Island Practice (30 page)

Hourihan had four weeks of chemotherapy, twelve weeks of Taxol and Herceptin (two breast cancer drugs), and then radiation—flying to Cape Cod Hospital daily for two weeks. That was followed by more Herceptin every three weeks for a year.

After the chemo, Hourihan started wanting something to ameliorate the side effects, to help her sleep, quell nausea, restore her appetite, and improve her mood.

“Friends said, ‘You need to get some pot. You need to smoke,’” remembers Hourihan, who was in her mid-fifties and had not smoked marijuana for two decades. A friend’s husband gave her some joints. But “when, all of a sudden, you’re smoking pot, that’s weird. I didn’t do well with it. It was strong. I wasn’t enjoying it.”

Hourihan started experiencing anxiety and went to Lepore’s office, where Meredith gave her Ativan, an antianxiety drug. It didn’t help much. When she next saw Lepore, he declared that the dose was so low “it’s not worth opening the bottle.”

She asked Lepore about marijuana pills, made of synthetic tetrahydrocannabinol or THC, the main psychoactive compound in marijuana. But Lepore knew that THC pills, though legal, are difficult to get and insurance companies won’t pay for them.

“I’ll get you some cookies,” he told Hourihan. “I have a guy who makes them.”

Lepore actually didn’t know for sure that he could get cookies. But he visited Henry, and in June 2010 Lepore told Hourihan he had some for her. She stopped by his office, but they weren’t there. “I went to his house and knocked,” she recalls. Lepore came to the door and said, “I can’t have them in the house. I have them out here in the car.”

As soon as Hourihan started eating the cookies, she began feeling relaxed. They helped her sleep, eased her nausea, and put her in a better frame of mind: “It definitely helped you think about something else besides how sick you are.” And a little bit of cookie went a long way. “The pot today is much stronger than we were smoking. I can remember
one summer day going to the beach and eating one and then starting talking, and I couldn’t stop.”

Plus, “they were delicious. They were like a sugar cookie, and they were amazing.” She allowed her son to try one but had to keep them hidden so her granddaughter wouldn’t get them. The only problem was “I only got the one batch.” As soon as they were gone, she thought, “I’d like to get my hands on more.”

But right at that time, Lepore was preoccupied with the death of Tony One-Eye. Tony—real name Anthony Viera, who had long ago lost an eye—was a well-liked islander who ran a junk yard and frequented the town dump to pick through stuff other people discarded. He was also known for digging up a continual bounty of sea creatures—mussels, littleneck clams, and quahogs—from spots whose locations he kept top secret.

That June, Viera brought the landfill crew some quahogs and was carding through piles of construction debris, searching for scrap metal, when a trash truck accidentally crushed him. Lepore, as medical examiner, had to pronounce him dead, and since “Dr. Lepore was involved in that, I felt weird asking for cookies,” Hourihan says. She stopped by the hospital and approached a nurse. “She goes, ‘Cookies, what cookies?’” Hourihan recalls. “So I didn’t feel comfortable asking for cookies.”

The marijuana didn’t erase Hourihan’s every symptom, but it helped ease the numbness under her arm, the slight mental fogginess from chemotherapy, and the embarrassment of losing her eyebrows and lashes. “It’s a lot for women to go through,” she says. “Cancer—it’s a big deal.”

One August night in 2011, Lepore’s voice when he answered his cell phone was short and breathless. “Dealing with a horse with cyanide poisoning right now,” he growled. “Gotta go.”

Lepore was in the middle of a field and his patient was an eight-year-old half-Percheron, half–quarter horse named Grace. Around 7:30 AM that morning, Grace had started trembling and acting strange, and her owner, Suzanne Duncan, made a beeline for Lepore’s office. She visited him repeatedly during the day, consulting about what to do. But by early evening, when things had not improved, Lepore headed to Duncan’s, where he would devote hours to a desperate attempt to save the animal—pumping her stomach, administering intravenous fluids, and even, to protect the horse from injuring herself, ripping fence posts out of the ground.

