Island Practice (18 page)

The lawyer they have asked to represent them asks the logical question: “What kind of drugs are we taking on the island these days?”

“Do you realize what a target Nantucket is?” the selectman continues. “When you think of the iconic staples of America that the world so hates: rich people, Wall Street gluttons, evil politicians,
Hollywood producers. They all have homes on Nantucket. It’s one-stop shopping.”

Plus, “if something ever happens, which the government says is inevitable, by the way, who’s going to come rushing to protect us? The Vineyard?”

That kind of bunker mentality has some historical underpinnings. In 1961, a nuclear bomb shelter was built on Nantucket to provide a safe haven for President John F. Kennedy. It was never used, and to conceal its purpose the U.S. Navy described it as a “jet assist takeoff fuel bottle storage area.”

Nantucket has so relished its independence that it has, in the not too distant past, threatened to secede from Massachusetts. And in 1977, after a change in the Massachusetts state constitution cut the number of state representatives, Nantucket and Martha’s Vineyard launched an actual secession movement. The islands voted four to one to break off and form the fifty-first state, and there was even talk of forming their own country. But they needed approval from the state legislature, which, naturally, refused them.

For a visitor undulating to the island on the ferry, security doesn’t seem like Nantucket’s most pressing concern. Lots of year-rounders leave their doors unlocked. But antiterrorism agencies have their antennae on alert. One summer weekend in 2005, Nantucket’s Hy-Line ferry got a call: “Don’t let the ferry leave, or it will blow up.” Before they figured out it was a teenage prank, a raft of state and federal agencies got involved, canceling ferry service and stranding hundreds of people on the island.

When a dignitary steps foot on the island, like Vice President Joseph Biden, who spends Thanksgiving on Nantucket, the Secret Service scours the hospital to make sure things are copacetic if the protectee should have a heart attack or a bad batch of clams. The hospital has to be well-secured enough to prevent prying eyes or psychopaths from getting near the patient. Lepore, who as the hospital’s medical director
is a designated emergency contact, says, “They get our names and phone numbers, talk about if the dignitary was injured, where would we go? What would we do? Where’s the helipad? Can we lock off a section of the building?”

They probably don’t think to ask if the medical director has brought any of his firearms to work that day. But it has happened more than once, because Lepore insists on being called for almost anything that comes into the ER, and sometimes when the phone rings, he’s out in the field.

“Are they going to kvetch if I come in my duck-hunting clothes, or are they going to wait ’till I take a shower? They want me to go home and change, hey, I’ll go home and change. But I’m not the one with the bad appendix.”

Sometimes, if he’s been out shooting, he has to bring his gun to the hospital. “It’s illegal to leave a gun in a car,” he explains. “I break it down and just put it somewhere in the back room.”

Not long ago, Lepore came in on a day off to operate on a woman experiencing problems from a hernia repair performed in Boston. After Lepore’s surgery, things looked fine, so he went hunting and “told everyone not to call him unless somebody was bleeding,” recalls Mary Monagle, a nurse. The woman began bleeding.

“I’m in the deer stand,” Lepore whispered into the phone (his cell phone ring is hard to miss in the field because it sounds like a dog bark). “I’ll call you in ten minutes.” He returned to the hospital in camouflage, no gun, but “he took out a knife,” recounts Monagle. “Dr. L! We never know what he’s packing.”

Often in the hospital, he is packing several knives, part of an assortment he stores in the drawers of his bedroom dresser. “I see a knife, I like it. I could live to about five hundred before I run out of knives.” Lepore doesn’t use them to operate but whips them out when he wants to open a box of medical supplies, so “I can do it with panache.”

The knives are also good for cutting up roadkill, something else Lepore collects. The dead animals are for Ajax, Lepore’s red-tailed hawk,
a sometime hunting buddy who lives in a large pen under trees in the backyard. In the early dawn light, Lepore cruises Nantucket’s streets, looking for “bunnies that haven’t looked both ways.”

