Island Practice (27 page)

Cathy Lepore, a counselor at the high school, tried to stop one boy, who kept getting into fights, from drinking. She told him he shouldn’t go to any more football parties. The boy’s father, enraged that she had the temerity to speak to his son, showed up at Tim Lepore’s office, yelling at him for suggesting his son had a drinking problem.

“You know, it’s not coming out of the blue,” Lepore told him. “There’s a pattern here, and you can look at it and think about it, or you can just deny it.”

For years, Cathy invited teenagers to the Lepores’ house for evening group sessions that allowed them to share feelings and concerns. They often revealed they were involved with alcohol or drugs. Some were robbing their friends’ parents’ medicine cabinets for prescription medication. Some kids drink out of boredom. Others, she says, “move here from other countries, get depressed, and turn to drugs and alcohol. The kids, they’re sort of stuck here. I always tell kids: the lucky ones get caught.”

Many kids who drink excessively eventually stop, Lepore says, but before they do, it can tarnish bright potential. “You know these kids; you’ve seen their pictures in the paper; you’ve seen them in the science fair. You almost feel responsible for these kids.”

So Lepore will try everything, sometimes asking his brother-in-law, Steve Tornovish, a recovering alcoholic, to talk to teenagers with drinking problems. Tornovish is happy to oblige because during the two and a half decades he has been sober, “if I felt squirrelly, Tim has never failed to support me.” Once, Tornovish felt so depressed he couldn’t get out of bed. He attributed the depression to a kidney stone, but Lepore “took me aside and said, ‘Look, you’ve got a problem, but it’s from the neck up.’”

Lepore has taken it upon himself to compensate for what he considered to be a hole in the network of addiction services on the island. He was particularly concerned about heroin addicts and tried to arrange for methadone treatment to be available on Nantucket. People have had to travel to Cape Cod, which is time-consuming and expensive. That can discourage them from regularly adhering to a methadone regimen or, if they do, can make it challenging for them to get their lives together because “it’s a little hard to hold down a job when you’re spending two hours on the ferry” to get your methadone dose.

Lepore’s first plan was to procure methadone from an off-island clinic and get an island pharmacist to distribute it in doses that Lepore would keep in his office for patients to sign out. He ran into resistance from the hospital, though: “Someone higher up than me didn’t want to do it.”

Then, a methadone alternative, Suboxone, became available, instantly popular with addicts and treatment professionals because it is less addictive and less likely to be abused than methadone. As a result, it can be taken home and used there, rather than having to be dispensed at a clinic. “We would have sixty people waiting to take the boat off-island to get Suboxone,” Lepore says. Ultimately, Family and Children’s Services, looking for someone to prescribe it on-island, “asked me if I could get involved. I volunteered.”

Cathy disapproved, calling it “a bad idea. I didn’t feel like it should be passed out in our office. Addicts take anything that’s not tied down.”

Lepore went ahead anyway. “It’s one of the nondiscussable items. I don’t bring it up, and she doesn’t ask me.” He made time to take an eight-hour course required to become legally authorized to dispense Suboxone, and is already prescribing it. He is allowed by law to take on up to thirty patients at one time.

“For someone who has a narcotic addiction, if you get them on something legal, you have removed the criminality associated with it, and the financial detriments, so that you give them a chance. This is a
very edgy subject area but is needed by our addicted population. It’s something I think is worth trying.”

Of course, he says, “if Cathy gets wind of this, I may be sleeping in the car.”

Not long after Lepore arrived on Nantucket, he was at a friend’s house one night having a gin and tonic. “The sun was over the yardarm”: it was cocktail time. Lepore had one drink. Nothing to write home about. Then he got a call.

Fourteen-year-old Jamie Legg had fallen off his moped. He had a head injury and a ruptured spleen. He came into the hospital with no vital signs, in full cardiac arrest.

Lepore raced to the hospital. He was sober, his abilities and thinking were intact, but, he wondered, what if that weren’t the case? “I had one gin and tonic. What if I had had two?”

