Island Practice (15 page)

Lepore often launches on escapades like this “at the last minute,” says Katie Pickman, one of his nurses. “Sometimes he doesn’t tell us—he just disappears.”

But occasionally Lepore figures the best thing he can do for a patient is look the other way.

Romelee Howard, a retired physician, was ninety-eight, and his condition was deteriorating. His wife, Eileen, a former nurse, was caring for him at home and says that one day she put him in the shower and left the bathroom briefly because she forgot his pajamas. When she returned, Howard “had turned the hot water on because he was a little confused, and he burned his feet.”

Then Howard cut his hip, caused, his wife believes, because he “had a way of falling or crawling out of his bed.” Lepore and his geriatric nurse practitioner, Laura Kohtio-Graves, wanted Howard to have a
hospital bed at home, to receive more mental and physical stimulation, and to have his wound treated with vacuum assisted closure therapy using a device called a wound VAC.

Lepore struggled with what to do. “We were going to call protective services. I didn’t think she would be able to handle this. I would never have believed that those wounds would heal.”

But first, Lepore visited Eileen Howard. She’d respected him ever since her mother fell on their deck twenty years ago, and Lepore drove over in a pickup truck, took her mother to the hospital, and operated on her hip then and there. Now they discussed her husband, and Lepore became convinced that Eileen Howard was, in her own way, providing care. He decided not to force anything on her. He was “so patient with us, so tolerant of our being older, doing this, doing that.”

Howard lived past his hundredth birthday, dying peacefully in November 2011. “I had a lot of great ideas, but she got the wound healed in spite of me,” Lepore reflects. “Sometimes it’s better to stand back and watch.”

Senator John Kerry, Democrat of Massachusetts, was in Nantucket’s emergency room. It was the fall of 2003, and Kerry, then a candidate for president of the United States, had had his flesh impaled by a blood-hungry predator: he had a tick bite. He called Lepore, who interrupted a Sunday football game he was watching at home. The senator, who has had a house on Nantucket’s Brant Point for decades, was very concerned.

“He was starting to run for president, and he was telling me that he couldn’t afford to get sick.” It was too early to know if the bite would cause Lyme disease. But Lepore advised Kerry to take a two-pill dose of vibramycin, an antibiotic, to snuff out any potential Lyme infection. “Out here, I think you really have to be aggressive. The other option would be to do a full course of treatment” with other antibiotics for
thirty days, but if, as a result, “he gets diarrhea, that’s probably not a good idea, because then he gets really sick.”

Kerry seemed hesitant. So Lepore baited him, mentioning one of his opponents, who happened to be a physician. “We can ask Howard Dean for a second opinion,” Lepore suggested innocently. Kerry “did not think it was that funny.”

Years later, Kerry vaguely recalls Lepore’s wisecrack. “He did say something like that.” But it didn’t stop him from consulting Lepore about a subsequent case of Lyme disease and following his advice then to switch antibiotics. (Lepore told the senator the drug he had been prescribed can cause sun sensitivity, which might frustrate Kerry, an avid sailer and windsurfer.) And when Kerry came to Nantucket to recover from hip replacement surgery in 2009, he listed Lepore as his doctor “in case I keeled over and was unconscious.”

Lepore has “treated any number of members of our family,” Kerry says. “He’s the only person who’s treated me on the island. Whether it was feeling sick, or a muscle, or a tick bite. There are not a lot of doctors who readily make themselves as available to everybody—it doesn’t matter who, what, how. He’s the real glue to the community. He’s the go-to guy.”

Lepore is far from starry-eyed about these kinds of relationships. In fact, he considers his outspoken libertarian leanings to be the antithesis of much of what Kerry and most Democratic politicians stand for. He isn’t shy about enunciating his own politics, sometimes landing him, colorfully or controversially, in the newspaper. But when political opponents become his patients, he keeps his views to himself. “Politically I’m not on their wavelength,” but “it’s not relevant usually to what I’m seeing people for. The last thing they want if they got a broken toe is some nitwit carrying on about the Democrats.”

“Nitwit” is not the word Kerry uses. He calls Lepore “a character,” a more neutral, senatorial term. And anyway, Kerry says, when he is on Lepore’s exam table, “we never talk about anything politically.”

Same thing when Chris Matthews, the MSNBC television anchor who once worked for Democrats, came to Lepore with pneumonia in 2008. Matthews says Lepore was “very generous in coming into the office off-hours to treat me. As I recall, we had a great conversation about all kinds of things.”

But not a word was said about Lepore’s appreciation of Sarah Palin or his preference for the punditry of Rush Limbaugh. “No reason to poke a skunk,” Lepore jokes. “I’m not going to convince him and he’s not going to convince me.”

Of course, says Richards, his former nurse, political tiptoeing can work both ways. “You might need to seek out Tim even though you didn’t vote for him for school committee.”

Rhoda Weinman considers herself “a staunch Democrat. I’m anti-gun all the way, and he’s such a big gun proponent and believes in the NRA and all that. Politically, we couldn’t be more opposite. We fight about it all the time. We’d have screaming matches on the Milestone Road while running, and I’d say, ‘We ’re going to run the next ten miles, and I don’t want to hear a word from you.’” And yet, “people are like: ‘He’s your best friend?’ Yeah, he is.”

One particularly devoted patient belongs to one of the most prominent Democratic families: Edmund Reggie, father-in-law of the late Senator Edward M. Kennedy. Judge Reggie, as he is usually called because he was a city judge in Louisiana, has been active in Democratic politics ever since he marshaled crucial support for John F. Kennedy for president in 1960. In 1992, Reggie’s daughter Victoria married Ted Kennedy.

