Down East 2013 ©
Just a hair past 5 a.m. on a November morning, nurse Sharon Daley leans over Matinicus lobsterman Mark Ames and with the smallest of motions slides a syringe into the soft crook of his arm. Ames, who has the puffed eyes of a boxer and a head of mussed, black hair, doesn’t flinch. He’s loud and joking at this early hour, his baritone filling the room.
Outside, night is still hard upon the harbor. Ames would usually already be speeding across the blue-black waters to his lobster traps. In fact, he was tempted to skip his blood test this morning, but with Daley here on the island and willing to do a draw this early to accommodate his and the other lobstermen’s early-bird schedule, he didn’t.
“She would have tracked me down no matter,” Ames booms. “She’s a sweetheart.”
In the past a cholesterol test was almost a luxury for islanders like Ames, one they often did without. To get any kind of blood test, not to mention have a cough that wouldn’t go away checked or an aching shoulder examined, meant grabbing a ferry or a plane. The ten-minute ride on the twin-engine mail plane costs fifty dollars one-way. The ferry is cheaper, but come winter the boat docks once every five weeks. Cold weather or not, the ferry’s schedule means an overnight on the mainland. Add the price of a motel room to losing a day, maybe two, of work. If it’s the lucrative, but brief lobstering season, a day without hauling costs plenty.
“If you have health problems, the island is not a good place to be,” says Frenchboro resident Becky Lenfestey.
And so, for years, many islanders skipped regular checkups and things like cholesterol tests, flu shots, and prostate cancer screenings. They waited out bad coughs and lived with infected ingrown toenails and suspiciously dark moles. Then Daley, a lean woman with intense eyes, arrived at their docks.
“Now you miss one hour of work, and your kids are in school,” Lenfestey says.
The seemingly indefatigable Daley, 59, is the sole health-care provider who regularly visits Matinicus, Isle au Haut, Frenchboro, Swan’s Island, Monhegan, and Little and Great Cranberry aboard the Sunbeam V, the stalwart seventy-five-foot-long icebreaker run by the non-denominational Maine Sea Coast Mission. A one-woman band, Daley screens for diabetes and cardiac problems. She examines patients for skin cancer, organizes AA meetings, and serves as a school nurse. She is equal parts nurse, educator, diplomat, master planner, and techie.
Her examining room toward the bow is crammed with ampoules, blood-pressure cuffs, and bursting file folders as well as cutting-edge technology that make her floating clinic possible. Via a TV screen over her teeny, corner desk, she and a patient can consult with doctors ashore. She can transmit up-close images, such as the spiraling depths of a patient’s ear or the slick, rosy back of their throats, in real-time. She can even hold an electronic stethoscope to a patient’s heart, the soft thump of which the doctor can hear across the water.
“I’m kind of [the doctor’s] hands,” Daley says.
Daley is at the forefront of a growing international trend, which is called telenursing. Over the past decade, telenursing has grown around the globe, especially in third world countries, but here in the U.S., too. Armed with high-tech equipment, nurses can effectively bring doctors to the most remote areas, even ones miles out to sea. It’s ironically a kind of return to the past, to the days when doctor’s made house calls.
But some things never change, such as people’s tendency to procrastinate doctor’s appointments, to ignore aches until they rage, fevers until they ravage. Daley contends with that as well as the challenge of ministering to islands, where nothing seems easy. Human nature, the weather, the remoteness, all conspire against the nurse regardless of how high tech her equipment. No wonder she can look so resolute, even fierce, yet, at times, so weary.
Daley and the rest of the Sunbeam crew, including Reverend Rob Benson, climb aboard the boat in Northeast Harbor and steam out every other week to the seven islands. The Maine Sea Coast Mission has sent some kind of boat to the islands since its founding in 1905 by two pastor brothers who, with the help of a sloop, led services on islands without churches. Over the years the mission has added more and more programs, becoming a de facto social service agency for the handful of remaining island communities.
