Island Medicine

The second book in the Casco Bay medical series

If you enjoyed reading Go by Boat, take a peek at the first chapter of Island medicine.

By Dr. Chuck Radis

Chapter 1

I flipped off the headlights of my truck on Widgery Wharf and clicked my neck, first to the right, then more forcibly to the left. Another missed ferry. A half-eaten chicken salad sandwich and an unopened Snicker’s bar lay within arm’s reach on the passenger seat. A stethoscope and 6 patient charts from my afternoon clinic on Chebeague Island protruded from my green satchel. My beeper vibrated. 766-5915. That would be home.

It is 1989. A phone booth stood at the far end of the wharf beneath a street light. The only person I know with a cell phone is my friend Jim. His phone takes up a third of the space in his briefcase. When he needs to make a call, he pulls over and places a specialized antenna with a suction cup on his car roof before dialing. His phone costs nearly $4,000. That’s a lot of quarters. Gulping down the remnants of the sandwich, I stuffed the Snicker’s bar into the front pocket of my windbreaker, zipped up the satchel, and headed for the phone booth. Before clicking the door shut, I remembered, backpack on the jump seat. Good.

My boots crunched against a thin rim of ice where the afternoon’s rain pooled on the rutted wharf.  A brisk, raw wind flushed dried leaves, light gravel, and empty beer cans off the end of the wharf into Casco Bay. I thumbed through the pockets of my windbreaker, hoping to find a knit cap or gloves and remembered exactly where they were: at home, in the kitchen closet, stuffed in the pocket of my parka, the parka my wife Sandi reminded me to wear today because most people change into more sensible clothes when the temperature dips into the teens. When I deposited a quarter into the coin slot, I heard a hollow metallic clink, then, a dial tone. I exhaled and felt my neck and shoulders relax. At least I’m out of the wind.

“Hi Sandra.” In the background I could hear jumping and squealing. Kate, age 5 was challenging her sister, Molly, nearly 2, to jump from the landing of the stairs into a jungle pit of friendly snakes.

“Hello my mate. Missed the 5:35 ferry?” Her voice was even, unhurried, even if she was monitoring controlled chaos. I imagined her looking up at the clock above the closet. If the closet was open she might even notice that my parka was neatly hung on a hook with a knit cap and mittens protruding from the pocket.

“I hit some traffic coming down Commercial Street and just now pulled into Widgery Wharf,” I explained.

“I know you try,” her voice trailed off, “but this is the third 5:35 ferry you’ve missed this week.” It wasn’t an accusation, merely a statement of fact. “The next ferry doesn’t leave Portland until 7:15, and by the time you walk home it’ll be after 8. I’ll need to put Molly to bed before you arrive. She’ll be…”

“Hey, Sandra,” I interrupted, “I’m in luck. A police cruiser just pulled into the lot. It’s Officer Mike and Big John. I bet they’re heading for the police boat down by the fish pier. If I hurry, I can catch a ride on the Connolly to Peaks and be home in thirty minutes. Lucky me. Love you.”

Heading off at a lope I caught the pair as they clambered down the iron ladder to the dock where the police boat was cleated. Mike, short and solid as a fire hydrant descended first; Big John, his crewcut exposing a pair of outsized ears, lowered himself two rungs at a time, the iron ladder swaying under his weight. A sprinkling of ice from my boots peppered John’s head as I followed him down the ladder. He released a hand and looked upwards, shielding his head from the debris, and grinned. “Doctor Radis, great night for a boat ride.”

Although the Connolly was more than thirty feet long and heavy-beamed, a wave suddenly lifted the bow and slammed it against the oversized fenders holding it off the dock. Bulky chains creaked and groaned as the dock rode up and down again a pair of telephone pole sized pilings. Mike and Big John boarded the Connolly while I prepared to release the lines.

Mike motioned me inside and closed the door of the pilot house. “It may be a few minutes. They need to pull one of the Lieutenants off the front desk uptown so we have someone to captain the boat again tonight.” Mike methodically checked the navigational lights and bilge pump and flipped on the radar and heater before reaching up overhead for a spare key taped inside a navigational chart. The engine turned over and idled smoothly.

“I hope it’s not Lieutenant Benton,” Big John said, warming his hands over the blower. “I hear the guy managed to blow an engine off Fort Gorges a couple of months ago and they had to drop anchor and wait for the Coast Guard to tow the Connolly back to town. Jerk.”

I raised an eyebrow. “Let me try to understand this,” I said as I stored my backpack and satchel under the console. “You and Mike both have your own boats and lobster in your spare time. Right?” John nodded and handed me a life jacket as he zipped up his own. “So why don’t one of you captain the boat?”

