by Pam Belluck
“It’s hugely significant, the vast differences in wealth,” Swenson says. “The money is outrageous. I think that does have a huge impact on people. It’s hard to understand that disparity, particularly for people living here. People try to tell you that restaurants are affordable, and you know you could never eat there. We’re here nine months of the year, and there are these people three months of the year giving you the finger and screaming at you. We are living where they are coming. People can’t stand them, but we can’t live without them, and that has a huge effect on people’s self-esteem.”
More and more people find that the economy is pushing them off the island, especially during the recession, when a slowdown in building and renovating houses has meant that contractors, landscapers, and caretakers have trouble finding work, and people with other jobs also suffer. “Some people who have lived here all their life can’t afford to live here anymore,” Swenson laments.
People who stay have to be able to handle the seasonal economic changes, the move from a summer tourist economy filled with jobs in restaurants, shops, and the waterfront to a doldrum economy in which many jobs involve taking care of summer people’s houses or scalloping. “People make a lot of money in the summer and have too little to do in the winter,” Lepore says. “Psychosocial issues end up as the biggest thing here. If I’m not empathetic, if I don’t listen, if I don’t ask the right questions, I’m not taking care of that patient, any more than if I did half an appendectomy. Whether it’s disease or dis-ease, there’s something going on.”
The wrenching case of Nicole Garcia Tejada called upon both Lepore’s medical skills and his psychological radar. Three-year-old Nicole landed on Lepore’s hospital gurney on March 14, 2011. Her limp body had been found lying on a table in her home, but there was a delay in getting her help. Whoever discovered that she wasn’t breathing was apparently more comfortable calling a Spanish-speaking friend instead of police. That friend called 911, but the call was first routed to the state police on the mainland, an extra step before getting to the Nantucket police. The friend had also given the dispatcher the wrong address: Pine Street instead of Pine Tree Road. It took a second call from someone at the house to inform police of the correct address.
By the time Lepore saw Nicole, she was still warm, but barely. “I worked for about half an hour trying to get the baby back,” he recalls. “She was just blue and dead dead.”
Then, Nicole’s mother, twenty-six-year-old Dora Alicia Tejada Pleitez, came into the emergency room extremely agitated and confused, Lepore says. She was given some Ativan, an antianxiety medication. Then he watched in chilling amazement as a police officer entered the hospital room and charged Tejada with the murder of her own child. It was only the island’s fourth killing since Lepore had arrived.
Tejada, a house cleaner from El Salvador who had lived on Nantucket for about five years, had according to local newspapers reportedly hallucinated while napping on the couch with Nicole, imagining that Nicole was possessed by the devil, that demons were inside her. She told a pastor that she believed that God wanted her to force a rose down Nicole’s throat to exorcise the demons, and so, police said, she complied.
Lepore had questions about Tejada’s mental state in the hospital and concluded that her behavior was “disorganized enough that at that point it wasn’t appropriate to send her to jail.” He filled out a form so she could be involuntarily committed to a psychiatric institution, but the weather was too thick to fly, and she stayed at the hospital overnight, murder charge notwithstanding. She was eventually found competent to stand trial and her case is pending.
One of Lepore’s many hats involves serving on the board of Family and Children’s Services, and he and Swenson have bumped heads at times: “I think we need to do more fundraising, and Tim hates it: ‘Well, I’m not doing that crap.’ At least you know where he stands. But when we’ve had people in trouble, he’s there—boom. Doesn’t matter whether it’s 2 o’clock in the morning, ’cause that’s what he does care about.”
When a kid with bipolar disorder bolted from the emergency room and began running around town, for example, Lepore ran after him. He couldn’t keep up but alerted police, who found the teenager at the home of a man Lepore had previously treated for bipolar disorder but who had stopped taking medication and seeing doctors. (With the latter patient, Lepore notes, “I wasn’t that successful. I did such a good job he shaved all the hair off his body.”) Police brought them both to the hospital.
Lepore will also give patients cover, helping arrange a smokescreen to shield their problems from public view as a way to encourage them to get help. When teenagers come to see him, he’ll often “take some blood just for kicks, just so the parents think we did something medical.”
Alexandra McLaughlin, whom Lepore is treating for narcolepsy, knows several people with addictions to drugs or alcohol who “keep his number on file” in case they slip out of sobriety. They feel safe coming to his office, she says, because “Dr. Lepore’s the one you can actually talk to, and he’s not going to ruin their medical file for life.”
