Island Practice (5 page)

Love, vestibular neuritis—why quibble? Vestibular neuritis is an inflammation of the nerve connecting the inner ear to the brain, and pretty soon Cathy began feeling nauseous. Later, at a job interview at another hospital, “I couldn’t walk. It was like I was just drunk. I couldn’t focus my eyes. I was just sitting on the floor of the ladies’ room and vomiting my brains out.”

She was sent to the emergency room, where, it turned out, an ex-girlfriend of Lepore’s was working. Cathy realized Lepore was the only person she knew in Boston.

“I get this phone call that she’s near death,” Lepore recalls. He picked her up in his truck and took her to his apartment, where she continued to throw up.

It was, Cathy remembers, “about as unromantic as it could possibly have been.” To be fair, it wasn’t only her fault. There was also the
enchanting behavior of Lepore’s dog, a slobbering bloodhound named Odie. Lepore was so convinced that Odie was a talented tracker that when his sister, Sherry Buckley, visited, Lepore had Odie sniff a pair of his sister’s underwear and then “had me hiding in the woods and the dog was supposed to find me,” his sister recalls. Odie “ran right by me.”

While Cathy was weak with nausea at Lepore’s apartment, she encountered his approach to another of Odie’s shortcomings. There were “all these bowls turned over with dog turds underneath them. I mean, who does that?”

She asked the obvious question: “Why is the turd on your floor?” Lepore gave the obvious answer: “If they dry out, they’re easier to pick up.”

Still, somehow, a romance was ignited. “His girlfriend had left,” Cathy remembers. “It was sort of like the lonely hearts’ club. You can be like that with somebody when you’re very comfortable with them.” Lepore helped her find an apartment and invited her to his residency graduation dinner, their first official date. “He was so interesting. He was just funny. He always seemed to be able to handle everything.”

When Lepore’s residency was ending in June 1975, he wanted one of Tufts’s fellowships in thoracic surgery. But the attending physician “didn’t support me,” recommending that he work at another hospital for a year first. “The hell with that,” Lepore thought, and returned to Roger Williams instead, which offered him a job working in the emergency room and handling the surgical side of the intensive care unit.

In August 1976, Cathy went to the Dominican Republic to get a divorce from her second husband. In September, on a Wednesday, Lepore said, “Let’s get married.” Cathy said okay. That Saturday they went to a justice of the peace they found in the phone book.

In retrospect, Cathy explains her thinking: “My first husband died; my second one I got divorced from. After that, I said, ‘I just don’t want to be bored. I want to have someone interesting.’” She pauses. “I think I went over the top.”

Their wedding was as briskly functional as Lepore’s description of it: “There was no ring. Her parents, my parents, two of her sisters, my buddy, Cathy’s grandmother. Cathy’s grandmother said the justice of the peace was a short man. We said he’s in a wheelchair. No vows. Whatever he said, we said. I sweated through my $5 Salvation Army suit, we went to an omelet shop for 25 bucks, and we were done by 11 and went to the Harvard-Columbia football game.”

They had no honeymoon and were back at work on Monday.

Lepore’s job at Roger Williams Hospital involved a gamut of cases from cancer surgery to trauma. A man fired a shotgun into his own mouth. A woman stabbed in the chest needed thoracic surgery. Another man shot his brother in the face, leaving his eye in a gruesome state. A pharmacist took a bullet on his first night on the job. A kid, twelve or thirteen years old, was shot so badly that Lepore had to elbow his way through a swarm of pediatricians to get to the boy’s side.

One night, “I got five stabbings from a Star Market, and they weren’t all in the same fight.” A man doused his body with gasoline and set himself on fire. Another jumped off a roof, and Lepore operated on him three times in one day, peeling off dead skin from gangrene that had developed in his legs.

If the violence weren’t enough, there was a constant stream of car accidents from the nearby highway. A teenager driving a station wagon struck a pole so hard that a spare tire flew forward, pinning the kid against the steering wheel and crushing his larynx. Lepore managed to get him breathing.

Calamity lurked everywhere. Christmas decorations ignited a major fire in a women’s dorm at Providence College. When Lepore arrived at the hospital at 1 AM, “every stretcher had a burned or dead girl. Some had jumped; some had smoke inhalation. There were some horrendous
burns. I was really the only one there. I went down the line and took care of everything, intubating people, sticking in IVs. It took about twenty minutes for anybody else to show up. After that they decided I should be head of the ER.”

Lepore made a point of living about two hundred yards from the hospital so he could always get there instantly. He and Cathy bought a house, but the hospital was not situated in the safest neighborhood, something the Lepores began to worry about more after they had children: Meredith, born in 1977, the day they moved into their Providence home; T.J. in 1979; and Nick in 1982.

Cathy was flashed twice by men when she was walking with the children on the street. At an auto repair class at a nearby garage, she saw people bringing in bags of money—bookies, she assumed, or corrupt cops. People would break into the house when they saw her leave to take the kids to school. Their car was burglarized repeatedly.

Even worse was the summer night Cathy heard men arguing outside. Lepore went to investigate and see if he could help. Instead, he was shot at. For Cathy, “it was just awful. I hated living in Providence.” Plus, Lepore was so busy he had little time for the family. He worked thirty-six-hour shifts and had academic responsibilities at Brown University. When Cathy went into labor with Nick, Lepore was treating a Brown urology professor who had fallen down an elevator shaft.