“Because,” Mike glared, turning back to me, “Because a Lieutenant needs to pilot the boat. That’s our orders.”

“Oh,” I smiled. Delicate topic.

There was a tap on the window. A pasty faced, plump man in a white parka, wearing penny loafers, police trousers with a side holster, and a pair of arctic mittens stared back at me. “Gentlemen! It’s a hell of a night! Should I get the lines?” he shouted above the wind.

“No sir. You’re piloting the boat sir. I’ll get the lines.” Big John exchanged places with the lieutenant and stood motionless on the dock, awaiting further instructions. Inside the dimly lit cabin, the lieutenant produced a key attached to a miniature red foam buoy from his zippered front pocket, and attempted, unsuccessfully, to force it into the ignition. There seemed to be something blocking access. He sat down in the pilot seat and tried again. It was Mike who explained that it was awfully dark in the pilot house, but there was already a key in the ignition. The engine was running. He and John wanted to make sure the Connolly was running smoothly before heading across the bay.

“Of course,” Lieutenant Benton said stiffly.  “Makes sense. Good work,” he added.

“Are you ready sir?” Big John undid the bow and stern lines and held the Connolly off against the wind. “I need to give the Connolly a push to clear the dock to get us underway, otherwise we’re going to grind against the pilings,” he shouted, then mumbled, “Like we did last time, sir.”

Officer Benton clutched the wheel. John pushed off against the wheel house, separating the boat from the dock. “Now!” Big John yelled. The lieutenant thrust the throttle forward and the Connolly lurched away, Big John just barely grabbing a side-rail as he jumped onboard. For a big man he was agile as a cat.

Underway, Lieutenant Benton turned the bow towards the islands of Casco Bay, the compass on the console swinging around to 85 degrees, a straight shot to the first green blinking navigational can, a mile distant. I was lulled into a measure of comfort; the Connolly had the wind and following seas at her back, and the Lieutenant opened a thermos of coffee and poured himself a half cup as he concentrated on the back-lit radar screen. Three miles distant a faint cluster of lights marked the wharf on Peaks Island.

November is an unpredictable month on Casco Bay. By the first of the month, virtually all the pleasure boats, both motorized and sail are on jack stands in boat yards or driveways, winterized and shrink-wrapped, awaiting spring. Lobster traps have been pulled and stacked; seal and whale watching tour boats have motored south to winter tourist areas. A few larger lobster boats and trawlers still ply the deeper, offshore waters but the work can be brutal; gale-force winds and heavy snow may blanket Casco Bay one day, and the next, a warm breeze might flutter in from the south with temperatures in the fifties.

The water cools slowly. By mid-November, which is to say, now, the bay water temperature is usually in the high 40’s, by January, mid 30’s. Every five or ten years, the inner bay, at least around the Portland waterfront, freezes solid. Every twenty or thirty years, the bay ices over as far as Peaks Island. Looking out from the Connolly, I figured I’d last ten, maybe fifteen minutes tonight if I fell overboard, that is, if I didn’t cramp or panic.

Lieutenant Benton’s nose pressed up against the radar screen, his parka’s tunneled hood obscuring his face. We passed an ocean tugboat pushing a barge towards Merrill’s Marine Terminal up the Fore River. A flock of seagulls flushed from where they rested on the water. The trawler, Northern Lights, unloaded its catch at the Custom House Wharf. Three spot-lights illuminated the deck while a hose suctioned up thousands of pounds of herring from the hold. Lieutenant Benton pushed the throttle forward and the Connolly accelerated through the rolling, black, seas. A loon, panicking, rose up and dove for cover. I reached out and grabbed the console for support. We came over the top of one wave and bounced heavily into the trough and I noticed that the flooring was awash in coffee.

“Lieutenant,” Mike peered through the windshield. “We’re coming up on the number 5 green can.”

“I know. I can see it clearly on the radar.”

“Lieutenant!” Mike repeated. “We’re dead on.

“I know,” the lieutenant answered. There was a note of irritation in his voice. “I can see exactly…” Abruptly his head bobbed up from the screen. The green, one-ton blinking number 5 navigational can loomed directly ahead. He swung the wheel sharply but in his panic neglected to throttle back. The bow of the Connolly nearly clipped the can. I fell off my seat. Big John banged his head on the low ceiling of the cabin. Mike, legs firmly planted apart, glowered at the back of the Lieutenant.

“That came up fast,” Lieutenant Benton muttered as he stroked his pencil thin mustache. On we sped towards Peaks Island. The gray silhouette of Fort Gorges—a Civil War fortification, rose up on our port side, shouldered by breaking waves churning over a shallow ledge extending east and west. We’re a good hundred yards outside the blinking red buoy, safely away from the shoals. Through the gunnery openings I noticed a flickering, orange glow.

