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Island Practice: Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor

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ISLAND PRACTICE was optioned for a television series by Imagine Television ("Friday Night Lights," "24") and Fox Television. Screenwriter is Amy Holden Jones, acclaimed feature film writer whose movies include "Mystic Pizza" and "Indecent Proposal."

ISLAND PRACTICE audiobook is now available! Read by talented actor Joe Barrett, who has also recorded William Faulkner, Tom Wolfe, John Irving, among others.

With a Foreword by Nathaniel Philbrick, author of the bestseller In the Heart of the Sea

If you need an appendectomy, he can do it with a stone scalpel he carved himself. If you have a condition nobody can diagnose—“creeping eruption” perhaps—he can identify what it is, and treat it. A baby with toe-tourniquet syndrome, a human leg that’s washed ashore, a horse with Lyme disease, a narcoleptic falling face-first in the street, a hermit living underground—hardly anything is off-limits for Dr. Timothy J. Lepore.

This is the spirited, true story of a colorful, contrarian doctor on the world-famous island of Nantucket. Thirty miles out to sea, in a strikingly offbeat place known for wealthy summer people but also home to independent-minded, idiosyncratic year-rounders, Lepore holds the life of the island, often quite literally, in his hands. He’s surgeon, medical examiner, football team doctor, tick expert, unofficial psychologist, accidental homicide detective, occasional veterinarian. When crisis strikes, he’s deeply involved.

He’s treated Jimmy Buffett, Chris Matthews, and various Kennedy relatives, but he makes house calls for anyone and lets people pay him nothing—or anything: oatmeal raisin cookies, a weather-beaten .44 Magnum, a picture of a Nepalese shaman.

Lepore can be controversial and contradictory, espousing conservative views while performing abortions and giving patients marijuana cookies. He has unusual hobbies: he’s a gun fanatic, roadkill collector, and concocter of pastimes like knitting dog-hair sweaters.

Ultimately, Island Practice is about a doctor utterly essential to a community at a time when medicine is increasingly money-driven and impersonal. Can he remain a maverick even as a healthcare chain subsumes his hospital? Every community has—or, some would say, needs—a Doctor Lepore, and his island’s drive to retain individuality in a cookie-cutter world is echoed across the country.

288 pages, Hardcover

First published June 5, 2012

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About the author

Pam Belluck

5 books33 followers
Pam Belluck has been a staff writer for The New York Times for more than fifteen years. She served for more than a decade as a national bureau chief, and has covered big breaking stories; investigated problems with food safety, public housing, and health care; reported from places as diverse as Colombia and South Korea; and written about subjects as diverse as cattle rustling, embryo adoption, and the place with the longest name in America: Lake Chargoggagoggmanchauggagoggchaubunagungamaugg.

She currently writes about health and science. An award-winning journalist, she has also won a Knight fellowship and a Fulbright. Her work has been selected for The Best American Science Writing and The Best American Sports Writing anthologies, and she was profiled in Current Biography magazine.

Belluck also plays jazz flute and composes music, and her jazz group, Equilibrium, plays regular gigs in New York City. She has been appearing in "Island Jazz" events, which combine musical performance with conversations about writing, journalism, and Island Practice. These events were featured in an article in The Writer magazine and mentioned in JazzTimes.

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5 stars
161 (22%)
4 stars
293 (41%)
3 stars
197 (27%)
2 stars
41 (5%)
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12 (1%)
Displaying 1 - 30 of 110 reviews
Profile Image for Christina.
50 reviews
August 12, 2012
I loved the concept of this book - year-round rural doctoring on an island known as a summer playground for the rich. But the organization was b-a-d. I felt like I was reading unedited notes. Very repetitive and lots of "This guy is so eccentric! He has weird hobbies! Here is what a celebrity has to say about him. Also, here is a bad pun!!" Yech.

