WGBH Radio; The Callie Crossley Show

I'm Cally Crossley This is the Cali Crossley Show. We're kicking off our week of health care coverage with New York Times health and science reporter Pam Bella in her forthcoming book island practice. She profiles Dr. Tim liberate the doctor has been treating the people on Nantucket for nearly 30 years. Dr. liberate is all things to all people. Surgeon tick expert unofficial psychologist and sometime veterinarian. From hedge fund managers to the guy who trims hedges he treats them all. If you can't pay your bills cookies yardwork and lobsters were good for this doctor House calls often work in reverse with the ill and ailing dropping by his home at all hours. This doctor is essential to the community at a time when health care is increasingly costly and impersonal. Up next Dr. Tim liberate and Island doctor without boundaries. First the news. From NPR News in Washington I'm Lakshmi saying the U.S. Supreme

Court will hold out two more days of debate on the national health care law that critics say unconstitutionally requires everyone to purchase coverage on this first day of arguments Washington attorney Robert long faced a series of questions he was appointed by the justices to argue that the case had been brought prematurely. NPR's Nina Totenberg says it's pretty clear to her that the justices intend to rule on the Affordable Care Act. The only question is what the rationale is going to be. It's very technical but one argument is that the government could simply waive its right to block one of these lawsuits in court. And the counterargument is well if you do that it's up to the government always sit aside whether people can go to court and that's a lot of more power to give to the government. The other potential way to get around it is to say they are serious what are called equitable exception. This needs to get done. That's NPR's Nina Totenberg at the U.S. Supreme Court. Federal Reserve Chairman Ben Bernanke he warns the job market will remain weak despite strong gains

posted in the last three months. He says the economy needs more robust consumer and business demand his comments signal the Fed may keep interest rates at record lows a while longer. Fewer people sign contracts to buy homes in the U.S. last month that's according to the National Association of Realtors. Still NPR's David Mattingly says the group remains optimistic. The mild winter brought out more home buyers but the MERS pending home sales index dropped a half percent in February and they are chief economist Lawrence Yoon says that's not surprising given the January's index hit a nearly two year high. The monthly decline was a very modest decline a generous figure. We're quite strong and compared to one year before D-cells are up 9 percent builders and realtors say they're growing more confident in part because employers seem to be hiring again. David Mattingly NPR News Washington.

Thousands of people across southern California lost electricity after yesterday's big storm that dumped nearly an inch of rain in downtown Los Angeles. Also left new snow in the mountains. NATO's reporting today another fatal attack by a member of the Afghan security forces. Two British troops were killed in southern Afghanistan by an Afghan soldier. Such attacks have increased in the aftermath of Qur'an burnings at a U.S. base and the killings of Afghan civilians allegedly by a U.S. soldier. Here's the latest from Wall Street Dow Jones industrial average up 116 points at 13000 197 and trading of a billion shares. Nasdaq up 36 more than 1 percent at thirty one oh four. This is NPR News. Good afternoon from the WGBH radio newsroom in Boston I'm Christina Quinn with the local stories we're following. Authorities say a rodent repellent in a passenger's bag caused a noxious odor that sent for Transportation Security Administration workers at Boston's Logan International

Airport to the hospital. Authorities say 15 TSA workers were evacuated from a bag room at Terminal A shortly after the odor was noticed at about 8:20 this morning. Four were brought to a hospital as a precaution. The all clear was given shortly after 10:00 a.m. after the chemical in the bag was determined to be camphor. The bags owners were cos were questioned but not charged. Their names were not made public. A former school lunch provider for Boston Public Schools has followed a lawsuit against the city alleging that it violated public bidding laws by awarding a contract to a competitor last year. The Boston Globe reports that preferred meal Systems Inc says the city wrongfully negotiated a lower price with its only competitor in the bidding process with since Food Service Corp. superintendent Carol Johnson defends the city's contract with wit since saying the city followed proper bidding procedures and that student lunches this year have more fresh fruits vegetables and whole grains than previously. In Rhode Island the Woonsocket school committee is considering asking state police to investigate budgeting errors in its school system that now faces a 10 million dollar deficit. The one socket

call reports the panel will vote Wednesday on whether to request a state police investigation. A proposed letter to state police says the panel wants to know whether it was given full and accurate financial information about school finances or whether data was manipulated or falsely represent or falsely presented. In sports the Red Sox are playing the Phillies this afternoon for some spring training action and the Celtics are in Charlotte tonight to play the Bobcats. The weather forecast for the rest the day sunny and breezy with highs in the upper 40s North one's way northwest winds rather will pick up to about 40 miles per hour gusts at times. Tonight will be clear and cold with lows in the mid 20s right now it's 45 in Boston. Thirty nine in Wister and 49 in Providence. Support for NPR comes from the Bill and Melinda Gates Foundation dedicated to the idea that all people deserve the chance to live healthy productive lives. Gates Foundation dot org This is WGBH. Good afternoon I'm Cally Crossley this week the U.S. Supreme Court is hearing oral arguments challenging the constitutionality of President Obama's Patient

