Island Practice (32 page)

Even mental health professionals on the island were stunned. Peter Swenson, executive director of Family and Children’s Services of Nantucket, recalls that when he moved to the island in 2006, a friend of his was starting a job in New Hampshire’s remote north country to work in addiction and suicide. Swenson told him, “That’s the last thing in the world I want to do.” A year after his arrival came Vaughn’s death, the first suicide of a Nantucket High School student in decades.

While Lepore, like others, suspected that “the initial suicide probably in a way lowered the threshold” for others considering taking their own lives, the deaths were still shocking. “We’re talking about high-performance kids from two-parent families.”

Teachers were especially stricken. “They were really wounded, collateral damage,” says Lepore, who is also a member of the school committee. Some teachers questioned the role of academic pressure. Others feared they had missed warning signs or somehow failed to take a step that could have prevented a death.

“In the beginning people thought it was the school’s problem,” Swenson says. “It’s really the community’s problem.”

The community mobilized as best it could. It brought in specialists from the mainland. State Department of Public Health counselors spoke to teachers and students. A trauma specialist and Harvard psychiatry researcher, Robert Macy, ran training programs and helped set up suicide prevention protocols, including a program to educate students about suicidal tendencies and a drop-in center supervised by a substance abuse counselor. A licensed clinical social worker from Family and Children’s Services helped out in the schools. And Cathy Lepore was asked to become a full-time adjustment counselor to work with fragile and at-risk high school students.

A posttraumatic stress management team was activated with about twenty members from various agencies. The community tried to find the right balance.

“I don’t think a kid gets through these years without having crazy thoughts, but they need someone they can talk to,” Lepore says. “We had all of these people come and volunteer, but the kids didn’t know them.”

Mental health professionals and school officials wanted to sound enough of an alarm so that struggling teenagers would know they had someone to turn to and adults and peers would be aware of warning signs. But some were concerned that memorials and tributes to the teenagers were giving the suicides too much attention and might encourage others to think they would be celebrated if they died.

A grief counselor from Children’s Hospital Boston urged parents not to treat the suicides as a contagion but to describe them as isolated incidents involving young people who could not handle their problems well. That made sense to some Nantucketers.

“You couldn’t go to a game anywhere on the island where there wasn’t a recognition” of the life that had been lost, Lentowski said. “Students are not persuaded from glamorizing it. You just put thoughts in kids’ minds, ‘Well, if I do the same thing, at least I’m going to be recognized.’ We have to tell them, ‘No, it’s bad.’”

Since then, Swenson says, “We’ve learned a tremendous amount, how to respond to things, how to do it appropriately. It’s been very difficult for the island and for the community. People are scared.”

For Lepore, the deaths took an emotional toll, even as he kept up his raft of professional roles. He knew the families as patients or through his various medical positions, and Cathy knew them through her school responsibilities. As medical examiner, Lepore pronounced each one dead. He was named to a newly-formed disaster response task force. And as a school committee member, he was involved in helping the schools respond.

“Could we have prevented one of these kids from killing themselves? I don’t know,” he kept asking himself. “I’ve been on school committee for years, and kids were not killing themselves. What has changed? What’s led to this loss of hope?”

Lepore’s son T.J. recalls how trying the experience was. “My parents were involved in every single one of those in a very personal way. I remember him talking about one of them, where he had gone to the funeral and said it was really bad. When it’s a kid, it just doesn’t make sense. It’s not something you can really wrap your head around.”

Richard Ray, director of Nantucket’s health department, observed it too. “That’s when you see emotion come out in Tim, when kids are at risk. I’ve only seen him cry once. That was with a suicide. For a brief couple of moments, he just fell apart.”

The teenager in that case was the seventeen-year-old girl, Kate. Her death was what Detective Tornovish called “heartbreaking to one of the inner circles of hell.” Lepore knew her parents. “The family was very high-achieving. This is a kid that you’d be so proud of. This was a star athlete, very, very bright kid, very, very driven kid. She had lots of friends.”

Her death occurred on an afternoon when Lepore was seeing patients in his office. “They called me and said a seventeen-year-old is coming in, not breathing. The emergency room was a very chaotic
scene with high emotions and anxiety. We attempted to resuscitate her for over half an hour. There was just no way we could get her back. It was gut-wrenching for her parents, the staff, and everyone involved.”

Lepore found the last suicide, of the twenty-year-old, Dean, especially devastating as well. He and members of his family were patients of Lepore’s. He had just graduated from culinary school, landed a job, and was known as a talented chef who had worked at many of the island’s finest restaurants. That night, he had been playing video games at a neighbor’s house, giving no hint of what was to come.

“He was a nice kid, a quiet kid,” Lepore says.

The method of death, cutting his neck with a band saw, was also highly disturbing. Detective Tornovish said the young man’s sister was in the next room and “heard the band saw turn on.” She asked what he was doing, but her brother told her not to worry.

It was, Lepore laments, “just a particularly violent way of doing it. This was violence beyond a certain dimension.”

Since that death, there have been no other youth suicides. Family and Children’s Services and the Nantucket Suicide Prevention Coalition have taken numerous steps, including screening programs for middle school and high school students, and training for adults who come in contact with young people: clergy, police, EMTs, workers at pizza places and taco shops.

“We’ve even done some outreach into the bars to educate people who work there,” Swenson says. The message was: “‘We just want you to know what it looks like if you’re seeing something.’ We’ve tried to capitalize on the fact that, look, Nantucket went through a pretty horrible time, and everybody wanted it to stop.”

