Island Practice (14 page)

When she wasn’t driving to find the nurse, she drove the children on trips, “lots of places, to get away,” Tim recalls. “My mother had been desperately ill and between losing my brother and the TB, there were a lot of screwy dynamics going on. I think that was a very rough period for them.”

Watching his mother, Tim absorbed the notion that fragility and resilience could intersect, that strength could be undermined and then rebuilt—useful observations for someone about to enter a lifesaving profession.

His mother was also someone who supported some of Tim’s eccentricities and harebrained schemes, like the time in elementary school when he created his own newspaper. He would run around the neighborhood and ask people questions on the street: “What do you think about peace negotiations in Korea? Should we bomb them all to smithereens?” To print his articles, he’d use ink on a kind of paper made of gelatin and “try and sell them for a nickel. I wrote all the stories. It didn’t go over well. I irritated the neighbors.” He kept it up for about six months, until he ran out of ink.

Edna Lepore could draw the line, however. “She did not necessarily approve when I went out camping and I had three knives in my belt.”

She also did not approve when one day Tim came home from fifth grade and said the word “fuck.” Concluding that her son was not working hard enough and had gotten all he could from public school, she sent him to the private Fay School. It was a shock. The public school
had been near Tim’s house, and “I was sort of the cock of the walk,” having read every book in the library and aced his classes.

At Fay, Tim instantly felt “at the bottom of the heap, and struggling: a square peg in a round hole. All of these guys knew each other and came from a somewhat more advantaged background. You’re in your pimply early adolescence, and you’re the sort of dumb one in the class.”

Tim mouthed off in school and had to write a couple hundred times on the blackboard: “I must endeavor to remember that silence is golden.” Homework included writing a “damn paper” every weekend, which his mother forced him to do. And every week, the headmaster announced each student’s grades to the whole school. “If you didn’t do well, he would speak to you directly in front of everybody. I remember sitting there and having him say ‘Tim Lepore got a 3.0. You got to work harder on this.’”

In seventh grade, Tim was scheduled to compete in a public-speaking contest at school about the Civil War battle between the
Monitor
and the
Merrimack
warships, but he went out hiking and lost track of time: “I was late. I forgot my notes. My parents were pissed. I felt like I had let my dad down, and that is a much worse punishment than any they could give me. I had put work into it, I wanted to do a good job, and I screwed it up. That type of stuff I would do routinely.”

After three years at Fay, Tim did not go to prep school like most of his classmates but stayed home and attended a Catholic high school. There he did better, played football, and joined the science quiz team that beat the pants off neighboring schools: “I can still remember the question I blew on the quiz team: the correct term for fish eggs. I answered too fast. ‘Roe’ was the correct answer. I said ‘milt,’” a term for sperm. “It haunts me.”

When it came time to apply to college, Tim figured he would go to St. Anselm like his father and many classmates. “To keep my mother
quiet,” he also applied to Harvard. Although he had good SAT scores, he never expected to be accepted.

“It was just for giggles,” Bob DiBuono says. “His mother went to Radcliffe. I remember Tim saying his mother helped him with the essay.” Tim got in. But after his first semester, Harvard started having second thoughts.

He had crashed in Advanced Introductory German, getting 115 wrong out of 130 questions on the exam. (“When I walked into class the first day and the bastards were all speaking German, it should have dawned on me,” says Tim, who had never taken the language before.) In his freshman humanities course, “I didn’t say one thing.”

Biochemistry didn’t go well either. And in freshman creative writing, when asked to write about how wonderful a Le Corbusier building was, Tim “didn’t see any particular utility. I can’t come up with this artsy-fartsy type of bullshit. I finally wrote this parody of James Fenimore Cooper, and the grad student liked it. That put me over the pass-fail line.”

After a semester of getting Cs, Ds, and an E, he got a letter from the dean saying that Harvard was essentially putting him on probation and would reevaluate him at the end of the year. “I was in deep water. I was in with all of these people who were extremely bright and seemed to be much more accomplished and polished than I was. I knew I was dancing on the edge.”

Thankfully, his second semester classes included anatomy and classical biology, for which Lepore found he had “a photographic memory. Plus I had every
Scientific American
reprint. So, the second half of the year, I hauled it out and ended up with Cs.”