Would have made an outstanding New Yorker profile, fell flat as a book. On the plus side, I learned a lot about tick-born illnesses. Did you know that you can get three tick-born illnesses from a single tick on Nantucket? Neither did I!
Profile Image for Jennifer Hummer.
Author 3 books131 followers
May 22, 2012
Island Practice by Pam Belluck is a nicely drawn biography of the infamous Dr. Lepore, the landmark doctor on Nantucket. Belluck writes with an overall sense of admiration for the doctor, even while describing some of his most controversial tactics. She makes it clear that the islanders feel this same admiration. The reader, however, might not. Dr. Lepore may make house calls and deliver emergency C-Sections, but he also allows islanders to live in underground caves and have sex with animals. Whether you like him or not, however, Dr. Lepore is an engaging and eccentric character, and one well worthy of a biography.

Belluck has certainly done her homework. Her interviews with key figures are short and to the point, and perfectly placed. She does a great job recounting each one of the sometimes strange, sometimes heroic situations the doctor finds himself in. Her readers are sure to come away with an entirely different image of Nantucket. In fact, it’s almost impossible to recognize the Nantucket of the uber-wealthy summer goers inside these pages.

Island Practice is part survival guide, part snap shot of one of the most beautiful and unique places in America. I chose to review this book because my father was raised on Nantucket and my grandmother lived on the island until her dying day. An uncle and cousin still reside year-round and I imagine remain ever grateful for Dr. Lepore.
Profile Image for Georgen Charnes.
Author 3 books7 followers
June 2, 2012
I couldn't put this book down. Granted, I'm a Nantucketer, so it was especially riveting to read about people I know or might know in the future, and to find out more about Dr. Lepore. But even with that added attractions, this was a truly interesting and well written book. It never seemed to bog down in too much detail, or be too sketchy.

I could see this book as the basis for a television series, a cross between House, Northern Exposure, and Doc Martin. Dr. Lepore is a challenging character... argumentative, honest, competent, and compassionate in turns. As someone who's been under his knife (not obsidian), I found his ability to have an interesting conversation and tell a joke to be a stress-reducer.

It very accurately captures the atmosphere of Nantucket, positive and negative. Nantucket is a small community with plenty of characters, both beholding to and resenting the extremely wealthy who surround us. One thing I like about the book is that it focuses on the lives of the year-round, working class people rather than the rich people. Too often anything about Nantucket seems to reflect the idea that it disappears when the tourists aren't here, a perspective as immature as a child surprised to see a teacher at the grocery store. I especially liked the discussion about the hospital being bought by the mega-corporation... it's a crucial issue in a small town in a world that's getting smaller and more regulated all the time.
Profile Image for Julie Flygare.
Author 2 books44 followers
January 4, 2013
Island Practice is the mesmerizing story of Dr. Tim Lepore, the only surgeon on Nantucket Island. Thirty miles off the coast of Massachusetts, Nantucket is best known for its beaches, red pants, and sky-high real-estate prices, but author Pam Belluck reveals a different side of the island, a diverse year-round population with quirky medical problems and a doctor as quirky as his clientele. Dr. Lepore does not shy away from mysterious strange cases - including two cases of narcolepsy with cataplexy.

This is a highly recommended read for anyone who enjoys non-fiction. You will laugh at times and feel heartbreak at other times. Thank you, Pam Belluck for uncovering this fascinating story.
Profile Image for Shawna.
116 reviews1 follower
March 6, 2015
It was interesting to hear about Nantucket, especially since I have been to nearby Martha's Vineyard. It is also fun to learn about such an amazing doctor. I am always amazed there are not more people like him. He reminded my husband of my grandfather, Pop that was very knowledgeable, could fix nearly anything, and would make a tool to get the job done if he couldn't find one.