Protection and Affordable Care Act. As part of WGBH his focus on health care. We're kicking off a week of health care conversations. Joining us today is Pam Belich. She is the health and science writer for The New York Times. Pam is the author of the forthcoming book island practice cobblestone rash underground Tom and Other Adventures of a Nantucket doctor. It's a profile of Dr. Tim leper ie a one of a kind doctor who's been practicing on Nantucket for nearly 30 years. Pam Belich welcome. Thanks so much Cali Thanks for inviting me. Now you've written an entire book about this one guy Tim leper. You got to tell us who is he. So yes I would never have expected that he would be interesting enough for an entire book but it turned out to be just really fascinating. Dr. Labrie has been on Nantucket for nearly 30 years. He is the he's not the only doctor there are a handful of other year round doctors there but I think all of

them. I would say that he is quite an individual in that he fills so many different roles on the island that he is just irreplaceable. He is the surgeon he's the medical examiner he's a football team doctor. He is the disease expert and tick diseases are a really big deal there. He will treat your animals if you want he acts as a psychologist for people although he has no formal training in that regard and he has a family practice that turns no one away and sees people at all hours sometimes at his home sometimes at their home. And it doesn't matter whether they can pay or not. It's really it's really an interesting and sort of unusual way to practice medicine these days. Well there's so much about him that's intuitively you know. Trajectory for example. He's a surgeon and he's essentially practicing a lot of primary care medicine. That's something that in most places just does not happen there

are clear lines of demarcation. How is it that he became comfortable doing it or just embrace doing it. Yeah and I think that's a very good point most surgeons would not practice family medicine. I think that it's partly the nature of the kind of cases that present themselves on and talk it. It's got an incredible diversity of medical cases that come up and some of them need surgery and some of them don't. But it's also it's a very close knit community it's got about 10000 people year round and they need a doctor for all different things in life and he has by virtue of his personality and the way he wants to engage with them decided that that he can be that doctor. What it does is as a surgeon it gives him so gives him a very. Well-rounded perspective on patients I think most surgeons don't see in many hospitals. If you're the surgeon you may

be seeing a patient after they've already seen many other doctors and you do the operation and then if everything goes OK you may never see them again. And for Dr. Labrie he is not only taking out their appendix but the next day he may be treating them for Lyme disease and he may be delivering their baby and he may be treating their mother or their son and so he is very connected to the families on the island and he understands a lot about what their lives are like and the kind of medicine that he's practicing. Is this what we see in some very remote rural communities I mean some of this would be normal or is this doctor liberate just unique even in this environment. Well I think that you used to see a lot more doctors like this in small towns across the country. And I think there probably still are physicians like this and in remote places and small places and also I would guess even in

sort of tightly knit urban neighborhoods where people make a connection to a doctor and that doctor has decided to kind of not sign up with the big. You know medical practice and to sort of go it alone. But it is increasingly rare. It's increasingly hard to do with health care landscaping what it is and the dictates of insurance companies and the kind of mushrooming of larger and larger hospitals and health care systems. So it's it's unusual. Before we talk more about Dr. leprous practice and how he practices. Let's get a sense of the island which is really the context in which he practices. And I want to read just a little bit of what you wrote in your book describing Nantucket leprous Island Nantucket is much more than a tourist destination or a Summer Haven for the exceedingly rich it may draw more than a million visitors a year and be known the world over for its cobblestone streets.