The telemedicine program was started in 2000 to improve islanders’ overall health. Hypertension and diabetes are prevalent problems on the islands, and require regular monitoring, which was not easy to do, says Stephen Richards, the mission’s director of development. The cost and inconvenience of getting health care was compounded by the island’s stoicism, Richards says, especially when it comes to mental health services. “They are supposed to be tough and not need that.”
And, yet, they do. Half of the virtual visits Daley schedules are with counselors. Richards says one islander, who was suffering from postpartum depression after the birth of her third child, told him the counseling was a lifesaver.
The mission has no study to demonstrate that the telemedicine program has improved health on the islands, but the islanders tell them so all the time, Richards says. One of those islanders is Natalie Ames, on Matinicus Island, who estimates that a visit with Daley saves her $250 to $300. When her younger son was born prematurely, weighing a mere four pounds, she visited the boat to cut down on doctor’s visits on the mainland. She says residents do take better care of themselves thanks to the telemedicine program and Daley, who is so easy to talk to.
“Just in general conversation with her, something can come up,” she says. “She knows you and knows your kids.”
Daley has wide, flat cheeks, grey-green eyes, and a long nose that slopes just a hair to the right. She has a loose-limbed gait and can fire back a one-liner with ease at even the most rascally lobsterman. Her manner is easy-going, yet intense. The intensity shows in her devotion to her patients — one islander describes her as motherly — and her expressive face, which easily shows worry or frustration.
This early November trip is like any other for the nurse. It will be a marathon of long, non-stop days followed by mostly restless nights. Daley rarely sleeps well on the boat. She’s giving flu shots as well as drawing blood for tests, including cholesterol and thyroid. Consequently she hopes to see most of the residents on each island, which will give her a chance to catch up with all of her patients.
“On this job I get to take care of the whole person instead of just a wound,” she says. “I get to see them when they are well, not just when they are sick.”
But on Frenchboro, the first island the boat lands on, the weather, as it often does, conspires against her. As the Sunbeam lumbers into the leg-shaped harbor at 7 a.m. under a steely sky, lobstermen in their orange rain gear wave from their bows as they pass by heading out to sea. After six days of high wind and seas, the lobstermen can finally pull their traps. Only a few come for blood work. One also misses his virtual visit Daley had scheduled with a counselor. His wife tells Daley, “He’s like ‘I have to haul. I have to make money.’ ”
The weather is just one element Daley juggles. There are also the doctors and counselors’ schedules on the mainland to consider. She must keep in mind when the ferries run. If the Sunbeam goes to Frenchboro on a Wednesday, many of the thirty-five residents will have gone off-island on the weekly boat. Then add Mother Nature to the Rubik’s cube. Daley has to check tidal charts before penciling a patient in, as the Sunbeam must leave the island harbor within two hours of a high or low tide. And after that, high winds can dash all her plans, like the time she rounded up dentists and dental hygienists and scheduled a long list of appointments on the islands: She had to cancel the whole trip.
“It really makes her angry and disappointed,” says Richards.
Here on Frenchboro, fair weather conspires against her. Daley didn’t get the turn-out she hoped for from the lobstermen, but she still got to follow up with an islander who’s been trying to quit smoking, discuss a billing problem with another, and getting blood work from about a dozen people. By mid-afternoon, with the tide rising, the Sunbeam leaves for Matinicus. During the two-hour cruise, Daley curles up in the chair next to the boat’s phone and dials number after number on Matinicus, until she calls everyone on the island to find out if they’ll be coming for a flu shot and blood test the next day.
Daley’s luck improves on Matinicus, where the lobster fleet rises well before dawn. As she kneels on the floor to take Ames’ blood pressure, Lavon Ames, a grizzly bear-sized lobsterman, lumbers through the Sunbeam’s rear door with his Jack Russell, Lady, prancing at his feet. He launches into a story about his “sterntard” while Lady laps the brightly lit room looking for pats. Daley asks Lavon if she can borrow his truck.