A coworker of my husband's knows the author of this book. This my husband learned after telling his co-worker, that frequently visits Nantucket, about the book. It is a small world.
Profile Image for Fredsky.
215 reviews6 followers
November 2, 2012
This was interesting at first, but became repetitive and boring. How could a book about such a diverse, eccentric, larger than life genius doctor practicing on Nantucket be boring? Ms. Belluck praised him too much. She didn't tell enough stories about him to support her awe. If she had written a book of anecdotes and left the readers to feel the awe and curiosity and annoyance on their own, it would have been a terrific book.
101 reviews
September 12, 2012
If you have any affilation with the island (meaning Nantucket, not MV)...you will enjoy this peak into the real life of a few islanders. Being made into a series!!!!
220 reviews
October 16, 2012
Combination of an interesting character's story, as the island MD, and the great differences in medical practice on an island.
Profile Image for Anne.
156 reviews
July 4, 2012
Island Practice, Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor by Pam Belluck (2012)

Dr. Tim Lepore (rhymes with peppery) left his mainland emergency medicine practice in Providence, Rhode Island to raise his family and tend to the people of Nantucket, MA. When he served a shift in the cottage hospital on the island one summer, he thought that trading the mean streets and mayhem of Providence in the 1980's for the quiet beauty of an American vacation paradise would be a gamble worth taking. Thirty years later, Dr. Lepore is such a fixture on the island, so legendary, and so deeply eccentric, that New York Times reporter Pam Belluck has written a book about him, his doctoring, his relationships with his patients, his service to Nantucket, his medical triumphs and tragedies. The good doctor is made in a mold that may have existed more commonly before managed care pushed patients and doctors into a few minutes of allotted time. He is the kind of doctor baby boomers remember having when they were young or heard about and wished they had. Dr Lepore has time to pay attention to his patients; he knows about their personal lives; he listens and he isn't afraid to tell the unvarnished truth to them. Dr. Lepore is no warm and fuzzy TV doctor like Marcus Welby, MD, though. Lepore is blunt, his bedside manner is more Dr. House than Dr. Welby. His waiting room is filled with heads of game he has shot and other evidence of his strange hobbies: "skulls, arrowheads, snake skin, turtle shells, fish jaws, and antlers." (17)

Chapter 1: Dr. Lepore is crashing through the underbrush on the island trying to find the "twigaloo" of Underground Tom, a homeless man who squats wherever he can remain undetected and builds tree-houses, underground bunkers or twig houses to live in until the authorities toss him off public land. The doctor makes house calls to Tom, if he can only find the well-hidden hovel. "Lepore allowed Johnson to pay his medical "fee" by providing informal advice about fashioning arrowheads." (17)

Chapter 3: Dr. Lepore makes scalpels out of obsidian by using a flint-napping method used in the Upper Paleolithic era and he uses them to perform surgery. (47) This method is discontinued when the health department objects to the method of sterilization used on the volcanic glass scalpels.(48)

Chapter 4: Moby-Tick. Dr. Lepore is an interesting mix of politically conservative ideas (pro-hunting) and libertarian ideas - he refers patients with severe pain to an island hippie who makes marijuana cookies. In Chapter 4, Lepore's practicality goes against the beliefs of the liberal segment of the island's population. Nantucket has a very high rate of tick-borne illness: Lyme disease, babesiosis and anaplasmosis (65). Lepore has educated himself to become a leading authority on tick-borne diseases and he thinks that the most effective way to combat the disease is to kill more deer which are the hosts for the infected ticks. Naturally that opinion does not go over well in Nantucket even though almost every resident or visitor has been infected or known someone who has been. The part-time population of celebrities and others who own summer cottages don't seem to like to hunt or to let anyone else extend the hunting season on Bambi. Lepore prints out bumper stickers ironically proclaiming "Save Our Ticks!" "Honk If You Love Ticks" (68).
It's a town hall confrontation we have seen here in New Jersey often enough.

Island Practice is a fascinating portrait of an eccentric, but highly capable doctor devoted to his community and his patients.

