Practicing medicine on Martha’s Vineyard introduces an extra variable in decision making for Karen Casper, M.D., HS ’97, and Pieter M. Pil, M.D. ’96, Ph.D.: the weather.

When presented with a complicated case, Casper, an emergency medicine physician, and Pil, a general surgeon, must factor in wind, fog and waves when deciding whether to treat the malady locally or send the patient to Boston. Patients needing big-city facilities go there by small plane, helicopter or ambulance (via ferry)—weather permitting.

Pil describes the 15-bed Martha’s Vineyard Hospital in Oak Bluffs, with its two operating suites, as “state of the art,” but it does not have a large blood bank and some specialists are not available full time on this resort island seven miles off the Massachusetts coast. Physicians there avoid doing high-risk surgery except when there’s no time or no way to send patients to the mainland. “It’s a whole new level of stress,” says Casper. “You’re hoping the Coast Guard will think it’s safe; you don’t want them on a helicopter and to have them go down.”

Considering the medical implications of weather has been just one orientation to island life required of Casper and Pil since they moved to the Vineyard in July. The couple, who met at Yale, run into their patients everywhere they go. On an island with just 15,000 winter residents, “you’re not anonymous,” says Pil. “You know half the island.” He likes that. “In a big hospital, you treat people and they disappear.”

“You have to be aware of patient confidentiality at all times,” says Casper. “It shouldn’t be different, but it’s more obvious.”

Even in this small setting, Casper makes a broad spectrum of diagnoses in the ER. “I’ve seen everything from an atrial myxoma [a rare cardiac tumor] to tick-borne diseases.” She’s seen lots of tick-borne diseases: Rocky Mountain spotted fever, Lyme disease, babesiosis and even tularemia. Ticks cause so many illnesses that the hospital staff includes a full-time infectious diseases specialist. The staff also includes Stephen W. Miller, M.D. ’67, an associate professor of radiology at Harvard Medical School and staff radiologist at the Massachusetts General Hospital. Since June 1998, Miller has directed medical imaging at the island’s hospital. This arrangement includes a teleradiology link to Mass General.

The onslaught of tourists, who swell the summer population sevenfold to 105,000, quickens the pace at the hospital but also reduces the rate of locals seeking elective surgery. “Everybody earns a living in three months, so they’re not going to get their hernia fixed in August,” says Pil.

Pil says he has attracted a following among patients for a surprising reason: “The word is out that I speak Portuguese.” An estimated 2,000 of the island’s year-round residents, about 13 percent, are Brazilian, and Pil’s Belgian parents raised him in Brazil, where they were working. The island’s Brazilians, many of whom work as deli clerks, carpenters, landscapers and small-business owners, often approach Pil to discuss nonsurgical medical problems because he is the only Portuguese-speaking physician on the island.

Because real estate is so expensive, some hospital employees live on the mainland and commute 45 minutes by ferry. Real estate costs pose a challenge for Pil and Casper too, since they are looking for a house.

But Casper says Martha’s Vineyard is a great place to raise their son, Gedeon, who turned 2 in February. The hospital runs a child-care center right on the grounds, and the schools are very good. Casper sees the island as a potential research laboratory for the public health degree she was working on when they left Boston. She is thinking about raising chickens, too—but she’s likely to postpone agricultural ventures for the moment. Casper and Pil’s second child, Alexa, was born December 4 at Martha’s Vineyard Hospital.

When they moved to the island, Pil says, “We figured we’d either like it or hate it.” They like it.