Author Sebastian Junger credits NCH Dr. Steven Kohler with saving his life.

Written By Brian Bushard

Photography By Kit Noble

“Walking in the room, I took his blood pressure and saw it was 60-something,” Kohler said. “It was likely an abdominal vascular catastrophe. It’s one of the few times I went down with the tech to the CT scan, and what we saw on the CT scan was a bunch of blood in his abdomen—but it was unclear what it was coming from.”

Kohler started working at Cape Cod Hospital in 1996. It was a reverse-commute from his house on Nantucket. He estimates that from1996 to 2023, he racked up 125,000 patient encounters either in urgent care or in the emergency room. Over those 28 years, he can’t remember any other patient with the same diagnosis as Junger. Junger was a code crimson. In layman’s terms, he needed blood, and fast.

“It’s vascular shock, and at some point you reach this spiral you cannot come out of,” Kohler said. “We were able to identify that he had a catastrophic blow-up in his abdomen somewhere, but we were not sure where, and I was initially thinking it was his aorta. I got the vascular surgeon on the phone, talked to radiology and tried to orchestrate things.”

What Junger had suffered was a pancreatic artery aneurysm, an obscure diagnosis, according to Kohler. It’s also a life-threatening one. “I later asked Dr. Kohler what was going on with me, medically, at that point,” Junger wrote in his book. “He said, ‘You were getting ready to buy the farm.’”

In total, Junger needed nine units of blood, meaning he likely lost roughly two-thirds of the blood in his body, he estimates in the book, writing that the CT scan revealed a “huge pool of blood” in his abdomen, with more blood gushing out around his pancreas. At that point, the doctors had a choice: either stabilize him and repair the rupture in radiology using a catheter, or open his abdomen in surgery with the hope of finding the rupture before he reached a critical point of internal bleeding. The team of doctors chose the radiology option. The latter choice, Junger wrote, was so severe that doctors later told him they would have called in his wife, Barbara, to see him for what could have been the last time, knowing his mortality rate would have gone up had they taken that route.

It was at that point that his blood pressure bottomed at 64 over 59. “It’s up there with one of the biggest emergencies,” Kohler said. “There have been plenty through my career, and this one happens to be a famous author. Most of us have read [Junger’s 1997 book] The Perfect Storm or watched the movie.”

The other doctor in the room was a man by the name of Craig Cornwall. He estimated Junger was 10-15 minutes from cardiac arrest, and potentially 10-15 minutes away from death. “One of the best things I did was ask for help,” Kohler said. “We had a young surgical resident who called and I said, ‘Can you put a Cordis line in his neck?’ I just needed to dump blood in this guy. And it gave me time to get on the phone.”

Junger spent four days in the hospital. Months later, he sent Kohler an email, thanking him for saving his life. He attached a photo of his daughter saying thank you. Kohler called it the sweetest email he has ever received. The question of fame, on the other hand, after treating an acclaimed journalist and author, never crossed his mind.

“I don’t know how much fame there is,” Kohler said. “Though he gave a talk at the Dreamland, which was very interesting. I went. It was packed and it was a cool talk. Then a few days later we go to Henry Jr.’s to pick up a sub and I walk in and the lady there says, ‘Thank you for saving Sebastian,’ and I’m like, ‘Did I see a kid Sebastian?’ She told me she was at the talk and that’s when I realized it was Sebastian Junger.”

Several years went by and Kohler found himself returning to his house on Nantucket from an urgent care shift in Harwich. It was a late ferry. Kohler estimates he saw 160 patients that day. As the boat entered the Nantucket Sound, he was approached by Diane Pearl, the former chief medical officer at Nantucket Cottage Hospital.

“She gave me her phone number and said, ‘If you ever want to do urgent care here, let me know,’” Kohler said. This was a matter of being in the right place at the right time. “It seemed like the right time to bring it home, get out of the [reverse] commute,” Kohler said. “I’m getting old. It’s my final turn, my homestretch.”

The timing was right for Nantucket Cottage Hospital, too. Just two years into its new facility, the hospital was looking to revamp its urgent access clinic, which at the time ran on appointments, as opposed to drop-ins. According to Kohler, it did not resemble urgent care at all. “It wasn’t urgent care,” he said. “[Joining] was like turning around an aircraft carrier, just to be blunt. I had never heard of urgent care with appointments. That’s not urgent care. You should just walk in and you’re seen. We had to rethink and retrain everything to look at it as an urgent care with an ER point of view rather than a primary care point of view. We’re not closing for lunch, you take lunch when you can. It’s walk-ins.”

The summer came and the hospital’s urgent access volume exploded. From Memorial Day through Labor Day weekend, urgent access saw 5,380 patients—a 76% increase over the same time in 2023. Of those patients, 86% of them walked in without an appointment. Close to 4,400 of them were in and out of the clinic in less than 30 minutes. If their visit was longer, it usually included the need for an X-ray. Roughly 3% of them (169 patients) were taken to the emergency department for more extensive care.

During the summer, the clinic is open seven days a week. Since Labor Day, it has been operating at an off-season schedule of six days, closing on Sundays (it will also be closed on Thanksgiving, Christmas and New Year’s Day).

When he’s not in the clinic, Kohler can probably be found training for his next triathlon. Kohler is a modest runner, never the one to brag about a marathon or triathlon sprint. He’s an 11-time ironman athlete, the super-human race consisting of a 2.4-mile swim, 112-mile bike ride and a 26.2-mile run—a full marathon. He also competes in the Nantucket Triathlon in July. Kohler is also modest in the clinic. Looking back at the time he treated Junger, he was quick to call it a “team effort.”

“I wasn’t the only person taking care of him,” Kohler said. “I was the first person in the room when he came in and got things in motion and identified it and handed it off, but it’s a total team effort and everything fell in line for him.”