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Truck Calls

by Eva Murray

Sharon is on the island.

Even those of us who are pretty convinced that we don’t need anything are on Sharon Daley’s radar. She’s the registered nurse associated with the Maine Seacoast Mission—to most of us, “the Sunbeam”—and she’s the closest thing a few islanders have to a primary care provider. Checking on her island patients she’ll often just stop by to visit, or we’ll drop by aboard the Sunbeam when they’re in the harbor, to visit with her, even if we don’t need anything. That’s how health care ought to work.

At the moment the 75’ vessel Sunbeam is in the shipyard, so our pleasant visits aboard (focused largely on steward Jillian’s cookie jar) will have to wait. The ‘Beam’s telemedicine unit, where a patient on the island—in a private area aboard the boat—can interact in real time with a physician, counselor or other provider over a high-resolution video link, has changed the nature of “isolation.” Folks who don’t go to the mainland much can have greater access to medical care and advice than ever before. Still, a videoconference is not the same as a conversation with a human being, particularly when that human is a trusted friend, an experienced nurse who knows a thing or two about the real world.

As Sharon gently makes her social calls and home visits she offers flu shots, blood pressure checks, and advice on connecting with medical providers. Ever conscientious about patient confidentiality, much of what she does the rest of the neighborhood never sees. Helping arrange for professional substance abuse counseling is no small part of island nursing these days, and Sharon is nothing if not sensitive to small-town reality.

When Sharon visits the island she likes to walk around. People generally offer her use of their vehicles, but, unless weather is awful or she has something heavy to deliver, she says more gets done if she’s on foot. People driving between home and wharf see her and stop to talk. Coming to the Sunbeam specifically to see the nurse requires timing, and might be public, and sort of means you’ve acknowledged to yourself that you need some help. It’s easier to just chat in the road. Sharon might hook a ride a half a mile up the island with somebody, in their pickup, listening carefully as they gradually get around to their health question. She calls these “truck calls,” and they make a difference.

The Sunbeam is at the Front Street Shipyard in Belfast this winter, receiving extensive maintenance including a complete sandblasting and painting of the hull interior, updates to systems, and new accommodations. In the meantime the Seacoast Mission is sending a reconfigured 34’ lobster boat—fittingly christened the Moonbeam by the Isle au Haut school children—to islands more easily reached such as the Cranberries. For Matinicus, to which the trip is often long and arduous and a bit much for the Moonbeam, nurse Sharon and chaplain Douglas Cornman generally make the trip by flying with Penobscot Island Air. Realistically, a lot of telemedicine services can be accomplished with a decent laptop these days. Whether arriving by boat or by plane, having the nurse come by once in a while is reassuring to us all. Even if we don’t need anything.

The history of nursing on Matinicus Island goes way back. Years ago, this place was a much larger community. 200-300 year-round residents was not an unusual head count back in the earlier part of the 20th century, and winter did not mean a time to go away on vacation as it does now for so many. A fundraising effort called the Nurses (or Nursing) Association existed for years on this island, sponsoring dances and suppers and such to raise the salary for a young RN to stay the winter. Some of these nurses married island natives and chose to stay. Grace, who married Vernon Philbrook, came to Matinicus as an RN; they had the house I live in now. Rena, the mother of Vance and Albert Bunker, was an island nurse, as was Nina, who married Clayton Young, the storekeeper and postmaster, Colby College math major, lobsterman, and town historian (this was not always such an uncivilized outpost!) Nina (pronounced “nye-na”) served as the island nurse and, by all accounts, beacon of civilization, for several decades until failing health in the 1970s. The island nurse had to deal with anything which came her way and assisted with both routine care and emergencies. After her death, as the Nursing Association had faded away and fewer islanders felt themselves truly isolated, nobody was hired to replace her.

I suppose nobody thought they needed anything.

It would be roughly 25 years before there were any sort of licensed medical people on Matinicus again. In 1987, when I moved here as teacher, people more or less knew who they could call upon for help, but no trained medical caregiver was established. Guys who had worked aboard ship might stitch each other up if enough rum was involved, and everybody knew who the compassionate and the sober ones were if an old lady with a broken hip had to be gently transported to a Coast Guard helicopter, but nobody kept up on the latest science or checked the dates on their aspirin bottles. The doctor on Vinalhaven saw each of the school kids at least once a year, and many islanders went there, by lobster boat, for care.

In the early 1990s there was discussion at Town Meeting about getting some small bit of training and more up-to-date first aid supplies into the hands of a few willing islanders. Not all of us remember Beth Bray, who lived here briefly then (she existed somewhat in the shadow of her husband, about whom stories are still told,) but Beth was a nurse herself and encouraged us to upgrade our emergency response options. We had no intention of starting a full-fledged EMS service (an “ambulance” service according to the rules, albeit with no ambulance most of the time,) but that turned out to be almost obligatory. Emergency response training beyond the most rudimentary, 3-hour First Aid course meant training as an EMT, and at the time, working as an EMT required affiliation with a licensed ambulance service. We started Matinicus Island Rescue in 1994 with five newly-certified EMTs, all beginners, because we had to. Huge thanks are due Paramedic Luke Church who spent much of the winter of 1994 on the island, teaching our EMT course at Lori Ames’ kitchen table.

Right from the start we were an oddball agency. Longtime public servants at Maine EMS in Augusta are probably still shaking their heads about us. The questions I posed to the state bureaucracy-types about how and when and why we can’t do things the normal way became a standing joke for some (and no shortage of material for a regular column I wrote back in the day for The Journal of Maine EMS). We trained as Wilderness EMTs and made a valiant effort for a couple of decades to increase our knowledge in back-country extrications and MacGyver technique, while discovering that most of our actual calls involved psychology, weather forecasting, and practicing nursing without a license. Emergencies, thankfully, were and still are rare. Strange calls are not.

Older patients as a rule would ask, “Aren’t you some kind of nurse?” Trying to explain the difference between an EMT and a nurse was like talking to a brick wall. For folks of a certain age any medically-trained person not a physician was presumed a nurse. They’d sometimes get mad when I couldn’t do “nurse things.” I’m learning.

There is a recognized aspect of EMS now—somewhat new to official status although not new in the rural reality—called Community Paramedicine. This is where specially trained emergency responders, when not busy with emergencies, in areas where other health care is sparse, might help with less urgent matters. This usually means getting to know shut-ins, elderly neighbors, and folks who need a regular check-in—perhaps wound care or a blood pressure check—but who don’t really need a hospital visit or doctor’s appointment. We do that stuff, whether we’re “specially trained” or not. I admit it.

But Sharon Daley does it better.

Matinicus Island Rescue as a state-licensed EMS service is now out of business due to shortage of certified membership and full-time presence. Matinicus has an informal responder group of experienced people, has one licensed EMT, and maintains basic-level supplies and equipment. Emergency care is often—but not always—available. Emergency transportation is always weather-permitting.

The Sunbeam with its Telemedicine unit will be back in the water sometime in 2020.

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.