There was no time for speculation like that. Lepore opened up Jamie’s heart. He massaged the boy’s chest, and he got a heartbeat back. Jamie’s belly was blowing up. Lepore took him to the operating room and removed his torn spleen.

By 3 AM, Lepore realized Nantucket did not have the wherewithal to save Jamie. He worried that the boy was severely brain-injured, but since the hospital didn’t have the ability to do a CAT scan then, he couldn’t tell for sure. “I had his vital signs stable; I had him great below the chin. I didn’t know if what was going on inside of his head was fixable, and I wanted a neurosurgeon to evaluate him.”

A horrible thunderstorm was raging, and it was not the night to be trying to get off-island. Lepore called a doctor at Tufts Medical Center, his former teacher, who ran the pediatric trauma program. “We’re coming up,” Lepore said. The doctor told Lepore he was crazy. There was nothing that could be done for Jamie. He was going to die.

Lepore refused to accept it. “If you got a fourteen-year-old kid, you want to take your absolute best shot. He is going to get the benefit of everything that can be done in Boston,” he thought to himself.

He began to fight with his one-time teacher. “I know he’s going to die,” Lepore barked. “But he’s not going to die here. He’s not going to die on Nantucket.”

Finally, Lepore convinced the Coast Guard, which summoned a helicopter. Lepore, a nurse, and a nurse anesthetist climbed in alongside Jamie. Thunder and lightning whiplashed them in the air. They made it to Boston, but by morning Jamie was dead.

Lepore never regretted the decision to send the boy to Tufts against the advice of its pediatric surgeon. “I really felt that the kid needed whatever chance he could get,” he says. “If people want to yell at me—I’m thirty miles out to sea—go ahead.”

But Lepore did make a promise he has never broken since. He decided never to drink while on Nantucket: “It’s not that I’m against drinking—I’m not a member of the Women’s Christian Temperance Union. But I would not feel right about myself. Things don’t always turn out right, but if they don’t, it’s not for want of being clear-minded.”

Despite Lepore’s disciplined teetotaling since the Jamie Legg case, he seems to have a special rapport with the alcoholics he counsels. He connects with them in part because of a tough experience, trying in vain to stop the drinking of a close friend from high school and college, who ultimately died of alcoholism. People on Nantucket also know that Lepore’s son Nick indulged in the party scene and that it was only after several hiccups that he made good.

Moreover Lepore’s round-the-clock work habits and unusual hobbies strike some people as being as obsessive as an addiction, albeit a healthier one. “Tim’s going to knit with dog hair—anywhere else you would think he’s crazy,” Swenson says. “But if you can lose yourself in that kind of stuff, you don’t get caught up in the other stuff. I think that’s one of the things that Tim has.”

It’s also something that can help him connect with patients. “His issues are a lot like mine,” notes a woman Lepore has repeatedly counseled for alcoholism. “They’re just work-related, being on all the committees. When you think about his life, he is on call 24/7. He said to me, ‘We all have our issues. Trust me, I have mine—I work too much.’”

The woman, afraid to be identified because she doesn’t want the island to know her secret, is not a daily drinker but has had at least two recent episodes in which she drank so much she passed out at home and had to be taken to Nantucket’s emergency room and then helicoptered to a Boston hospital.

“I don’t know what the heck snapped,” says the woman, who has a daughter and works in a family business. “It was a lot of anger,” plus feeling trapped, “growing old in a place that you didn’t grow up in. I’ve chosen to live on an island, and there’s a lot of baggage with it. The other thing I can’t take is the extremes, and that’s what this place is. Extreme extremes. The weather, the people—the population goes from 10,000 to 60,000 from winter to summer.”

Lepore says the woman had some underlying psychiatric issues, including hebrephenia, characterized by disorganized behavior and thinking and by acting inappropriately silly at odd times. “It was not her first rodeo. She’s been hospitalized before; just something triggers, and she’s off. I’ve been involved with her and her husband, in the hospital, off to rehab, and back to rehab. When she goes off on a toot, she goes off on a toot big time.”

