Island Practice (25 page)

After three years, Meredith moved to Seattle, because “otherwise, I’m going to end up alone and bitter with nobody to talk to because there’s nobody to go out with” on Nantucket. “The few people I went out with were all patients in the office.” And she knew a little too much about some. “One guy had a history of genital warts, and I was like, ‘Oh!’ Another patient who was hitting on me, I knew he had herpes, and I’m not really game with all that.”

T.J., who became a doctor, had less direct exposure to Lepore’s practice. In fact, “I always felt that he shielded me. I’ve actually probably only seen him in a patient care situation a dozen times. I’ve been in four appendectomies and a bowel resection with him, but just observing, never in a clinical capacity. He’s always been very cagey about having me see him in that environment.”

Still, T.J. recalls that watching his father skin deer that had been hit by cars, “seeing him find tissue planes in a deer, actually really helped me in gross anatomy and surgery. I still remember the smells and the sights. And we had an entire freezer of dead things. Once, someone left the door open overnight, and in the morning it looked like something Jeffrey Dahmer had collected, a quarter inch of blood on the floor, really a horror show of dead things that he picked up on the road for the hawk.”

Lepore did offer some advice, telling T.J. he was “too nice to be a surgeon” because a surgeon “needs to be a little compartmentalized. I
always joke that you have to have a certain loathing of patients. You need to be able to reach in and say, ‘I can solve this problem.’”

T.J. thinks his dad’s judgment also reflected a lack of social confidence. “He always saw that people liked me. He doesn’t see immediately that people like him. He gets uncomfortable when people say nice things about him. He has a lot of self-doubt about what he does and whether or not he’s doing the right thing.”

Now that T.J. is an obstetrician, people often ask if he wants to practice on Nantucket. He’s concluded that being the island’s second Dr. Lepore “would be a very hard thing to do while he’s still working. And he’s the one person who hasn’t asked me to come back.”

Lepore has told T.J., “You don’t see me working in Marlborough,” his hometown. He knows the perils of being in someone’s shadow. “That’s why I didn’t go into practice with my father,” Lepore says. “He was the big guy. I covered for him one weekend, and they kept asking for the real Dr. Lepore.”

Nick’s path was much rockier. “With T.J. and Meri it was very easy, out of a textbook on parenting,” Lepore recalls. “Nick was difficult, 180 degrees from how I was. I worked hard. I was four square. We’d go to a teacher’s meeting with Nick, and he’d be sullen and angry and hostile and a pain in the ass. All of a sudden I was faced with the fact that a child of mine would not necessarily view life as I did.”

It’s not that they weren’t close. They had the same sardonic humor, and Nick was interested in guns. But “I was much more impulsive,” Nick admits. “I would be sitting there baiting him and baiting him. And oh God yes, I got in trouble a lot.”

Nick had skipped fifth grade and found it tough to make friends the following year. In junior high, he got suspended for a day. In high school, “I didn’t apply myself. I was just really trying to get through the day and hang out with my friends and my girlfriend.”

Nick got caught up with alcohol and marijuana. He cut his hair into a Mohawk. While his brother and sister were National Honor Society members, Nick’s graduating rank was forty-four out of sixty-six students, which, he acknowledges, “especially coming from a small public school, is not exactly what college recruiters are looking for.”

After high school, Nick did an extra year at a private school on Cape Cod, where things seemed to be going well. Then a few days after New Year’s, at 2 AM, Nick and a friend stumbled drunk onto the village green in Falmouth, with its giant Christmas display that included thirty life-sized Styrofoam carolers and a huge Santa. “We started laying waste to the place, punching these Styrofoam figures in the face,” Nick remembers. If only he’d stopped there. But he happened to notice an adorable Styrofoam baby Jesus, and “I went over there and grabbed him.”

They fled, but the police pulled them over. In the car, “we have the baby Jesus, the three wise men, and a goat,” recounts Nick, who covered the Christ child with his feet to hide it from the cops. “They said, ‘We know you did it.’ We said, ‘Okay, we did it,’ and they said, ‘We’ll come get you tomorrow,’ and they let us go.”

