Island Practice (29 page)

Still, Dr. Henry will occasionally decide not to treat. “I’ve got a buddy who’s dying. I ain’t giving him no cookies. Aw, he ain’t that much of a buddy. I think he’s got Karma to deal with. He’s a state cop. He was a prick and misery to a lot of people. He ain’t getting shit from me.”

One day, a card arrived at Lepore’s office. On it was a picture of a newborn baby, and the message “Don’t Do It.” If he didn’t already have one, indeed scores of them, “it would give me a reason to go buy a gun,” Lepore says. “It’s not something I want to get shot over.” But it isn’t enough to compel Lepore to stop performing abortions. Nor is his Catholic background, his often-conservative political views, or his personal distress about terminating a fetus.

Robin Rowland, program director for Nantucket Family Planning, first discovered that Lepore was willing to perform abortions about five years ago. She was on the school committee with Lepore and mentioned in passing that it was difficult for women seeking abortions on Nantucket. She had a patient who wanted one and could not get off-island.

“He said that he would do the termination,” she recalls. “And I was shocked because I didn’t think he would do that. Politically, he would appear to be very conservative.”

Even in the liberal northeastern United States, many surgeons won’t perform abortions. It can be a lightning rod for controversy. And with most doctors working in group practices these days, “the partners are going to say, ‘That’s wonderful that you’re all full of piss and vinegar, but we don’t want you to do it,’” Lepore says. “It’s legal, but radioactive.”

Perhaps even more radioactive in these parts since a doctor on Cape Cod, Rapin Osathanondh, was convicted of involuntary manslaughter when a woman he performed an abortion on in 2007 died. Prosecutors and the state medical board said Osathanondh did not adequately monitor the woman, twenty-two-year-old Laura Hope Smith, who was thirteen weeks pregnant, while she was under anesthesia, and did not have oxygen ready if she needed to be revived. They said he delayed calling for an ambulance when Smith’s heart stopped and tried to cover up his actions. He was sentenced to six months in jail and lost his medical license.

Lepore says the Osathanondh case has pretty much left him the only doctor between Nantucket and Boston who regularly performs abortions. “He went to a meeting on the Vineyard with all the local docs,” Rowland recalls, “and he asked them, Do any of them do abortions? And none of them did. He was willing to stick his neck out, saying, ‘I do it.’ He had one of his usual quips that he was the only Dark Lord.”

Lepore says he probably does about two abortions a month. Some are considered “medical abortions,” which don’t involved surgery and can be done until about seven weeks into a pregnancy. He gives an injection of methotrexate, which stops the embryo’s development. Then, about eight days later, he administers misoprostol, a pill placed in the vagina that forces the uterus to contract and expel the dead embryo.

When drugs are not appropriate, Lepore performs surgery. “I don’t want to make a career out of it, but I’ll do them.” He doesn’t abort pregnancies beyond the first trimester because he feels “it gets a little iffy.” The procedure can be technically trickier, and “that is starting to get fairly deep into some ethical issues, as opposed to first trimester, which is less objectionable, albeit still a termination.”

Lepore’s actions have been controversial even among some Nantucket medical personnel. In 2010, an ultrasound technician at the hospital showed up to assist, not knowing the procedure would be an abortion. “She didn’t understand what I was doing. She left crying after the procedure,” Lepore recalls. “I got called by the head tech in radiology. I went and apologized.”

Now, Lepore tells hospital staff beforehand: “We’re going to do a termination. I want you to understand it. If you don’t want to do it, that’s okay.” He understands “it is fraught with some overtones that are uncomfortable for people, and I don’t think people should be forced to do things they’re uncomfortable with.”

Resistance from Lepore’s own staff has been a little more challenging for him. Some of them have ethical, moral, or practical concerns. Diana Hull, his longtime nurse, says: “I’m all for pro-choice—I just don’t
want to be the one to do it. My personal opinion is they should definitely take this to the mainland.”

Other staff members are concerned about whether women having abortions on the island have access to appropriate counseling.

When Lepore’s daughter, Meredith, was a nurse in his office, from 2007 to 2010, she handled most abortion counseling and pills for medical abortions. Even she was ambivalent. “When I started out, it was like, what’s the big deal? Who cares? Somebody needs to do it,” Meredith recalls. “Then I started doing them, and it’s a big deal. I was just giving them the medicine, but you’re still giving them what they need to make whatever’s there die.”

Still, “when Meredith was here, I had someone who could arrange things,” Lepore says. “Now I have to arrange things. My nurses want nothing to do with it.”

In January 2011, Lepore, concerned about his staff’s reactions, asked Rowland from Nantucket Family Planning to meet with him and his staff. Rowland thought she was simply going to educate them about the procedure. But, she says, “really, I ended up sitting back and watching them all have this discussion. They were all saying they didn’t want to do it—they didn’t want anything to do with it.”

Most raised moral objections, and some worried about their safety if opponents made threats. The meeting, recalls one staff member, “didn’t go well. He seems to think it’s happening less often than we do. We feel if somebody wants to do it, that’s okay, but it’s the personal involvement that we object to.”

Lepore, Rowland says, “shrugged a lot. And he kept saying, ‘Look, we’ve got to provide it. Somebody has to do it.’ Without saying it, he was really saying, ‘Look, I really don’t care what you think. We’re going to do it.’”