It’s not unusual for people to ask Lepore to treat their animals. Veterinarians can be in short supply on-island or lack certain medical equipment. Veterinary bills can be expensive, while Lepore usually isn’t. And for some, Lepore is just always the person they call. “He’s my main point person,” as Duncan put it. “He’s always open to things.”

Lepore has great respect for veterinary medicine because “an animal can’t talk to you” to explain the problem. But the patients can be easier. “The animal isn’t drugged or drunk or embarrassed.” Plus, “they don’t have lawyers, and they heal well.”

He also turns to butter around animals. On his iPhone he keeps a list of every dog he has ever had—Prince, Lucky, Chico, Norman, Odie, Rosie, Hobbs, Betty, Macy, Monique, to name a few. “I think about them. I can picture each one of them. I can’t even watch
Old Yeller
, which is a little-known secret. I can’t even read about it; it’s horrible. Even cats. I remember driving and seeing this cat get hit by a car—that was thirty years ago, and I still remember it.”

Lepore tried to pitch in by officially offering occasional animal medical care, but “the hospital has refused to help,” he says. “They’ve got CAT scans and X-rays, but they have forbidden me from bringing animals in, even though a lot of times these animals are cleaner than some of the patients.”

Still, he has managed, usually when the senior X-ray technician is not around. He X-rayed a goat with a funny-looking foot and dead birds of prey that he found, looking for bird shot in their bodies to see if they had been killed or died of natural causes. “That’s what they make nights for,” he insists.

In the hospital, Lepore worked on a deer hit by a car. The driver had put the animal, unconscious, in the back seat, but the deer revived on the way, and “raised a lot of hell,” Lepore recalls.

In his office, he sutured up an injured mutt cut on its head and back. On his zoological patient roster, “sea gulls are big items.” And he tried in vain to help a sheep that had just given birth and had a prolapsed uterus, in which the womb collapses into the vaginal canal. “I kept trying to push it back, but I couldn’t get it to stay. So I popped the sheep. There was nothing you could do.”

He had greater success with Sula, a golden shepherd with two broken bones in her leg. Her owner, Beth Peterson, a home health nurse, first took her to an island veterinarian, who “put a splint on it and said the dog would have a limp,” Peterson recalls. Then the splint came off. Peterson asked Lepore for help.

“I met him over there on a Saturday morning,” Peterson says. “He scooted the dog in the back door, did an X-ray on Sula’s leg. It was so sweet and so natural and so fine to put her there in the back room. He resplinted her leg like three or four times.”

Once, someone called Lepore’s house to say “they had an eagle who was hurt and they were bringing him by,” Cathy Lepore remembers.

“Don’t bring him by,” she told the caller. “I’ve got people here visiting. He’s not a veterinarian.” They brought him by. “Get—Get out of here,” Cathy sputtered. “The nerve!”

The island also has a large population of feral cats that, Lepore says, are a threat to songbirds, pheasants, quail, and other fowl. He thinks many of the cats should be trapped and euthanized, but knows that would not be popular. An animal rights advocate, with whom Lepore
had butted heads over his conviction that more deer should be killed to reduce tick diseases, was also concerned about the cats. She wanted them spayed or neutered so they wouldn’t overpopulate the island and endanger their own survival.

Lepore offered to provide that service, figuring it would help solve the problem and earn him some goodwill from a deer hunting foe.

“I’ve read enough books about spaying and neutering,” he told Cathy. “I have an anesthesia machine around. I can do it.”

“Where would you do that?” Cathy asked, incredulous.

“In the back room.”

“I think you’ve gone too far now, Tim. What patient is going to want to be in the room after a cat’s been in there?”

“They wouldn’t know,” he assured her. So far he hasn’t catered to the feral cat trade. But if it ever becomes necessary, “I’m poised.”

The case of Grace the horse was an unfamiliar challenge. Lepore had had only minimal experience treating horses. He had treated one with Lyme disease, administering IV antibiotics, but the horse bled out and died. He had sutured up the nose of a horse that cantered into a wire.

