Island Practice (9 page)

Out of the corner of his eye, Lepore spots something: a faraway pickup truck, the driver wearing orange. Lepore’s eyes light up behind his wire-rimmed glasses.

“A hunter—maybe he bagged a deer. Hey, I know that guy. It’s Ronnie Conway. He works for the electric company. He’s also a patient.”

He whirls his boxy, green Honda Element into a U-turn and races down a looping island road toward Conway’s house. He can’t believe his good fortune. Inside Conway’s garage, hanging upside down from triangular hooks: five slaughtered deer.

Lepore grins. “Can I?” Conway nods.

Lepore squats by one blood-dribbled head, placing his bare hands on the scruff of the neck almost tenderly, as if petting it. The deer were gutted in the field, so their rib cages splay open, and Conway has placed buckets under their mouths so blood doesn’t splash all over. “After two or three days, we’ll skin and quarter them,” Conway enthuses, and a hunting buddy, son of the meat manager at Stop & Shop, will cut them into venison steaks.

Combing through the deer hide, Lepore hits pay dirt: a thick, round, black tick, then two, then three. He pinches them off with his fingers, beaming through his brush mustache.

Fishing in his pocket, he pulls out a glass vial with an orange top; he always keeps some handy. He pops in the squirming creatures, swollen from the deer’s blood, and moves on to Conway’s other carcasses. Soon Lepore’s vials with their wriggling eight-legged captives will be winging their way to the mainland via Federal Express. There, they’ll be sliced, diced, and tested for a rogues’ gallery of diseases, diseases that have become all too familiar on Lepore’s island.

“Not that it’s going to get me the Nobel Prize,” Lepore smirks. “I’m not going to meet the king of Sweden.” But that’s beside the point. This afternoon, Ronnie Conway’s garage has become a beachhead in what, to Lepore, is a struggle of epic proportions:
Homo sapiens
versus
Ixodes scapularis
—man versus tick.

Like a certain fictional ship’s captain obsessed with a great white whale, Lepore is out to conquer another of nature’s leviathans: the wily tick. His style is somewhat different, of course. Lepore isn’t the raging megalomaniac Captain Ahab was. He’s more what you would expect if Ahab was played by Robin Williams. But make no mistake: Tim Lepore has a tick fixation.

Given the slightest provocation, or not, he will expound on the three main tick-borne diseases: Lyme disease and the less well known but potentially deadly babesiosis and anaplasmosis. Or one can read the squeamish details in Lepore’s delightful color brochure: “The breeze blowing, the sun shining . . . the tick crawling up your leg . . .”

Lepore, who has been bitten but never infected, tracks Nantucket’s tick cases with meticulous religiosity. He can list celebrities and demi-celebrities who’ve had tick diseases. And among his tick-themed paraphernalia are a cell-phone ring tone based on Brad Paisley’s country song “Ticks” and a parody of the famous gray T-shirt from Martha’s Vineyard’s Black Dog tavern—Lepore’s says “The Black Tick” and has a bug silhouette.

An acknowledged expert, he gets calls from doctors and researchers around the country. Some patients bring him deer they’ve killed so he can siphon off ticks in his own backyard.

“He has this obscene interest in it, and everybody gives him credit for that,” says Jim Lentowski, who runs the Nantucket Conservation Foundation. But on Nantucket, Lepore is also controversial in his outspokenness about a highly charged topic: He believes the only way to prevent tick diseases is to kill more of the island’s deer. “He really understands and is so passionate that he turns a lot of people off because they just think he’s being a nut about it. He’s a high-profile person on that point, and he wears a lot of people down.”

On the same December day of the Ronnie Conway bonanza, Lepore is waging his tick crusade on other fronts too. It happens to be the Saturday of the Christmas Stroll, the biggest—well, pretty much the only—tourist event of the off-season, so most year-round Nantucketers are downtown reopening shops they had otherwise mothballed for the winter or helping run tourist activities.

Ferries from the mainland are filled to the gills with giddy landlubbers. On the island, they promenade in red hats and jingle bell necklaces, mink vests and Prada high-heeled boots (perhaps not optimal footgear for Nantucket’s cobblestoned streets, but some folks are too well-heeled to care). As Victorian-costumed carolers sing, visitors tour gussied-up Georgian Revival mansions, imbibe generous goblets of eggnog, and fill their bags with trinkets like Christmas ornaments from the Cold Noses boutique, featuring a silhouette of any breed of dog personalized with your pet’s name.

Lepore is having none of it. He has more important things to do: staking out the waste water treatment plant, for one.

The plant is drab and dank, its interior a mass of gigantic tanks and labyrinthine pipes, festooned with perky signs like “Anionic Polymer—Caution.” But Lepore isn’t there for the ambiance or the sewage. He is lying in wait for ticks.

During the weeklong deer-hunting season in November and December, the plant becomes a check-in station. Hunters haul in freshly killed deer and heave them onto a wooden scale, warped and reddened with years of deer blood. James Cardoza, a retired state wildlife biologist, records each deer’s weight, sex, and age. Then Lepore swoops down and pores over the dead animal, scooping up blood-bloated ticks with his hands.

Hunters, usually eager to cart their deer home, can be taken aback by the bald, bespectacled man gleefully picking ticks off their conquests. But Lepore persists: “Jim lends me an aura of officialdom.” Anything to get his hands on the island’s prime promoter of ticks—in his view, a devil disguised as Bambi.

“The deer basically is the taxi cab for the ticks” is how Lentowski puts it. And on Nantucket, ticks have no trouble hailing a cab. Where are deer going to go, after all? They stay on-island and multiply, so that, state biologists say, there may be sixty white-tailed deer per square mile on Nantucket, the highest concentration in the state, where most counties have about ten to twenty per square mile.

