Island Practice (10 page)

In 1932, “Old Buck, the original deer on Nantucket, met with an accident which cost him his life,” hit by a car, the paper lamented. “Everybody will feel sorry, for he deserved to live to a good old age, that he might see his grandchildren, great-grandchildren, great-great-grandchildren,
and a lot more grand progeny, thrive happily in the swamps and moors of Nantucket.”

Nantucket was so enamored of its deer that an article described “the strange pastime known as ‘deer hunting.’ No, you don’t take a gun with you . . . more like a sightseeing excursion at night,” an “added attraction to all those couples who like to drive slowly along the ‘lovers’ lanes’ to catch visions of the moon and all its attendant fancies and effects.”

When in 1935, the state authorized a weeklong February hunt on Nantucket, the paper called it “a barbaric slaughter” with “bloodthirsty gunners from the mainland posing as ‘sportsmen’” and locals “augmenting the gangs which came down from America.”

It was “disgusting” to see cars “with deer carcasses lying across the engine hoods or on the running boards.... A car bearing Rhode Island number plates drove down into Pearl Street with four deer stretched across it and left the nauseating sight there all day and evening within the sight of passersby, many of them children, while the men ‘tanked up’ in a nearby emporium.”

The outcry was so great that by the second day, Massachusetts’s governor agreed to stop the hunt, marooning the gangs from America on the island for days until ferries could fetch them. Ten months later, the governor had to halt another hunting season when a man was killed by another hunter who had “leveled his gun and fired, thinking a deer was approaching—perhaps wishing to get in the first shot before his companions espied the supposed game.”

Long before Old Buck came to Nantucket, George Hull’s ancestors did. Seven or eight generations of Hulls have ironed their identities into the island. Hull’s great-grandfather was fire chief, a great-uncle was a monsignor, and Alvin B. Hull held the sentinel post of Nantucket town crier.

To George Hull, that legacy bequeathed a certain perk: immunity to diseases carried by Nantucket’s ticks. Never mind that Hull’s wife, Diana, a nurse in Lepore’s office, has seen every permutation of tick malady. Hull told Lepore: “My whole family comes from here—we’re immune to it.”

Three months after making this claim, Hull, an electrician, was digging trenches when he developed flu-like symptoms that mushroomed into “bad migraines and just continuous pain. By the twentieth day, I just couldn’t handle it anymore.”

“I swear you got a tick thing going on,” his wife told him. It was babesiosis. Hull had shortness of breath, plummeting platelets, and fevers so high doctors packed ice around him.

Eventually he recovered, stunned that “anything like this could ever touch me. The last thing I remember before I lost consciousness was Tim laughing at me.”

Not only is there no magical immunity, but babesiosis, while still uncommon, is spreading, “being seen in areas that it wasn’t seen before,” says Barbara Herwaldt, a medical epidemiologist at the Centers for Disease Control and Prevention. Up to 5 percent of patients die, with or without treatment, says Telford, the Tufts tick researcher.

Nantucket, more than any place else, has put babesiosis on the map. It began in 1969, when Nancy Gray, a fifty-nine-year-old widow from California, spent the summer in a Nantucket farmhouse on a property so heavily blanketed with trees it eventually became known as the Hidden Forest. Gray, healthy and outdoorsy, walked, cared for a neighbor’s horse and donkey, and had a dachshund that brought home dead mice. She frequently checked the dog for ticks, and that May she found a tick on her own neck, plucking it off with difficulty.

Two months later, Gray was feverish, cringed from abdominal pain, and was listless and depressed. No Nantucket doctor could figure it out.

A neighbor, convinced she was dying, called a doctor he knew in New Brunswick, New Jersey—Benjamin Glasser, a colorectal surgeon
who was flown to Nantucket on a private plane. Gray instructed him to let her die at home. But Glasser took her to St. Peter’s Medical Center in New Brunswick, where a lab technician noticed similarities between Gray’s anemic blood and that of malaria patients. The CDC got involved, and scientists peering through microscopes identified babesia parasites. Gray, given antimalaria drugs, gradually recovered.

But her case rocked the infectious disease world. Babesia parasites were thought to affect primarily animals: rodents, cattle, dogs, horses. Of the documented cases in people—a thirty-three-year-old tailor in Yugoslavia, an amateur photographer in California, a forty-seven-year-old fisherman in Ireland—all had previously had their spleens removed and therefore had problematic immune systems. The Nantucket case was the first time babesiosis was known to afflict a healthy person whose spleen was perfectly intact.

More cases cropped up on the island, to the point where the illness was christened “Nantucket fever.”

One cold morning in 1973, a Harvard entomologist, Andrew Spielman, took the ferry to Nantucket with two research assistants: a Vietnam veteran whose jittery manner made Spielman think he had posttraumatic stress disorder and the veteran’s girlfriend. They carried mouse traps and raccoon traps with peanut butter for bait, strapping the traps to bicycles and bumping over cobblestones until they reached a biological field station. They stayed over at the Siasconset home of Gustave Dammin, a friend of Spielman’s and the chief pathologist at Boston’s Brigham and Women’s Hospital.

Spielman thought Nantucket fever probably originated with voles who were transmitting it through dog ticks. But the voles he trapped and tested had no babesia parasites. For kicks, he tested white-footed mice and found their blood flooded with parasites. They had hardly any dog ticks but were crawling with deer ticks.

Spielman scooped deer ticks off mice, infected them with blood from a babesiosis patient, and turned them loose on hamsters in his lab.
When the ticks bit the hamsters, the hamsters developed babesiosis, showing that deer ticks were the culprits behind Nantucket fever.

