"Giving up too much time for others; that's how it was in those days. It was the norm for medicine."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is David B. Nichols' story.
"Aviation" and "medicine" were the two highest scores from his high school career aptitude test. And for the past 31 years, David B. Nichols, MD, has been commuting once a week to Tangier Island, piloting his own plane or helicopter. The 15-minute flight takes Nichols to an area where the residents have triple the rate of diseases he has seen any place else.
Islanders with major injuries like fractures and even heart attacks sometimes wait days for Nichols to arrive to provide them with care, due to difficulty traveling to the mainland.
"We have people here dying in their 20s and 30s of heart attacks; it's a big, big issue," he says.
Nichols is currently facing his own mortality—cancer is this superhero's kryptonite.
Six years ago he survived melanoma in the back of his left eye, only to learn that this year the cancer had spread to his liver, giving him only a few months left to live. The family physician, 62, knows his kind is a dying breed. Seventy hour workweeks and after-hour appointments are not as common as when he started his practice.
"Giving up too much time for others; that's how it was in those days. It was the norm for medicine," he says. "I can understand why today younger doctors don't want to work the long hours; they want to go home to their families."
Compared to other areas of Virginia, Tangier Island families often fall below the norm in some areas, making healthcare accessibility a challenge. For example, the island falls below the state averages for median household income, employment, and house values.
The average population on the island was 605 people in July 2007, a tiny dot on Google maps amidst the Chesapeake Bay. There are few cars. There is one medical clinic. Nichols describes the area as "something out of a Norman Rockwell painting." The residents speak an Elizabethan English derived from their heritage and isolation.
Nichols first encountered the people of the remote island on a family trip, and began traveling back and forth in 1979 doing missionary work on the island —treating patients "like family." That's when he made the decision not to leave the islanders stranded without healthcare.
"Turns out the mission's in my backyard—which I think is the case for a lot of places in America—there can be a lot of room to help people without going to Africa or other places," he adds.
The patient care is often more expensive than what Nichols brings in financially; he subsidizes a majority of the care he provides as owner of White Stone Family Practice, part of the Riverside Health System, based in Hampton Roads, VA.
Over the years, Nichols' notoriety has snowballed. In 2006, his colleagues secretly nominated him for “Country Doctor of the Year,” a national competition. He won. Nichols has also been called "Dr. Copter" because of his love of helicopters and "Dino Doc" for his so-called "ancient" practice of long hours and a life's work of patient dedication.
He recalls one card from a patient he helped one evening during his off-hours 19 years ago. "It's amazing the little things that people remember when you go out of your way to take time out and help someone else."
Today, hundreds of cards from patients offering love, thanks, prayers, and good-byes litter his house as terminal cancer forces the family physician toward retirement and the end stage of a life of patient care. Before his diagnosis, Nichols had no intentions of retiring soon.
Nichols' time for others is sandwiched between his own blood work tests, media interviews, and family time. Nichols still takes flight to Tangier for visits.
While airborne with his son on the way to the island, "I told him I wished I could see it through to the end. And he goes, 'Dad, at least you're going out with a bang.'"
And a bang it was, as the islanders honored their doctor in August.
Planes packed the tiny runway at Tangier Island. The magnitude of the crowded street could not be captured with a camera lens. Witnesses came to watch Nichols' vision for a healthcare facility come to fruition after five years in the making. The new Tangier Island Medical Clinic comes equipped with primary care, emergency services, wellness and prevention programs, and a surprise: the name "David Nichols Medical Center" branded on the outside. The facility was built to replace the existing 50-year-old clinic. Nichols' medical legacy continues as Elizabeth Inez Pruitt—island resident and physician assistant—oversees care under the supervision of Keith Cubbage, MD, of White Stone Family Practice.
Now islanders can receive an enhanced level of care with colonoscopies, digital x-rays, EMRs, gastroscopy, cardiac stress testing, a modern lab, and a surgical suite for minor injuries.
"I would say that there is not one other family practice building anywhere in this country that could top this," he says.
“I've received way more than what I've given," he says of his legacy on the island. "I hope people will remember, Dr. David Nichols tried his best to help people."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
