Dr. Timothy Lepore seems plucked from fiction.
Nantucket’s only full-time surgeon is a recognized expert on the tick-borne illness babesiosis, a conservative and the island’s only abortion provider, and an animal lover who collects roadkill and keeps “mice-icles” in his freezer for his hawk, Ajax, a pet and hunting partner. The trained specialist and sometimes veterinarian also counsels alcoholics and addicts, attends to vacationing politicians, and treats tourists who take a tumble drunk on a summer’s night and end up with “cobblestone rash.”
New York Times reporter Pam Belluck met Lepore in the summer of 2007, when she profiled him for the newspaper’s American Album series. She spent about three years following his work and learning about the wide network of people who call him their doctor. Her new book, Island Practice , gives readers an inside look at the peculiar challenges of health care on the island while reflecting on those that all communities face.
Lepore is a contrarian, Belluck said in a recent interview. He is a healer and a gun collector, a surgeon who loves to shoot.
“He has this sort of brash, almost cavalier persona, and you can tend to forget that he is dealing with real life and death situations all the time,” she said.
He also has a tenderness that harkens back to an old style of medicine, in which the doctor is at the center of community, on call at all hours.
Belluck said she never tired of her subject. He was unpredictable.
She recalled checking in with him by phone on her way to a send-off for New York Times Executive Editor Bill Keller. Lepore told her he was in a field, trying to help a horse with cyanide poisoning.
“All night at the party I’m thinking about this horse. What’s going to happen to this horse?” she said. “There were constantly things like that.”
The story is book-ended by the fascinating tale of Underground Tom, a man who chose a life of near-exile in public spaces, building elaborate homes on -- or in -- borrowed land. Thomas Johnson trusted Lepore.
And Lepore’s emotions comes through clearly in a chapter that tells of a rash of suicides by teens and young adults on the island. Lepore, who serves as medical examiner, and his wife Cathy, a school counselor, were intimately involved in the aftermath of each.
“Nantucket is different,” Lepore says in the book. “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.”
Lepore rebels against the modern medical model of Partners HealthCare, which bought Nantucket Cottage Hospital in 2007. He objected to changes that hospital leaders and Partners wanted to make, including adding a second operating room (“Where are you going to get these cases from?”), asking physicians to be part of a large physician’s organization (“I want my employees answering to me”), new office rules, including limits on how many hours a resident could work, and the general influence of Partners (“When the giant sneezes, the little guy gets a cold”).
Still, hospital leaders know what Lepore means to the island.
“My personal nightmare is succession planning for Tim Lepore,” Dr. Margot Hartmann, the chief executive, says in the book. “There are no Tims out there. There probably really isn’t another Tim Lepore in the whole country.”
Certainly not one with the same talents and quirks. But Belluck said she hopes some readers with recognize Lepore in doctors they know, “somebody past or somebody present.” Lepore is committed to his patients, she said.
“That’s really what patients want out of whatever is going to happen in this health care landscape,” Belluck said. “They want doctors to spend time with them and not have to be ruled by the dictates of insurance companies and the 18-minute timeslots. ... They want a doctor who knows who they are.”