Big John pointed to the pale outlines of a skiff pulled up on the sand beach. “Party Island, Doc. Some group of yahoos is camping somewhere inside. They probably have a bon-fire going in the courtyard.  Probably didn’t count on this kind of wind. I hope they have their skiff squared away and don’t get too drunk. The last thing I want to do is rescue some idiot with a broken leg later tonight. “And don’t think we won’t call you for help,” John smirked.

I peered past Fort Gorges down Diamond Pass–the channel separating the Diamond Islands from Peaks Island and spied a pair of red and green navigational lights plowing through the waves. Probably a lobster boat from Long Island down the bay, I decided, or maybe even a vessel from Chebeague or Cliff Island bucking the headwinds to drop off their catch in Portland. The sight of the lobster boat triggered something else. That’s the problem with bouncing around the bay to four islands, daily hospital rounds, and a part-time in-town practice, I have an uneasy feeling there’s something I promised to do tomorrow and neglected to write down; a phone call, maybe a request or favor. I closed my eyes and focused. Something I need to do tomorrow. Something. I pulled my 3 by 5 inch pocket calendar from my shirt pocket and clicked my ballpoint pen. There. Now I remembered, and scribbled, House Call Cliff Island, Yohanna VonTiling and then, Hat/Gloves.

Officer Mike tapped his commanding officer on the shoulder. The outline of Peaks loomed ahead in the darkness, the wharf coming into sharp relief. From the wharf, a metal ramp angled down to the public safety float. “Lieutenant, we’re coming up on Peaks.”

“I can see it on the screen. I’m heading for the public safety float.” Lieutenant Benton replied.

“Sir, you’re coming in too fast.”

A van pulled up on the wharf, its headlights bouncing off the water. We flew by Rick Callow’s scallop boat, E. Cosi, and Bobbi Emerson’s lobster boat, the Carrie Anne, nodding on their moorings. The lieutenant pulled back ever so slightly on the throttle, his face still glued to the hypnotizing game being played out on the radar screen.

Big John whispered in my ear, “Grab your stuff, NOW. This guy is a major jerk.” Two figures on the wharf emerged from the van and waved the Connolly off. We were coming in hot. Reflexively, I grabbed my backpack and satchel and scrambled after Mike and John outside the pilot house. For a moment I didn’t quite understand what Big John had in mind. Then he leaned into my ear and shouted, “When I count to three, jump onto the public safety float!”

Wait. That was the plan? Jump? I blinked and tried to make sense of our predicament. Dead on, not thirty feet beyond the public safety float, was Covey’s Lobster Shack. On the waterside of Covey’s shack, was a finger pier with lobster traps neatly stacked on one end and a dingy tied on the other. Oh my.

“One.” Mike and John crouched on the rail of the Connolly.

“Two.” I reluctantly joined them.

“Three!”

At the moment we jumped, Lieutenant Benton in a panic, abruptly threw the Connolly into full reverse. We tumbled onto the public safety float, rolling towards the opposite edge. Big John reached out and caught my leg. I felt a sudden, unwelcome tearing sensation in both shins. We sprung upright. The Connolly lurched to a full-on STOP, the back-wake surging over the float nearly knocking us over, as the boat settled in the water.

Lieutenant Benton stuck his head out the pilot window. “You guys are crazy! There was no need to jump!” Above the howling wind I hear a tinny, abrasive, grinding noise. A puff of smoke rose from the diesel cowling. A darker cloud followed. “Wait! I need help tying off!” the lieutenant shouted. Big John and Mike, pretending not to hear, silently headed up the ramp. Somehow, I’d held on to my satchel and backpack.

Up on the wharf, I realized that the men who’d tried to wave us off were actually police officers. The Chevy van they arrived in was none other than our makeshift, dreary, island ambulance. I stood off to one side and listened in as Mike and Big John received their report. The four men huddled together, knit caps pulled over their ears, Big John looming over the others, his face, now and then glowering in the general direction of the Connolly. The report was routine; major crime is rare on Peaks Island, but minor crime such as public intoxication, fist fights, drunken driving, loose dogs, and shoplifting keep the patrolmen busy, particularly during the summer months when the population of Peaks Island may swell from our 900 year-round islanders to 3,000. Not infrequently, the police are summoned for domestic abuse calls, which are often alcohol fueled or, in more recent years, connected to drug use. Fortunately, fire, which places the entire island at risk, is exceedingly rare. Older islanders still remember the Great Fire of 1948 when three fourths of Peaks burned after a fire broke out on the old military reservation, barely sparing most of the year-round homes clustered near the ferry dock.