Picturesque beaches and whaling industry nostalgia. It may be a magnet for hedge fund managers media personalities and the political elite but it's roughly 10000 year round residents experience Nantucket in an altogether different way. They know the charms and liabilities of living in a place that is not always easy to get to or to get away from. Mystery has a way of drifting ashore like the SCRAM of fog that can erase fat lady's beach and long time residents are the first to say at this forty eight square mile boomerang shaped island seems to host more than his per capita share of outliers. Eclectic independent minded OKs really slippery are up to no good. Often just aiming for a little reinvention. So tell us about the Nantucket of Dr. Tim Labrie. Well I hasten to say first of all that I am not a man Tucker and I certainly cannot speak for the people who live there year round or the people who spend the summer there. I'm a journalist. I've spent the last 10 years or

so either writing about New England or in the last few years writing about health and medicine. And so this book is written from observations and discussions with Dr. leprosy and the people he works with and the people he has taken care of and helped along the way but it is by no means meant to be the authoritative book on talk it there are others who have done wonderful jobs. Oh I know that I'm just getting an observation and I'm 16. But my observation even that might have survey Sion is that this is an island that has. A sense of an independent spirit. I think that because it is 30 miles out to sea and there's sometimes limited accessibility because of the weather it is a place where. People have to be comfortable being a little bit apart from what

some of them call America. They have to be comfortable with living in a small town and and so the kind of person who are one kind of person who seems to be attracted to living there are people who are very creative. They're they're independent they're maybe a little iconoclast ik and Dr leper he fits that description very well. He's you know he's a he's a guy he's an individual ist and he thrives there because this is a community where people celebrate individuals. My guest is Pam Belich she's health and science writer for The New York Times and author of the forthcoming book island practice. Now Pam Dr. leprous did not grow up on Nantucket so you know he was practicing medicine as he did elsewhere. And one would know from I would imagine looking at him that he would fit him in this in the scenario that you just described is

Nantucket. So how do you happen to come to Nantucket and how did it seem to. He and Nantucket seem to just grow together if you will that they seem to be made for each other. Right well you know one of the things that was so much fun in reporting this book is that I learned a lot about his family history which ended up being a lot more interesting than I thought. He grew up in Marlborough Massachusetts. And he is the son of a doctor who actually plays a role or played a role much like Dr. Leppard plays in a talk. However. Dr. leper his father was was almost kind of a local hero. He was somebody who served in World War Two and was just widely respected and admired and. And I think for Tim Labrie the doctor that is the focus of my book. This was a little bit daunting.

It was a it wasn't something that he aspired to do but also there was some distance between him and his father. And so in a way while his father became a kind of conventional medical hero the doctor Labrie of my book is is much more unconventional and some of that is really just I think the luck of genetics I mean he kind of came out of the womb as he says with some you know kind of eccentric interest and he doesn't have any idea where they where they came from. But I think some of it also is sort of a little bit of chafing at the medical establishment. He he went to Harvard you nearly flunked out in his first year but he did graduate. He went to Tufts Medical School. He worked as his first jobs were working in Providence Rhode Island a big hospital there. And so he he followed the mainstream

path and then he got a little taste of Nantucket as an emergency room doctor filling filling in one summer. And I think it just seemed like a place where he could breathe and where as I say in my book it's a place that could let Lepper be a leper. That's I mean it just is amazing to me as I was reading along thinking you know anybody else and many other people had come through there doing some rotations at the hospital but this guy just seemed to be you know perfectly fit for it for this island. We should say that you know he's married to someone who doesn't seem as unconventional as he would be by virtue of reading your book. And you know he's got kids and they've gone on to work in the medical field as well. Right right he has he has an equally remarkable wife Kathy who is who is in nurse by training and now is a counselor at the high school. And she is a source of real stability and

rationality. And just incredible dedication to the community as well and I think they balance each other very well. And all three of his children are grown now and all of them have gone into some field related to health care. They have some very. Interesting it almost even to me unbelievable stories about growing up being the son of Dr. leprosy the tricks they played on the sort of pranks that he pulled on on their friends. And you can just imagine you know growing up when you know your father decides that if you're arguing just lock them out of the house for a while and let them kind of see what happens. But you know they're they're all they've all become very successful. Well as we said he's quite the character. And so the questions to ask you next what is cobblestone ration.

Who is underground. My guess is Pam and Alec and we're talking about her forthcoming book island practice which is a story about Dr. Tim leper and what he means to the people on Nantucket. It's also a book that looks at what it means to be a good doctor in a time when the giant health care system is making it harder for physicians to deliver personalized care. Coming up we'll hear from Dr. Tim liberate. You can join the conversation at 8 7 7 3 0 1 8 9 7 8 7 7 3 0 1 89 70. We'd love to hear from you if you've ever been treated by Dr Tim Lepore 8 7 7 3 0 1 89 70 8 7 7 3 0 1 89 70. You can write to our Facebook page or send me a tweet at Cali Crosley. You're listening to WGBH. Boston Public Radio. This program is on WGBH thanks to you. And Dedham savings your

bank providing personal and business banking services to our community. Proud to support WGBH and the Boston speakers series March twenty eighth with Frank Abigail at Boston Symphony Hall. And it's your move. We are a group of professional women who have gotten together to help families move from where they are to where they want to be. Janice are more co-owner. We're in a very specific market and we wanted to get the word out more aggressively. GBH has got a certain reputation that supports what we want to do and we'd like to support that as well. Responsible very good. To learn more visit WGBH dot org slash sponsorship. After Sunday's long awaited season premiere of Mad Men. Fans of the show will be eager to talk about it on the next FRESH AIR we talk all about the new episode with executive producer Matthew Weiner who wrote it and created the show. Join us. This afternoon at 2 here on eighty nine point seven WGBH.

