Excerpt from the book:

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The November morning broke crisp and clear, pulling back the curtain on a magnificent scene made even more dazzling from the privileged vantage point of
1,500 feet above it all. The creeks and coves of Virginia’s coast stitch together a quilted landscape of forests, farms and neighborhoods. Out on the bay, sunlight danced across the sparkling water as fishermen and flocks of birds congregated in search of the same treasure. An occasional boat on the move cut a glistening and mesmerizing path.

David Nichols had witnessed this spectacle hundreds of times, maybe thousands, yet he never tired of it. From the passenger seat in his single-engine plane, he
gazed with a silent joy until his eyes locked onto a tiny tuft of land in the distance, all alone in the bay, and his spirit lifted even more.

“Glorious,” he said in hushed exclamation. “Paradise.”

As Tangier Island drew closer, Nichols could see the homes where so many of his patients and friends lived, the crab shanties and small shops where they
worked, the freshly painted blue water tower that along with the steeple of historic Swain Memorial United Methodist Church loomed large over this low-lying wisp
of precious earth. The island’s airstrip, hugging Tangier’s western shore, beckoned his plane.

But Nichols saw something much more and felt something much deeper. He had grown to like saying when on Tangier “you’re a little closer to heaven.”
He had begun traveling to Tangier from his mainland home more than 30 years earlier as a once-a-week mission, though he was not the second coming of Albert
Schweitzer, and never claimed to be; he was operating a medical practice, not a free clinic. But he never made money practicing medicine on Tangier. In fact, he lost
significant sums every year, though he managed to find ways to write off some of the costs. Make no mistake, however; he was a medical angel to the people of Tangier.

Somewhere along the way, Tangier came to represent something far more profound to Nichols than a worthy excuse to set off in flight over the bay once a
week. He developed a deep love for the place and the people that wasn’t necessarily clear unless you witnessed Nichols in action on Tangier or talked to those islanders
who were his patients and became part of his extended family. If you knew Nichols only on the mainland as a gifted doctor and shrewd businessman, you quite possibly
missed the depth of his feeling for Tangier and the place’s hold on him. He was the same physician wherever he went, the same man, but on Tangier he seemed more
relaxed, more at ease. He very much felt at home among the people, plainspoken and unpretentious who maintain a genial but somewhat wary view of outsiders.
There’s a saying on Tangier that someone from away who comes to know the island and truly love it – squishy marsh muck and all – gets “mud between their
toes.” In a metaphorical sense, Nichols found himself knee-deep in the mud over the years, though the only times he could recall actually taking off his shoes and
socks on Tangier were when extraordinarily high tides washed over the island, requiring him to wade back to the airstrip and his plane or helicopter. He couldn’t recall, but
even when he removed his shoes he probably never unknotted his necktie, and it probably never even occurred to him to do so.