Island Practice Read online

  Lentowski, whose conservation foundation protects a third of the island’s land, notes that more people are visiting Nantucket for longer stretches, coming in spring and staying until fall, allowing more time to be vulnerable to ticks. Houses are being built closer to deer and tick habitat.

  “It used to be to get Lyme disease, you had to be going blueberry picking or out in the moors hiking, and not that many people did that,” says Richard Ray, the health department director. Now, “deer are moving into our properties because we’ve taken away their feeding area.”

  The new houses make it harder for hunters, who can’t legally hunt in residential areas, to get to places to shoot deer. And, says Rob Deblinger, a Massachusetts Division of Fisheries and Wildlife official, houses are being landscaped with “expensive ornamental plantings, rhododendron, arborvitae, all excellent deer food. People put down nitrogen in the form of fertilizer, and that’s like ice cream to white-tailed deer.”

  Diagnosing tick diseases can be tricky. People don’t always feel tick bites. Tristram Dammin says a tick secretes a kind of anesthetic when it alights, and then affixes itself stealthily with a cement-like substance and the barbs of its feeding tube. And not every tick bite resembles the classic bulls-eye.

  Symptoms may not be obvious, either. Initial Lyme blood tests may be negative because it takes weeks for antibodies to develop. Anaplasmosis and babesiosis are easier to diagnose from blood tests, but doctors often don’t think to test for them because the symptoms—fever, muscle aches, fatigue—are common to many conditions. And while tick diseases are treatable, they can linger for months or years, sometimes causing permanent joint damage or recurring fatigue.

  Doreen Goodwin spent a year trying to determine what she had. Two Lyme disease tests came up negative. A third was positive, and the hospital gave her antibiotics, but she didn’t improve. One day in the shower, soap kept getting in her eye, and she realized she could no longer close her lid. As she brushed her teeth, her mouth “wasn’t working right.” In the mirror, she saw that “only one half of my face smiled.”

  She consulted Lepore, who determined she had a double tick infection, Lyme plus babesiosis, and the illness had given her Bell’s palsy. It could last, he told her, “three weeks, three months, three years.”

  Goodwin, then forty-three, endured an hour of intravenous treatment daily. She could only sleep at night by putting a cotton ball on her eyelid to keep it shut.

  “I didn’t say much anymore when I saw people. You can’t really deal with people when you’re self-conscious of your fallen face. My husband took me out for lunch to the Sea Grille, and the salad kept falling into my lap, so I burst into tears.”

  When function finally returned to her face twenty-three days later, she promised herself: “I’ll never not smile at people again.”

  Michael Miller, a longtime martial arts instructor on Nantucket, thought a spider was biting his right thigh, killed the bug, and didn’t give it a second thought. Then he landed in the emergency room with such severe internal bleeding that he used up half the hospital’s blood supply before being told, by doctors other than Lepore: “Mr. Miller, you’re too sick for Nantucket.” He was airlifted to Boston, where doctors quarantined him, thinking the strapping Tae Kwan Do expert had malaria or tuberculosis.

  Then Miller asked about tick diseases, and the Boston doctors instantly knew whom to call: a doctor on Nantucket they referred to as Leh-Poor. “They were saying they had read some of these journals and he’s very famous for his work on Lyme disease. They spoke of him as if here were a god.”

  They returned Miller to Nantucket, where Lepore determined he had one of the worst combinations of Lyme and babesiosis he’d seen and treated him back to health.

  The mere fear of tick diseases stresses Nantucket’s health system. In a recent year, about 2,500 hospital visits concerned suspected tick cases. Only about 10 percent were actually tick-borne diseases, but the hospital’s resources were stretched by having to screen every patient.

  So recognizing a false alarm has become Lepore’s expertise too. One patient, a medical malpractice executive, was convinced he had Lyme. When Lepore, finding microscopic traces of blood in the man’s urine, suggested a CAT scan, the patient protested that he’d had one nine months earlier that showed nothing. But Lepore persisted and discovered the man had a kidney tumor. He’d caught it early enough for the man to be cured.