Still, sometimes Lepore’s counseling attempts fall on deaf ears. After a sixteen-year-old boy who was on probation for drugs failed a drug test, Lepore arranged for a bogus medical follow-up appointment for him just to get him to come into the office. He sat down with the teenager for forty-five minutes.
“You’re hanging around with stupid people,” Lepore told the boy. “You’re doing stupid things. You just got out of rehab, and you tell me you’re cranking oxys, drinking, smoking dope.”
The boy listened but was not terribly swayed. “At the end of the ser-monette,” Lepore recalls, “he told me to go shit in my house, essentially.”
About 60 percent of the people who seek counseling at Family and Children’s Services come in at least in part for drinking, Swenson says. “People on-island don’t like to talk about it because we’re a tourist community, but alcohol is the biggest problem we have on-island. It’s connected to anything and everything. You spend time downtown in the summer, you see people walking around just blotto.”
Peter MacKay, the social services manager for the hospital, is seeing more alcoholics, and “the time to treat them is longer.”
Lepore sees a slew of intoxication injuries. The cobbled downtown streets are “hard to walk on when you’re drunk,” he notes. “People think it’s Disneyworld and that you can’t get hurt at Disneyworld.”
One drunk driver struck a deer and flipped his car over, killing a man and a deer. Lepore drew a chalk outline around the deer. Another man, with an off-the-charts blood-alcohol level of .300, stumbled into another person’s driveway and lay down. The homeowner didn’t see the man and drove into him, causing severe injuries.
In 2009, after two house painters, Scott Bernard and Thomas Ryan, went drinking, Ryan stabbed Bernard, whose body was found alongside a road.
The summer before, at the Bamboo Supper Club, in an attack stemming from an apparent love triangle, a woman smashed a coworker in the face with a pint glass and a high-heeled shoe. The victim, Erica Sparks, a Canadian working as a summer waitress, was left with a permanent scar from a six-inch gash from her left eye to her mouth. The attacker, Laurie Ray, was convicted of mayhem. Both women appeared to have had a substantial amount to drink. Lepore, who treated Sparks in the emergency room, said her blood-alcohol level was .249, just over three times the legal limit.
“If I became king of the island, I’d close all the bars at 9 PM,” Lepore proclaims. “I think it’s a horrible problem. It breaks up families, kills people—get rid of it. Half the island goes to AA, and the other half should. It isn’t a surprise who you’re going to see at AA. The only surprise is that more people don’t go.”
Lepore has seen people “come in three days in a row drunk to the emergency room.” Occasionally, when he needs to suture up an especially surly drunk, he will be a little less generous with the Lidocaine that he gives to numb the site of the wound. “
Some people I put in more, some people I put in less. At 3 o’clock in the morning, dealing with drunks who are spitting up on you and cursing at you—sometimes you’re allowed to return the favor.”
One man was such a problem drinker he got into three moped accidents in a single day. Not long after that, he came into the hospital with a sword. Lepore wrote out a Section 35, an official request to a court to have him involuntarily committed to a rehab facility, where he would be evaluated by a court-appointed forensic psychologist and could be institutionalized for up to thirty days. It was the fourth time he had given the man a Section 35.
Lepore frequently encounters teenagers with alcohol problems. He says “there has historically been this acceptance of underage drinking” on the island. “It used to be the cops showed up at a party, and the kids dropped the beer, and the cops went away. Now the cops show up, the kids don’t drop the beer.”
Swenson reports that a 2009 survey found that Nantucket’s youth drinking rate was about 50 percent, outpacing the rate for Massachusetts and the rest of the country. He thinks new programs his agency has put in place are “starting to move this in the right direction,” but “I still think we’re a little bit higher than the state and national average.”
Swenson and Lepore say that some parents, with the goal of preventing their teenagers from driving drunk, allow parties where kids can drink, but take away all car keys. “It’s pretty common,” Swenson says. “But if a child begins to drink before the age of sixteen, he is four times more likely to have problems with addictive disorders late in life. Doesn’t it make sense that we should not let them have alcohol when they’re sixteen? Some people say, ‘Wow, I didn’t know that.’ Other people don’t care. My response is you’re playing Russian roulette.”
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.