Island Practice Page 3

  Lepore never billed Underground Tom for his visits. Fascinated by weapons ancient and contemporary, Lepore allowed Johnson to pay his medical “fee” by providing informal advice about fashioning arrowheads. He tried to get Johnson to protect himself from the island’s disease-carrying ticks, but Johnson refused to be tested for Lyme disease. Nor would he let Lepore repair his hernia. He allowed hardly anyone to visit him underground, although he told Lepore that at one point he had a girlfriend who would join him in the pull-down queen-sized bed he had notched into one subterranean wall.

  Then, in November 1998, a hunter, Jack Hallett Sr., was searching for a deer stand, crawling under a low branch, when he happened upon the stove pipe and the trapdoor. Hallett deliberately left a footprint so the occupant of the underground house would know he had been discovered. The next day, over breakfast, Hallett told Paul Johnson, an X-ray technician and reserve police officer, what he had seen.

  “You’re going nowhere until you prove to me that this is true,” Paul Johnson asserted. Hallett led him to the spot, and they knocked on the hatch. “I was expecting you ten years ago,” Underground Tom intoned. He was cordial, but his hand trembled so much coffee sloshed out of his cup. The hermit gave his name as Tom Underwood, one of his smart-alecky aliases; Dick Human and Forest Green are others.

  Although many islanders would have just as soon left him be, the jig was up for Tom. Nantucket officials worried that allowing him to remain an illegal squatter, especially in a community with sky-high rents and property values, would set a dangerous precedent. Paul Johnson worried that the disguised trapdoor was “a death trap for some kid running and falling through the window and landing on the stone floor.”

  The health department cited Underground Tom for multiple violations. Richard Ray, the department’s director, described the dwelling as “wonderful and marvelous and purely functional, but it was without question unfit for human habitation because of state sanitary guidelines. It didn’t have anywhere near the requisite natural lighting, electric, refrigerator hookup, no bathroom, no hot or cold running water. He was very proud of it, as well he should have been. He showed me around, he had books, clothes, radio. It looked to me like he was a voracious reader.”

  He was also a collector. Agents from the U.S. Fish and Wildlife Service and the state environmental police, one of them packing a gun, ordered Johnson to fork over the hawk claws and great horned owl’s wing he used as wall decorations and the dream catcher he had made from peregrine falcon feathers. He said he hadn’t killed the birds; they were roadkill.

  Lepore spoke out in Johnson’s defense. “He should be left alone,” he told reporters. “I don’t think he represents a threat to the community or the environment. If you want an archetypal low-impact guy, he’s the one.”

  Lepore was so impressed with the underground house that he told Johnson he could build another in his backyard. “I would have moved in there,” Lepore proclaimed. “The temperature’s always right, cozy. I could have all my books down there.” But Cathy Lepore was not thrilled, nor would island officials have been.

  Underground Tom clearly wanted to stay ahead of authorities. When Ray went to the bunker a second time, everything was gone, and so was Johnson. Soon, though, other Johnson-built structures were discovered. A brush-covered log cabin made from pine trees notched by hand was found on land owned by the town’s water agency. A tree house, eight feet off the ground with a bed cut into one wall, was discovered on state park land near Old South Road. Ray heard that “when they dug the foundation for the new police station on Fairgrounds Road, they found remnants of an underground house.”

  Tom himself had vanished. Few people knew where. Maybe to his old log cabin in Pennsylvania or one of the other habitations he’d reportedly built in Colorado, Delaware, New York, and Hawaii.

  But before he left, he took Lepore to another hideaway: the vine-and-twig igloo. If the underground house was a place where, as Johnson once said, “I can hear the heartbeat of the island,” the dome-shaped home near Hidden Forest was like a tiny thumb stealthily slipped atop the island’s primal pulse.

  The floor was paved partly with ceramic tiles and partly with glass bottles embedded in clay and dirt, the round bottle bottoms producing an inlaid stained-glass effect. A fireplace was fashioned from cement and clay, shaped to look like a tree trunk with a face sculpted in it. There was a skylight with a screen, quahog shell shelves, a towel rack, a fire extinguisher, a candle holder, an alarm clock, frying pans, and a car’s side-view mirror affixed to the interior branches with a bungee cord. The bed was a wooden bunk supported by branches, with a sleeping bag and foam mats.