I'm Brian O'Donnell. Join me and singer songwriter Robbie O'Connell for an Irish soldier this September. It's a 10 day tour through the southern counties of Ireland. We visit ancient burial mounds and majestic castles traverse the wonderfully named mountains. Visit Dublin and Kilkenny castles and enjoy the music sessions. This trip with an up fast and you won't want to miss out. To register visit WGBH dot org slash learning tours. This week WGBH focuses on health care a personal perspective on the health care crisis local impact of a national issue. Hear the reports all this week here on eighty nine point seven WGBH Boston Public Radio. Welcome back to the Calla Crossley Show. If you're just joining us my guest is Pam Belloc health

and science writer for The New York Times. We're talking about her forthcoming book island practice a profile of Dr. Tim leprous who has been practicing medicine on Nantucket year round for nearly 30 years. You can join us at 8 7 7 3 0 1 8 9 seventy 8 7 7 3 0 1 89 70. If you've been treated by Dr. Lepore give us a call 8 7 7 3 0 0 1. Eighty nine seventy eight 7 7 3 0 1 89 70 and you can write to our Facebook page or send us a tweet him one of the things that I wanted to make clear to folks because even though we've alluded to it the wealth disparity on the island particularly the difference between summer visitors and those who live there is huge and that needs to be taken into context as we look at how Dr. Lepper e has adjusted his practice style. People should know that the average house is 1.6 billion dollars we're talking about summer visitors now people who are the wealthy people

there and that. The the other folks that live there are many of them uninsured. There is something in your book that I just wanted to highlight before I get your response to that and this is a comment from Peter Swenson who is the executive director of the Family and Children Services on Nantucket and he says it's hugely it significant the vast different differences in wealth 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. Now I read that just to give people really a stark contrast of the income disparity so that you understand when you write about people inability to pay doctor leper rate and what how he operates with those people who

can't don't have the funds to pay. Talk to us about that if you would. Right and the disparity is not just that there are you know 10000 people who live there year round and 50000 who come in the summer who have. Some of them really just extraordinary wealth. What that does is the price of real estate is very high that has pushed up the price of really everything. Gas is more expensive. Groceries are more expensive so it's just an expensive place to live as a year rounder and many of the. Many of the jobs are are there to sort of support that summer population. So it's like many other kinds of tourist communities where in the in the tourist season people are generally you know able to be employed in construction or restaurant work or other kinds of tourist related industries in the off

season. It can be much harder especially in the last few years with the recession. And this affects the population in many ways it affects. How many people can you know continue to live on the island. It can affect the kinds of the kinds of health needs that they have. The other thing that that is kind of interesting is that just as we were talking about there's a huge diversity of medical situations that people run into. There's also. Very diverse your own population. There are a lot of people from different countries who have migrated there. They bring their own health situations sometimes medications that are not usually used or even approved in the United States. So it makes for a you know it's kind of a real microcosm of the United States in a very small place.

And it's the tensions and some of the. Struggles that people have to go through can be exacerbated by this division in wealth. And the thing about health care is expensive. Anywhere you go including on Nantucket. And so here are people who can who get sick as you know we all do any population. But they don't have the money to pay if they were in Boston. Maybe if it were an emergency they could go to the emergency room and be treated. But otherwise a lot of people get no care on Nantucket. They have Dr. Tim liberate often treating people without monetary payment. Right. One of the things I found also kind of interesting especially since Massachusetts of course is this is a pioneer of of near universal health care. A story that I covered when I was when I was based in Boston a few years ago is that Nantucket actually. Even with the new law does have a large number of people who are relatively large percentage of people who are uninsured or who have

no insurance that might require a larger or percentage co-pay for example of their care. And for them if they if they're getting sick you know one instance can can really make things difficult for them in the in the economics of their life. So Dr. leper will. You know basically let them pay what they can. One of my favorite stories is about a immigrant from South Africa who needed an emergency appendectomy and he had no money and he really wanted to pay something and so Doctor Labrie said well you know you work at this sandwich place and I think they they make these great oatmeal raisin cookies that I like. So just bring me a few of those every week and you know he did. People have offered him yard work. People have given him the guns because he's a gun fanatic. There's a whole chapter on this in the book. And you know if you have