Deer scamper through backyards and driveways, are spotted around Main Street and the hospital parking lot. The deer furnish adult ticks with a “blood meal,” Dracula-style. The blood meal is critical to allowing ticks to reproduce. Filled with blood, a tiny tick can swell to the size of a grape and lay 2,000 eggs. “A deer could literally cause tick reproduction so that everybody would be up to their necks in ticks,” says Sam Telford III, an associate professor of infectious disease at the Tufts School of Veterinary Medicine and the guy who receives Lepore’s FedEx packages of neatly bottled arachnids.

Deer don’t directly cause infections; baby ticks get those from feeding on mice carrying disease-causing bacteria or parasites. But deer give adult ticks the sustenance they need to have those babies, who grow up to bite and infect unsuspecting human. “A public health nightmare,” Lepore contends.

That Saturday at the sewage plant, Cardoza tapes up charts showing the number of deer shot each day that week. He sits behind a desk placed incongruously among tanks and pipes, picking his teeth with a white pocket knife, munching potato chips, and nibbling from a bag of mini Oreos, the kind found in a kindergartner’s lunch. Affixed to some equipment is a pencil drawing of a deer with a cartoon bubble: “I got ticks—want one?”

What with the Christmas Stroll, few deer, tick-toting or otherwise, are crossing the sewage plant threshold.

“There are not enough hunters,” Cardoza laments. But then Sergeant Dean Belanger, a state environmental police officer, appears, carting a doe he’d found dead on the road. With deer so common here, “we have a lot of deer versus car,” he explains. Lepore heads out to Belanger’s truck for a look.

The doe has been dead several days. But Lepore runs his hand through the matted hide and smiles. “Yeah,” he crows, popping his find into his orange-topped vial. “I got one.”

“I’m dying,” Laura Mueller kept repeating. “I’m just dying. I’m telling you that.”

At seventy-one, Mueller, a summer resident and retired nurse, had barely made it to the hospital. She had excruciating chest pain spreading rapidly to her neck and shoulders, a gaping hole in her spleen, and bleeding in her belly. She could feel herself going into shock. Mueller had been struck by babesiosis, a malaria-like disease that can spike 105-degree fevers, destroy red blood cells, and cause facial paralysis, congestive heart failure, even death.

Lepore, one of the few doctors who know about babesiosis, knew that the spleen had to be removed immediately, before it filled up with too many damaged blood cells and burst. But he feared the hospital’s
blood supply was too limited to keep Mueller alive. And the hospital’s only operating room was being used for other procedures.

Lepore called for a helicopter to take Mueller to Boston but discovered her vital signs were too unstable for her to fly. “We just have to operate right now because I don’t think you’ll make it otherwise.”

He cleared the operating room. Moments before she passed out, Mueller summoned strength to reassure the worried-looking anesthetist: “Don’t be nervous. Dr. Lepore’s here.”

Lepore stuck in his hand, scooped up the spleen, clamped the blood vessels. Mueller needed almost all the hospital’s blood, five transfusions, and remained hospitalized for days that August, only able to return home to suburban Chicago in October. There she had to be rehospi-talized, and complete recovery took ten months. But she lived.

Nantucket wasn’t always swimming in ticks. If there were any, scientists say, they were in tiny pockets, in forests, surviving on small animals like rodents or rabbits. People probably never came in contact with them. Nor did deer because, for a very long time, Nantucket had no deer. Lepore says that judging from carbon dating of deer bones he has dug up at old dump sites, Nantucket may have been deer-less since 1000 CE.

Others think there were deer until the 1700s or early 1800s, when they were driven off by sheep that grazed forests into grassland, ruining deer habitat. That, and hunting by Indians, finished the deer off.

Whichever version is true, Nantucket had no deer at all for at least a century, until June 3, 1922. That day, the
Antonina
, a fishing sloop, spotted a white-tailed deer swimming—or trying to. The
Antonina
took pity, hoisted it aboard, and brought it to Nantucket. There, the deputy game warden, William H. Jones, released the deer among some pines outside town. Then he decided no self-respecting buck should have to go it alone.

“Warden Jones has suggested to the state department that a mate be sent down to keep it company,” the Nantucket
Inquirer and Mirror
reported. Deer romance was apparently not the state’s highest priority. It took four years, but on February 22, 1926, a huge crowd gathered on the docks, the biggest “since Clinton S. Folger brought his automobile to the island.”

Two does had been imported all the way from Michigan, an arrangement “secured” by the deft negotiating skills of Breckinridge Long, a summer resident and diplomat who had helped Woodrow Wilson establish the League of Nations. Town approval was needed for this momentous step, but the “islanders took kindly to the proposition,” and the selectmen voted to “formally accept the deer.”

When they arrived, “there was a grand skirmish as the youngsters followed the deer along and watched the crates being lifted into Irvin Wyer’s truck.” Next morning, the release of the deer into the swamps drew enthusiastic onlookers, including “folks who passed their boyhood years ago, but were still boys, nevertheless.” The buck “will probably deeply appreciate the companionship after his four years of loneliness,” the newspaper wrote, wondering “how long it will be before he locates his new chums.”

Not long, apparently. Some years later, the
Inquirer and Mirror
editorialized: “there is no telling how many deer there are here now” and “those who have occasionally caught a glimpse of one or more of the deer while out driving, have been elated and returned to town to tell their friends all about it.” The editorial warned that “anyone who would dare molest or shoot one of the deer during the state’s open season of two weeks in December would bring upon himself the condemnation of the entire community.”