  Lepore didn’t know how often Johnson stayed on-island, but he would periodically materialize at Lepore’s office. On one such visit, Johnson was covered in tick bites, and as he left, he handed Lepore his house key. “He’s a few clicks off,” Lepore ventured as a diagnosis.

  Lepore was entranced by what Johnson called his “twigloo,” to the point where he suggested to Cathy that they spend a night there. She demurred.

  The day of Lepore’s unannounced house call, he has not seen Johnson in about eight months. It is time, he decides, to check on his phantom patient. At the dome home, clues suggest Johnson has been around. Greenish-yellow mosquito netting is draped over the door, something that had not been there the last time Lepore had seen the place.

  There is an empty beer can, a drained Cup Noodles soup container, and fragments of fire-starter logs. And there are provisions: instant coffee, black pepper, lamp oil, a bleach stick, matches, a fork, a knife, charcoal in a tin can, Coppertone sun block, and two sample-size bottles of Augmentin, an antibiotic Lepore had no doubt given him as a prophylactic against infection from his tick bites. There is a pair of work boots and a denim shirt lined with red-and-black checks splayed on the bunk, unfolded.

  There is, however, no Underground Tom. The only living thing Lepore spies is a snake wriggling through the vines that form one of the house’s walls. As the doctor watches, it shimmies toward the bed, slithering near a cache of Tom-thumbed reading material: Where Nights Are Longest, The Importance of Innovation, Stone Circles Ancient and Modern: How to Build Your Own, and a well-worn copy of Ralph Ellison’s Invisible Man.

  CHAPTER 2

  WHY ARE WE LEAVING?

  On New Year’s Day in 1983, the noon boat out of Hyannis, Massachusetts, pulled into Nantucket Harbor, and a doctor, his wife, and their three young children stepped off the ferry and clattered down the ramp to the pier. They were pulling up stakes from the mainland, taking a chance on an island they hoped was ready to take a chance on them.

  Their move had come about by happenstance. This wasn’t where Lepore expected he would wind up when he finished college and started on the path to becoming a doctor. And it was hardly a seamless journey. Lepore would learn that although he had strengths, there were skills he lacked, particularly in the realm of social and political finesse.

  Lepore graduated from Harvard in 1966, with the Vietnam War in full swing. He was classified 1-A, available for service, but received a deferment for medical school at Tufts. In residency, he was again eligible and could have signed up to serve in the military for two years before returning to medical school. But he decided not to: “I didn’t burn my draft card. I took my chances, and I didn’t get drafted.”

  After the 1968 assassinations of Martin Luther King Jr. and Robert F. Kennedy, “half the medical school class would want to go out on strike,” he says. But “I was working my ass off. I didn’t see any great benefit of picketing the school.”

  When riots broke out in Harvard Square, Lepore went to the basement of a Baptist church in Cambridge to care for people who encountered the forceful side of the crowd-control police. “I washed tear gas out of people’s faces and stuff. A line of state cops was coming up with batons, and they’re whacking people. One of the cops knew me and said, ‘Hey Tim, get out of here.’”

  It was a tense, unsettled time: “Every
body hated everybody. There were such cliques, a right-wing group, an extreme left-wing group. The women were pissed off at everybody. There wasn’t a sense of collegiality.”

  Lepore’s personal life became unsettled too. “I had this girl I went out with all through high school,” he recalls. “We were engaged. I gave her a ring over at King’s Chapel Burying Ground. We had pictures and announcements.” Then she went to Norway for the summer, and Lepore double-dated with her brother. “Probably wasn’t a good idea. She found out, broke up with me. Wouldn’t have worked. We’re too much alike.”

  At Harvard, he dated a woman who belonged to a fairly radical organization called The People First. In medical school, after “a brief interlude for an Irish nurse,” Lepore began seeing a married woman. But at graduation, “the girl I was engaged to showed up and I was spending too much time with her,” so the married woman “got pissed off at me and took off with her family.”