But Grace was in distress, and it wasn’t clear exactly why. She had been “perfectly healthy” until that morning, says Duncan, a physiatrist, who bought her from Amish farmers in Ohio and would ride her downtown to pick up the mail and to the nursing home where she works weekly with elderly residents.

When Duncan came to see him about Grace, Lepore mined his brain for possibilities. Duncan said she had gone out to feed Grace and found her standing there shaking, her gums white. Then she mentioned a berry stain on her mane and said Grace might have been munching on a nearby chokecherry tree. Lepore happened to know that the seeds of chokecherry fruit can contain large amounts of hydrogen cyanide. So while Lepore was seeing patients in his office, Duncan brought over samples of the plant, and Lepore studied toxicology reports. He gave her a big batch of vitamin B
₁₂
, used to treat cyanide poisoning.

It helped, but not enough. Duncan got assistance from a veterinarian and a veterinary technician, who gave the horse enemas and walked her around. But not long after Lepore drove to Duncan’s early that evening, the horse sank to the ground. Lepore went to the hospital and his office to cadge some supplies: more B
₁₂
and some Ringer’s lactate, a saline solution to restore lost fluid. Besides the vet and the vet tech, Lepore was joined by Wayne Wilbur, a nurse anesthetist from the hospital. With no large-animal veterinarian on Nantucket, they called some on Cape Cod for advice.

“It was a real in-field kind of warlike situation,” Duncan recalls. “Dr. Lepore was in his element.”

They inserted an intravenous tube in the horse’s neck—not easy with a 1,400-pound, thrashing animal. The horse kept dislodging the tube, and Lepore repeatedly helped sew it back in. They arranged three sticks like a teepee to hold the IV bag in place, so gravity would help propel the fluid, and they eventually pumped in thirty-six liters. “That’s what kept her alive for so long,” Duncan says. “I have this image of Dr. Lepore squeezing the IV bags so the fluid would run faster.”

Although “we thought it was cyanide,” Duncan says, there were other possibilities. Hoping to pinpoint the diagnosis, Lepore recalls, “I even got the hospital to run some blood work for me in the middle of the night. Sometimes they can get a twist in their bowel,” or “they can get a fecal impaction.”

The team in Duncan’s field commandeered a bilge pump, using it to flush out the stomach by pumping water through a tube Lepore inserted in the horse’s nose. To clean stool out of the horse’s rectum, “one guy was going in up to his elbow without a glove,” Lepore says. “That was not me. I chew my fingernails.”

Grace kept “struggling and struggling to get up, and falling,” Duncan remembers, and as she moved, she was getting too close to fence posts in the field. Finally, Lepore and Wilbur pried the posts up so Grace wouldn’t get hurt knocking into them. They gave the horse
pain medication to ease her discomfort. As the night stretched on, they worked by the beam of one of Lepore’s $200 flashlights. “It’s a pain in the ass to see the goddamn horse trying to get up,” he recalls. “It’s a bitch to have it down like that because they really don’t tolerate being down that much. It’s just so frustrating because it was a nice horse.”

At one point, Duncan got the fire department to come, and using a front loader a construction company had left nearby, firefighters tried hoisting Grace to her feet. “But there wasn’t an ounce of strength in her to stand up,” Duncan says.

Still, when Lepore left around midnight, “I thought we were going to make it,” he says. Duncan says the B
₁₂
seemed to give her more energy, and “she was doing some hopping around, so we thought she might get better.”

Lepore got home to find that “Cathy was pissed off at me” for having stayed there so long. “She’d had dinner ready. She thought I should have been home. But what are you gonna do? If somebody has a sick horse, I’m going to try and help them. Even people I don’t like I try and help. And sometimes dealing with other species is interesting—you learn things.”

Around 6 AM the next day, Lepore dropped by to check on Grace, but “the horse was down, and there was nobody there. It was just awful.”

Duncan had called a veterinarian to put Grace to sleep at 4 AM, having run out of medication for her pain and realizing that nothing could save her. Later, Duncan and Wilbur performed two autopsies, concluding that it was not poisoning but a twisted gut that blocked Grace’s abdomen, ruptured a blood vessel, and caused her to bleed out.