Island Practice Read online

  Lepore doesn’t make yacht calls, only because he fears he could miss an on-island emergency. While many of Nantucket’s wealthy and prominent summer people never need pay him a visit—they have private physicians elsewhere—some are Lepore regulars even though they could see any doctor they wanted. John Chancellor, the television anchor, came to Lepore when he smacked his head into a door frame. Another patient, the author David Halberstam, liked to attend Nantucket high school football games, where he would chat with Lepore on the sidelines.

  Gordon and Lulie Gund first heard “these outrageous Tim Lepore stories” from the caretaker of their Nantucket house, an old-timer named Gibby Burchell. When Gordon got the flu one summer, Burchell advised: “You gotta go see Tim.” Gordon Gund is a venture capitalist and owner of sports franchises like the Cleveland Cavaliers. He is blind from retinitis pigmentosa, and the Gunds, who also have homes in Aspen, Cleveland, and Princeton, New Jersey, are philanthropists who cofounded the Foundation Fighting Blindness.

  The Gunds’ encounters with Lepore were pretty routine until August 2008, when Lulie, whom the hospital had diagnosed with Lyme disease and given amoxicillin, discovered that “my eyes had turned bright yellow.” She also “lost any much desire to eat” and “felt so grumpy.” She returned to the hospital for a blood smear, and Lepore was called. “You have babesiosis really badly,” he told her. What’s more, “because I didn’t think it was important,” Lulie, then sixty-seven, had not told anyone that she didn’t have a spleen. Hers had been removed twenty years earlier, when she’d had Hodgkin’s disease. Without a spleen, which collects damaged blood cells, a disease like babesiosis could spiral out of control.

  Lepore gave her an antimalarial drug, Mepron, and an antibacterial medication, azithromycin. When she was ready to leave the island, he told her she could only go if she kept up the medication and got regular blood tests.

  But soon after returning home to Princeton, Gund went to an infectious disease specialist who did a blood test that came back negative for babesia. “You’re fine,” the specialist told her. “Go off the medication.” The doctor “wasn’t familiar with babesia,” Gund says. He didn’t know that babesiosis can linger for months at levels a blood test can’t always detect, and that for a Hodgkin’s patient it may last longer. The doctor didn’t know to give her a more definitive test, called polymerase chain reaction, or PCR.

  “Four days later I was so sick I ended up in the hospital with congestive heart failure and a temperature of 103, 104,” Gund recalls. “I was having trouble breathing. I had pulmonary edema,” fluid in the lungs. “My husband called Tim.”

  Lepore insisted she resume taking Mepron and azithromycin immediately. He directed Gund’s doctor to administer frequent PCR tests. He also did his own tests: the hamster protocol. He sent samples of Gund’s blood to Sam Telford III at Tufts School of Veterinary Medicine. Telford injected the blood into hamsters. “If the hamster goes belly-up, then you know there are actually live organisms in there,” Lepore said. As long as the disease was active in Gund, the hamsters died. They followed the hamsters’ progress quietly, not wanting to alarm the patient. It took six months, until February, for babesia to completely quit her system. “My God,” Gund realized recently, “I’ve never asked Dr. Lepore what happened to the hamster.”

  She was also impressed when Lepore referred her to Peter Krause, an epidemiologist at the Yale School of Public Health, who studies microbial diseases. “A lot of doctors are reticent to refer you and sort of share the limelight.” Ultimately, the Gunds donated $1 million over three years to research Krause and Lepore are conducting on tick-borne diseases. Notes Lulie: “There are so many doctors who don’t realize how sick you can get.”

  The Gunds know Lepore can lack the diplomatic demeanor common in their charitable and corporate circles. “I’ve heard him answer people very curtly at a public meeting if he really disagrees,” Lulie acknowledges. “The flip side is he’s so unbelievably humane when you’re with him. And it doesn’t matter if you’re not there—he always has time for you. He has so many facets, he’s like a diamond.”

  “Did you notice the new rug?” Lepore asks. It’s a welcome mat in front of his office’s reception desk. Under the word “Greetings” is a homespun, tapestry-like picture of a dog sniffing the ass of another dog with a raised tail.