I know we’re fortunate to have a core group of patrolmen who enjoy the slower pace of island police work. What’s more, in an age of specialization, the police on Peaks are triple-trained: each officer has fire-fighting capabilities and is a certified emergency medical technician (EMT). As a city island, this, and the financial support for our island grade school and library, is what keeps Peaks tethered to Portland, which is good or bad, depending on who you talk with. Me, I want to secede. My wife, Sandi, wants to stick with Portland.

Mike and Big John offer to drive me home. The off-duty patrolmen on the wharf tossed their cigarettes into the bay and silently marched down the ramp, their backs bent and forlorn, awaiting further orders.

Big John turned the van around as Mike rubbed his hands over the heat vent and I crammed into the front seat. A pool of water formed on the floorboards. The adrenaline rush of our jump was replaced by a deep aching in my lower legs and left hip. It was Big John who snorted first, trying unsuccessfully to stifle a laugh. Officer Mike erupted in a high pitched, staccato titter. Shivering uncontrollably, I joined in, our shared misery not all that dissimilar from the black humor of practicing medicine.

As the van worked its way up the cobblestones of Welch Street, we passed Jones Landing, a restaurant and bar. On my first visit to Peaks Island five years ago to explore the possibilities of an island medical practice, I remember sitting at the bar waiting for the return ferry when an anchored sailboat exploded into flames not fifty yards offshore. The flames triggered a lively conversation at the bar. No-one seemed particularly concerned other than to note that the owner wasn’t on board. And that he an idiot.

Mid-way up the hill, we passed Lisa’s Peaks Café. Between 6 and 6:14 a.m. is a delicate time in the cafe. Islanders want to fill their mugs, pay their bill, and rush down the hill to board the 6:15 ferry. Woe to the someone who cuts the line. Without a word, Lisa may famously dump your coffee in the sink or allow your egg sandwich to drop onto the floor. If you value your health, don’t get in an argument with Lisa. She brews your coffee.

Danger lurks outside Lisa’s as well. The hill is short but steep. There are patients of mine with emphysema or heart disease who barely navigate the hill. If I am coming off the ferry behind them, I carefully observe their progress. If they pause at the stone wall in front of Lisa’s, breathless, or worse, clutching their chest, I’ll saddle up to them and ask, “Having a hard time?  Here, sit down at the picnic table.” A quick evaluation follows. If a few puffs on an inhaler or a tablet of nitroglycerine—I carry both in my green satchel—fail to resolve the symptoms, I arrange for a transfer to Portland on the fireboat—our island rescue boat.  That is, if they’re willing to go. Following medical advice on Peaks Island, even in the case of an obvious emergency is not a given.

The hill has other dangers. I don’t know how many times I’ve watched an islander slip and fall on a patch of ice racing downhill for the ferry: Fragile octogenarians pushing a cart, children skipping merrily on top of the stone wall, distracted commuters sipping their coffee. Simple stuff: sprained ankles and wrists, forearm abrasions, a bump on the head; serious injuries: a broken hip, a fractured leg, a concussion.

For those racing downhill, I have nick-named Welch Street the hill of mechanical mishaps, trudging uphill, heartbreak hill.

At the top of the hill, Big John turned left. We’re on level ground now, thirty feet above high tide. I turned round and surveyed what passed as our Peaks Island ambulance. Behind me, on the bed of the van, a plastic orange Stokes litter held several folded sheets and a small gray pillow. The sled, similar to evacuation litters used in the Korean War, looked, to my eye, suspiciously like a Walmart children’s sled. Adjacent to a makeshift wooden cabinet, an oxygen tank was attached by a shock cord. An emergency kit nestled on a clump of tire chains. A shovel clanged against a rusted wheel well. I cracked open my pocket calendar and scribbled: Lobby Portland City Council for better Ambulance! Then I thought to myself: Again.

We drove slowly past Feeney’s Island Market where Heather, a British transplant, married to Paul our island plumber, works the cash register and mysteriously tracks how much beer or liquor you’ve purchased. If it’s by the half gallon or case “for a friend” there is an informal labeling of your alcohol intake ranging from a barely raised eyebrow to a flat out denial of purchase. Sometimes this decision is easier than you might think. When Jimmy Flourney staggered into Feeney’s last week and managed to wiggle a case of Budweiser out of the cold case but couldn’t remain upright and pushed the case to the register on all fours, leading with his nose, Healther calmly confiscated the beer and instructed Jimmy to keep crawling out the door.