Instead of going home, the boys decided to get rid of the evidence: “We went down to the ocean and dumped everything, being really smart criminals.” When the police came the next day, they offered to drop one charge “if we could bring back the baby Jesus. We ran out to where we had dumped the stuff. Out on the horizon, we could just see Joseph’s head bobbing. We would have gone for it, but really we needed the baby Jesus, and he was gone.”

They were charged with malicious destruction of public property, vandalism, disorderly conduct, and larceny—misdemeanors, but still. The crime was splashed on the front page of the local paper. “A woman wrote in saying we should all go to jail for ten years,” Nick says. The case was continued without a verdict on the condition that the boys paid the cost of replacing everything: $4,100. The Lepores paid the fine but ordered Nick to repay them by working summer jobs. He was
sentenced to community service—vacuuming, mopping, and changing light bulbs in a church.

Nick says his father “got mad at me for that, but he didn’t really get mad.” In a way, Lepore could relate. In high school, Lepore totaled three cars, including “my mother’s beautiful sky-blue Skylark convertible that she loved” and a car the nuns at his high school let him borrow. “I did a number of stupid things, and I got away with it. Nick did some stupid things and got caught.”

Those stupid things were not yet behind him. Enrolled at Wheaton College in Norton, Massachusetts, Nick was placed on academic and housing probation in his sophomore year. He attended classes sporadically and, says his father, “made an honest attempt to sleep with every woman at Wheaton.” He was using and selling pot.

One day, as public safety officers approached, Nick ran. He tossed his backpack into some trees near the soccer field, not wanting the cops to find the ounce of marijuana he’d been carrying. But he slipped on wet grass and fell. “And in a decision that will live in infamy, I decided to play dead.” When the police rousted him, he lied about where his backpack was. “I was an idiot.” Told he would face criminal charges unless he left Wheaton and didn’t show his face for a year, Nick returned to Nantucket.

His parents were less forgiving this time. “I remember my mom crying, ‘What were you doing? If you wanted money, you could ask for it.’ I just remember my dad repeatedly saying how stupid it was—stupid to use it, stupid to sell it.”

Nick went to counseling, where he realized “I was kind of angry at the world for no good reason” and “felt powerless to change what I was doing with my life. Maybe it was because I was always Tim Lepore’s son.”

Lepore, who attended some sessions with Nick, understood. “It was a little intimidating to be my son on Nantucket.”

Nick had been counting on a summer police officer job, a position he’d held before, but Nantucket police heard about his problems at Wheaton and rescinded the offer. When the Lepores called Wheaton to complain that its security chief violated a promise not to tell anyone about the incident, the college agreed to allow Nick to take finals and get credit for work he’d completed. That jump-started Nick’s turnaround. “The Wheaton episode caught his attention,” Lepore notes. “He was really, really upset about that.”

Nick got into Suffolk University in Boston, graduated, and worked in San Diego doing construction. He had one more run-in with the law when, traveling in Texas, he and a friend got pulled over with pot in their car. Told charges would be dropped if they pleaded guilty and paid $500, “I said, ‘Hey, no problem,’ called my mom, she sent the check out, and two days later the charges were dropped.”

After that, though, Nick improved. He applied to law school, getting a recommendation from the dean of Wheaton College, who “said I was a young kid with a lot of problems, but I got myself together.”

He became a lawyer, first in Seattle, then Atlanta. “I always wanted to be away from the island. I love Nantucket, but I have a hard time being there for more than a week.”

Nick works for a personal injury law firm that, among other things, sues doctors for medical malpractice. To that, Lepore’s reaction is: “I prefer that he play piano in a whorehouse.”

But Lepore is happy that Nick has made good and is “getting a unique perspective from the other side of the handcuffs.”

Nick doesn’t take it for granted. Life, he reflects, can be “really tough for people coming from Nantucket” because “you’re in a really small, inclusive, supportive environment and all of a sudden you’re just kind of thrown out into a bigger environment. It was difficult sometimes. But I was very lucky to even have a father, let alone someone who gave a damn.”