  “We haven’t gotten any complaints—yet,” remarks Lepore’s longtime nurse, Diana Hull.

  Lepore’s sentimental side can be hard to decipher, encrusted as it often is in a gruff, unvarnished demeanor. It’s certainly not apparent from his medical office, which has none of the soothing seascapes or pictures of cuddly babies that people might expect from their friendly family doc.

  On one wall is another doggie tapestry picture showing dogs licking their testicles, with the caption: “Because they can.” There’s a taxidermied armadillo, lying on its back, holding a bottle of Lone Star beer. The most prominent chair in the waiting room is a huge, shaggy mountain goat–like animal with horns, black hooves, and a furry white chest, open-mouthed with a red tongue.

  Yes, there are the framed degrees: eight, including his Harvard bachelor’s. But those could be easily missed amid the gross-out and God-complex accoutrements:

  TIMOTHY J. LEPORE, MD, WIZARD

  TIMOTHY J. LEPORE, MASTER, TEMPLE OF DOOM

  TIMOTHY J. LEPORE, BIG FISH—SMALL POND

  TIMOTHY J. LEPORE, ANAL INSPECTOR, HEAD A.H.

  (A.H. presumably stands for asshole.)

  REMEMBER THERE HAVE BEEN MANY KINGS, BUT THERE IS ONLY ONE CZAR (TIM 1–1)

  There is a sign proclaiming the office a “House of Pain,” and an uplifting Latin aphorism: “Cuius Testiculos Habeas, Habeas Cardia Et Cerebellum.” When you have them by the balls, the heart and mind will follow.

  “He has the most wonderfully politically incorrect facility there,” Philbrick says. “I’ve heard earnest young mothers with their kids look around and say, ‘This is inappropriate.’”

  Philbrick thinks the office is a way for Lepore to indulge his independent streak. “It’s hard to be a public person all the time. Some people, you just feel like they’re posing. He’s not—he’s just having fun.”

  Nothing wrong with a little shock to the system, Lepore figures. At a town meeting, Lepore lobbied for broadening the law to require bicycle helmets for everyone, standing up so the light bounced off his bald head. “Feeling the wind in your hair is vastly overrated,” he quipped, then wrote a poem about helmets, which he handed out on cards to patients.

  It’s the sort of thing that continues to make Lepore “a conundrum to people,” Philbrick observes. “He comes off as an NRA, gun-toting yahoo, who is a Harvard degree medical guy, who is doing all these things that are causes that any liberal would embrace. I enjoy so much people who are outside of the stereotype. Irony is underrated in our society. I just sort of enjoy immensely Tim saying things that leave people gasping. He’s always trying to needle someone. He’s very mischievous.”

  Almost nothing is sacred. One summer, Lepore’s friend Weinman was caring for an off-island friend’s teenage daughter. The girl developed stomach pains, so Weinman called Lepore to meet her at the emergency room around 10 PM. For over an hour, the girl is “in with Tim, in with Tim, in with Tim,” Weinman recalls. “He walks out without her, looks down, and says, ‘I’m so sorry. I tried. I couldn’t save her.’”

  “What are you talking about?” Weinman panicked. “What do you mean you couldn’t save her?”

  “I’m just kidding,” Lepore grinned. “She’s fine.”

  Even though she knows Lepore better than almost anyone, Weinman was incensed. “It was a really mean thing to do.” Lepore says if the situation were dire, he would never have joked about it. But he got a thirty-second charge out of throwing Weinman off balance. “It was interesting to watch all the color go out of her face.”

  Mary Monagle, a former nurse at the hospital, thinks Lepore plays up his eccentricities for effect but
can also dial them back. “One minute you’ve got him labeled as the countrified quack doctor, and the next minute he’s the Tufts grad, and you say, ‘Where’d you pull that out of your pocket?’ I have seen him be über-professional, and I’ve also seen him be, ‘Yeehaw, I gotta go kill a deer.’”

  The contrast between Lepore’s practice and, say, Diane Pearl’s, could not be more stark.

  “My office is very quiet—his is like chaos,” Pearl says. “I couldn’t work in that situation.”

