Island Practice (12 page)

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.”

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.

On this day, John Lepore was conscripting his son as a blood donor. Tim’s blood is O positive, the most common blood type, which meant that many of Marlborough’s ill or injured could benefit from what flowed from his veins. And every couple of months, Tim’s father would
send Tim’s mother out to haul him into the hospital so he could give one patient or another better odds of staying alive. “He knew where I was, and it was quick and easy,” Tim recalls.

Tim would also accompany his father to the hospital every New Year’s Day, where he would see trauma cases streaming into the emergency room, observe as X-rays were taken and developed by hand, and look over his father’s shoulder as he performed surgery in the OR—stopping only when his father took a break for coconut cream pie.

“He could do anything,” it seemed to Tim. “He could fix the damn elevator. Literally, he would work on the elevator in the hospital, and then he’d fix some tools in the OR, and then he’d operate. He was very technically and mechanically talented, and he had very fast hands. He had a great curiosity.”

John Lepore loomed so large in the world Tim inhabited that the son would invariably compare himself to the father. “I have a curiosity, but sometimes I end up with a couple of screws left over,” Tim thought. “He was much better than me.”

It wasn’t only his father’s skill and reputation that made Tim feel that way. In some ways, from the moment he was born, Tim would be unable to measure up to an ideal—the angelic image of an older brother Tim would never be able to know.

The first child of John and Edna Lepore was born on the last day of 1941, a few weeks after Pearl Harbor and a couple of months before John Lepore went off to war. Captain Lepore was thirty-one, older than most soldiers, but his battlefield accomplishments quickly drew notice: He was named surgeon in chief of a field hospital in Ireland and then landed at Algiers during Operation Torch, part of the first American contingent in North Africa.

He received a commendation from the British and American armies, noting “he has apparently inexhaustible energy, has worked many long hours, has displayed very high surgical skill, has overcome difficulties which presented themselves, and altogether has shown himself to be an officer of exceptional ability.” Other commendations followed, including
one praising his work “under adverse conditions with lack of sufficient surgical equipment and medical supplies in such a manner as to gain the confidence and admiration of every patient and member of his command.” The commendation quoted soldiers saying: “As long as officers like Captain Lepore are to be our surgeons, we don’t mind taking chances of being wounded in front line duty.”

Captain Lepore took chances too. He scavenged wire from the Germans to provide electricity to tents where battlefield surgery was performed. He removed a fan motor from a car to fashion it into a suction pump, which he used to pump the stomachs of soldiers with abdominal wounds.

Lepore wrote to his wife saying how much he missed baby Johnny. But in one of her letters back, when Johnny was two, Edna Lepore told her husband that their son had a bad case of measles (it would be about twenty years before the introduction of the measles vaccine). Johnny developed postmeasles encephalitis, swelling of the brain tissue as it tries to fight off an invader—it can cause brain bleeding and severe brain damage. Even today about half of all measles encephalitis cases result in death.

With fluid building up in Johnny’s brain, destroying tissue and causing seizures, he was sent to Children’s Hospital Boston, where Edna Lepore was allowed to visit him only once a week.

At first, John Lepore, nearing the end of his tour in North Africa, wrote his wife assuring her that “Johnny was fine,” according to their daughter Cheryl, nicknamed Sherry, who was thirteen months younger than Tim. “He was assuming that my mother might be exaggerating a little bit, overly worried about her firstborn.”

As things got worse, though, Lepore headed for home before his tour ended, finagling passage on a series of boats and planes. But the decorated war surgeon could do nothing to save his own son, a child he had not seen since the boy was two months old. Johnny died in February 1944.

Ten months later, Timothy James Anthony Lepore was born. When Tim was growing up in the house on Main Street, the catastrophic loss
of the Lepores’ firstborn child was barely mentioned. There were no mementoes of Johnny in the house, and Tim never even saw a picture of him until after his mother’s death decades later. But each year, his parents visited and decorated Johnny’s grave. And “the day my mother died, she was talking about it.”

During Tim’s childhood, the devastation of his brother’s death was forever in the shadows, lurking.

“At Passover you set a place at the table for the prophet—it was sort of like that,” recalls Tim, who was raised Roman Catholic. “It would come up occasionally as the great unspoken. It would come up—like a summer storm—come up and go away. My father and mother were very closed-mouthed about it. It was always there, sort of like the place setting.”

Tim says he wasn’t particularly conscious of being compared with his brother or of carrying the weight of having to make good. But he was aware of the idealized impression that parents carry with them of a child lost so young. “When you die at two years, two months, you’re always at the top of your game. They don’t want to borrow the car. They haven’t screwed up in school or knocked somebody out. A two-year-old is all promise.”

Bob DiBuono, Tim’s closest childhood friend, who happened to have the same birthday as Johnny, says that Tim would mention Johnny, sometimes wistfully. Bob, who had an older brother, recalls that “when Tim and I would get into a fight, we used to punch each other, and when we were duking it out, Tim would say, ‘Oh I wish I had an older brother like Johnny. I wish Johnny was still alive. He would beat the crap out of you.’”

And, Bob says, Tim intuitively saw the maddening irony and frustrating limitations of becoming skilled in medicine: “when your father is a doctor and he couldn’t do anything about it.”

The insidious power of disease colored Tim’s early life in another way—this time involving his mother, Edna Lepore. Tim’s first memory of his mother is of visiting her in a medical facility, a sanitarium where she spent a year when Tim was about four, causing her to miss a chunk of his early childhood.

She had severe tuberculosis, which Tim now believes she may have become vulnerable to during the postpartum depression she suffered after the births of Tim and Sherry. Because of the tuberculosis, she had one lung removed, plus the lobe of the other lung.

She would likely have died if the antibiotic streptomycin had not been discovered and made available just before she got sick. “But she was always a little deaf from it,” Tim says. She was also given an infinitely refillable prescription for another drug, Isoniazid, which kills bacteria but can be toxic to the liver in large or long-term doses, especially in women. “Now, they only let you take it for six months to a year,” Tim notes. “She refilled that prescription for thirty years.”