“I like yours because I can always pick it out, with the crack in the windshield,” Daley says. “The brakes are still working?”
John Griffith, a tall, drawn, but handsome lobsterman quietly slips in. When he takes a seat for his blood draw, Daley asks why he looks thinner.
“I quit drinking beer and eating cheese,” he says.
“You don’t think you’ve lost too much?” she asks, squeezing the blood-pressure cuff pump. His blood pressure is, as Daley says, “Perfect.”
The Sunbeam, with its endless supply of coffee, cookies, and company, is a floating community center of sorts, even at this early hour. So though everyone is here to get a shot, the room is not heavy with the silence of a doctor’s lobby, but is as boisterous as a bar, as people catch up over muffins and the lobstermen boom one-liners in husky voices and brag about their boat engines.
“Good morning, I guess,” a lobsterman with a handlebar moustache calls as he ducks in.
Daley doesn’t mind the party atmosphere because it relaxes people, making her job easier. Dressed in jeans and a loose V-neck sweater, her glasses sliding down her nose, she weaves back and forth though the coffee klatch, injecting flu shots, filling out forms, and hushing people while she checks their blood pressure. “Both numbers are too high,” she says to one lobsterman.
She pushes handouts on cholesterol and thyroid problems into people’s hands and commands, “Here, read this.” She admonishes a lobsterman with a croaky cough for working with a bad cold. She also teases some of the islanders, and they tease back. “Quit telling me what to do,” says Lorie Ames with a laugh.
A number of islanders are hacking and sneezing from a bug going around, but few as badly as Lorie. She’s been sick for a month. Daley takes a quick listen to her chest with her stethoscope and then asks her to come back to videoconference later with a doctor.
Daley has a lot of caché with her islander patients because she is one herself, which was not lost on Sea Coast Mission when they hired her. She lives on Islesboro, where her husband, Tom, runs a water taxi and the couple raised their two daughters. But Daley is really more country girl than islander. She grew up on her parents’ farm in Missouri. They had chickens, pigs, and a few cattle. She attended a one-room schoolhouse and rode horses bareback, something she dreams of doing again.
“Nobody thought I could be a nurse because I cried over every chicken that died,” she says.
She earned her RN at a St. Louis hospital nursing school. She planned to move to Arizona, but met Tom during a trip to Boston. She got a job with the Visiting Nurse Association of Boston treating elderly people in Beacon Hill rooming houses. She liked getting to know her patients much more than was ever possible in a hospital. That’s why she has spent most of her career as a home health-care nurse, which ultimately prepared her for being an island nurse. When she worked in midcoast Maine, Daley had to make do in houses without running water or nearby drug stores.
“When you are a nurse in someone’s home you just have to figure it out,” she says.
If Daley saw something about a patient that concerned her, she’d call a doctor, and they would instruct her to do a more thorough examination. She’d do what she does now, but over the phone. “This is easy because they see the patient,” she says. “With the autoscope they can see better than they can see in the office in some cases.”
At the start, all that high-tech equipment unnerved Daley. The nurse, who doesn’t watch TV, had never held a remote in her hand. “The person who taught me [to use the equipment] was a man,” she says. “Every time I turned around he had the remote. The first patient I had, also a man, walked out of the examining room with it.”
The islanders seem to take Daley’s high-tech equipment in stride, not to mention that with Daley they have a level of health care most people would envy. What they truly prize are her tight lips.
“She knows how to keep her mouth shut,” says Pat McEachron, a longtime seasonal resident on Frenchboro. “She can’t but help hear what people say . . . If you confide in Sharon, it won’t go anywhere.”
“She’s not judgmental,” says Ellen Bunker, a lobsterwoman on Matinicus. “She gets information but is not pushy or nosey.”