a have a. 44 magnum you have no particular use for give it to Dr leprosy and next time you break your leg he'll fix you right up. That's just amazing Let me take a call. Michelle from Arlington Errington Rhode Island Go ahead please you're on the Carolyn Crossley Show. Eighty nine point seven WGBH Exactly. Barrington Rhode Island Barrington sorry OK. Oh no problem. I'm an operating there. I'm 57 now. But I did work in an active hospital when I was 22 in the operating room and everything else why I do have. A sense of what it must be like to be what it was like where almost the medical care was nonexistent and if you had to be airlifted or anything off hopefully the weather was good and that's the point that I did work at watchability Medical Center

and I now work with Doctor left brain but I work with some of his colleagues and he was a legend in Providence Rhode Island. I'm telling you if Venter's Spirit is on an excellent surgeon and I just wanted to say that people still talk about him that I work with and he was very loved and very missed when he left. So that's really just my comment. Sounds like he is the perfect person to work on Nantucket than he was and he is personality. From what I have heard seem to fit in perfectly to what I am when I work at the Cottage Hospital. One of the doctors there has died. He did. You delivered animals he delivered babies. He did everything and I was always impressed by that and I'm sure he's filling that void very very well. Michele before you leave us question the Supreme Court is hearing oral arguments this week about the Affordable Health Care Act. And

you know hopefully would allow more people to have some preventative health care if they decide to support it. But if it goes away and we don't know what the impact will be. But in fact what Dr. leper is practicing is a kind of old fashioned medicine that some people who had it long for and other people who didn't have it feel they've missed something even if they never had it. Well how do you respond to that. Well I think medicine is in a complete crisis. I worked in a surgery center where it is all about how much surgery you can do how quickly you can do it and how much money you can make I'm going to be very honest and I think because of that I I I'm I'm all for socialized medicine. I think. Everyone deserves to have the care that they can get and I think it's been ruined by the vast amount of specialty that I still see that don't fit that family practices.

So I you know you think that you can't go in the team and get into a family practice. Here I'm looking to change my position because he's older and it's very difficult to even find the family practitioner that has any opening. Everyone specializes thinking that they're going to make the most money and I think it's very sad. And I wonder sometimes how how how much abuse is really going on and you have a problem with your hand and go to surgery right away or do you really take the step that you need before surgery to make sure that that surgery is the answer and I wonder about that. I wonder about it. Michelle thank you so much for your call already. Thank you I enjoy your show. Thank you so much. We are talking about Pam Delex book PEMBELI as health and science writer for The New York Times. Her book is island practice and it's a profile of Dr. Tim leper who is on the line with us right now joining us on the line from Nantucket is

Dr. Tim Labrie himself. Thank you for joining us Doctor. Thank you very much Kyra. I'm very excited about this book it's so interesting and you seem awfully interesting in this book. I must say I got a compliment there from Michelle from Rhode Island. So she mentioned something that I think is key part of the discussion that is a part adjunct I guess to the Supreme Court oral arguments this week and that's a lack of what people call family practice what's known as primary care. You're actually not a primary care physician as Pam and I discussed in the first segment. You're a surgeon but you've you do a lot of primary care practice actually on the island. Talk to us about that and why you feel that's a mission that's what you should be doing. Well when I was in Rhode Island I primarily did surgery and on the logic surgery surgery for cancer and trauma. But I always got very interested in my patients because I think

between a certain and a patient is very special somebody is. Risking their life and I may have met you 15 minutes before and so I've always felt the obligation of any patient I operate on and when I moved to Nantucket I really got very involved with my patients through a whole series of things. I worked in the parents room. Very often I had my practice Mr. Tickell practice I had a big research going on and to wonder if these right I just extended it from that I mean I think what people need is a physician that is interested and is third in the last attrition that can be a family practice doc. It's somebody interested in taking care of a person. That's what I feel I do. I sometimes feel like I am. I was doing that windmill

when I go up against the powers that be. But you know my most important person the person I'm sitting right there and I want to you know if I want their blood work if I want to know a blood count I'll go over and get it done right away. I will look over and look at the X-ray because I want that patient to leave my office feeling that somebody gave it to him in short. And that's how I got involved that I mean surgery is wonderful and I love to operate. But that isn't all of taking care of patients. I mean actually operating the patient they're going back to their family and they have all of their other issues. Doctor you seem to have a go with the flow attitude about a lot of stuff that goes on on the island and some of your patients in in caring for them. We referenced underground Tom and Pam begins and ends the book with underground. He's a guy that built many underground places to live illegally but.