  “I knew it wasn’t Lyme disease,” Lepore proclaimed.

  Tim Lepore was cranking out bumper stickers. They were festooned with pictures of his bloated, blood-sucking, spindly-legged nemeses and sported slogans: “Save Our Ticks!” “Honk If You Love Ticks,” “(Nan)Tick(et) Advocacy Association.” They bore the name of a group Lepore had just formed: The Committee to Protect Nantucket’s Deer Ticks.

  It was Lepore’s last-ditch effort to inject some irony into an island-wide brouhaha over ticks and deer to try to persuade Nantucketers to see things his way.

  The uproar had started more than a year earlier, in 2004, when Lepore, Ray, the health department director, and others proposed adding extra days for deer hunting on Nantucket. They argued that more deer had to be killed for tick diseases to decrease. Deblinger, of the Massachusetts Division of Fisheries and Wildlife, agreed. At the request of Nantucket’s selectmen, he convened a public meeting and said other methods of deer control, like darts that inject deer with contraceptives or feeding stations that apply insecticide to deer as they eat, are ineffective or too expensive, so hunting was best.

  Deblinger felt the only problem was “attracting hunters to Nantucket. It’s not your typical trip for deer hunting purposes, where somebody jumps in a camper. It’s a $200-plus ferry ride, and then you have to rent a place, and most everything’s closed in the winter.”

  Deblinger proposed a twelve-day deer-hunting season in February, “a time when we’re not competing with any other state,” so hunters would find it “so tempting that it would override the expense.” February is also when bucks have no antlers, so hunters, normally drawn to deer with impressive antler racks, would be as likely to shoot does, and killing breeding does is more effective for controlling deer reproduction.

  But Nantucket has many hunting opponents. In fact, after complaints during the Thanksgiving hunting season about blood-stained cobblestones and cars with dead deer on Main Street, deer carcasses had to be covered to spare shoppers and visitors the sight.

  The selectmen compromised with a six-day hunt and, Deblinger recalls, picked a week in “the dead of winter when the fewest number of residents of Nantucket would actually be on the island.”

  Leading up to the 2005 hunt, things seemed fine. More than nine hundred permits were sold, most to out-of-towners, often from places as far away as California and Texas. “All the guys who had gotten their new guns for Christmas said, ‘Hey, let’s go to Nantucket,’” Lentowski remembers. Restaurants and inns were enjoying a weeklong resuscitation at a time when much of Nantucket is shuttered for the off-season.

  Then, trouble started. First, the week before the hunt, this island that rarely sees blizzards experienced a series of punishing snowstorms. Two-foot accumulations made it impossible for hunters to drive to moors and forests, the normal deer-hunting locations. Recalls Telford, “All these SUVs were parked everywhere. All these guys in orange were trespassing all over the place.”

  Many hunters, new to Nantucket, had no idea where to go. Some asked how to avoid getting lost, and Belanger replied, “You can always follow your own blood” from the scratches the thick brush would cause.

  Hunters popped up everywhere they shouldn’t be. “People were going bananas thinking they were going to shoot,” Lentowski recalls. “All these Rambo-type guys wandering the island with their shotguns.”

  An SUV was struck by a twelve-gauge shotgun. A preschool closed for the day because hunters were too close by. Three people were arrested for poaching on private property and shooting deer illegally. There were even complaints fr
om people annoyed that their dogs had rolled in deer guts.

  Some 246 deer were killed, more than double the state’s expectation. State officials had counted on 100 deer being killed that week, which would have required just five to seven more years of February hunts to reduce the deer population to a safe size. But “the hunt was so successful that the new prediction was that we’d reach the goal in three to four years,” Deblinger notes. The state “expected the people of Nantucket would be grateful so many hunters came to the island to help them solve their problem.”

  Not quite. People were furious, like 1935 all over again. At a packed Board of Selectmen meeting eleven days later, one resident, Annye Camara, called the hunt “extremely terrifying,” saying she “moved here from a large metropolitan area, largely because I thought I would not be dodging bullets.”