Still, Tim could get in his own way. In anthropology, he started with an advantage because of his encyclopedic childhood-learned knowledge of Native Americans, arrowheads, and fossils. “If only I hadn’t slept through the first hour and a half of a three-hour final. I knew all the answers, just couldn’t write them down fast enough.”

Somehow, Tim pressed on at Harvard. “It took me awhile to figure things out, and it was scary. I had to figure out that I am not going to do literary commentary, that as an architectural critic I lack things.
Portrait of the Artist as a Young Man
or
Ulysses
escaped me. I prefer things to be straightforward: Jack went up the hill, not Jack has this crisis of confidence that’s wrapped up in some Freudian mystery.”

He did get As in public speaking and a class dealing with fairy tales. He realized he had strengths. “If you turn me loose in arcane subjects like myths, I kill. If you turn me loose in immunology and embryology, I can kick ass.”

And he learned a lesson he would take to Nantucket in spades: “I could outwork anybody. I did not screw around.”

Tim was also beginning to understand that if he were to succeed, especially as a doctor, he could not expect to slip blithely into his father’s impressive shoes. Things did not come as easily to him in school, and they wouldn’t come as easily in medicine.

One day in particular seemed to underscore that. During his residency at Tufts medical school, Tim was performing a cardiac operation, replacing a woman’s heart valve. The patient, by pure coincidence, had had her gall bladder removed years earlier by John Lepore. Her heart condition was shaky, but when she saw the name on Tim’s lab coat, she relaxed. Tim even looked remarkably like his father, the same curly brown hair, the same solid build.

“There’s another Dr. Lepore taking care of me,” the woman sighed with relief. “Everything’s going to be all right.”

But everything was not all right. Hearts are more serious than gall bladders. After the surgery, she was so fragile she had to be moved to intensive care while still on the operating table to avoid being shifted from one bed to another. In the ICU, she opened her eyes, appeared to look directly at Tim, and had a heart attack. Soon afterward, she died. Tim had lost his father’s patient.

“I’m a tepid copy,” he thought.

But things are not always as they seem. Several years later, when Tim was working at the hospital in Rhode Island, his friend Bob DiBuono bumped into John Lepore at the Marlborough dump.

“Hey, have you seen Tim lately?” John Lepore asked.

“No, geez, Doc, I haven’t,” Bob replied. Then the father spoke words he had never managed to say directly to his son.

“To tell you the truth, Bob,” John Lepore murmured, “I think he’s a better surgeon than I’ll ever be.”

“Uh, I just got your name from the phone book,” the caller said. “It’s about my son—he’s eight. . . .”

It was way past midnight, and Lepore had been fast asleep. “My son, he’s got a tick, and it’s someplace I’m not comfortable examining,” said the voice. “I don’t know ticks from what-have-you. It’s underneath, on his upper thigh, in the, uh, bathing suit area.”

The doctor sprung awake. “Is it a black tick? When did you notice it? You don’t want to grab it with your hands. Pull it out with tweezers.” Sensing the caller’s hesitation, he got ready to jump in his car. “What’s your address?”

“Uh, I’m not really sure. I’m just here for the weekend,” said the voice, mentioning some places tourists would frequent. “I think it’s near Sanford Farms. I have a map here from Young’s Bicycle Shop.”

But as Lepore tried to figure out where to go, the voice shifted gears. “Oh, he pulled it off. Oh, that was chocolate. I’m sorry—he had a Hershey’s kiss in his pocket.”

The caller hung up—and dissolved in laughter. Score one for the Dr. Lepore Game. Lepore’s say-no-to-almost-no-one accessibility is so well known that it inspired a teenage prank.

“The game was to see if he picked up the phone, how long you could keep him on the phone, or could you get him to offer to come out and check on you,” recalls Sean Kehoe, who played the Lepore game in high school. “Those phone calls were priceless. It was 3 o’clock in the morning, and he was ready to drive out to Madaket to take care of an imaginary eight-year-old.” Sometimes Lepore would smell a rat and hang up. “But,” says Kehoe, now in his late twenties and a New Yorker who returns to Nantucket often, “he wouldn’t lose his cool.”