It was not issued to you you were just wanted to make sure that he was OK. Is that the kind how you have to sort of be if you're really going to be the doctor that as you say cares about the patients on Nantucket given how they live and what people are doing there. Well I think you have to participate in their lives you have to be interested in what they do or you have to know what they do for exits that you have to know where they live you have to know what you know what they do for work. These are all things that I think are important to find out about people. And that's what makes the whole fun of being out here and being in practice. I got to say I don't think I know another surgeon who would be tromping around in the woods looking for underground to make sure he's OK. He had a beautiful place of worship built one up at my house so nice and warm in the winter and cool in summer. One of the thing that you did that I think is really telling and you made a decision early

on that you wouldn't drink. I mean not that you were a heavy drinker but because you recognized your relationship with the community you always wanted to be in good shape talk to us about that. Well I think I had a certain responsibility coming out here at the surgeon because to a certain extent depending on the situation could do anything. And the thing is if you have a drink it probably doesn't pear you but I think that these are not the trick because then I feel that I can give my best in any situation I'm involved in addressing it when for example a patient company with a stab or a patient that has been the patient get a perforated ulcer I can feel that I am at my absolute best and so I don't drink. It also gives me an edge when anybody but I can always you know get up on my platform and and hold forth on the evils of drink.

That Woman's Christian Temperance Union sort of like Carrie Nation except I don't have a hatchet. You know I just and I've also I think the effects of alcohol you know and you deal with people in the state is tremendous. One of my roommates in college drank himself to death. I mean it was really the brightest guy I knew what Harvard drank himself to death and you know I think that I see the problems that arise with alcohol. Doctor we read we read Pam's book and look at that and just be tired reading about everything that you do and all the ways you treat people and how available you are. People come and buy the house in addition to coming by your office. What about this the way that you practice in the way that you have practiced for 30 years on Nantucket which seems all consuming really works for you. It just makes you feel good.

Well medicine to me I mean it's a vocation an avocation I mean there are. I like taking care of people I like helping people I like there are so many interesting things that happen tick borne diseases. I mean I when I moved to Nantucket I dropped into the middle of the beginning of the epidemic of Lyme but these and Alexia and so many fascinating things that happened and if I sat home and decided that my day off with my day off that I was going to come to the hospital I was going to pay attention I was going to answer the phone I've missed it. So it's you know I get patients phone number my phone number and stuff and they don't call me or if they do call me then it's important important to them and then I'll make an important myself. You're listening to eighty nine point seven WGBH an online of WGBH dot org I'm Kelly Crossley. My guest is Dr. Tim leper who's been practicing medicine on Nantucket year round for nearly 30 years. Dr. Levering is a surgeon at Nantucket

Cottage Hospital and my guest is also Pam Belloc health and science writer for The New York Times and we're talking about her forthcoming book island practice which profiles Dr. Tim leper. And you can join us at 8 7 7 3 0 1 8 9 seventy 8 7 7 3 0 1 89 70 now. Doctor I have to ask you about some of your interests you have many. But one of them is Pam and I discussed briefly in the first segment has to do with gun collecting You are as a very serious gun collector which she writes about but here's a part that I think people should know your exam rooms are named cold when Chester Smith and Wesson the bathroom has a name too. Peashooter inside are posters of Remington cartridges the Winchester repeating arms company and an Annie Oakley like figure holding a revolver a rack of arrows rests near the nurses station. Some people might take that a lot of deaths going on there but you're giving life and the rest of the rest of your existence. So how do you balance that.

Well I think my parents were very normal. My dad came back from the Second World War. We never went camping that he spent too much time in the campus and then to live they died when shooting with me once and got interested in the trap through a clay pigeon. I don't know I just have always had the interest from a mechanical and taking them apart and putting them together and the history I'm in now. I actually own very few in new farm so I have a lot of title beaters that I like to fix it up and put away. It's just an interest you know I have from 1849 Cole which was a gun that's not a cold firearm. Company and really and always were interested in making 11 1811 Springfield flintlock very early U.S. military find you know interesting things. They have some of your patients found this a little odd.