Rowland was so appreciative that she wrote Lepore, thanking him “for sticking to his guns on that and not letting his staff sway him.”

Lepore did have “a long conversation” with a young woman who was twenty-eight weeks pregnant and her mother about how “the knee-jerk
reaction is to have an abortion. I thought it was reasonable to have the baby and give it up” for adoption. That’s what she did.

But in a case that particularly upset his staff, he agreed to perform an abortion on an older woman with three kids who’d had two previous abortions. His nurses believed the woman was being reckless by not taking steps to prevent pregnancy and then aborting the unwanted fetus. Lepore replied: “I don’t think she is.”

Mary Monagle, a former nurse at the hospital, says, “A lot of us were kind of shocked” about Lepore performing abortions. “But that’s Dr. Lepore’s moral decision. I’m sure he’s not going around saying, ‘Woohoo, come in, gift with purchase!’ I’m sure he struggles with it in his own way. It’s another part of him being an enigma wrapped in a riddle wrapped in a question mark.”

Rowland had certainly considered Lepore an enigma. When she first got on the school committee (on which Lepore has served, Rowland says, “for 1,000 years—he can’t lose an election”), “I had anticipated that I wasn’t going to like him at all. I came away really, really admiring this guy. He’s so much more sensitive and giving than you would know. He has a generous, generous heart.”

Rowland says many women seeking abortions are low-income immigrants with limited English, daunted by the American medical system. Many would also find it difficult to travel off-island. “I just look aghast at the idea of sending them to Boston.” Plus, Lepore provides most abortion services for free if needed. He cannot waive hospital operating room charges, but “he’s always willing to see people for less or no payment.”

Since the meeting with his staff, Rowland says she tries to refer women to Lepore sparingly because “I don’t want to overdo it with his staff. I don’t want to burden him with this.”

And it is a burden, morally, for Lepore, says his son, T.J., an obstetrician-gynecologist who also performs abortions. “We see a lot of the same stuff, but I see more of it, really bad cases,” says T.J., who practices in Springfield, Massachusetts. “In my field, we do them farther
along. These are very delicate situations. It’s not a happy story. Nobody goes into an abortion thinking this is a great thing. Even the people who have had five, six abortions, you can see they leave something” behind, emotionally, after it’s over.

Lepore make it clear he believes an abortion after the first trimester is “wrong and it’s killing,” T.J. says. And although he performs earlier terminations, he doesn’t want “to be known as the guy who does abortions.” But “if a patient decides that this is their choice, someone shouldn’t be made to feel degraded. If you’re a physician, the most important thing is, especially in a small town, you can’t lay judgments on people because everybody’s coming at you with their own baggage and their own history.”

Margot Hartmann, CEO of Nantucket’s hospital, says Lepore’s willingness to perform abortions is a sign of being “emotionally brave, willing to hold conflicting and sometimes confusing positions in trying to do the right thing and probably err on the side of commission rather than omission. He’s really quite unsentimental in the most beautiful sense about the life cycle, accepting of mortality, and that there’s living and dying all the time.”

T.J. says the reactions of Lepore’s nurses “bothers him because he sees that he shells out every day for his patients, and I think it disappoints him in some way when he doesn’t see that in other providers. And his office staff is all people that he has strong feelings for and he protects them a great deal.”

But while abortion is fraught with personal and moral challenges for Lepore, his handling of it is typical of his approach to other controversial subjects. “He does not shy away from getting in the line of fire,” Rowland says. “He shoots his mouth off without thinking quite often, but it’s total gut response, and oftentimes it’s totally right on, even though you’re saying, ‘I can’t believe you said that in public.’ There are those that love him and those that hate him. He’s the only surgeon on the island, so we need him, and we got to take him with whatever he comes with.”

But “the thing about him is every issue is kind of a separate issue. You don’t have to have fisticuffs with him. You can have your differences and walk away from it, and he’s okay.”

The marijuana cookie idea first occurred to Lepore when he began treating Louise Hourihan, a fifth-generation Nantucketer diagnosed with breast cancer in December 2009. Hourihan, who with her husband, a bank executive, is deeply involved in island community programs, did not know Lepore well.

“For years I went to a different doctor. Dr. Lepore, he says and does things other people think are crazy.” Some people who “see him only on school committee, they say, ‘I wouldn’t let that guy touch me with a ten-foot pole.’ I mean, you walk into that office, and he has an armadillo”—dead, stuffed, lying on its back—“chugging a beer, when we’re trying to stop the whole youth drinking problem . . .” Her voice tails off in wonderment.

The first time she went to Lepore, she was accompanied by her then-teenage son Evan, whose reaction to the office was, “Oh my God, where are we?” Evan, who needed treatment for warts, was convinced “he’s going to use one of those knives to remove them.”

But Hourihan’s regular physician, David Voorhees, had died, and she decided to give Lepore a try.

When a tumor was discovered in Hourihan’s right breast, she found Lepore’s initial reaction somewhat disconcerting. “He started telling me about the history of breast cancer and how they used to have to open them up,” she recalls. But she discovered he could be sensitive and generous with his time. Lepore reassured her the tumor wasn’t too large and recommended a specialist in Boston, who performed a partial lumpectomy. She returned to Nantucket with a tube implanted in her breast to drain excess fluid, and Lepore came in on a Saturday to remove the tube.