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Book Review

‘Island Practice’ by Pam Belluck

“Island Practice” by Pam Belluck.

‘Island Practice’’ weaves together tales of Dr. Tim Lepore’s almost 30 years of residence and medical practice on Nantucket Island. During this time, this maverick physician has functioned as a medical jack of all trades: delivering babies, performing surgeries, even standing in as a veterinarian when the need arose.

Over the years, Lepore, one of a handful of full-time doctors on Nantucket, has made himself an indispensible part of life on the island, which is a summer playground for the wealthy and famous and the year-round home for about 10,000. Over his career he has treated celebrities such as Jimmy Buffett and various Kennedys as well as legions of fishermen, foreign workers, and waitresses — the book begins with Lepore bushwacking his way through a forest to make a house call on a virtual hermit, “Underground Tom’’ of the subtitle.


“Hundreds of people would have died if he wasn’t there,’’ notes a mainland surgeon who sometimes covers for Lepore when he takes an infrequent trip off the island. “His is a job that very few people want to do, and nobody’s doing it like he does it,’’ says a fellow island physician.

The hours Lepore works are the stuff of legend. He counts among his many jobs: general surgeon, head of medicine at Nantucket Cottage Hospital, high-school football team doctor, tick-disease expert, and school committee member.

Lepore moved to the island after a stint as an emergency room doctor in Providence. The satisfaction he so obviously derives from the intensity of his work and the very close relationships forged with his patients is enviable (even if many of them seem unable to distinguish between his office and the middle of the street when it comes to seeking medical advice).

This lifestyle can be very emotionally and physically taxing, however, even for someone such as Lepore, 67, who is willing to sacrifice much for it. He describes his patients as being “like little piranhas. They take a little bit out of your heart.” In contrast, many younger physicians have a very different outlook on how to integrate medicine into their lives (and not vice versa). It’s not surprising that Lepore opposes the duty-hour restrictions for trainees that have put an end to 36-hour shifts. He doesn’t have any, and that seems to suit him just fine.


Lepore views the long hours as a necessary evil. He seems not to believe it possible to maintain the relationships he has with his patients without them having unfettered access to him, or without being able to give of his time without someone “coming in every twenty minutes to tell me that I’m done.’’

“Patients, he says, ‘all have faces, and particularly on a small island like this, you see them again and again and again. In some places you can call it a one night stand — you meet a patient, operate on them, discharge them, and they go back to their other doctor. I operate on somebody: I know their wife; I know their brother; I know their kids. Here, they don’t go away, and you don’t go away.’  ”

In her portrait of Lepore, Pam Belluck, a New York Times reporter, teases out the contradictions of a man who loves guns and embraces conservative and libertarian positions “but will also perform abortions and supply patients with marijuana cookies.’’ Throughout, Belluck’s prose is beautiful and lyrical. Describing the complexities of life on Nantucket, she writes “[m]ystery has a way of drifting ashore, like the scrim of fog that can crease Fat Ladies Beach.”


In its breadth, “Island Practice’’ is similar to the memoirs of country doctors written 50 and 100 years ago. However, it doesn’t quite manage to come together as a cohesive unit, and instead seems to be more a collection of vignettes without a clearly defined narrative arc.

Still the Lepore she gives us is a fascinating character. He sounds exactly like the kind of doctor anyone would want on his side in a pinch, even if he has a taxidermied, beer-swilling armadillo displayed prominently in his waiting room. Unfortunately, there are fewer and fewer like him out there. As the chief executive of his hospital says: “My personal nightmare is succession planning for Tim Lepore. . . . There are no Tims out there. There probably really isn’t another Tim Lepore in the whole country.”

Dennis Rosen, a pediatric lung and sleep specialist who practices in Boston, can be reached at dennis.rosen@childrens.harvard.edu.