Speaking with the providers who staff the emergency department at Cottage Hospital on Nantucket Island, one word keeps coming up in their descriptions: magical.

Even then, Nantucket seems to evoke a special kind of magic, a kind of nostalgic wistfulness for the most perfect, wonderful, calming place in the world. They talk about the island’s sheer beauty of course. But it’s also the little neighborhoods and the sandy points, the fishing and the beaches. It’s the eateries on every corner, the fish tacos, the line outside the ice cream shop and the smell of waffle cones. It’s sipping daiquiris while watching the sunset, or a simple walk through the cobblestone streets or along the quay after a night out.

And it’s about the people. Founded on the whaling industry, Nantucket is packed with families whose roots go back to the 1600s. The common cultural thread is hard work and grit. It’s not uncommon for those that live on the Island full time to maintain two or three different jobs, whether it’s working as a carpenter on the island’s beautiful homes or as a chef at one of the many incredible restaurants. The providers who work shifts there describe caring for them as a pleasure, an honor, even. They talk about the dedication of the hospital staff, and the gratitude of the patients, vacationers and locals alike.

Working at Nantucket Cottage Hospital, where USACS staffs and manages the Emergency Department, is a place that gives you “a feel of being included and grounded,” said Dr. Noah Keller, USACS’ Regional Vice-President who oversees Nantucket. “It’s really what medicine is all about: taking care of patients and leaving the politics behind.”

“There is great joy and great reward to taking care of people who are vacationing there,” added Dr. Craig Mittleman, who has been coming to Nantucket for more than twenty years. “But it pales in comparison to serving the people who make up the character of the island.”

A Beloved Island

There is no doubt that Nantucket is beloved by some of the USACS physicians who regularly work shifts there. Dr. Jenny McQuiston said the island was a place where emergency physicians can go both to work and to “mentally recharge.” She and her husband Jim, also a USACS physician, have been going there for years, their two young boys in tow. They both work shifts while also enjoying the island’s incredible atmosphere.

She described taking trips where she would work four shifts a week, but then sit outside in the incredible beach houses, shared accommodation with her USACS colleagues who she’s known for years, eating out at one of the many wonderful seafood restaurants, even sitting on the beach listening to a classical orchestra – the Boston Pops – play a concert.

Every year, Boston’s famous symphony orchestra comes to Nantucket for a benefit concert to raise money for the Hospital. Every physician interviewed for this story described it as a surreal, wondrous event. “It’s an incredible experience and a huge honor to go there and be appreciated,” said McQuiston.

The concert only happens once a year, but there are activities throughout the year for every age and inclination. “You’ve got eateries on every corner. When you’re not working, you’re hanging out with your wife, kids, hospital staff, work-family, and you’re in a beautiful place,” said Keller. “That’s kind of the magic out there.”

Mittleman, for his part, is like a walking tour guide encyclopedia of Nantucket’s many enchantments. He talked about going to Madaket Beach, on the west side of the island, where you can watch the sun set into the horizon and then walk a tenth of a mile up to Millie’s, where you can sit on the porch eating tacos and having a drink. Or, you could go to Children’s Beach, next to the harbor, where the kids can swim in perfectly calm water or tumble around the playground, while parents can relax on the benches under the shade. Or, you could take an off-road vehicle to Great Point on the northern tip of the island, which requires a special permit to drive over the sand, but once you get there it’s “one of the most beautiful places,” Mittleman said.

His list of recommendations goes on and on, from recommendations on nightlife and food to museums about the history of rescuing boats from the shoals, to a ghost walk, to that famous line stretching out of The Juice Bar, where the kids line up to get the best homemade ice cream anywhere on earth – that is, if the copious glowing reviews about the place are to be believed. There is also the island’s “extraordinary” fishing, the many charming neighborhoods, and the ocean water that is just a few crucial degrees warmer than what you can find anywhere on the mainland.

But Mittleman’s highest praise is reserved for Nantucket’s people. And that includes Nantucket Cottage Hospital’s year-round staff. Maria Carey and Calvin Peterson, two PAs who work there year-round, are “truly special,” and “represent the Nantucket ER as much as anyone,” Mittleman said. Keller added his admiration for the tireless work of Dr. Faith Frable, who lives on the island full time and works there both as the Director of the ED, and a hospitalist.

Unique Practice Environment

The experience of working on Nantucket starts just with getting there. “You fly to Boston then you hop on a little puddle-jumper, a nine-seater,” Keller said. “If you are lucky, you can sit co-pilot. That little experience is really cool.” Other times, though, weather on the Island, usually fog, makes air travel impossible. “There are certainly some downsides to it, when you’re forced to take the long ferry that takes two hours, and you’re tired, and you’re like, ‘dear God just get me there so I can go to sleep, so I can get up and work in the morning.'”

That comment echoes the overwhelming sentiment of the physicians who work shifts at Nantucket Cottage Hospital: it is an incredibly rewarding practice environment, but absolutely not for the faint of heart.

“It’s Island Medicine,” said Dr. Jeremy Tucker, another long-time USACS physician who continues to visit the island, occasionally bringing his family along. “You don’t have a lot of backup. And it’s a small ER.”

The department sees about 20 patients a day in the off season, but it balloons up to 80 patients a day during the Summers. You see everything from small lacerations and sun burns to heart attacks and strokes. There are also significant injuries like neck fractures, from people getting hit by waves. “It runs the gamut,” Mittleman said.

Resources are limited, and transfer is mostly by air. Only, on an island like Nantucket, air can be tricky. Early sailors nicknamed Nantucket “The Grey Lady of the Sea,” on account of the heavy fog that could sweep in. To this day, the fog remains a fact of life. Some of the cars on the island have bumper stickers that read, Fog Happens. As Mittleman put it, “That’s all fine and good until you’ve got a critical patient in the ER who needs more than you’ve been able to provide, and MedFlight is blind.”

Tucker recalls an early patient he was treating there who had appendicitis. The fog meant the helicopters couldn’t get in, so one of the island surgeons at the hospital suggested Tucker transfer the patient by ferry. “I was like, do you have any idea how much that would hurt?” For the patient’s sake, Tucker said, he waited for the helicopter.

“Sometimes there’s a patient you need to transfer who you can’t. In winter, when there are nor-easters, or the ferries stop coming for up to a week. You don’t know when the next truck is coming to put food in the Stop n’ Shop,” he said. The breadth and variety of patients can also vary widely. Some patients who have been going to the island for years for vacation continue to go even if they get gravely ill. “They may be end stage cancer, or terminal, and they are trying to get that last Summer on the island,” Tucker said.

Other times, a celebrity will come in, which “sets the hospital abuzz,” Keller said.

But it’s the locals who really make it special. “The people that work in the hospital and live out on the island are just really genuine people. They’re not entitled, they’re really fun to work with, and they like to have a good time,” Keller said. “It’s a place where the people are so grateful for their care, they will literally walk across the entire department to shake your hand and say ‘thank you’ before they walk out.”

“It’s an incredible experience and a huge honor to go there and be appreciated,” McQuiston said. Mittleman mirrored that, saying: “The beauty is that the culture of the staff is really just very unique and very special and it makes even the most trying circumstances and busy days seem less challenging.”

Tucker, too, kept coming back to the unique practice environment: “That’s what makes it exciting to work there. We get stuff done. That’s what ER providers do. We use the resources we have available to solve problems… and it’s immensely rewarding and satisfying to solve those problems.”

WORKING AT NANTUCKET COTTAGE HOSPITAL:

• Typical trip is Thursday to Thursday
• If you are interested in working at Nantucket, contact Dr. Noah Keller