Then, in the summer of 1980, Lepore was invited to visit Nantucket by a medical school friend, Paul Thompson, who worked summer emergency room shifts at Nantucket Cottage Hospital. Lepore had been to the island only once before, in the fall of 1974 with a girlfriend. His main recollection was of trying to teach her to drive a stick shift there; he claimed she nearly blew out the transmission.

But when Lepore visited Thompson, he liked what he saw. The hospital was small and manageable. Cases could get wacky—water injuries, exotic diseases, a woman who brought in a rabbit with red eyes—but they were unlikely to involve gang violence or the carnal
wreckage he saw in Providence. And the shifts were better: twenty-four hours on, then forty-eight hours off.

It was an appealing arrangement, recalls Jeffrey Drazen, a summer doctor from 1974 to 1979 who is now the editor in chief of the
New England Journal of Medicine
. “You worked every third day, they gave you a house, they paid you $200 a week, and you saw twenty patients a day.” A head nurse staffed the door. “If you had a fishhook sticking out of your head, she’d let you in. But if you had poison ivy or something like that, she’d tell you to come back.”

When the Lepores first saw it, the hospital had an exam room, a room for sewing up patients, and fifty beds (nearly three times as many as it has today). An heir to the Campbell Soup fortune, whose family had donated a lot of money, stayed in the hospital as if it were a residence. And there were free meals for the medical staff. “You could come in and order breakfast, do your rounds, and get your eggs over easy,” Drazen remembers.

But despite its comfortable trappings, this was a hospital that needed to be more medically sophisticated, to learn to operate with greater urgency. Drazen recalls his first case, a thirty-year-old with serious heart problems. The physician in charge said to “just wait it out. He was into doing that for a lot of things.” Drazen finally persuaded the doctor that the patient should be sent to the mainland.

With the island drawing ever-wealthier summer residents and the working-class people to support that influx, it was time to give Nantucket the sort of health care people could rely on whether they trimmed hedges or owned hedge funds.

Lepore’s friend Thompson arranged for him to work in the hospital for the month of August 1981. The Lepores returned the following summer, relishing the tranquil contrast to inner-city Providence. Narrow streets, some set with brick or studded with cobblestones, made the pace of life seem more manageable. Strict building codes—pitched roofs, unpainted gray shingles—kept sprawl in check and had a way of letting the island showcase its natural surroundings: plants, birds,
water. On the boat heading home the Lepores asked themselves, “Why are we leaving?”

The island had a vascular surgeon, Earl Mahoney, but he had already retired once, been pressed back into service, and wanted to retire for good. The hospital talked to Lepore about working there full-time.

“They needed somebody who was well trained, enthusiastic, had good judgment—and wanted to live on Nantucket,” says Drazen, who still summers there. “Boy, they got the right person. He keeps up with what’s going on. He adapts to his environment. He knows what he can’t do and what he can do. He is willing to take chances when that’s the only option, particularly when the weather shuts things down. He’s involved in the community—to succeed on Nantucket, you have to be.”

Lepore did wonder what he might be giving up at Roger Williams, but he didn’t think he was going to get promoted there any time soon. He was also losing patience with the de rigueur meetings and mundane responsibilities of a big hospital; they seemed to take him away from patient care. In September, he told Roger Williams he would leave January 1. “Nobody quite believed me until December 28.” Then “they put all kinds of pressure on me to stay. They said, ‘It sounds nice, but you won’t be happy there.’ I asked for a leave of absence for six months. They wouldn’t give it to me. So I said, ‘Okay, guys, I’m out of here.’”

Lepore and his family didn’t know exactly what they were getting into.

On a visit to the island a few months before they moved, they got blasted by a big storm. Pilot whales were beaching left and right. Boats were blocked from coming or going. The family was stuck. “There’s no reason to get all heifered up,” Lepore decided then. “You’re either going to get off or you’re not going to get off.”

They stayed for the first few months in a “very fancy-dancy house on lower Main Street,” but it became clear they needed something more affordable. After a stint in a tiny hospital-owned house at the bottom
of a hill—“if your brakes fail, you’d run right through it”—the hospital asked if they wanted to buy the land up the hill for $75,000. It was on Prospect Street, right next to a windmill built in 1745, just a hundred-yard dash from the hospital. Meant for a mind-set like Lepore’s. “It’s a conscious decision that I live that close.”

Cathy, who helped set up Lepore’s family practice next to the hospital and worked there as a nurse for a while, hoped that Nantucket would allow her husband to relax and spend more time with the family. Reality sank in for her all too quickly: “On call twenty-four hours a day. Medically isolated when emergencies occur. You don’t have a lot of backup. Here, he’s sort of it.”

But for Lepore, the unpredictability of Nantucket was part of the attraction. “I thought it would be an adventure. A situation where I was going to be pretty much on my own. It was, ‘What the hell. Go thirty miles out to sea and see what you can do.’”

He had a chance his very first night, when a patient came in with complete heart block, needing a pacemaker, something Lepore had never put in before.

“What do I do?” he asked himself. “Oh, what the hell,” he replied, since there was no one else to answer the question. He racked his brain for a few seconds before calling his friend Paul Thompson, a cardiologist, who talked Lepore through putting a line into a subclavian vein, one of two large veins that run from the ribs to the collarbone. Lepore got the pacemaker in. It was a watershed moment and a harbinger of what the next thirty years would have in store: Lepore felt “mildly totipotent after that night.”