I've had one patient there here was upset about it. But other people find it sort of interesting. OK and I'm always available from the drop off old firearm. Now you've had such a long list of colorful characters that you've treated and I must say your character yourself as you look back over your years of treating patients is there one or two that stands out that you would like to tell us about. I think Pam mentioned in the book a gentleman that was quite attracted the force and he was he was a fascinating character. He had it would get drunk and become quite entranced with the animals. Not a particularly tasteful but. When he was sober he was it's a fascinating character. Talked it had a very extensive knowledge of firearms and

you know he had it about 20 years kept it a very very little. I mean it was an interesting guy. Just very fascinating character. I mean some of the people I've met out here are wonderful retired professors that are just fun to sit and talk to. We had a retired ambassador who retired out here and then started teaching school teaching seventh grade social studies. And I got to meet him through that through. He was an assistant football coach. I wonder for people with tremendous stories and you know all of a sudden you're asked the right question and they open up to you when you find it fascinating stuff. Well let me ask you about something that probably is not so fascinating to you and that is that Mass General Hospital has taken over the hospital where you work and neva offered something to most of the physicians that you have refused to join call the Massachusetts general

physicians organization and that means that the doctors get salaries and certain amount to cover management costs. It's looks like the rest of America as we say. But that's not how you want to practice so so far you said no. Are you feeling constrained by this arrangement now and you're still relatively young guy. Will you will you continue if you get feel more constrained as time passes. Well lacking one of the advantages of a gallant it's probably not cost effective for them to try and replace me. No I listened I sampled my staff that worked for me to neurosis. I usually have two nurse practitioners and all the other people the berk in my office and I pick them because I like them and I like to run my office the way I want to run my office. I really do not do well with people telling me I'm going to be 14 patients and that's it.

I prefer to see everybody act that it be thin that day. I just I don't fit into that I did that when I was at Roger Williams. I was on the faculty at Brown but I found academics authoritarian very restrained. Out here. I really have a certain amount of freedom that they don't happen in America. I find it's very enjoyable I think I probably would not. I'm a very square peg and wouldn't fit into the round hole back in America. One last question and when we know you're busy and have to go you're an avid runner you've run in many many marathons including the Boston one new one is coming up soon will you be there will you be right I'm going to be there there will be forty four in a row 44 in a row and I ask your time. Well. I probably will bring your flashlight. At a time when the sun dial. Ok back I let it for it was a time when I was a

contender. Well we appreciate talking to you and the next time I'm on Nantucket I'm going to have to stop by just to use the bathroom. Are you talking right. OK. When I talk to you nice to talk to you. We're talking about health care medicine and what it means and what it takes to be a good doctor. I'll be continuing my conversation with Pam Belloc author of the forthcoming book island practice. Her book Profiles Dr. Tim leper you just heard him who's been practicing on Nantucket for close to 30 years and I've been speaking with Dr. Lett leper who gave us a chance to talk to him despite his very busy day so I thank him for it. You can join us on the conversation at the conversation with the conversation at 8 7 7 3 0 1 89 7 8 7 7 3 0 1. Eighty nine seventy particularly if you live on Nantucket if you've been a patient of Dr. Lepore. We want to hear from you. 8 7 7 3 0 1 89 70 8 7 7 3 0 1 89 70 you can write to our Facebook page or send us a tweet this is WGBH Boston Public Radio.

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Welcome back to the Calla Crossley Show. If you're just tuning in my guest is Pam Belloc. We're talking about her forthcoming book island practice which is a story about Dr. Tim leper and what he means to the people on Nantucket. It is also a book that looks at what it takes to practice medicine in a time when the giant health care system is making it harder for physicians to deliver personalized care. Pam part of the title of your book the in the subtitle has to do with cobblestone rash We must discuss what that means so people will know what it is. Tell us about that. Right that's that's one of the Dr. leper isms a phrase that that I believe he has coined in Nantucket as many people know has this lovely downtown that is partly paved with cobblestones and cobblestone rash refers to injuries that people get when they when they fall on cobblestones and

frequently if they're out drinking at the bars or you know something late at night they may be more inclined to fall on the cobblestones So he's he you know fixes him up. And that's just one of the many. Kind of conditions that he has to that he encounters there. One of the things that is documented on any kind of island living in Nantucket is not an exception is you know an increase in alcoholism particularly you know in winter months when it's a very small population it's you know it's isolated. All of that stuff and you you heard Dr. Lepore talk about not drinking himself and also as a result of that being able to talk to other people about not drinking. How much is his influence how much has that influence been felt in that arena. Well I think for some people some of his patients it's been really almost lifesaving actually. There are there are people who

have. Problems with alcohol or other issues like that who have chosen to come to Dr leper even though he has no specialty in these areas because he they find him to be a good person to talk to and he has as you probably got it got a little bit of a taste of there when he was on the line. You know a very sort of straight shooting no nonsense approach. He sits people down he talks them without judgement but sort of very straight saying you know if you if you want to quit I can help you do that but you've got to make the decision to do that. And and I think people for some people it's just been very effective. There are several stories in the book about about people with issues like that who have turned to Dr. Labrie and he says he's you know he's helped them stay sober.

