On Call: Hospital Emergency Team Cares for Island with Skill and Commitment

By MANDY LOCKE

A heat haze hangs over the Island, and gray-haired men chat about the need for rain as they make their way to the door. Just inside, a visitor leans over the counter and jokingly asks for a cure for summer. A nurse replies: "We have a pill in the form of a ferry ticket off the Island."

The scanner is quiet. No one rushes. No tears. No sign of crisis. Not yet.

But the day is young for the emergency department staff at Martha's Vineyard Hospital.

It's 8:58 a.m. on a recent July morning. A handful of patients - including a few regulars - thumb through magazines in the waiting room. One woman crouches slightly, hand pressed to her belly. She still wears her bathroom slippers. The morning news flashes across the television screen, mumbling forecasts of afternoon showers. A few stare blankly at the screen. They wait to be called back into the triage nurse's office.

Crimson toes - too painful to wiggle - peek from behind a curtain pulled loosely around one of four cots opposite the emergency department's front desk. Dr. Gerald Yukevich leans over a set of X-rays, tapping his pen lightly on a fracture no wider than a pencil mark.

Dr. Alan Hirshberg looks once out the window, then down at his watch and ventures a prediction.

"It's a hazy day. Everybody who has had a problem for the last three days will say, ‘It's raining. I'm not doing anything else today. I'll come on in,' " says the director of the hospital emergency services department and member of the medical center's trauma team.

But he knows it's a gamble. It's an uncertain business - a fact that the month of July confirms. His team of seven emergency-trained physicians treated 2,100 patients in the last 26 days - an increase of about a dozen emergencies a day compared to last July.

"Believe me. It's not just poison ivy and tick bites," Dr. Hirshberg says, noting that they have seen more than their fair share of tick hysteria this season. Memories of July Fourth are fresh - an emergency room stretched to capacity with heat strokes, tick scares, spinal injuries and lacerations. Some patients left with bandages; one moped accident victim was air evacuated to Massachusetts General Hospital in Boston; one arrival in the emergency room never returned home.

Despite the 70-plus hours a week the emergency team has been pulling through the summer, the building itself looks more haggard. Basically untouched since its debut appearance in Jaws, the 27-year-old building could use some spit and polish. Just below the bright red "Emergency" sign, paint chips and slivers of wood hang loose from the awning - bruised by emergency medical staff ambulance drivers. Ambulances are taller now than in the mid-1970s when the emergency department's entrance was constructed. But Dr. Hirshberg is quick to defend the emergency medical service volunteers - a cadre he refers to as the health care system's "minutemen."

"I had to watch the movie Jaws to figure out where certain things used to be, so we could think about changes in the physical plan for the future," Dr. Hirshberg says with a laugh. He pulls back a cart of fresh towels to reveal water pipes that once supported a trough sink.

By afternoon, the cries of a newborn drown out a television rerun of Seinfeld in the waiting room. A father juggles the restless baby from arm to arm while the mother fills out financial paperwork. She flips through her wallet to check the date on an insurance card, an incidental detail in the emergency department.

"It's a system that does not discriminate. No card or a gold card, we'll take care of you," Dr. Hirshberg says. He sounds like he's said it a million times in an attempt to explain the financial complexities of rural hospitals these days.

"It's a critical access problem. You have to keep the lights on and be ready for action 24 hours a day. But reimbursements are down and we make less for more work," he explains.

Nine-year-old Christopher - with a pink bandage on his nose - hobbles over to the kids' table. He lifts his socked foot as he hops. He's still getting the hang of crutches since slicing his foot open on an oyster shell last week when he fell out of a kayak. Dr. Hirshberg, who remembers Christopher from last week, smiles as the child makes his way out on crutches.

"I usually get follow-up news [from patients] in the grocery store," Dr. Hirshberg says after Christopher's father offers a progress report.

By six o'clock in the evening, Dr. Hirshberg's prediction for the day holds true. The two emergency room doctors on duty - a change from only one last summer - breathe easily. Dr. Yukevich leans around a bouquet of flowers, a thank-you gift from "Wounded Knee Tom," to describe his soon-to-be-published book, a "Monty Python meets cruise ship" novel.

"It's a rollick through the Caribbean. An ER doctor gets mixed up with a ballerina and finds himself in a metaphysical service," Dr. Yukevich, who used to be a cruise ship doctor, explains with a laugh.

The Martha's Vineyard Hospital emergency department encounters plenty of drama, but it's usually a far cry from NBC's zany sitcom Scrubs or the network's heated drama ER.

"It's real. It's sudden. There's joy and there's extreme pain," Dr. Yukevich says.

Alice Russell, part of emergency room support staff, talks calmly into the telephone, patiently explaining to a caller that she cannot diagnose tularemia over the phone. She encourages the person to come in.

"We have to be all things to all people. They're bewildered. We're seeing them at their worst moments," she says after hanging up.

A small boy peels off his hospital bracelet and drops it into the trash. He scurries toward the exit, waving goodbye to the triage nurse. Before he clears the double doors, he yells, "I'm free, I'm free." His mom doesn't look nearly as relieved.

It's nearly seven o'clock; half of the eight beds are empty. A group of nurses and doctors gather around the counter: waiting, listening, watching the entrance.

"The door opens and you're expected to know exactly what to do. It's challenging," says nurse Sharry Cox, who will spend 13 weeks in the Martha's Vineyard Hospital emergency room this summer before moving on to another hospital.

The hospital emergency department operates with skill and commitment under the highly respected direction of Dr. Hirshberg. The number of people on the Island swells with each summer season and many of the Vineyard's visitors are of retirement age. Vacationers often ignore the dangers of the Vineyard's ocean waters and many seasonal Vineyard residents return to the Island to recuperate from difficult illnesses. The complexities and stress of yet another summer season on the Vineyard confronts the hospital emergency room and its dedicated staff with one challenge after another.

"We're not perfect. The sun's not always shining and the birds aren't always singing. We won't become Massachusetts General overnight.

"But we've made some really good changes and will continue to do that," Dr. Hirshberg says. That is his prognosis for the future of the hospital emergency department on the eve of his third anniversary as director.