Readers who enjoy medical memoirs, biographies and popular non-fiction might also like:

The Immortal Life of Henrietta Lacks by Rebecca Skloot

Every Patient Tells a Story by Lisa Sanders


Profile Image for Liralen.
3,340 reviews275 followers
September 17, 2016
I've read my fair share of medical memoir, but this is not medical memoir: it's a biography, or at least an extended profile, of a doctor written by a journalist.

Tim Lepore has been the resident surgeon on the island of Nantucket for decades. It's a somewhat isolating job, but it gives him the chance to play cowboy—to flout convention and go his own way. (The book argues that he's not a cowboy because he's very careful about safety and so on, but I'd argue that you can be a 'cowboy' while still being mindful of safety.) He's obsessed with guns and ticks and arcane history. He's generally beloved on Nantucket.

He sounds like a character...but it doesn't make for that interesting a book. It seems that this project started with an article, and though I think I would have enjoyed a long article, I ended up finding the book something of a slog. It's perfectly good writing (which decided me between two and three stars), but...I don't know. In some ways the book is presented as an investigation into an unusual community—isolated not only by distance but by ocean—but I think I would have preferred to read something where the focus was spread around more characters. Two hundred and seventy pages of peppery Lepore was at least a hundred pages beyond my interest.

Review written November 2015; revised September 2016 to correct a typo.
Profile Image for Kurtbg.
701 reviews19 followers
February 23, 2013
This book chronicles the journey of a New England doctor who becomes unsatisfied with the industrial revolution ideals of mass production applied to one of the few noble endeavors of mankind - the caring and treating of humans. Boxed in by the profit-focused and quick-lube approach to medical brought on by the introduction of HMO between care-giver and care-needer an opportunity opens up for Tim Lepore on the island of Nantucket. There, medical facilities and staff are minimal allowing him to practice across all medical disciplines and peculiar needs of the island's residents and the visiting vactioners and elites. What is the role of a physician? How are they best supported to provide care? How much personal interest should be invested versus a detachment to treating a nameless body is the best method to provide care? These aspects are all brought to light as Dr. Tim, a self-professed (and eccentric) libertarian provides thought through actions and commentary.
Profile Image for Grant Sanders.
57 reviews1 follower
December 19, 2012
I am a former (and perhaps future) patient of the doctor in this book, Tim Lepore, and the stories spun here are all true and very entertaining. I found myself laughing out loud at parts. Tim is a larger-than-life figure on the island. Eccentric. Brilliant. Hard working. A vital part of the community. I found the book to be a little scattered and would have appreciated a slightly more linear approach to telling Tim's story, but overall, it was quite enjoyable. The only downside of this experience was the narrator in the audio version, who did his best to make everyone who lives on Nantucket sound like a back-water r-smearing hick. Not everyone here speaks with a folksy fishing-village New England accent. (Although, admittedly, some do.)
Profile Image for John.
2,154 reviews196 followers
June 21, 2012
A disclaimer that my parents have been patients of Dr. Lepore's since he arrived on the island a generation ago. I've never met him myself.

I wasn't as interested in the doctor's personal details - there are a chapter each on his growing up, and his wife and kids - as about the island in general. Definitely recommended for the discussion of the challenges of practicing on an island, where fog can be a serious problem in terms of getting emergency patients to the mainland, as well the discussion of mental health issues in a community where everyone (pretty much) knows everyone else.

Profile Image for Erin.
124 reviews8 followers
August 15, 2012
A fascinating glimpse of what it's like to live and work full-time on Nantucket. Not exactly a storybook picture. An island-wide epidemic of Lyme Disease, extremely high rates of substance abuse and suicide, and population of people who seem to be just outside the definition of "normal". All of them rely on one doctor who is not exactly normal himself. But the island couldn't make it without him. Well-written and interesting, now I'm not so disappointed that we didn't get to visit Nantucket on our vacation! I feel like I've been there just from reading this book.
Profile Image for Agnes.
1,635 reviews1 follower
August 11, 2012
Suggested by one of our librarians, this non-fiction tale of a doctor pracricing on Nantucket was a real eye-opener. Is there really such a doctor out there who puts his patients first and not the almighty dollar? I can see how the locals are becoming worried as to who will follow when Tim Lepore decides to retire,