  Pearl has two employees. Lepore has at least ten, more in the summer. A typical Lepore staff consists of three registered nurses, a nurse practitioner, two physician assistants, a receptionist, a finance manager, and people who handle medical records and insurance referrals, plus a couple of people studying to be nurses or physician assistants.

  Pearl will close her practice to new patients so as not to take on more than she wants to handle. Lepore’s practice is elastic enough to accommodate the person who ran into the office and announced that a goat had gone on the lam. Lepore barreled out the back door to help search; the goat was found grazing among the Quaker cemetery’s headstones.

  He also makes room for people like Tony Yates, a welder who visits him once or twice a month. “Whether I need to or not, I just come to talk to him. I depend on him. He always has time to see me. I think he listens. Lots of people don’t listen no more.”

  Lepore even had trouble turning away a woman who called and showed up at the house at all hours. True, she “could sometimes sneak out of the bushes,” Lepore acknowledges, but the woman raised chickens, horses, and other fauna, and “people like that get a lot of latitude with me, frankly.” The worst was when she would traipse into his office with a bag full of the snakes she kept as pets. “She just liked to share them with me. I am not fond of snakes. I liked her except for the damn snakes.”

  The woman’s health issues were legitimate: pain, osteoarthritis, Lyme disease. It was just that she “occasionally had boundary issues,” Lepore understates. “I don’t have boundary issues.”

  For Lepore’s wife, though, the line was crossed. “Cathy put a stop to that,” her friend Michelsen remembers. She told the woman not to come around so much.

  Cathy sometimes intercepts phone calls, lets the answering machine pick up, or gently discourages people from simply dropping by on a Saturday morning. She tells Lepore she is worried that people take advantage of him.

  “I don’t perceive it that way,” he replied once.

  “You,” Cathy pointed out, “are not married to you.”

  But to Lepore, the people he treats, “they’re like little piranhas. They take a little bit out of your heart.”

  CHAPTER 7

  ARMS AGAINST A SEA OF TROUBLES

  The Lepore house was Lepore-less this particular April evening. Nantucket was Lepore-less too, something that happens once a year when the doctor runs (if one could call it that) the Boston Marathon. He leaves only a handful of other times, usually to attend off-island high school football games as the team physician. He worries that a medical crisis might erupt while he’s gone or that he’ll miss something interesting. Who knew his very absence this weekend would trigger just such an event?

  It was during the dead of night that a woman the Lepores had asked to house-sit for their dogs thought she heard a noise. It seemed to be coming from the cellar, so the woman, who worked for the fire department, headed downstairs. She scanned what appeared to be an ordinary workroom of a home-repair hobbyist and, seeing nothing unusual there, cracked open a closet. A loud, rattlesnake-like hiss cut the air. Alarmed, the woman slammed the door and called her boss, the fire chief at the time, Bruce Watts.

  Rushing to the house, Watts opened the closet too and was suddenly enveloped in a cloud of gas. Stinging, pinching, choke-inducing gas. Tear gas. The island doctor had teargassed the island fire chief.

  Lepore was sorry to miss the commotion, but he was unperturbed by Watts’s unfortunate escapade. “He opened up the wrong door. It’s on a string, a trip wire, and if you open the door so far, then it goes off.” Luckily, “it dissipates in a couple of hours. But he was uncomfortable for awhile.”

  The gassy booby trap protects Lepore’s prized possessions: guns, scores of them, an extraordinary collection, all of them shootable and most of them shot, at least once, by the good doctor.

  Chief Watts was lucky to get away with a relatively light gassing. The closet contains a safe with Lepore’s rarest guns, protected by an additional trip switch that sets off “things that are sort of like little firecrackers.” Another trip switch is attached to a twelve-gauge shotgun flare that, when fired, “shoots up like a roman candle.” So far, though, that one is just for show—the rigging is there, but “I have never armed it. Thought about it, when I’m feeling particularly paranoid.” Luckily for Lepore, his paranoia is usually under control because arming the shotgun flare would be “not quite legal,” and “I would probably shoot myself and burn a hole in my chest, or burn the house down.”

  Once, Lepore accidentally tripped the tear-gas switch himself. He heard the misty hissing that preceded the full-fledged burst and hurled the door shut, high-tailing it upstairs. But once the gas dispersed, he ordered a replacement canister and, impressed with the efficacy of the deterrent, began thinking about putting another tear-gas trap at the top of the stairs. Some people never learn.

