Island Practice (38 page)

In fact, while Richard H. Koehler, a laparoscopic surgeon, comes to Nantucket to cover when Lepore goes off-island, neither Koehler nor anyone he can think of would fill Lepore’s running shoes. “You will never find a general surgeon who’s going to do primary care. Never. Maybe in the outskirts of rural Montana or Manitoba. I would be stunned. He’s two people. Then, when he acts as an obstetrician, he’s three. He also does endoscopies,” inserting a scope into the body to look inside. Many general surgeons don’t do that either, Koehler says. “He’s four people.”

All of which means, says Pam Michelsen, that if Lepore ever stops doctoring, the island “will be like the rest of the world, and that’s just not Nantucket.”

Lepore, at sixty-seven, shows no sign of retiring, but the hospital is dreading the possibility. “That’s a very serious issue now,” Chabner asserts.

It’s a question other small communities across the country are confronting in their own way: what to do when the kinds of doctors people have always relied on can no longer make a living practicing medicine that way. What to do when medical care becomes less personal, more expensive, farther away, more cookie cutter, less Lepore-like?

“How can you replace a guy like that?” Chabner asks.

Hartmann thinks that, at least for Nantucket, it’s virtually impossible.

“My personal nightmare is succession planning for Tim Lepore,” she says. “There are no Tims out there. There probably really isn’t another Tim Lepore in the whole country.”

One day, a DVD arrives in Lepore’s mailbox. Its title is
Trees Inn: The Next Best Trespass
. It says it is “a film by Dug Underwood” about “another handmade home by Forest Green.”

Lepore is intrigued. Dug Underwood and Forest Green were two aliases of Underground Tom, who built illegal hovels and hideaways all over Nantucket, but whom Lepore has not seen in a while. The video turns out to be nearly two hours long, a molasses-paced montage with shots of trees and birds. But to Lepore it is invaluable because it gives a fascinating update on his mysterious patient.

“This is Dick Human,” Johnson says, appearing on screen dressed in camouflage pants and cap with netting pulled over his face. “You’re watching the
Forest Green
show. In this episode, we’re going pioneering.”

What follows is a documentary of Johnson building a new illegal abode, a tree house on stilts somewhere on Cape Cod. Filmed around Christmastime and spiced with country and reggae music, the film shows Johnson under the gun to build his new residence before authorities disconnect utilities in a place he had been squatting.

“Six days ’till they’re shutting the water off,” Johnson grumbles. “Only thirteen more chopping days till Christmas.”

Some days Johnson doesn’t chop because he fears the noise will attract attention. He carefully arranges brush and trees. “As I go along, I camouflage.” One day, he mourns: “Broke my axe. This thing has helped me build so many places.” Still, he presses on, working from before dawn till moonrise: “When you’ve done this as many times as I have, there are few wasted steps or opportunities or wasted materials.”

The first snowstorm of winter arrives, making him fear being discovered if his feet leave “leading tracks back out of here.” Plus, “everything’s frozen solid,” so it is it harder to use his primary tools, a pruning saw and a machete. On Christmas, Johnson sings, “It’s beginning to look a lot like Trespass,” then mutters, “So glad that Christmas is over. All those goddamn songs stuck in my head.”

The house, finished in six weeks for $195.17, has neatly crisscrossed logs, glass-paned windows, a peaked roof. Johnson builds a wood stove from an ash can and empty soup cans. “I’ll never be done with this place, always be doing something. But no one heard or saw me, and I didn’t get hurt, which is saying a lot with these sharp tools and being accident prone.... But I am bone tired. I feel like my whole body has carpal tunnel syndrome.”

Watching, Lepore worries about Johnson, out in the elements, eating and drinking who-knows-what. Even someone used to reclusive wilderness life is at risk for disease and deterioration. Johnson mentions smoking pot several times, and in at least one scene it appears that he is. He’s contracted poison ivy so bad that his eyes are swollen and his face puffed up. “This is why I live in a swamp all alone,” he says, laughing maniacally, as he stares into the camera. “I got a face like an ass. I got the P.I. as bad as you could hope to have it.”

