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“I Wouldn’t Want to Live on an Island”

Part one of two addressing health care and

emergency response offshore

by Eva Murray

The remote Faroe Islands 200 miles north of Scotland and
half way between Norway and Iceland. Among the earth’s most remote islands.

Back in September, my husband and I took off for Labrador, the two of us in mind to flee the local calling area for a few days of wine and roses or, to be more accurate, gravy and French fries. Prior to our trip we were stumbling around the “dot.ca” side of the internet and discovered that should we wish to see the tippy top northern end of Labrador, the Torngat Mountains, a medical waiver was expected, to wit: “If your ticker, or your appendix, or your sacroiliac, or anything else of consequence blows out while you’re up herewell, that’s rough.”

We understand the concept.

Offshore islanders are frequently asked variations of the same question. “What would you do if you got really sick?” or, “Supposing you had an emergency in the middle of the night?” or—a common judgment somewhat distanced from reality—“How could you even consider raising your children out there without a pediatrician?”

From time to time, upon describing our home town to somebody elsewhere, instead of “Oh—that must be so lovely” we hear, “Boy. Hmm. Right. It’s probably very pretty but I would not want to live on an island!”

There’s nothing wrong with being honest. To be sure, we wish more people sat themselves down and had this conversation with themselves. Prospective one-room schoolteachers, new sternmen, and would-be year-rounders come to the island with all sorts of charming mythology in mind and quickly find themselves tossing and turning over the idea of being stuck here. That is no joke; my husband’s grandmother tried living here back in the 1970’s, back when the year-round community was a good deal larger than now, and she developed an ulcer over the worrying. There is no shame in admitting that the anxiety can spoil all the fun.

You could get sick, even dangerously sick or injured, and be stuck here without a physician. It’s true. Happily, it is also extremely rare.

It’s not a matter of mileage; it’s a matter of weather. The problem is not that we are approximately 22 miles from Rockland; it’s the marine forecast, the ever-threatening summer fog, the battering winter wind. My fairly lame (but somehow irresistible) wisecrack is, “ ‘You can’t get there from here’ is not Maine humor, it’s a weather report.”

The community nose-count, for most of the year, is under 100 people—sometimes way under. We may not be a “healthy” place in terms of our diets, our beverages, and our morning jog (or lack of same) but we are on balance a peculiar demographic of working-age people with bad knees but the willingness to give it a go every morning. The sort of medical calls I get as an island EMT are largely injuries, and most calls are minor first-aid assists, not emergency transports. Sometimes all I am asked to do is help somebody figure out whether or not they indeed have an emergency. The same can be said for the other responders here—former EMTs and paramedics and ski patrollers, RNs here part-time, and others with potentially helpful experience. Nobody, by the way, is sitting on duty waiting for that call. Everybody has other jobs. And, it seems, all of us who do respond to illness and injury around the neighborhood could easily assume that we are the only person who does so, because we rarely show up as a team. That is not true, though, and the community has a handful of potential responders—assuming people are home.

Matinicus has no clinic or aid room. We have no physician or PA, no full-time and equipped nurse or paramedic. We offer basic-level, wilderness-trained, Good Samaritan emergency assistance. We have defibrillators but no 12-lead EKG machine; we have oxygen but there will be no intubation. If somebody needs help, available people will do the best they can—and nobody will say “It’s not my job,” or “I’m off duty,” or “Call somebody else because I don’t like you”—but you take your chances about who is around on any given day. We can’t provide definitive care for serious issues on the island, and we don’t do stitches here, despite what you heard around the bar in Rockland.

Here’s an example of how it works, and one with a happy ending: last summer, on a day of dense fog, a summer visitor in a rental cottage had symptoms which fit the usual description of appendicitis, although you never know for sure. He first contacted some sort of doctor-by-internet service and the online doc supported that assumption. His wife came to my house asking to use my telephone without explaining (the cottage phone must have had local calling only). I left her in privacy, not knowing that I would soon become involved; she did not ask me for medical assistance. Finally, the passenger boat captain, who was also in communication with the couple and who happened to be trained as a ski patroller, told me over the phone that he sensed that the whole thing sounded potentially urgent.

As a neighbor (not dispatched by 911) I called the patient, who seemed clearly to be suffering, and invited myself over to his rented camp in the woods. I took his vital signs, chatted with him long enough to develop a rough sense of his overall state, and was discussing transportation options including the passenger boat and the possibility of requesting a LifeFlight helicopter. I was thinking to myself that I’d better find out what the sea conditions were like; a pounding and thrashing trip might not exactly qualify as “do no harm.” Turns out, it wasn’t a rough day, but it still takes an hour to go across (and of course Matinicus has no daily vehicle ferry service). Then, the phone in the cottage rang; to my surprise (and relief) it was Penobscot Island Air! Turns out the patient’s wife had called them earlier, despite the fog and the unlikelihood of them being able to fly to this island. The weather had been what we call “unflyable” that morning due to the poor visibility; to land on Matinicus requires being able to see Matinicus. Instrument landings are not a reality here. Fortunately, a short break in the gray murk meant the air service was on their way to us. (Remember that a helicopter would have to fly from Bangor or Lewiston, and while sometimes necessary due to the nature of the emergency, is not always fastest way to get somebody to the mainland).

I piled the couple into my pickup, gave our patient a cushion to cradle against his belly, and crawled as gently as I could over the potholes and ruts the mile-and-a-half to the airstrip, from where he was flown to Owls Head and a waiting ambulance. Appendix it was, and all well in the end.

We suggest the rest of the world think of a remote island not as a broken city, inadequate in its provision for one’s every urgent need and somehow “letting the public down,” but instead as a compassionate sort of semi-wilderness. We might have more in common with a trail up Katahdin or a scenic fishing spot in northern Piscataquis County than Peaks Island or Vinalhaven. The people here will do their best, but yes—you can get stuck here, and no, we can’t make any promises. Being here in good weather means a ten-minute flight to a mainland ambulance, or a helicopter if you need sophisticated medical care en route. Being here in bad weather means a rough trip or no trip at all. Think about it first, and ruminate upon your comfort level with the back-country setting, before you climb aboard.

Eva Murray is the Recycling and Solid Waste Coordinator for Matinicus Island. Eva’s last lobster license was dated 1990, the year her son was born, and cost $53.00, which at the time she thought was an awful lot of money.