One of the keys it seems to me as you made clear in the book is that he's outside of practicing medicine quite involved in the community period. Talk to us about you know how intra girl his other life I mean his life is on the island in addition to the practice of medicine. Right well in addition to all the different medical has he wears He's also in his vast amount of spare time. He's on the school committee there he's been on the school committee I think for about 20 years. So he's very involved in issues that have to have to do with the schools of course that's you know vital part of the community there. The kinds of things that he's done with tick research is has he's basically taken built up a kind of almost singlehandedly an expertise in this very significant. You know batch of a batch of diseases that that occur on the island

but also of course elsewhere in the United States and he's become kind of an expert on it people call him from all over the country all over the world. And that's just because he sort of indulged this interest in capturing ticks picking them off deer lying in wait wait for them in in various places on the island. And that's just sort of another sideline of his that has really benefited people there. I think a lot of people may not understand if they they don't know about the damage or the harm that it to can do. How important it is. You know I was really taken with how he taught himself and expanded his expertise in this area because there are a vast amount of ticks on the many deer that traverse the I lament. And this is also an issue on any other island particularly with long grass and all of that so this is very important to the health and safety of the people who live there and the people who visit there.

Right and not just you know not just on the island I mean of course Lyme disease was was coined in Lyme Connecticut so so all over particularly the northeastern United States and Nantucket is interesting in that way because not only do you have this huge concentration of ticks they are a part of their life cycle involves the deer. It's a very it's an island the deer can't go anywhere. So so things become very concentrated ecologically which is why you have all these infected ticks and you have you know. Again sort of a you know the flipside of having all this beautiful unspoiled nature out there is that on the island you also have things that thrive in nature. And many people who go to Nantucket for the summer. May not really realize that they've been bitten by a tick or that they or that they've you know become infected so a lot of cases occur when people go back

home. And Dr. leopard has been very concerned with trying to educate people about about that and trying to inform their doctors when they get back home how to treat them. It's it's a sort of ongoing struggle for him. There are also a couple of you know most people heard of Lyme disease but there are a couple of other tick diseases be beezy osis and Ehrlichiosis and they can be fatal or very debilitating. So he's saved the lives really touch and go away of more than a few people who have come down with with your fatal tick disease. So let me ask you as we draw to a close here. The question that I asked him which is operating the hospital now is operating under a new arrangement with Mass General Hospital which means some corporatization some uniformity of the kind that he as he explained ran away from he can still operate you know

independently somewhat. But you know as a surgeon you need a hospital. So what what what would be the impact if he just gets to the point where that arrangement is just too constraining for him. Yeah it's a really interesting kind of marriage there between. Between the Mass General Hospital structure and the way Tim leper runs his practice it's you know as the CEO of the hospice the Nantucket Cottage Hospital says in the book you know it's a culture clash. And I think that the hospital realizes that they have somebody extremely valuable in Doctor leper and in fact they talk about it. Their nightmare is what to do when he needs to be replaced. It's going to be very very difficult. So you know they bridle at some of his his habits. You know they don't want to bring in guns into the hospital anymore they don't want to bring in his his dog

into doing ultrasound on the dog. You know they're they would they would love it if he would become a company guy. But they know he's not going to become a company guy. So they're they're sort of tolerating it and I think it's a kind of uneasy but you know an easy arrangement that's really born out of necessity and at least for the time being it seems it's seems to be you know continuing if he retires. I mean it really is going to be not only the end of a tradition but the end of something that a lot of people recognize is quite valuable and important. Thank you for sharing his story with us Pam. Thank you so much I really enjoyed it. We've been talking about Nantucket Health care about what it takes to get quality treatment in a time where medicine is becoming increasingly impersonal. My guest is Pam Belloc health and science writer for The New York Times. She's the author of the forthcoming book island practice. It's a profile

of Dr. Tim Lepper a one of a kind doctor who's been practicing on Nantucket for nearly 30 years. For complete Supreme Court health care coverage you can visit WGBH news dot org. Today's show was engineered by Alan Mathis and produced by Chelsea Murray's will Rose live an abbey Ruzicka This is the Calla Crossley Show a production of WGBH Boston Public Radio.