Spielman was summoned by Nantucket’s board of selectmen, where the chairman, laying his great tattooed forearms on the table, grunted: “So, Doc, whadda we spray?” But there was no quick fix.

Spielman named the tick:
Ixodes dammini
.
Ixodes
is derived from the Greek word for sticky and is a genus of hard-bodied ticks.
Dammini
is derived from Spielman’s host, Gustave Dammin. Dammin’s wife, Anita June Coffin, was descended from a genus of hard-boiled Nantucketers: the Coffins, one of the island’s oldest whaling families. The Coffin home took in paying guests, including dignitaries like Ernest Hemingway’s mother, who painted on the moors. But to Gustave Dammin, the tick thing was the bees’ knees. There was a tick naming ceremony. Dammin’s wife embroidered a tick on her husband’s Harvard tie. Once he thought he had babesiosis and was “very upset” when he didn’t, recalls his son, Tristram Dammin, an emergency room physician in Boston.

The tick naming ignited controversy in entomology circles, however. Most experts ultimately decided it was the same species as
Ixodes scapularis
, so they have de-Dammini-ized it.

“Those young Turks at the CDC took the name away, the bastards,” says Tristram Dammin. As consolation perhaps, “Andy Spielman sent me my own bottle of ticks,” and his father became the namesake of a backyard antitick method: Damminix, tubes of insecticide-treated cotton balls that mice will use for nest-building, causing ticks that feed on mice to die.

Several years after the babesiosis discovery, researchers discovered that a mysterious arthritis-like disease in children in Lyme, Connecticut, was caused by the same tick. That illness became known as Lyme disease.

Then, in 1994, Genevieve Gordon, a longtime Nantucketer, started feeling funny. An energetic sixty-eight, she worked two jobs, selling
tchotchkes at the John Rugge Antiques Shop and spices at Nantucket Gourmet. But, she remembers, she became disoriented, feverish, and nauseous and had “terrific diarrhea.” Her grandson “found me semiconscious” and rushed her to Lepore.

“I was sure she had babesia,” Lepore recalls. But the hospital’s lab “kept looking at the slide and could not find babesia.” Finally, Patricia Snow, a longtime Nantucket lab technician, identified Gordon’s illness as anaplasmosis, a tick-borne disease in the same family as Rocky Mountain Spotted Fever. (Initially, anaplasmosis was called ehrlichiosis, a term Lepore still uses in one of his tiny gleeful rebellions against medical convention.) Anaplasmosis had never been seen in this part of the country. And it was caused by the same deer tick that spreads Lyme disease and babesiosis.

Gordon recuperated after three months but found her dog, a French Bordeaux named Bijou, “dead in the bathroom” from anaplasmosis.

It turns out a single tick bite can cause one, two, or all three diseases. And some experts believe people on an island like Nantucket are more likely to be bitten by ticks carrying more than one disease. That could be because the sheer number of ticks increases odds that people will encounter ticks carrying multiple infections, or that the concentrated nature of the island ticks’ food supply makes it easier for ticks to become co-infected.

There may also be more tick diseases than those three. In 1997, Telford discovered deer tick virus, which appears related to tick-borne encephalitis.

Telford says he and Lepore are constantly “fishing for new infections” caused by ticks. Lepore also sends Telford other insects to check for diseases. He catches greenhead flies near beaches, attracting them with the motion of a swinging rubber ball and then trapping them when they fly into a canvas cone.

At night, he sets traps for mosquitoes in Hidden Forest, an area so murky and impenetrable “you think a dinosaur is going to stick his head up.” He fills a sack with sugar yeast and water to create carbon dioxide,
which, circulated by a fan, entices the mosquitoes. At 5:30 AM, Lepore ventures back into the swamp, collects mosquitoes from the sacks, transfers them to plastic bags, and squirts in ether to euthanize them.

Then he deposits them in his home refrigerator. Cathy abhors finding his creatures in the kitchen, but a bag of mosquitoes draws relatively few complaints. “It doesn’t have fur, doesn’t have eyes,” Lepore says. “Compared to the other stuff—a squirrel looking at you, a bag of dead mice—mosquitoes are pretty good.”

Telford tests Lepore’s greenhead flies for tularemia, a potentially fatal disease that causes skin ulcers, pneumonia, and breathing problems. Mosquitoes are checked for eastern equine encephalitis, which killed a horse on Nantucket in the 1970s and has caused outbreaks on the mainland.

Plus, there’s always the possibility of discovering something new, “if Tim comes up with a mysterious disease,” Telford says. “The study of tick-borne diseases has benefited greatly from the active mind of Tim Lepore.”

Nantucket has been one of the top three counties for Lyme disease since 1992, according to the CDC. “Their risk is obviously among the highest,” says Dr. Paul Mead, a CDC medical epidemiologist. Between 2002 and 2006, the latest county data available, Nantucket averaged an incidence rate of 357 cases per 100,000, which probably understates the actual number of cases because it only includes people diagnosed with lab tests, not clinically. Also not counted are short-term vacationers and people who get infected on Nantucket but don’t discover it until they’ve left.

Anaplasmosis affects about fifteen to twenty people on-island each year. Babesiosis is increasing, with sixty-nine cases in 2008, nearly triple the count a few years earlier. “Nantucket is far and away the babesiosis capital of the world,” asserts Telford. Fortunately, “Tim is by far the
world’s expert on diagnosing and treating babesiosis. He is Mr. Babesiosis.”

Some of the increase might relate to better reporting, because Lepore doggedly logs any case he finds, but another reason probably lies in Nantucket’s ecology. Explains Telford: “On the mainland, you have lots of other things, like fox and raccoon, that could take the ticks away. On Nantucket, ticks are stuck with deer. Biodiversity is less on the island, so the intensity of disease transmission is higher.”