  Lepore has some two hundred guns, stored in the safe, a vault near the basement boiler, and a locked cabinet in an upstairs closet. Occasionally, gun paraphernalia overflows to the main floor: a disabled rifle against the kitchen counter, a shotgun in the laundry room closet, a box of bullets by the phone.

  Instruments of death prized by a man who saves lives. But Lepore is not bothered by any cognitive dissonance. “Guns: I never met one I didn’t like. I like the history part of it. I like the shoot part of it.”

  Guns are not a common hobby on Nantucket. Despite its summer influx of corporate executives, the island is not a bastion of conservatism. It is notionally in Massachusetts, after all, and has its own long-standing liberal tradition, with roots that include abolitionist activism and Quaker fellowship. If someone were to poll people on favorite U.S. constitutional amendments, the Second would not likely top the list.

  “Here is a person who is a pillar of the community, but he has all sorts of guns lying around, including a collection which he keeps under lock and key and tear gas,” marvels Lepore’s neighbor, Chris Fraker. Even his main floor powder room would be more accurately described as a gunpowder room—the toilet-side reading material includes The Gun Digest Book of Firearms, Fakes and Reproductions.

  His collection is worth almost $200,000, by far his most valuable possession. There are guns from Russia, Finland, Germany, China, and America; rifles, pistols, shotguns, military guns, hunting guns. Some he buys at gun shows, but many are gifts or castoffs from patients or friends, “beaters” worth next to nothing. Lepore takes them all.

  Even his medical office broadcasts his affinity for deadly weapons. A cap-and-ball pistol inside a shadow-box frame adorns the waiting room. The hall leading to the exam rooms exhibits photos of English and Spanish muskets, and Henry Deringer’s single-shot pistol (the name is usually misspelled as “Derringer,” but Lepore has it right). He has a Buffalo Bill poster and one for Peter’s True Blue Smokeless Shot Shells.

  The exam rooms are named Colt, Winchester, Smith & Wesson. The bathroom has a name too: P-Shooter. Inside are posters of Remington Cartridges, the Winchester Repeating Arms Company, and an Annie Oakley–like figure holding a revolver. A rack of arrows rests near the nurse’s station.

  “When I came into the office, there was a big fat jar with a deer fetus in it,” recalls Martina Richards, who was one of Lepore’s nurses. “I grew up in a household where everybody’s a Democrat, and he’s like, ‘Can you order me six cases of bullets?’”

  An arsenal of aphorisms is also scattered throughout the office: “Once more unto the breach, d
ear friends, . . .” “Sometimes you just have to come out shooting,” and “This is the office of a dedicated hunter. Expect daydreaming, tall tales and sporadic attendance.” Lepore’s doctor’s uniform has often been a hunting vest instead of a lab coat.

  When Peter Swenson came to the island in 2006 to become executive director of Family and Children’s Services of Nantucket, he was dumbstruck. Lepore is on the board of Swenson’s agency, which provides mental health counseling, and Swenson’s first impression of Lepore was: “This guy’s weird. He has an old pair of khakis on. He has a shotgun vest on. He’s got all these statements: ‘You reel that in too fast, you’re going to lose the fish.’ I’m like, ‘What does that mean?’ In his office, there’s stuffed animals everywhere, knives and guns. I really felt I’d been transferred to Northern Exposure.”

  In the courtroom farce Boston Legal, the leaders of Nantucket seek to sue in federal court for the right to construct a nuclear bomb.

  “We want to build a weapon of mass destruction,” the fictional head of the select board says earnestly. “We’re a very small island, totally exposed. The homeowners are becoming increasingly concerned about security, and well, we’re rich, we can afford it, we want one.”

  The lawyer they have asked to represent them asks the logical question: “What kind of drugs are we taking on the island these days?”

  “Do you realize what a target Nantucket is?” the selectman continues. “When you think of the iconic staples of America that the world so hates: rich people, Wall Street gluttons, evil politicians, Hollywood producers. They all have homes on Nantucket. It’s one-stop shopping.”