Johnson’s “Trees Inn” location is a mystery, though he refers to a specific highway, suggesting southern Cape Cod. Later, the house gets discovered by state public works employees. “Somebody lives there,” one says. Johnson replies, “Yeah man, that’s me, dude. Any chance of keeping that cool?” The worker is awestruck: “Unbelievable craftsmanship . . . unfreakin’ real.”

Johnson, afraid of being ratted out, tells him, “I’m freaking out right now, man. . . . I’m homeless you know.”

“Well,” the worker says, “obviously you need some camouflage. I’m going to cut cedar branches for you.”

Another worker tells Johnson: “I read about you on that Nantucket. . . . We’re going to cut back on what we’re doing . . . let you be and let it be our secret.”

Johnson shows them around, proudly displaying a decorative carving of a rat, duck, and shore bird that he creates “in all my places.” He asks that they dispel any rumors about him or the house by saying, “Nah, we just met some guy that was in there for a few days.” A worker readily agrees, saying that would be “a damn believable story. It’s almost more believable than what you’re doing.”

After they leave, Johnson can hardly believe his luck. “Well, I got away with it. To my health, stealth, and wealth.”

At one point in the film, Johnson is briefly on Nantucket, visiting a tree house he built in 1998. It is weathered and some of what appear to be corrugated metal panels are peeling away from the tree house frame. But Johnson looks on with pride. “Still standing after ten years, for all the high winds and storms,” he says, as another storm starts brewing. “And there’s the ironic thunder rumbling in my life.”

At the end, before the credits roll (“construction consultant: Frank Load Right”), Johnson as “Dick Human, hobo semipro” does a mock commercial for the “Trees Inn. . . . They got everything a bum on the run needs.” For a movie by a hermit with barely a nickel to his name, it is a tour-de-force.

The film prompts Lepore to try a cell phone number Johnson had given him once, but it is disconnected. He pays another visit to Johnson’s Nantucket “twigloo,” which he finds to still be outfitted with crammed-in creature comforts, giving the impression that Johnson may return.

“He sort of comes and goes with the wind,” Lepore muses. Then, after returning home, Lepore has a thought. Firing up Google Maps
on his computer, he searches to see if the Hidden Forest house is visible on the satellite images. He doesn’t want people intruding on it, destroying it like they did the Nantucket tree house, which, Lepore discovered when he went to check on it , was pulled down to make way for a Frisbee golf course.

Of course, Lepore figures somebody will stumble upon the twigloo one day. In fact, eventually it will not only be discovered, but dismantled, stripped of its accoutrements, hauled out of the forest on bamboo poles, and set up in a schoolyard—an empty shell to be used as a children’s playhouse. Not a very Tom-like denouement.

But for now, this patient’s secret is safe, zealously guarded by the only person with a key to his hidden homestead. Zooming in as far as possible on the satellite maps, Lepore spots a white smudge and wonders if it is the twigloo. The doctor cocks his head, squinting carefully at the screen. It’s as though he is scanning an X-ray, an X-ray of the life of a patient who trusts almost no one else.

“What’s your book about?” people ask. When I give them a summary, I often get this reaction: “It’s fiction, right? This stuff doesn’t really happen, does it?”

It’s true, I tell them. But I can understand the impulse behind the question. Often while working on this book I had the same feeling. Toe-tourniquet syndrome? A horse with cyanide poisoning? Knitting with dog hair? Really? Sometimes in exploring the world of Tim Lepore, I could understand how Cathy Lepore felt when she talked about why she married him: “I want to have someone interesting . . . I think I went over the top.”

In fact, the biggest challenge was one that every writer should be fortunate enough to have, that every time I spoke with Tim there would be something else: another fascinating patient, an anecdote he’d forgotten to tell me, a comment that was just too funny or quirky to ignore. It was a challenge I exuberantly accepted.