He usually puts them in his home freezer. But occasionally he’ll leave them in the car, and Cathy will unknowingly drive them to her job as a counselor at Nantucket High School. “Mrs. Lepore,” students have said, “somebody’s trying to play a horrible trick on you.”

Lepore’s critters can pop up anywhere. In the sink might be pieces of frozen rabbit he has chopped up and left to thaw. By the mailbox or on the porch might be paper bags full of squished squirrels or crushed chipmunks, left by island residents helpfully supplementing Lepore’s macabre menagerie. Nurses leave him a rabbit or two in the hospital freezer. The daughter of Lepore’s friends Paul and Brenda Johnson began carrying a bag for potential roadkill with her when she was as young as thirteen.

“Oh, somebody brought me something,” Lepore noticed one day. “For Ajax. Squirrel” was scrawled on the bag hanging from the gate post. “Yeah, it’s been there a few days,” Cathy said. “Why didn’t you tell me?” he asked. “Let me put it in the freezer.”

When some off-island friends of Lepore’s daughter, Meredith, were visiting, the family was jolted awake by a screech. Racing to the kitchen, they found one of the girls standing stock still, holding an ice cube tray containing frozen mice. “Oh,” shrugged Lepore to the traumatized girl. “Those are my mice-icles.”

Lepore’s friend Rhoda Weinman recalls that when he first got Ajax, he invited her over, telling her he had a surprise. Before she arrived, he left to attend a school committee meeting, so when Weinman walked in, “Cathy was sitting in the dining room with this hawk strapped to her arms. She couldn’t even move. Tim didn’t want the hawk to be left alone.”

Some years later, David Goodman, a patient, walked into the Lepores’ house to find the family unit in a not atypical tableau: “Cathy’s stirring the soup, Tim’s with the hawk on his arm, and the hawk is tearing a rabbit in the middle of the kitchen.”

John Gardner, a friend of Lepore’s son T.J., remembers that at high school graduation there is a tradition of giving the chairman of the school committee a gift. Gardner’s year the chairman was Lepore, and although the students didn’t follow through, “we talked about giving Tim dead mice in little plastic bags.”

Lepore would have been at home in a world where hunting with hawks was an everyday activity. He makes his own stone arrowheads, using antlers from moose and deer to chip away at a piece of flint in a technique called flint knapping. He fashions his own bows.

He carves wooden duck decoys, although he has “this mental block against painting them,” so “I got a box full of heads that I carved, but none of them are painted or have eyes put in them.”

And he transports himself to the Stone Age by building atlatls, a prehistoric hunting weapon that resembles a spear-thrower—a long stick with a hook that can hurl a dart a hundred yards or more.

“We all have these mental pictures of Tim in a loincloth going out with an atlatl,” says Jim Lentowski, who runs the Nantucket Conservation Foundation. It hasn’t come to that yet, possibly because hunting with the Paleolithic weapons is illegal in Massachusetts. But at least Lepore can say, without much fear of a challenge, “I’m probably the best atlatl guy on the island. If we get an invasion of mammoths, just get behind me, and you’re all set.”

Lepore himself is baffled as to why he “emerged from the womb with a fascination with guns, knives, bows and arrows.”

His father, John, despite serving with distinction as a World War II army surgeon, did not share his son’s hobby. Only once did they ever fire weapons together, taking aim at clay pigeons at a skeet shoot. Lepore got his gun induction elsewhere, beginning in kindergarten at a Veterans Day commemoration at the cemetery in his hometown of
Marlborough, Massachusetts. When the soldiers fired their guns in salute, he scrambled to pick up the shells.

When he was a little older, Lepore took a Daisy Golden Eagle BB gun, which looks like a rifle, up to his attic. There he shot flies with the BBs. Flies. He spent hours doing that. “I used to get a lot of flies. I’m very good, really.”

When flies got to be too easy, Lepore turned to pigeons, aiming his Golden Eagle at them from the roof of his house. His grandmother, sunning herself on the porch, “was not pleased to have a pigeon drop off the roof and land next to her.”