  Even some local hunters, like Tony Barone, protested, claiming the out-of-towners’ bad behavior gave hometown hunters “a black eye.... We can argue the tick thing until our heads fall off, but the majority of people don’t want the hunt.”

  Some opponents objected because some deer were pregnant in February. Deblinger dismissed that, saying “the mating season for deer is in September and October, so if they’re shot in the November archery season or the December shot gun season, they’re just as pregnant as in February. That’s just an animal rights, rhetoric emotional issue, something that’s fun to bring up at a public hearing.”

  If deer are pregnant, Lepore said, “Who cares? The idea is to thin the herd. You shoot a doe and it could be a two-fer or a three-fer. These people are pro-choice for humans but pro-life for deer.”

  Residents formed the February Group, signing petitions, making phone calls, writing letters to newspapers. One letter, from Ursula Austin, asked, “Have we considered the litigation this town will face when someone is shot or wounded through inept hunting?”

  Even Doreen Goodwin, who had gotten so ill from tick diseases, said, “I don’t like it when they’re making me sick, but you look at that little Bambi face.”

  Families were divided. Tristram Dammin, son of the namesake of the Ixodes dammini tick, has a second cousin with the accidentally literary name of Warren Pease. Some of the Peases, who live on Tuckernuck, a tiny island in Nantucket County, would feed the deer, Dammin says. “And then Warren Pease, he would shoot them.” Dammin himself is in the middle: “I wouldn’t shoot them, but I would eat them.”

  In November 2005, at the selectmen’s request, the Division of Fisheries and Wildlife’s board members returned to Nantucket for a raucous public hearing. That’s when Lepore launched his sarcastic pro-tick campaign. He argued that deer hunting was so clearly the best antitick disease method that to consider scrapping the extra hunt is “like putting whether or not you get operated on for appendicitis up for a vote.”

  He had his backers, but ultimately the Fisheries and Wildlife board decided it had to cancel future February hunts. “Usually you bring the objective scientific observers, the boys from Harvard and people like Lepore, and you win the day,” Deblinger notes. “But something really happened over the February hunt. It wasn’t just animal rights activists. People really saw it as though there were nine hundred people from off-island slaughtering their deer.”

  The scientists had lost, and they were completely befuddled. “It shocks me that people in that socioeconomic class will tolerate the public health problem that they have,” said Deblinger, noting that the number of complaints was small compared with the number of people getting tick diseases each year. “If I could afford a house on Nantucket, I would not want to deal with not being able to walk around my property because of the fear of being bitten by a tick and contracting a very serious disease. My God, I have no idea how they tolerate that.”

  George Darey, chairman of the division’s board, went even further: “I just feel sorry for the people who come to Nantucket and don’t know it has the highest rate of Lyme disease in the country. You won’t see me go there for vacation.”

  More than three years after the February hunt, in the summer of 2009, Nantucket’s tick predicament had reached fever pitch. The previous year had seen 411 laboratory-confirmed cases of tick diseases, up from 257 in 2007.

  In a survey of property owners in the island’s Tom Nevers section, 61 percent said one or more people in their households have had Lyme disease. An average of 2.3 people per household, including guests and renters, had had one of the three tick diseases.

  People were anxious, especially summer residents, who flocked to a select board meeting. Tom Foley, a technology executive and twenty-year summer resident, was there. He had babesiosis that summer, which dangerously ruptured his spleen. Emergency room staff immediately called Lepore, whom Foley had never met. “You could tell right off the bat he was brilliant,” recalls Foley, who says doctors on the mainland later told him, “if I had walked into any other hospital, no one would have known what was wrong.”

  “Tim,” Foley asked, “am I going to die?”

  “No,” Lepore assured him. “You’re going to be okay.”

  Lepore insisted that Foley be flown to a Boston hospital so he could be watched round the clock. But the fog was so thick that the helicopter had to turn around. Eventually Foley was airlifted by jet. “Tim sat with me the whole time. And everything he said turned out to happen. I kept telling people in Boston, ‘Tim says this.’ I am one of few people that got to keep their spleen.”