Next to Feeney’s Island Market is the Cockeyed Gull, our only year-round restaurant. On my way to an early morning ferry it isn’t unusual to see several islanders at the bar downing shots of vodka or tequila. In fact, my very first patient at the Peaks Island Health Center four years ago was a man I observed sharing a drink at the Gull with his dog Skippy. If it sounds like there’s a lot of drinking on Peaks Island, it’s because there is, and what’s more, it’s often public, including on the ferry to and from Portland where passengers regularly sip their beverages from brown bags.

Above the bar, a framed photo from the 1950’s shows a Peaks Island ferry off-loading passengers down a ramp onto the ice several hundred yards from shore. In the photo, mothers grasp children’s hands and men in burly overcoats trudge miserably across the ice towards Peaks. Someone has taken a black magic marker and circled a barrel-chested, white-bearded man smoking a pipe and wearing a captain’s cap. His pink, beefy hands are visible below the cuff of his seaman’s jacket which is flung wide-open. Above the figure is the notation: ‘Bud Perry’— my second patient at the Peaks Island Health Center.

Bud’s gone now, his life not unlike a stream cascading down a mountainside with a series of abrupt drops, each signifying a life-threatening medical event. Each time I thought a hospitalization would lead to his demise, whether it was gangrene leading to amputation of several toes, pneumonia, blindness, or kidney failure requiring dialysis, he stabilized in a quiet pool, regained his caustic edge, and irritated most everyone he came in contact with— until he entered the rapids and dropped over another ledge. In his last 3 years, Bud visited me at the Peaks Island Health Center twenty-seven times. When he died, I lost a good friend. He was 71.

Big John drove on in silence, past Plante’s marina and laundromat, Brad’s bike shop, the library and fire-station, and took a hard right and then a left at the Peaks Island grammar school. Snow peppered the windshield. A blast of wind coming off City Point rocked the vehicle. John flipped on the windshield wipers. We slowed as a herd of 9 deer ambled across the road in front of the van. Three quarters of a mile from the ferry, Big John pulled over and I gathered up my satchel and backpack and limped down the boardwalk towards our house. Wind-driven snow swept over the dried cattails and Canadian goldenrod in our front yard. Another deer barely looked up from where it browsed on dropped apples amidst a clump of bittersweet tangles.

I clicked the door open and slipped off my shoes and hung up my windbreaker without turning on the light in the mudroom. Entering the kitchen, I shouted hello and turned on the stove to heat water for a cup of tea. Sandi came around the corner and her jaw dropped. A trail of blood-caked footprints followed me from the door. I looked down and realized that the front of my dress pants was torn below each knee and a burgundy red stain flowed from my mid-shins into my socks. So that was the nagging ache I felt as I rolled on the dock. There was blood on the palms of both hands. I reached up and realized my pocket calendar was missing, and my pen.

Sandi grew up on a dairy farm in New Hampshire. She is matter of fact about blood, crying children, and minor injuries. In high school she was crowned Upper Valley Sewing Bee Queen. As a member of the local 4-H club she fed and groomed juvenile cows for the local county fairs. Blue ribbon or not, when a cow’s days of giving milk were over, Sandi’s father took the animal to the local butcher, and the cow transformed from a steady source of milk into dinner for the Korpela family.

Kate and Molly came roaring around the corner and stopped abruptly. Kate asked, “Daddy, do you have red paint on your socks?” Molly, stared curiously but didn’t appear particularly upset. True, her father looked scary but he was smiling like all this blood was, well, normal. Kate looked at Sandi, near tears. I felt I need to say something, anything, so I went with, “Oh my goodness, I just realized why my feet ache. No shoes! Give me a minute and I’ll be good as new.” Kate, wrapping her arm around her younger sister, disappeared back into the living room.

In the bathroom, under Sandi’s critical eye, I stripped down for a shower and gently washed off the wounds. Similar to scalp wounds that bleed like stink, the cuts on the lower legs were not particularly serious. They should close with a few Steri-Strips. After the blood washed off my hands, my fingers looked and worked just fine. The steaming water in the shower flowed over me. Sandi joined me, just to be sure of her initial impression. She found several additional injuries and wondered if I broke a rib, and asked, “There’s nothing to do about that, is there?” Then she told me she had an extra pocket calendar for me, just in case I lost the first one. Like most of the articles of clothing and personal items Sandi buys for me, they are bought in duplicate. “Look beneath your socks, second drawer on the right, next to a spare wallet.”

Afterwards, before bed, I took several Tylenol. I laid out my clothes for the morning and cracked open the new brown 3 by 5 inch weekly planner to November 17^th and wrote:  House call Cliff Island, Yohanna VonTiling and then, Hat/Gloves. I turned off the light.

The phone rang. It was the answering service forwarding a number.

