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.