  In medical school, Lepore’s skill and work ethic landed him the position of chief resident. But he was not the easiest person to work with. Once, he wanted a patient’s arterial blood gas analyzed, a measurement of how much oxygen and acid is in a person’s blood. It is often ordered when a patient is having shortness of breath or vomiting. The lab technician was delaying doing the test, and Lepore was beside himself. He stormed to the lab, kicked the door open, and “I came in like Attila the Hun. If I’m taking care of a patient and I want something, I’m not making a suggestion.” Lepore barked at the technician: “You’re going to run this. I don’t want it done tomorrow, not in an hour. I want it done now.”

  Subtle diplomacy was not one of his hallmarks. During a rotation in the pediatric cardiothoracic department, Lepore sat in a rocking chair all night next to a child who’d had heart surgery. He stepped away briefly to grab a sandwich in the cafeteria. When he returned, a pediatric resident had written in the patient’s chart: “Dr. Lepore’s taking care of this patient. He should be writing notes.”

  This annoyed Lepore to no end. He confronted the resident. “What am I going to be writing notes to myself all night? If I’m taking care of this kid, I don’t need someone sticking their nose in.”

  The next day, the entire team of pediatric residents “trooped into the chief of surgery to complain about me. He looked over the note and said, ‘Lepore was right.’ Inappropriate, but right. I don’t think he appreciated my handling of the situation, but he also thought it was a stupid note in the chart.”

  Lepore insisted he was not being argumentative for argument’s sake. In his view, he was putting patients’ interests first and others shouldn’t stand in the way of what he believed was best. “I did all my scut work. If somebody gave me trouble along the way, one time is okay; two times, it’s not going to happen. I had a testy attitude at times,” he acknowledges now, realizing that if he were a resident adopting that kind of stance these days, “I’d probably be kicked out in thirty seconds.”

  Then there was the matter of the not-quite-dead guy. Lepore was watching Sunday afternoon football in the residents’ dorm when he and another resident got called about a patient with severe atherosclerosis, a degenerative disease of the arteries. The patient was in his eighties, and he seemed to have breathed his last.

  Lepore was matter-of-fact. “You look at them, they look pretty blue. He was not obviously breathing. I don’t think we checked to listen to his heart, but I mean, he looked dead. So we pronounced him.”

  Lepore called the attending physician to report the patient’s death. “He was not surprised. I called the family, who were not surprised. I went back to watch the game.”

  Not long afterward, a nurse called with a discomfiting question: “Do patients sometimes breathe when they’re dead?”

  Lepore hurried back, panicked. “The son of a bitch is alive!” He had to call the attending physician and the family. They were “less than pleased.” The man lived for another week or so. Pronouncing a live man dead is kind of a no-no in medical circles. “It probably did reflect poorly on me,” Lepore says, but it was not considered a disciplinary offense, presumably because nobody had died. Indeed that was the problem: nobody had, at that point, died. However, “You don’t get gold stars for that. If the attending is not made to look good, they do not smile on you.”

  The one salvageable lesson for Lepore was a rule of thumb about what makes for a convincing corpse: “Call us when the body is room temperature,” he told the nurses. And not a degree warmer.

  In the early 1970s, Lepore spent about nine months of his residency doing rotations at Roger Williams Hospital in Providence, Rhode Island, where his reputation preceded him: “The guy before me had said I was a pain in the ass.”

  Cathy Clark, a nurse at Roger Williams, heard the rumors too and thought, “Oh my God, no.” The scuttlebutt about the sturdily built, curly-haired doctor was hardly flattering: “His name is Lepore; they call him the leper; he’s always fighting with everybody.”

  Still, as Lepore prepared patients for surgery, handled their postoperative care, and ultimately scrubbed in himself, he and Cathy became friends. Cathy, a tall brunette, unpretentious and down-to-earth, lived upstairs in his apartment building. She had recently lost her husband, whom she met growing up in Newport, Rhode Island. He died from aplastic anemia after two gruelingly unsuccessful bone marrow transplants.