I crept down the stairs with my clothes and dialed the number. “Dr. Radis, this is Liz Smith, I’m sorry for calling you so late, but I’m not sure if I’m in labor. I’m having contractions but they’re not so bad. I’ve been timing them and sometimes they’re every two minutes and sometimes they’re every five minutes. I’m not sure what to do.”

I listened, quietly tapping my fingers, uneasy, hyperaware. I absolutely don’t want to deliver a baby on Peaks Island. Never mind that most babies nearly deliver themselves. It is the problem deliveries, the breech deliveries, the babies who come out unexpectedly gray and limp, the post-partum hemorrhaging, which scares the bajesus out of me. During my last year of residency, when I knew that I was going to practice on the Casco Bay islands, I took electives in pediatrics and gynecology—unheard of for an internal medicine resident, but drew the line on obstetrics. No, I was not going to deliver a baby at home on Peaks Island.

The clincher came a few months before moving to Peaks Island to begin my practice. I learned that a woman chose to deliver her baby at home on Peaks and something went dreadfully wrong. The baby died.

I looked down at my notes—Liz Smith, was reaching out for advice. She sounded reasonable. She wanted to do the right thing. And by my own philosophy of patient care, because we were talking, she was now my patient. I couldn’t, in good conscience, fob her off to Big John and Mike if she called the police station in the middle of the night. What if Mike and Big John had to manage the delivery as an emergency? What if it all went dreadfully wrong…and I wasn’t there?

I scribbled down the address and told her I’d be right over.

Upstairs, I gathered up my emergency supplies from the closet shelf and reached under our bed for the pediatric endotracheal kit I purchased several years ago when a family moved to the island with a two week old baby with a congenital heart defect associated with Down’s syndrome. By placing the kit in my emergency bag, I convinced myself I will not need to use it. Even so, I don’t know how many times I’ve held the tiny instrument in my hand, wondering if I could both relax and concentrate sufficiently to slide the tube down a newborn’s windpipe in an emergency. Sandi stirred. I patted her on her hip. “I’ve got to see a woman in labor. I’ll be back as soon as I can.”

“Take an extra Tylenol. Your parka and gloves are in the closet.”

On my way out of the house, I called the police station. No answer. I scraped off a layer of ice from the windshield of our Toyota hatchback, and turned the car around. The hatchback is a big step up from our original vehicle on Peaks in 4 years ago. The Toyota starts in frigid weather and has good traction in the snow. It has a new battery and the windshield wipers work. Having a vehicle on the island is not a necessity. At four miles around, and with most of the year-round population of 850 clustered within a ten-minute walk of the ferry, most people walk or bicycle.

There are other noticeable differences on Peaks from mainland communities. For instance, no one seems to have a garage. There are no STOP signs or cross-walks. Street signs are largely absent. Come to think of it, I thought, as I drove back up the hill towards the school, there are, thankfully, few signs of any kind on the island. I like that.

What’s more, and this is a public safety issue when there’s an emergency, only a handful of island houses have numbers. It’s not uncommon for someone to describe their house location as: It’s the brown-two story cottage with yellow shutters the next left after the Bradbury house, you, know, the people with the cat named Oscar. Tonight I know where I’m going. I’m looking for the street before Brad’s bike shop. After hanging a left, the woman in labor’s house is the fourth house in on the left. I pulled over and knocked on the door. After a moment, a slouchy, droopy-eyed, young man wearing painter’s overalls cracked open the door.

“Yeah?”

I held up my emergency bag. “Doctor Radis. I’m here to see Liz.” He looked at me blankly. A TV blared in the background. In his right hand he held a can of Budweiser. Was that a joint I smelled? “I’m here to see Liz?” I repeated. “She called and thinks she might be in labor.”

Inside, two more men lounged on the couch, watching TV, their unlaced boots resting on a coffee table. Magazines and empty beer cans littered the carpet. A stack of wood lay next to a woodstove. I stepped inside. One of the men pointed towards a back room. “Liz! Doctor’s here.”

“Thanks. Can I use your phone?”

“For what?” The third man on the couch stirred for the first time.

“I need to let the police know that I’m here in case we need to transfer her to town. They can be over in 5 minutes.”

“No police,” he said emphatically.

I blinked. The police will need to wait. I’ll examine Liz first. It’s possible I won’t need them. If need be, I can call the Portland Police dispatcher directly in Portland and convince them to send the fireboat without involving the police. The magic words: woman in labor is usually enough to start the emergency wheels moving.

Lying on a rumpled bed inside the dimly lit room was Liz. I felt a cool draft on my legs as I removed my parka and draped it over a chair. She laid on her side, facing away from me, her black, stringy, shoulder length hair pulled back over her ears by two silver barrettes. A single, oversized, gold hoop draped off one ear. On the dresser next to the bed was a lighter and several loose cigarettes. Panting and groaning, she was oblivious to my presence.