Health professionals who’ve worked with Lepore consider his approach highly unusual and sometimes maddening. “He can’t say no,” says Martina Richards, a nurse who worked for Lepore until moving to London. “But it’s hard to complain about that because he also won’t say no to you. That’s why we’d all stay around, because as much as he might drive us nuts, he’s the first person there if you need anything.”

Lepore visits patients to save them the hassle of coming to the office or if he thinks they’d be more at ease at home. He also allows—even encourages—patients to visit his home. Rhoda Weinman, his former running partner, says that while they ran, people driving by would yell out the car window, “‘I need a new prescription,’ or ‘I need this or that,’ and he’d always say, ‘Stop by the house.’”

When Pam Michelsen, who lived on Nantucket for twenty years, separated her shoulder playing softball, her friend advised, “You could go to the emergency room, or you could go to Tim’s.” The choice was easy. Michelsen notes, “I can’t tell you the number of people who walked up on his porch. Rather than go to the emergency room, you go to Tim’s. It takes you half the time and it doesn’t cost you anything.”

It doesn’t cost anything because Lepore frequently provides care for free or allows patients to pay him in kind, whatever kind. Indeed, on an island flush with the financially fortunate, Lepore is the great leveler. A South African immigrant in need of an appendectomy had no money
or insurance. “You work at a good cookie place; every week bring me a couple of cookies,” was Lepore’s solution. “What’s more important—you have some good oatmeal raisin cookies, or you have money you have to share with the government?”

He told a patient who was a runner that he’d cut her bill in half if she ran a marathon. She did. Scores of other patients have standing treatment-in-trade deals. “In the real world, if I need more Ritalin, I have to go to a doctor, make an appointment, sit in a waiting room,” says Chris Fraker, Lepore’s neighbor and a builder. “I go next door, tell Tim I need a prescription, and he writes it on the kitchen table.” In return, “the other day Tim’s putting new mirrors on his Land Rover, but it’s not working for him, so I get some tools and help them lay right. He fixes us, and I fix all of his stuff.”

Paul Johnson had a .44 Magnum that “kicked like a mule” and wondered, “What can I do with this gun on Nantucket? I’ll give it to Tim and trade it for medical work.” That was payment enough, even when Lepore painstakingly removed a scalpel blade that an off-island orthopedist who’d operated on Johnson had accidentally left inside Johnson’s knee. “It was an unsaid thing. I never got a bill.” And one day, he dropped by Lepore’s house, and “there’s Tim and his six-year-old son, Nick, shooting that .44 Magnum.”

At the other end of the spectrum Lepore gets gifts from wealthy patients who have already paid their bills. One “captain of industry” gave him a gas grill for removing his daughter’s appendix. Champagne would arrive from Jane Engelhard, the wife of Charles W. Engelhard Jr., the gold mining magnate considered the inspiration for Goldfinger, the arch-nemesis of James Bond.

But when a landscape worker with a hernia offered to do yard work at Lepore’s house, the doctor gently turned him down, saying: “I don’t want to get the grass too nice.”

Lepore’s approach to money can exasperate his staff. “Someone would come into the ER in the middle of the night, and they would call him in, and he wouldn’t bill for it half the time,” Richards says.

Weinman, a lawyer, was astounded to learn how much work Lepore was doing without a contract with the hospital entitling him to get paid. She finally negotiated a contract, but even then, “I kept saying, ‘You should get more money for this.’ Money is so nonimportant to him.”

Lepore believes “getting paid is like getting whipped cream. I can worry about the lady with the spleen or the guy with the hernia, or I can worry about money.” His one financial concern is “if people are not going to pay me, tell me up front. It’s the two bucks spent billing you that kills me.”

Lepore often tries to honor patients’ unusual or unorthodox requests. One patient’s grandson wanted to be a fighter pilot but had a spontaneous pneumothorax, a collapsed lung, which would disqualify him—needlessly in Lepore’s opinion. “We ‘lost’ his X-rays,” Lepore says. “He’s doing very well as a fighter pilot now.”

Another family wanted Lepore to remove the brain of a relative who died of Parkinson’s disease so they could donate the brain to research. “I did it down at the funeral parlor. They didn’t have any power tools, so I used a wing saw. I kept the brain in a strawberry container, tied up by the blood vessels.”