  Cathy was devastated: “I felt like I had just dropped out of society.” She began dating another resident, and they got married and moved to Wisconsin. Almost immediately, she discovered it was an ill-fated choice. “I was miserable. He was just busy all of the time. On the weekends he would go play golf both days, so I would never see him. He wasn’t abusive; he just was absent. It was like he all of a sudden dropped out of the marriage.”

  Within a year, Cathy decided to move back east and wrote Lepore, remembering that he had a big house in Brookline, Massachusetts, outside Boston, and often rented out rooms. He had moved out of the house by then but agreed to help Cathy find an apartment. Cathy met Lepore at Newton-Wellesley Hospital in suburban Boston, and an odd thing happened. “I saw him walking across the parking lot, and I got very dizzy. I thought it must be love. Then I realized I had vestibular neuritis.”

  Love, vestibular neuritis—why quibble? Vestibular neuritis is an inflammation of the nerve connecting the inner ear to the brain, and pretty soon Cathy began feeling nauseous. Later, at a job interview at another hospital, “I couldn’t walk. It was like I was just drunk. I couldn’t focus my eyes. I was just sitting on the floor of the ladies’ room and vomiting my brains out.”

  She was sent to the emergency room, where, it turned out, an ex-girlfriend of Lepore’s was working. Cathy realized Lepore was the only person she knew in Boston.

  “I get this phone call that she’s near death,” Lepore recalls. He picked her up in his truck and took her to his apartment, where she continued to throw up.

  It was, Cathy remembers, “about as unromantic as it could possibly have been.” To be fair, it wasn’t only her fault. There was also the enchanting behavior of Lepore’s dog, a slobbering bloodhound named Odie. Lepore was so convinced that Odie was a talented tracker that when his sister, Sherry Buckley, visited, Lepore had Odie sniff a pair of his sister’s underwear and then “had me hiding in the woods and the dog was supposed to find me,” his sister recalls. Odie “ran right by me.”

  While Cathy was weak with nausea at Lepore’s apartment, she encountered his approach to another of Odie’s shortcomings. There were “all these bowls turned over with dog turds underneath them. I mean, who does that?”

  She asked the obvious question: “Why is the turd on your floor?” Lepore gave the obvious answer: “If they dry out, they’re easier to pick up.”

  Still, somehow, a romance was ignited. “His girlfriend had left,” Cathy remembers. “It was sort of like the lonely hearts’ club. You can be like that with somebody when you’re very comfortable with them.” Lepore helped her find an apartment and invited her to his res
idency graduation dinner, their first official date. “He was so interesting. He was just funny. He always seemed to be able to handle everything.”

  When Lepore’s residency was ending in June 1975, he wanted one of Tufts’s fellowships in thoracic surgery. But the attending physician “didn’t support me,” recommending that he work at another hospital for a year first. “The hell with that,” Lepore thought, and returned to Roger Williams instead, which offered him a job working in the emergency room and handling the surgical side of the intensive care unit.

  In August 1976, Cathy went to the Dominican Republic to get a divorce from her second husband. In September, on a Wednesday, Lepore said, “Let’s get married.” Cathy said okay. That Saturday they went to a justice of the peace they found in the phone book.

  In retrospect, Cathy explains her thinking: “My first husband died; my second one I got divorced from. After that, I said, ‘I just don’t want to be bored. I want to have someone interesting.’” She pauses. “I think I went over the top.”

  Their wedding was as briskly functional as Lepore’s description of it: “There was no ring. Her parents, my parents, two of her sisters, my buddy, Cathy’s grandmother. Cathy’s grandmother said the justice of the peace was a short man. We said he’s in a wheelchair. No vows. Whatever he said, we said. I sweated through my $5 Salvation Army suit, we went to an omelet shop for 25 bucks, and we were done by 11 and went to the Harvard-Columbia football game.”

  They had no honeymoon and were back at work on Monday.

  Lepore’s job at Roger Williams Hospital involved a gamut of cases from cancer surgery to trauma. A man fired a shotgun into his own mouth. A woman stabbed in the chest needed thoracic surgery. Another man shot his brother in the face, leaving his eye in a gruesome state. A pharmacist took a bullet on his first night on the job. A kid, twelve or thirteen years old, was shot so badly that Lepore had to elbow his way through a swarm of pediatricians to get to the boy’s side.