“Liz? It’s me, Dr. Radis, I’m here to check on your labor.”

She turned onto her back, the contraction easing, and after a low-pitched groan of relief, licked her lips and swallowed. “It’s dry in here.”

“And cold, the room is cold,” I added.

“Ron said he’d look around for a space heater.” Her voice trailed off. “Might as well take a look.” In one sweeping movement, she pulled the blanket down to the level of her waist. Pale blue stretch marks flowed off the outer contours of her abdomen. Her arms were pencil thin. A sliver of light angled in from the living room, lighting up her face.

“First baby?” I asked. Please let it be a first baby, please let it be a first baby. First-time labors usually progress S-L-O-W-L-Y.

“Yes. I lost a lot of weight last year, nearly 60 pounds, people said I was getting fat, but I’ve gained back 16 with the pregnancy. Dr. Fredericks, at the Maine Med clinic, says I should have gained more, but I don’t like being fat. At our last visit a few months ago, she said I was doing fine. The baby was doing fine,” she corrected herself.

As she spoke I opened my emergency kit and pulled on a pair of sterile gloves. Then I squirted a dollop of Vaseline onto the second and third fingers of my left hand. “Liz, I need to do an internal. We need to know how far along you are.”

“Sure. I was expecting you’d need to do that.” She scooted closer to the edge of the bed. I rested one arm on the closest leg and with the other gently probed the entrance to the vagina. Liz bit down on her lip. “Another contraction is coming.”

“Breath through it,” I asked, “short, tiny, pants. Blow it away. Pick a spot, like the poster on the far wall, and concentrate on it. Don’t push. Blow.”  As I coached her, I pushed further up the birth canal until I felt the cervix, the entrance to the uterus. It was thinned and partially open, about 3 centimeters. Until she was fully dilated at 10 centimeters, the fetus should remain safely tucked away in the uterus. I have time to call for the fireboat.

“Good news Liz,” I began. “You’re in active labor. Your cervix is thinned and partially open. I’m going to call the fireboat. You’ll be in town and in the hospital before you know it. Only one thing more, I need to take your blood pressure and listen to the baby’s heart-rate.”

“What time is it?”

“10,” then realizing what she was getting at, I added, “The last ferry for Portland left fifteen minutes ago.”

“Shit! I thought I could…”

I ignored this as I reached over and wrapped a BP cuff around her arm and recorded the blood pressure on a sheet of paper. 156/98. Then I transferred the cuff to the other arm and chewed on my inner lip as I recorded the numbers: No mistake, it was 158/96, nearly the same. The readings wouldn’t be of immediate concern if Liz wasn’t pregnant with her first baby. Life-style changes: reduced salt, exercise, and smoking cessation would be recommended. But the numbers were worrisome during labor. I tried to recall the cut-off number for blood pressures for preeclampsia, but was at a loss. What I did recall was that preeclampsia was a serious complication of first pregnancies and was often a prelude to eclampsia, a seizure disorder which may occur either during labor or post-delivery. Both Liz and the baby were now in a high-risk category.

Without a word, I placed the obstetrical stethoscope over my ears and leaned over her abdomen.  I couldn’t hear the fetal heart sounds. Cracking open the door, I shouted down the hallway, “Please turn down the volume! I’m trying to listen to the baby’s heart-rate.”

Closing the door, I could hear muffled laughter as one of the men on the couch imitated me in a winy, pleading voice, but almost immediately the blare of the TV diminished, and I returned to my work. Pressing the stethoscope firmly on the lower abdomen I checked the second hand on my watch as I counted the heart beats out over 15 seconds and multiplied this by 4. A normal fetal heart rate is usually between 120-160 per minute, Liz’s baby’s heart was 120, on the lower end of normal. With fetal distress, lower rates are often the rule.

Folding away the stethoscope, and placing it back inside my green satchel, I said, “Okay, here’s where we stand, Liz.” I pulled up a chair to the side of the bed. “Here, take a sip of water. You need to keep up on your fluids.” She sat up and eagerly drank from the cup I offered her. “Your blood pressure is up and your baby’s heart-rate is a little lower than I’d like. At the moment, I don’t think you or the baby is at immediate risk, but we need to get you to town for the remainder of your labor. You likely have what is called preeclampsia and may need specialized medications. I’m calling the Fire boat.”

This was no time to discuss the fine points of my tentative diagnosis. I squeezed her hand and walked back into the hallway. On the wall was the phone. I lifted up the receiver and dialed 911.

“Portland Emergency services, how can I help you?”