The efforts have led to improvements. “We don’t like to say it out here on the island, but on the mainland they say we’ve stopped it in its tracks,” Swenson says. “We like to say we’re doing really well.”

Lepore still gets reports of young people with suicidal ideation, and both he and Cathy encounter teenagers who cut themselves and engage
in other self-destructive behaviors. And “we have a number of adult suicides,” he says. “Nantucket is different. If you can’t make it here, it sort of pushes you over the edge. The social isolation, the drug and alcohol issues, the socioeconomic disparities, I think that pushes people.”

For Ben, the summer of 2008 should have been a time of optimism and excitement. He was about to head off to Pratt Institute to study architecture, something he had been interested in for years. He had been accepted to all but one of the schools he had applied to. And Pratt was giving him a $25,000 scholarship, on top of $6,500 he received from the town of Nantucket. He had a summer job plastering and painting, and he had friends.

“Everything was right there for him always,” says Ben’s mother, Barbara, one of Lepore’s longtime patients and running partners. “Dr. Lepore said Ben’s the last kid we would have expected . . .”

Lepore knew the family well. He had been Barbara’s doctor for years. Barbara considered Ben, brown-haired and soft-eyed, her easygoing child. His brother was somewhat more emotional, she says. When Barbara and the boys’ father divorced after more than two decades together, Ben’s brother, then fourteen, was more obviously upset. Ben, then eleven, was calmer. He was also an honor student. “He didn’t have issues in school. He didn’t have a ton of pizzazz. He was a second kid. Ben was a pretty even-keel person with fewer ups and downs. I trusted him. He always seemed really intelligent, and he had that measured response.”

Not that Ben never experienced upheaval. In eleventh grade, Ben’s parents sent him to a private school, Cushing Academy, west of Boston, a school they had planned to send him the previous year until housing arrangements fell through. By eleventh grade, when he arrived, he felt
out of place as the new kid, and he bridled at the rules. “He was there for a week and was miserable,” Barbara recalls. “He came home, and we didn’t make him go back. It was a mistake because in the long, long run, it would have been better for him. I don’t think he would have been as worried about going away to college. Maybe he was afraid of failure because in the back of his mind he had that Cushing experience. Getting him away from here would have helped. He didn’t have that wider perspective.”

Nor was Ben entirely free from trouble. At fifteen, he was arrested for possessing marijuana when he was caught rolling a joint with an eighteen-year-old. He was placed in a juvenile diversion program and given community service. About a year later, police stopped Ben and other teenagers in a car, searched and found some pot, as well as a pipe in Ben’s pocket. Barbara says she considered that latter arrest “actually harassment—why are you following around my kid? Clearly there are dealers on the island, and why don’t you just leave Ben alone?” But overall, the arrests “weren’t huge things to me. They were annoyances.”

After the suicides began and the school arranged for more counseling and discussion groups, Barbara asked that Ben be included. His brother was in college by then. An uncle had killed himself several years earlier, and around the time of the first Nantucket teen deaths, a cousin of Ben’s had killed herself too. That girl’s sisters had come to live with Ben’s family, so unspoken reminders were close at hand.

“Ben has had two relatives who committed suicide in the recent past, and it’s looming there,” Barbara told school staff.

Ben had also known the two teenagers who died in 2007. In fact, he and a friend had been walking by Vaughn’s house around the time his body was found in the basement. Ben’s friend was also close to another teenager who lived on the mainland but had visited in the summer and who had recently taken his life.

“One of the things that’s shocking is you don’t know everything about your kid,” Barbara reflects.

Then, in January 2008, the sixteen-year-old, Will, died. Ben knew one of Will’s sisters, and the family was familiar to many. After that, a group of kids gathered in Ben’s living room. “This house has always been central for them,” Barbara recalls.

Barbara still didn’t really think Ben was at risk himself. She was sure she would know if he were. She remembers that, at one of the funerals, “I said to Ben, ‘If you ever feel like committing suicide, promise me you won’t ever do that, that you’ll talk to me.’ He said, ‘I would never do that.’”

But with the turmoil on the island, and the family history of suicide, Barbara thought Ben could use some comforting and a sense of stability. “He’s not going to step up and say he needs it, but I think he does,” she told the school.

A counselor the school brought in, Jeffrey Bright, met occasionally with Ben and other students during lunch. After Ben’s second marijuana arrest, he began meeting with Bright more often because Ben’s community service sentence was to paint the walls of Family and Children’s Services, where Bright worked. Bright, a British-born counselor with decades of experience, would conduct Ben’s required drug-testing. One of Ben’s test results was invalid because he had drunk cranberry juice, a tactic employed by users to try to clean out their systems before a test. According to Ben’s mother, “Jeff handled it in a way that Ben saw him as an ally, but was legally appropriate. Ben trusted him.”

Cathy Lepore, in her role as high school counselor, also noticed that “Ben and Jeff really connected. He wouldn’t talk to anybody else.”

Then Bright was abruptly forced out after a judgment call he made while chaperoning a trip for high school seniors to Washington, DC. Another chaperone fell ill in DC, ending up in the hospital, and Bright decided to stay with her and send the seniors home on the plane by themselves. Some parents complained, and Bright was barred from future work in the schools, says Swenson, who strongly objected to the
school’s decision. Bright found that “the pressure was just overwhelming,” and he quit his island counseling jobs, Swenson says.

Soon afterward, Ben told his mother, “Jeff’s just gone. He’s not there anymore.”