Next he tried bow-and-arrow frog hunting with his friend Bob DiBuono. Zinging the arrows into the muck, the boys punctured a passel of frogs. “We’d spend hours in the swamp. We’d get the frogs, cut the frog legs off, skin them. Then Bob’s mother would go and cook frog legs for us. She’d fry them. When you put salt on them, they’d twitch.”

When he wasn’t shooting small creatures, Lepore liked playing with knives. So much so that when he was about twelve, he sliced open the palm of his left hand while doing some random carving. “My father sutured it up. He was not overly sympathetic. I’m not sure he said anything. He may have reflected on the stupidity of it. It was a dangerous childhood.”

Lepore joined the Marlborough Fish and Game gun club in his teens, thrilled that he “could walk out of my house with a gun, walk into the woods. If you walked around Marlborough town now with a gun, you’d have thirty-seven cops on you.”

Lepore’s mother hated his hobby, and “if I was out hunting and I shot something, my mother would not give me a ride home.” But his father was “supportive in a benign neglect kind of way.” He made Lepore a gun case and gave him his first gun when he was sixteen: a Marlin .22 lever action, model 39A, probably sixty or seventy years old. Later, after a neighborhood widow gave John Lepore a pistol that belonged
to her husband, he passed that on to his son. It was “this Luger that a guy down the street had killed himself with.”

As a kid, Lepore liked the adventure and technical challenge of shooting. As an adult, there is something else too. To Lepore, performing surgery to keep a patient alive has a lot in common with the act of shooting lethal weapons. Both “require a lot of concentration and a lot of effort,” he believes. Shooting is “controlling where you want to hit, doing it right, and doing it repeatedly.” Surgery is like that too. “If you’re not in control, you have to figure out what’s going on.”

When Lepore is not performing surgery, he is almost always thinking about it. “Surgery should look easy. If I find I’m doing a case and I’m struggling, I try to remember why I was struggling. Did I ask the anesthetist, ‘Was the patient relaxed?’? Did I set up the lights in the right way? Maybe you haven’t made a big enough incision. What was I doing to make it look difficult?”

Shooting guns requires such intense focus that he considers it pretty much the only activity that forces his mind away from such detailed re-analysis. “It’s very relaxing,” Lepore insists. “If I’m operating, I’m not thinking about shooting. If I’m shooting, I’m not thinking about operating. Shooting, I’ll tell you: it sort of wipes the slate clean for that period of time. The stress, when I’m shooting—that all falls away.”

So much so that if Lepore can’t get out to the police shooting range by the airport, he fires air rifles in his basement, where he has affixed a mattress to the wall.

Part of the joy for him is the history that comes with the guns. When someone gave him a couple of Ballard rifles, he boned up on their background as Civil War–era, single-shot-action guns. Same with pepper-box revolvers, which were shot from the hip in the California Gold Rush, and the M1 Garand, the first semiautomatic rifle to become regular army equipment. He owns a “Bolo” Mauser semiautomatic pistol made in Germany in the 1920s and several Russian Mosin-Nagant sniper rifles, including copies from China and Finland.

Lepore knows the 160 varieties of 1849 Colts, with their different barrel markings: “the one-line New York, the two-line New York, a Hartford, a London. You start comparing, contrasting; you start handling a piece of history.”

Some of his guns are valuable, like a Browning Superposed shotgun, called an Over/Under, worth about $3,000. Others are “very, very nice guns that are flawed”: a Winchester Model 70 carbine that somebody drilled into to mount a scope on it; a Colt pistol with ivory grips and decorative engraving but, alas, the wrong rammer. Still, they all work.

“His collection has a ‘the Russians are coming, the Russians are coming,’ feel about it,” notes John Gardner, Lepore’s son’s friend. Nathaniel Philbrick thinks Lepore also likes the gun hobby because “it connects him with a segment of the population that I don’t think most doctors would have interaction with.” And guns, like island life itself, embody the frontier spirit: independence, contrariness, the ability to stand on one’s own.