“Hi, this is Dr. Radis on Peaks Island. I have a young woman in labor on the island. I’m at the house and she needs to be transferred to Maine Medical Center.”

“And are the island police on the scene?”

“No, not yet. I’ve called their number and they’re not answering.”

“Then, we need to wait until…

“No, she’s in active labor and may have pre-eclampsia. The baby may be in fetal distress. I need the Fireboat underway NOW. The EMT’s on the fireboat can call me at this number for more information. Her blood pressure is: 156/96. The fetal heart rate is: 120. Are you writing this down?”

“Yes.”

“We need to move on this.” I cradled the phone on my shoulder and opened my emergency converted Sears fishing tackle box on a hallway chair.  The compartments unfolded like an accordion, exposing my emergency medications. Good, Kathryn replaced the 500 cc bag of normal saline I used last week on Cliff Island. I can start an IV before the fireboat arrives.

“What is your address?”

I stretched out the cord line and nudged open the bedroom door with a foot. “Liz, what’s your address?”

“We’re on Grunder Street.”

“Do you know what number?”

“No.”

One of the men on the couch grumbled “26.” Another said, “No, it’s 33, isn’t it?”

“I don’t know,” said a third.

“Operator, I’m on Grunder Street. It’s the fourth house in on the left coming off island avenue. Please notify the police. I’ll be looking for them.” I hung up the phone and half-closed my eyes. Concentrate. I’m not convinced my patient fulfills all of the criteria for preeclampsia. The looming issue is that she might have a seizure. That’s where the magnesium sulfate comes in; as an infusion, it can prevent seizures triggered by preeclampsia. But I don’t have magnesium sulfate in my emergency box. Intravenous Valium is the drug of choice to terminate a seizure. I have that.

There was a knock on the door. I peeked out the blind. It was Mike and Big John. The 3 men fled out the back door. I’d forgotten that the Public Safety building was literally a stone’s throw from the police station.

Big John ducked his head under the door jam and sniffed as he entered. Mike carried his own emergency box and a canister of oxygen. Mike glanced down at my pants. “Your legs okay? Figured the ripped pants and bloody hands weren’t much to worry about. Fireboat’s nearly underway; should be here in twenty minutes. Can she walk to the Ambulance?”

“I think so,” I answered. “She’s down the hallway. If you can retake her blood pressure while I set up for an IV line I’d appreciate it. Her initial BP was high.” Inside the room, Mike flipped on the light and chatted with Liz as he wrapped the blood pressure cuff around her right arm. I prepped the other arm with an alcohol swab before advancing a large bore needle into a healthy-appearing vein. Okay, I half closed my eyes. We have access if she begins to hemorrhage or seize. I lay the 10 mg vial of Valium off to the side. Mike flashed me the blood pressure numbers: 162/94.

Outside, sleet was mixing in with the wet snow. We bundled Liz up and walked her to the van. Mike drove and I squeezed in next to Liz. Big John wisely decided he’d walk; folding himself into the back of the van amidst the plastic sled and medical supplies, frankly, didn’t seem possible. Mike gently applied the brakes down the slick cobblestones of Welch Street. In the distance, just off House Island, I could see the fireboat.

Liz whimpered as another contraction took hold. She reached up and grabbed Mike’s shoulder as I held the IV bag aloft in the front seat. I felt her shiver and suddenly grab a breath and bear down. My rational side thought: first baby, 3 cm dilated, she has a long way to go. My irrational side shrieked, no, no, no, no. Blow it off! Stop pushing! The contraction passed. Liz took several cleansing breaths and relaxed, temporarily. A few minutes later, the fireboat slid into the Public Safety float and two emergency medical technicians (EMT’s) hopped off and raced up the ramp.  Mike and I wrapped Liz in two blankets and walked her towards the boat. In the lee of the freight shed, I relayed the latest blood pressures to the EMT’s and expressed my concern about preeclampsia. As one of them helped Liz board, the other EMT assured me that they were in contact with the Maine Medical Center emergency room. I hesitated at the edge of the ramp, unsure if I should hop on.  “Do you have magnesium sulfate?” I asked.

“Yes. We’ll get her settled onboard, get a fresh blood pressure, and give them an update in the ER when we’re underway. It helps that we have IV access for meds. We’re good to go. Thanks.”

“Here. Take this,” I handed the EMT the vial of IV valium, “Just in case.”

I stepped back from the ramp and removed my glasses, squinting into the wind-driven sleet as the fireboat churned towards Portland. At the far end of the float, the silhouette of a wide-beamed boat caught my eye. There, neatly tied off on the inside of the Public Safety float, rocking with the incoming waves, was the Connolly.