Daley treats people in one of the most intense social hives, where privacy is much coveted but next to impossible. When Daley started her job, she walked around each island introducing herself and made lists of everyone’s names so she could memorize them. She also learned each island’s various divisions, who didn’t speak to whom, and how to negotiate the schisms so as to not be drawn into the disputes.
“I always think of [each island] as an onion, and it has various layers.” Daley says. “It takes a while to work your way through.”
She also has to keep in mind that when someone comes on the boat or she visits a home, most everyone knows, especially on Frenchboro, where nearly all the houses ring the long harbor. With that in mind, when she organized an Alcoholics Anonymous meeting on Matinicus she made it more of a reception so anyone would come. If it was just for alcoholics, no one would have come because it would be an island-wide announcement that they had a drinking problem. As she says, “On the islands there’s no such thing as AA, only A, because no one is ever anonymous.”
Around 8:30 a.m. Daley throws on her roomy barn jacket — no scarf or gloves, despite the chill — and jumps into Lavon’s truck to collect the flu shots at the airstrip. A shotgun crosses the passenger foot well and boxes of bullets on the dash jingle as the truck bumps along the pocked-dirt road.
“This is like the truck I grew up with,” Daley says, smiling, glad for a break from the boat.
At the airstrip, a long patch of mowed grass runs through the island’s dense forest down to the ocean, and Daley joins the few other islanders watching the sky for the plane. One tells her another resident is low on blood-pressure medicine. She scribbles a note on her palm in ink and then, once the Cessna lands, collects her box of flu shots. On the way back to the boat, she stops by the post office to give the postmistress, who can’t leave her job for the boat, a flu shot in the trim building’s lobby. As Daley pulls back on the syringe, she looks at the postmistress, a heavy-set woman with olive-colored skin who’s wearing a skirt.
“I can see the knees are better,” Daley says.
Back on the boat, Lorie Ames sits on a futon trying not to cough. Lorie is small and bird-like, with the slightest hook in her nose. She’s bright-eyed and smiling despite her cold. She would have never bothered to go to a doctor on the mainland about her cold, but since Daley is here, she’s going to get it checked out.
Daley leads the way to her office in the fo’c’sle of the boat. She has Lorie blow into a peak flow meter, which measures the amount of air she exhales, and then dials up Dr. Richard Intel on Vinalhaven. The connection is down for some reason (it turns out later to be from a loose plug) and so the doctor’s face does not materialize on the screen. They are left with the speaker on the phone.
As Lorie perches on the padded bench that doubles as an examining table and Daley leans against a wall of the office, the doctor explains that Lorie’s score on the meter is low, very low. That indicates two things: asthma or emphysema. Given Lorie is a longtime smoker, he suspects the latter. She needs to have chest X-rays, but in the meantime he will prescribe an inhaler for her. When the doctor tells her there’s something she could do to help, Lorie, who’s never quit smiling, beats him to the punch and whispers, “quit smoking.”
By 6 p.m. the tide is just right to head for Isle Au Haut. On the trip over, Daley counts up payments for the blood tests and flu shots, but comes up short. So she counts it again. She calls a doctor to get an antibiotic prescription. As a sternwoman has walked past the Sunbeam earlier, she had held her infected finger up for Daley to see. Then Daley phones people on Isle Au Haut, reminding them to come for their blood work the next day. Her voice grows hoarser and hoarser.
“I don’t know if I’m tired or getting a cold.”
When the boat docks in the dark close to 9 p.m., a feminine young woman in a pink hoodie and with a spray of thick black hair steps aboard. A teenage mom raising her baby with only the help of a friend on the island, she always comes down to talk with Daley when the boat docks. Though the nurse has been up since 4 a.m., she leads her to her office, where the two women chat privately for an hour. Finally, near 10 p.m., Daley goes to bed. But the island nurse can’t sleep even though she knows she should, because if the weather gods smile on her and human nature doesn’t trip her up, the Isle Au Haut lobstermen will clamber about the boat for their blood tests before dawn.