After the most recent episode, Lepore visited the woman in the hospital, sat with her, and urged her to see him when she was discharged, which she did. “You know what, Dr. Lepore, this is crazy,” she admitted. He prescribed some medication to help reduce alcohol cravings, but mostly he just asked questions and listened without “that look” of pity or wariness. “There’s a lot of shame involved, but with Dr. Lepore it’s more like, ‘You know better. What are you doing?’ If
I was feeling funky, I would call and get in to see him because he’s so real.”

Drinking problems take many forms, and Lepore sees them all. He often refers to patients he is counseling as ETOH, using medical and rehab lingo. ETOH is the chemical term for ethanol, the primary ingredient in alcohol.

“People come in, and they feel disgusted with themselves,” Lepore says. “My feeling about it is nobody made them drink, nobody is going to make them stop. Sometimes you can be the person that crystallizes an idea for them to get them to stop. When people start putting up hurdles to their sobriety, they’re not going to get sober and clean. But if somebody comes to me with a substance abuse issue and they are honest and forthright, if they hit bottom before they die, I sit down, and I spend a lot of time.”

One patient had been sober for seven years before he started drinking again. He was very ashamed. “If you want to stop enough, if it’s the most important thing in your life, you’ll stop,” Lepore told him. “If not, you’ll be back here next week. If you unload that fear and shame, you don’t have to drink.” The man listened, visited Lepore repeatedly, and sobered up.

Morgan Browne and Alison Stark were being pushed to the brink by alcohol and wanted help quitting. Since the time he became mired in a brutal divorce in about 2007, Browne started drinking more and more. “In the end I found myself drinking all the time. I even played hockey on Nantucket after drinking.”

Stark, a graphic designer and photographer whom Browne began dating and later married, was more of an evening drinker. A cocktail at 5 PM. Half a fifth to a fifth of vodka at night until she fell asleep. Stark had grown up in a family with alcohol problems. At ages seven and eight she called the police frequently because her drunken stepfather was beating her mother—breaking her arm or leg, throwing her down a staircase. Her mother eventually divorced the man, but continued
drinking and rarely got out of bed, forcing Stark to steal money from her mother’s purse to take a cab to third grade.

“Those experiences were very formative, and I remember them clearly,” says Stark, who ultimately moved in with her father. Alcoholism caused her mother to fall and die from a hemorrhage when Stark was fifteen.

In 2009, Stark, also having experienced an ugly divorce and having been laid off from her job, started drinking to self-medicate, she says. Eventually though, Stark realized she was mirroring some of her mother’s behaviors, and she did not want to put her then ten-year-old son through anything like what she had been through.

Stark and Browne knew Lepore as a regular doctor who’d helped them manage various medical situations, but nothing psychological. He had stepped in to deliver Stark’s son, when her obstetrician neglected to tell his patients he was going away and Stark’s water broke and she needed an emergency C-section. She took note of his no-nonsense approach even then: For two days after the birth, he “wouldn’t let me eat until I farted.”

Lepore helped Browne after an ear, nose, and throat specialist had removed a cyst on Browne’s neck, leaving a wound that became infected, oozing, and excruciatingly painful. A “fancy, fancy specialist in Boston was going to take out my whole salivary gland,” Browne says. But the surgery got delayed, and Browne was feeling so sick he consulted Lepore, whose first reaction was, “That is definitely not a chick magnet.”

Lepore put Browne in the hospital and gave him intravenous antibiotics. And when the surgery in Boston continued to be postponed, Lepore announced, “This has gone on long enough.” He told a nurse: “Get the green box.” Before Browne knew it, he was getting an anesthetic—“I think it was liquid cocaine, but it could have been crème de menthe.” Instead of taking out the gland, Lepore simply removed a stone the size of a tooth. “Can I keep this?” Lepore asked excitedly, running down the hall to show other doctors. “Look what I’ve got!”