic systems had depended upon God to flush the entire Island twice a day with the tides. Howevcer, the mainlanders were anxious to show the Islanders that there was a better way. So, the modern sewer system came to Smith Island with the mandatory property taxes to pay for it. Some refused to hook up. They were prosecuted and forced to do so. Glen has a modern hookup but his neighbors say he pays his taxes in an unusual way. He goes to the bank and and gets a large box of pennies which he takes to the courthouse in Princess Anne. He then asks for a receipt and while the money is counted, he takes a paper back book from his ever-present jacket and reads peacefully.

When in an expansive mood, Glen Marshall is a wonderful story teller. Recently he told me about a business trip he had taken to Pennsylvania. The car had not run properly. Within an hour of leaving Crisfield he was homesick. He had trouble finding the place for the appointment. "Then they took me to a place called "Wendy's," where I had to eat a fucking square hamburger."

Story telling is natural to the region. Book learning is seen as having very little survival value on the water. The culture is oral and experiential. You learn how to make a living by going out on the water with your dad or a trusted friend of the family. You are taught by word of mouth and can't find what you need to know in a book.

Story telling survives in the general stores, both in Ewell and Tylerton. The men gather there early in the morning and evening to pass along information, to tell jokes, and to gossip. The favorite form of joke is the lie. With a lie you must keep a straight face in order to further confuse the listerner who must make a decision about the veracity of the story. The lies are frequently versions of "tall tales."

For example: One day I was trying to put shingles on the side of my house when a thick fog rolled in. I was trying to get done that day so I kept on nailing down those shingles. But the fog was so thick that when it left, it took the shingles with it. 

Practical jokes are also a highly esteemed form of entertainment. Once Mrs. X conspired with Charlie Marsh to play a joke on her husband. Mrs. X told Charlie that she wanted to surprise her husband with a practical joke and to raise some money for the church at the same time. She told Charlie that she intended to hit her husband in the face with a pie on a certain date in the Tylerton store but she wanted to sell tickets to insure that the church benefitted and to guarantee a big audience.  Charlie worked with great diligence and sold many more tickets than expected. On the scheduled day of the event, the village assembled at the general store and waited for Mr. X's appearance. Charlie was in the front row of the crowd. When Mr. X did appear, Mrs. X took the pie and hit Charlie square in the face.

Today Mary is feeling somewhat better.  She has a sharp mind (and tongue) and has discovered a good deal about her family history. Her maiden name was Tull. The first Tull on Smith Island was Mary's great-grandfather,  a shipwright from Pocomoke City who arrived after eloping with a thirteen year-old girl, who was a 'Marshall.' Mary said, "She was a Marshall who married a Tull. I was a Tull who married a Marshall.

I asked Mary if she and Ullie had been related. "Very distantly," was her reply. "Ullie's father's uncle was my grandfather. The exact nature of the relationship was not immediately apparent to me and I had to diagram it to understand that Ullie and Mary were second cousins. As I drew the diagram, Mary related her concept of a scandalously close realtionship and that was Captain Cale of Ewell who had married his first cousin. "When the love bug hits you, you're done for," she said.