“You go to Dr. Lepore,” Reggie was told about a decade ago by a Boston urologist treating him recurrent bladder tumors. Reggie, who with his wife, Doris, lives half the year in a charming, airy house in Nantucket’s Shimmo section, had no idea how significant the relationship would become. First, whenever Reggie had tumors scraped off in Boston, he visited Lepore, who administered catheters of bacillus Cal-mette-Guerin, BCG, an inactivated tuberculosis bacterium that triggers
the immune system to battle tumors. Lepore used the occasions to “talk to him about Huey Long.”

Then, when a New Orleans doctor perforated Doris’s intestine during a colonoscopy and sewed the tear with heavy sutures, she, in extreme pain, “immediately went to see Tim.” Lepore removed the sutures, joking that they were of such a heavy gauge they “could have landed a fish.”

Next, Edmund came in with chest pains, “trying to have a heart attack,” as Lepore put it. Lepore wanted to get him to Massachusetts General Hospital but was told no beds were available. “If I want something, that’s not an answer I want. Whatever I have to do to get the answer I want, I’ll do.”

“Do you know who he is?” he prodded the hospital. Then he informed Ted Kennedy’s office, and eventually, “mirabile dictu, they found a bed.”

Remarks Doris: “Once you’re his patient, you’re his patient forever.”

But, says Edmund, “the big enchilada was what he did for me on my crucial night.” It was July 2009, and the Reggies had been entertaining friends, including Louis Susman, the Democratic fundraiser who was the new ambassador to the United Kingdom. That night, Reggie recalls, he felt “extreme back pain. I got up in the night, and my legs were weak, shaking. A little while later, around 3:30 AM, I fell, and I couldn’t get up.”

“Well, let’s call Tim,” Doris said.

“No, it’s the middle of the night,” Edmund replied.

“We waited on the floor because I didn’t want to wake him up,” he recalls. “The man works so hard. He had given us his cell, and I didn’t want to use it.”

They finally called Lepore at 6 AM, who, without even seeing Reggie, ordered a jet ambulance to ferry him to Boston from Nantucket’s hospital. While awaiting the jet, Lepore ran a CAT scan and blood tests. The hospital’s visiting MRI service wasn’t there that day, and Reggie says he was later told by other doctors that “a person who needs to be more studious might wait longer and say, ‘Stay overnight,’ and wait till the MRI came.”

But Lepore, who thought Reggie, then eighty-two, might have compression of the spinal cord, didn’t want an MRI anyway. “You can’t take someone who is not stable and put them in there.” And with spinal cord compression, “you have a very finite period of time before you have permanent damage. If you put pressure on the cord, you damage the cord so you can’t get electrical impulses across it.”

Lepore “scooted me off the island,” Reggie recalls. “The doctors in Boston told me, had he not called a jet so quickly, had Dr. Lepore delayed my situation, I wouldn’t have been able to walk. My legs were dead. I couldn’t move them at all.”

Boston doctors performed surgery immediately, and with rehab, Reggie recovered. “Your rapid response is what saved my legs, and how can I thank you for that?” he wrote Lepore. “This grateful patient will always be in debt to you—always!”

A year later, after Reggie visited Lepore for leg pain and a hamstring tear, a package arrived at the Lepore house: peaches picked fresh in Louisiana and overnighted to Nantucket. “If Tim Lepore left this island, to replace him we would need four to six more doctors,” Reggie mused in his light-filled living room one summer afternoon. “He does everything for Doris and me. Tim is my doctor.”

Some doctors are more inclined to wait and see how a patient’s condition evolves or deliberate with a team of physicians before recommending a treatment. But while Lepore regularly consults with mainland specialists, on Nantucket he is his own team. His nurse, Katie Pickman, says, “He will instantly pull things together, getting them to a specialist if necessary, in a ridiculously quick amount of time for being on an island.” Ridiculously quick for anywhere actually. “If someone were in Boston, it would take them three months.”

Lepore owes his confidence to the vast array of cases he’s seen, to his voracious habit of reading about illnesses and treatments, and to
his assertive, unequivocating personality. “It isn’t always wonderful because sometimes he’ll just throw the orders at you,” admits Shelley Foulkes, a visiting nurse. “But I do admire that he is able to do that.”

When a bartender came to him with inflammation of the penis, Lepore was concerned. One possibility was balanitis, in which the foreskin becomes red and inflamed. But “this was unlike any balanitis I’d ever seen. To me it was obvious it was cancer.”

Lepore sent the bartender to a mainland urologist, but “the urologist thought it was just an infection, so he watched it for a while. It wasn’t getting better.” Finally, the urologist conceded it was cancer and removed affected areas of the penis, a potentially avoidable approach if he had confirmed Lepore’s suspicions sooner and tried cancer treatment instead of surgery. The operation was unsuccessful because the tumor had already spread, so the urologist ultimately removed the entire organ. “The guy’s alive, but he’s gone through a lot of surgery, radiation. He’s got some cancer in his lymph nodes,” Lepore laments. “You can sit around and fool around,” but “I just think you have to be aggressive and get after these things.”

Nathaniel Philbrick, the best-selling author of
Mayflower
and
In the Heart of the Sea
, has been on the receiving end of his nimble diagnoses. “He is a man of action, and I think that’s the only way you can survive and become the figure he is,” says Philbrick, who lives on Nantucket year-round. “It’s so easy to sort of ask for another test.” But hesitating can be hazardous, “given the state of care here and the time-bound realities he, and everyone, is operating under. That puts a lot of pressure on him—to just sort of come up with that diagnosis and go with it. He has the courage to make those kinds of calls, to do something rather than waffle.”