In truth, a writer could not ask for a better relationship with a subject or his family. Tim and Cathy opened their lives to me, were unfailingly honest, and exceedingly generous. They shared their time, their family, their friends, their work, their home, and even their car (the one with the driver’s seat frozen into a position so far back I could barely reach the gas pedal). Cathy made me more than a few delicious meals, and in countless other ways went the extra mile to assist my work.

The Lepores shared their painful stories as well as their successes. They never tried to airbrush anything or turn the book into hagiography.
They were always the way I hope they come across here: real people involved in real, if sometimes extraordinary, situations in an unusual and intriguing place. I cannot thank them enough.

The Lepore children—Meredith, T.J., and Nick—were also extremely helpful, bringing Tim, Cathy, and the community to life with wit and understanding. I am thankful to them for their openness and for making me laugh with their colorful memories and razor-sharp characterizations of their father.

I am grateful to Sherry Buckley and Martina Jakober, Tim’s sister and niece, for their willingness to talk about sometimes-difficult family matters that provided invaluable depth to the book. And to Bob DiBuono, the childhood friend whom Tim nicknamed “the Weasel,” but who was anything but weaselly in his forthright recollections.

Many Nantucketers, too many to mention here, gave of their time, their stories, and their insight. I am appreciative of all of them, as well as to those I did not have a chance to meet but whose day-to-day lives and work make the island the special place it is and helped inform this book in indirect ways.

In particular, I would like to express my profound gratitude to the families who have suffered the terrible agony of losing a child. Because of the sensitivity of these tragedies, I took great care to consult with these families and to respect their wishes concerning information that would be included about their experiences in the chapter called The Lost. Some family members chose to share their stories openly and in detail and were comfortable with being fully identified in the book. Others preferred that less information be disclosed. And ultimately, although national and local media had previously published the full names of the young people who passed away, I decided to publish only their first names in an effort to be especially compassionate to the ongoing pain that these losses have caused their families, their friends, and their community. My heart goes out to them.

A number of people showed tremendous courage in revealing difficult, delicate, or emotional experiences that will undoubtedly help inspire
other people in similar circumstances. They include Alexandra McLaughlin, Justin Curry, Sean Kehoe, Alison Stark, Morgan Browne, Louise Hourihan, Linda Peterson, and others who preferred to not be fully identified but who deserve recognition as well. Thank you to Julie, who lived with the Lepores, for being candid about her family and her struggles.

Barbara Rives, Doug Kenward, Michelle Whelan, Elliot Norton, Rob McMullen, Laura Mueller, Doreen Goodwin, Michael Miller, Shelley Foulkes, Tom Foley, Lulie Gund, Edmund and Doris Reggie, Foley Vaughan, John Kerry, Chris Matthews, George Hull, John Gardner, Carolyn Condon, Eileen Howard, Genevieve Gordon, and Christine Kopanski were remarkably generous and open in sharing their experiences as patients or relatives of patients.

The members of Tim Lepore’s excellent office staff were always welcoming. Diana Hull and Katie Pickman offered their reflections and allowed me to witness the devoted care they give to patients. Laura Kohtio-Graves provided useful background. Duncan MacDonald cheerfully gave me more than one ride to the ferry. Others deserving recognition include Carla Ray, Alicia Labrie, Diane Pittman, Shane Peters, Connie Holgate, Michelle Nee, and Beth Tornovish.

Several other medical professionals on and off the island, as well as current and former employees of Nantucket Cottage Hospital, deserve great thanks. Margot Hartmann, Diane Pearl, Bruce Chabner, Mary Murray, Mary Monagle, and Richard H. Koehler were especially giving of their time and insight. Others who were helpful include Wayne Wilbur, Jane Bonvini, Suzanne Duncan, Judy Divoll, Mary Kendall, Chris Iller, Chuck Gifford, and Charlene Chadwick.