Island Practice (26 page)

There are, notes Jim Lentowski, executive director of the Nantucket Conservation Foundation, “very few secrets on Nantucket. You can run, but you can’t hide. If you’ve got a problem and you don’t want everybody to know about it, you internalize it.”

Swenson often tries to work around that by scheduling sessions in unconventional places—at church, or on the beach so it looks just like a chance encounter. The fishbowl feeling goes both ways and can make it hard to attract and keep therapists on the island. People can easily bump into their counselors at the grocery store, restaurants, and community events.

“You’re trying to figure out what tomatoes you’re buying, and there’s your client asking, ‘What are you having for dinner?’” Swenson
says. “I’ve been out fishing, and someone walks up and starts talking about their kid. I have to say, ‘You know what, I’m really trying to get a bass here.’ This is a very open environment. You have to be okay with that.”

One of Swenson’s counselors moved off-island after encountering a patient at a party where the therapist had been hoping to relax and drink. He realized he could not separate his personal and professional lives on the island. “I can’t deal with it,” he told Swenson.

Other people are driven off-island by a winter that seems to stretch endlessly. “People think of Nantucket as having tourists and lots of people, and the weather is beautiful, and it’s just flowers and gorgeous,” Swenson notes. “Really, from November through the middle of April, there’s not a lot of people here, there’s not that much to do, the weather’s not great, and finding work is very, very difficult. People’s lives get condensed to about a three-mile circle—you’re at work; you’re at home; you’re at Stop & Shop. People off-island who come here in the summer, they have no concept of what that’s like.” And staff members who have moved to the island in the summer “invariably come in in February and say, ‘I think I’m losing my mind.’”

And March, affectionately called the “Hate Month,” can seem sixty days long, Lepore says, and sometimes, “you just want to kill everybody.”

When Swenson arrived in 2006, the agency was fielding ten or fifteen requests for help per month. These days, there are about thirty requests each week. “There are no full-time, year-round psychiatrists,” Swenson says. Two psychiatrists who live on the island give the agency about one day each week, and one who lives off-island comes out twice a month. Until recently the agency had to rely solely on off-island psychiatrists. Still, the need is great enough that patients usually have to book appointments eight weeks in advance. Lepore, on the other hand, squeezes them in more or less immediately.

“In a lot of ways, being a mental health facility here, it’s almost missionary work,” Swenson asserts. “We deal with it all. We’re it; we’re all it is. And Tim.”

Coping with stress and depression on the island can be aggravated by the inability to always get to someplace else, by the quiet sparseness of the off-season compared with the thrum of vacationers in the summer, by the cost of living in a place where even the basics are strikingly more expensive than the mainland, and by the economic disparities between summer visitors and year-rounders.

“It’s hugely significant, the vast differences in wealth,” Swenson says. “The money is outrageous. I think that does have a huge impact on people. It’s hard to understand that disparity, particularly for people living here. People try to tell you that restaurants are affordable, and you know you could never eat there. We’re here nine months of the year, and there are these people three months of the year giving you the finger and screaming at you. We are living where they are coming. People can’t stand them, but we can’t live without them, and that has a huge effect on people’s self-esteem.”

More and more people find that the economy is pushing them off the island, especially during the recession, when a slowdown in building and renovating houses has meant that contractors, landscapers, and caretakers have trouble finding work, and people with other jobs also suffer. “Some people who have lived here all their life can’t afford to live here anymore,” Swenson laments.

People who stay have to be able to handle the seasonal economic changes, the move from a summer tourist economy filled with jobs in restaurants, shops, and the waterfront to a doldrum economy in which many jobs involve taking care of summer people’s houses or scalloping. “People make a lot of money in the summer and have too little to do in the winter,” Lepore says. “Psychosocial issues end up as the biggest thing here. If I’m not empathetic, if I don’t listen, if I don’t ask the right questions, I’m not taking care of that patient, any more than if I did half an appendectomy. Whether it’s disease or dis-ease, there’s something going on.”

The wrenching case of Nicole Garcia Tejada called upon both Lepore’s medical skills and his psychological radar. Three-year-old Nicole
landed on Lepore’s hospital gurney on March 14, 2011. Her limp body had been found lying on a table in her home, but there was a delay in getting her help. Whoever discovered that she wasn’t breathing was apparently more comfortable calling a Spanish-speaking friend instead of police. That friend called 911, but the call was first routed to the state police on the mainland, an extra step before getting to the Nantucket police. The friend had also given the dispatcher the wrong address: Pine Street instead of Pine Tree Road. It took a second call from someone at the house to inform police of the correct address.

By the time Lepore saw Nicole, she was still warm, but barely. “I worked for about half an hour trying to get the baby back,” he recalls. “She was just blue and dead dead.”

Then, Nicole’s mother, twenty-six-year-old Dora Alicia Tejada Pleitez, came into the emergency room extremely agitated and confused, Lepore says. She was given some Ativan, an antianxiety medication. Then he watched in chilling amazement as a police officer entered the hospital room and charged Tejada with the murder of her own child. It was only the island’s fourth killing since Lepore had arrived.

Tejada, a house cleaner from El Salvador who had lived on Nantucket for about five years, had according to local newspapers reportedly hallucinated while napping on the couch with Nicole, imagining that Nicole was possessed by the devil, that demons were inside her. She told a pastor that she believed that God wanted her to force a rose down Nicole’s throat to exorcise the demons, and so, police said, she complied.

Lepore had questions about Tejada’s mental state in the hospital and concluded that her behavior was “disorganized enough that at that point it wasn’t appropriate to send her to jail.” He filled out a form so she could be involuntarily committed to a psychiatric institution, but the weather was too thick to fly, and she stayed at the hospital overnight, murder charge notwithstanding. She was eventually found competent to stand trial and her case is pending.