Sean Kehoe had hit a wall. A high school senior, he missed days of school because “I was drinking cough syrup” to get high. He developed what he called “a reputation for outlandish behavior” that often got him reprimanded. “I didn’t want to go to class; I didn’t want to do homework; I always showed up late. I was just a pain in the ass.”

Then he got suspended after joking that he was going to “do something during the graduation,” something disruptive like wearing a blood-soaked T-shirt. Although he wasn’t expelled, he was banned from attending graduation. “The principal didn’t want to risk anything,” Kehoe says.

Feeling “just out of my mind with rage and anger,” Kehoe went to see Lepore. He wasn’t his regular doctor, but Cathy Lepore, then the school nurse, suggested that her husband could help.

“I’m going crazy,” Kehoe told Lepore. “I’m punching holes in the wall. I can’t control myself. I want to hurt myself.”

Lepore didn’t coddle Kehoe or psychoanalyze him. He didn’t pepper him with questions. “It’s just high school,” Lepore responded. “It’s
bullshit. You’re going to forget about it. It’s not going to matter in ten years.”

Disarmed but not quite buying it, Kehoe asked Lepore for Valium, although, as he recalls, “if you saw what I looked like in high school, there was no way that anyone with a conscience could give me Valium” because he’d either abuse it or sell it.

“Don’t be a baby,” Lepore retorted. “Be a man. Don’t knock yourself out ’cause you can’t deal with it. Just rise above.”

Then he told Kehoe how. “Go and distract yourself,” Lepore prescribed, telling Kehoe to spend a couple of days on Cape Cod. “Go buy shit you don’t want and don’t need. Go see a terrible movie you don’t want to go to. Get out and clear your head.”

Which is exactly what Kehoe did. Lepore wanted to make sure “I didn’t go and get arrested, or start a fight with the principal at graduation.” So Kehoe stayed away. “I didn’t do vandalism. I didn’t do anything stupid. I went to Hyannis for the weekend. I saw
Pearl Harbor
. I bought some weird crap. I did all he told me to do.” And, Kehoe says now, “he was right.”

Surgeons, and even many family doctors, wouldn’t get involved in a case like Kehoe’s. They would refer him to a mental health professional, something Lepore sometimes does as well. But some people find his type of counseling especially effective, and some will only come to him.

He acted as therapist for a man who, while out scalloping on the island, had a vision and began quoting the Bible. Later, he ran into Lepore’s house and announced that the light on his phone meant that there was a nuclear weapon in Nantucket Harbor.

He also intervened when a woman took another islander’s dog and dyed its light-colored fur black. The woman’s logic was simple: she figured nobody would suspect she was a dognapper if the pet she so suddenly acquired was a dog of a different color.

But Lepore knew his patient and recognized this was more than a bizarre crime. She was a troubled soul needing help. He’d operated on
her when she was injured in a case of apparent domestic violence. He’d helped her cope when her daughter gave birth twice while in high school. He’d worked with her when she went off her medication and began hearing voices. So, in the dog case, he counseled her too.

“I’ve taken care of her a long time,” Lepore notes. “She’s a person who was rode hard and put away wet.”

Lepore’s informal therapy, and his ability to prescribe psychiatric medication, fill an important need on Nantucket. While mental health and substance abuse issues occur everywhere, of course, certain attributes of island life can exacerbate those issues, and a limited supply of therapists doesn’t help.

“The depression numbers out here—nowhere else I’ve been even compares,” says Peter Swenson, executive director of Family and Children’s Services of Nantucket, who estimated that more than 1,500 people a year get help from his agency, a significant percentage of the 10,000 people who live on the island year-round. Those numbers are particularly notable, Swenson says, because of the transparent and tight-knit nature of island life. It’s hard to hide that you’re going to a mental health counselor or a therapist, and “it’s more intense of a stigma than other places. People know where you are. Why else would you be parked here? You’re on stage all the time.”