  Foley told the selectmen his story. “People are going to die from this. People don’t want to talk about it—they’re worried it will hurt property values—but something has to be done.”

  The selectmen appointed a special tick committee to hold hearings and make recommendations. “We recognize that it’s a big problem here,” said Michael Kopko, then the board chairman, whose wife and daughter have had tick illnesses. “Those of us who live here all know someone or are related to someone or have ourselves had a tick-borne disease.”

  The committee met for months, hearing experts on all sides. Some members downplayed the problem. Elizabeth Trillos, a businesswoman, noted that a friend had babesiosis but said, “people understand it’s a part of life of being in Nantucket.”

  Another member, Beverly McLaughlin, said her husband contracted Lyme and babesiosis but “didn’t check himself” for ticks after being outdoors. “You know, men aren’t too bright.” As for Nantucket’s hundreds of cases, “you know what? That’s not an epidemic.”

  Most committee members disagreed. Noting that Nantucket has more cases of tick disease than HIV, Bruce Hopper, a doctor, declared, “This is a public health problem.”

  Committee members looked at trimming brush to attract fewer deer to backyards, but considered that insufficient. They evaluated spraying pesticides, but cited too many unknown health risks. They considered the “personal responsibility” approach, asking people to avoid woods and long grasses and keep skin covered with pants tucked into their socks. Dammin, a committee member, scoffed: “They all look like nitwits. Who’s going to do that in the summertime?”

  They discussed four-poster deer feeders, structures that entice deer with corn and spray them with insecticide. But Malcolm MacNab, a doctor and the committee chairman, said feeders would be too expensive, hundreds of thousands of dollars a year. Injecting deer with contraceptives was considered costly and impractical.

  At talk of expanded hunting, McLaughlin protested: “I really love the deer, and I can’t help it: My mother took me to see Bambi.” Hunters, like Kevin Madden, a committee member, objected too, wanting deer to be plentiful enough for them to easily kill and eat. “Let them live until I need them,” Madden said. “I don’t want to see all the deer wiped out because some people get Lyme’s disease.”

  Lepore, considered too dogmatic to be a committee member, suggested acidly at one meeting that the island consider “introducing a chronic wasting disease” to afflict deer so they “drop dead right on your lawn.” When he testified, though, he reined himself
in: “These diseases, while not necessarily the four horsemen of the apocalypse, have caused near-fatalities. This is more than just a nuisance.”

  The committee’s final report said people needed to be educated about protecting themselves from ticks, but that more hunting had to be part of the solution. Voters, in a nonbinding resolution, approved hunting and other “deer reduction” methods by two to one. The selectmen agreed gradually to increase hunting to bring deer down to under twenty per square mile. But so far, no changes have been implemented. “Everything was put on hold,” Dammin says.

  “Everyone wants to get rid of the disease, but no one wants to cut down our hedges, no one wants the four-poster, no one wants to kill the deer,” MacNab says. “There is no magic bullet.”

  So, with the bullets he has, Lepore does his part.

  When a friend inquired about a place to hunt, Lepore had a tip. “The most awesome spot: the town dump.” He said deer are attracted to pruned leaves and grass clippings that people discard and can’t detect encroaching hunters because the dump has too many competing smells.

  “I have a blind there,” Lepore pointed out. “On top of the first refrigerator on the right.”

  CHAPTER 5

  IN THE BLOOD

  One frigid day, a teenage Tim Lepore was engrossed in a scrappy game of pond hockey on a lake in his hometown of Marlborough, Massachusetts. Glancing up between goals, he spotted a woman making her way toward the pond, her unsteady gait more than offset by her air of determination. Tim quickly lowered his hockey stick and skated to the pond’s edge.

  Tim’s mother had come to fetch him because his father needed him. More precisely, Tim’s father needed his son’s blood.

  John James Lepore was a general practitioner and a well-respected surgeon at Marlborough Hospital. To many, he was a heroic figure, the first doctor in Marlborough to enter the Army Medical Corps in World War II, returning home to become a medical mainstay of this industrial city’s growing community.