One of Lepore’s many hats involves serving on the board of Family and Children’s Services, and he and Swenson have bumped heads at times: “I think we need to do more fundraising, and Tim hates it: ‘Well, I’m not doing that crap.’ At least you know where he stands. But when we’ve had people in trouble, he’s there—boom. Doesn’t matter whether it’s 2 o’clock in the morning, ’cause that’s what he does care about.”

When a kid with bipolar disorder bolted from the emergency room and began running around town, for example, Lepore ran after him. He couldn’t keep up but alerted police, who found the teenager at the home of a man Lepore had previously treated for bipolar disorder but who had stopped taking medication and seeing doctors. (With the latter patient, Lepore notes, “I wasn’t that successful. I did such a good job he shaved all the hair off his body.”) Police brought them both to the hospital.

Lepore will also give patients cover, helping arrange a smokescreen to shield their problems from public view as a way to encourage them to get help. When teenagers come to see him, he’ll often “take some blood just for kicks, just so the parents think we did something medical.”

Alexandra McLaughlin, whom Lepore is treating for narcolepsy, knows several people with addictions to drugs or alcohol who “keep his number on file” in case they slip out of sobriety. They feel safe coming to his office, she says, because “Dr. Lepore’s the one you can actually talk to, and he’s not going to ruin their medical file for life.”

Still, sometimes Lepore’s counseling attempts fall on deaf ears. After a sixteen-year-old boy who was on probation for drugs failed a drug test, Lepore arranged for a bogus medical follow-up appointment for him just to get him to come into the office. He sat down with the teenager for forty-five minutes.

“You’re hanging around with stupid people,” Lepore told the boy. “You’re doing stupid things. You just got out of rehab, and you tell me you’re cranking oxys, drinking, smoking dope.”

The boy listened but was not terribly swayed. “At the end of the ser-monette,” Lepore recalls, “he told me to go shit in my house, essentially.”

About 60 percent of the people who seek counseling at Family and Children’s Services come in at least in part for drinking, Swenson says. “People on-island don’t like to talk about it because we’re a tourist community, but alcohol is the biggest problem we have on-island. It’s connected to anything and everything. You spend time downtown in the summer, you see people walking around just blotto.”

Peter MacKay, the social services manager for the hospital, is seeing more alcoholics, and “the time to treat them is longer.”

Lepore sees a slew of intoxication injuries. The cobbled downtown streets are “hard to walk on when you’re drunk,” he notes. “People think it’s Disneyworld and that you can’t get hurt at Disneyworld.”

One drunk driver struck a deer and flipped his car over, killing a man and a deer. Lepore drew a chalk outline around the deer. Another man, with an off-the-charts blood-alcohol level of .300, stumbled into another person’s driveway and lay down. The homeowner didn’t see the man and drove into him, causing severe injuries.

In 2009, after two house painters, Scott Bernard and Thomas Ryan, went drinking, Ryan stabbed Bernard, whose body was found alongside a road.

The summer before, at the Bamboo Supper Club, in an attack stemming from an apparent love triangle, a woman smashed a coworker in the face with a pint glass and a high-heeled shoe. The victim, Erica Sparks, a Canadian working as a summer waitress, was left with a permanent scar from a six-inch gash from her left eye to her mouth. The attacker, Laurie Ray, was convicted of mayhem. Both women appeared to have had a substantial amount to drink. Lepore, who treated Sparks in the emergency room, said her blood-alcohol level was .249, just over three times the legal limit.

“If I became king of the island, I’d close all the bars at 9 PM,” Lepore proclaims. “I think it’s a horrible problem. It breaks up families, kills people—get rid of it. Half the island goes to AA, and the other half should. It isn’t a surprise who you’re going to see at AA. The only surprise is that more people don’t go.”

Lepore has seen people “come in three days in a row drunk to the emergency room.” Occasionally, when he needs to suture up an especially surly drunk, he will be a little less generous with the Lidocaine that he gives to numb the site of the wound. “Some people I put in more, some people I put in less. At 3 o’clock in the morning, dealing with drunks who are spitting up on you and cursing at you—sometimes you’re allowed to return the favor.”

One man was such a problem drinker he got into three moped accidents in a single day. Not long after that, he came into the hospital with a sword. Lepore wrote out a Section 35, an official request to a court to have him involuntarily committed to a rehab facility, where he would be evaluated by a court-appointed forensic psychologist and could be institutionalized for up to thirty days. It was the fourth time he had given the man a Section 35.

Lepore frequently encounters teenagers with alcohol problems. He says “there has historically been this acceptance of underage drinking” on the island. “It used to be the cops showed up at a party, and the kids dropped the beer, and the cops went away. Now the cops show up, the kids don’t drop the beer.”

Swenson reports that a 2009 survey found that Nantucket’s youth drinking rate was about 50 percent, outpacing the rate for Massachusetts and the rest of the country. He thinks new programs his agency has put in place are “starting to move this in the right direction,” but “I still think we’re a little bit higher than the state and national average.”

Swenson and Lepore say that some parents, with the goal of preventing their teenagers from driving drunk, allow parties where kids can drink, but take away all car keys. “It’s pretty common,” Swenson says. “But if a child begins to drink before the age of sixteen, he is four
times more likely to have problems with addictive disorders late in life. Doesn’t it make sense that we should not let them have alcohol when they’re sixteen? Some people say, ‘Wow, I didn’t know that.’ Other people don’t care. My response is you’re playing Russian roulette.”