These stories are interesting and keep attention, without being preachy or too fr over the limit.
178 reviews
October 23, 2012
Very nicely written non-fiction book about a small town doctor doing big things on the island of Nantucket. After reading this book and learning about the huge problem they have with tick-borne diseases there I will no longer be envious of Martha Stewart or John Kerry's vacations in Nantucket. Nope. You can mark that off my list of places to go. Great book with lots of human interest stories of the town doctor. Interesting read!
122 reviews
February 22, 2013
I bought this book for my spouse to read; but I could not resist reading this true story about Tim Lepore, M.D. from Nantucket.
I have met this man many times and I love the island where he practices! This is such a great story about a wonderful, eccentric, committed physician. The author's "take" is wonderfully refreshing.
I actually felt like I was a part of Dr. Lepore's world!
Profile Image for Debbie Manning.
60 reviews5 followers
June 6, 2013
Thank you Goodreads and author, Pam, for a wonderful read. I love Nantucket, and it was a real treat to read about people who make it their year round home. Dr. Tim is an amazing character. I think he should be cloned to replace most physicians practicing today! I hope to look him up on my next Nantucket adventure and bring him some roadkill.
Profile Image for Jennifer.
127 reviews
August 14, 2012


Great book about a great place and evidently a great man. I have always enjoyed Nantucket and this book show the complex nature of this amazing place. Good luck to Dr. Lepore and the citizens of Nantucket.

Seriously, read this book
855 reviews8 followers
August 31, 2012
The dark side of Nantucket. Its not the island paradise most people perceive. The chapter on teen suicides was especially depressing. Tim Lepore seems a bit "off", but he is often praised as a great doctor. Interesting read, but it did occasionally drag.
Profile Image for Leeann.
94 reviews
January 5, 2013
This was a facinating biography of an island doctor and Nantucket. I learned about ticks and their diseases and about the lives of those that live on Nantucket. It was hard to read before bed because I wanted to stay up and read one more chapter.
102 reviews
February 2, 2013
Sam and I have worked with this doc on Nantucket for >20 years. He's a great and really unique guy. The book is a good read, and an accurate portrayal. He really does have a jackalope drinking beer in his waiting room!
Profile Image for Ann.
165 reviews
February 26, 2013
What an interesting and well-written book. Dr. Lepore is a unique person, so stays focused and independent for the welfare of his patients. He has a few quirks. Pam Belluck is a very good writer. Will look at the NYTimes for more written by her.
Profile Image for Nora.
497 reviews
March 8, 2013
This was a great book about a fascinating doctor and his practice. It's a light fun read that is about the real people who live on Nantucket year round. After reading so much Elin Hildebrand, it's an interesting contrast.
Profile Image for Amy.
121 reviews16 followers
July 30, 2013
A serious book about a serious way of life. Learned a lot about modern medical practice in a remote setting & the people who live there, languishing both in their own problems and their love of the island.
67 reviews
July 11, 2012
It was a very interesting look into the life on Nantucket and Dr. Lepore who certainly is a very unique character and vert important person to the island.
Profile Image for Piepie.
51 reviews
July 12, 2012
A nice taste of life on an island as seen through the practice of Nantucket's primary surgeon & general practitioner. Dr. Lepore is an interesting man. Personally, I wish he was my doctor.
Profile Image for Denise Hoecker.
165 reviews1 follower
October 8, 2012
The book was really interesting but it jumped around a little too much for me to always follow. I do like how Dr. Lepore was portrayed and enjoyed how he is eccentric.
Profile Image for Jennifer.
806 reviews43 followers
September 17, 2012
This doctor is weird, but is going all out for his patients-anyone who needs him regardless of ability to pay. I wish their were more like him!
Profile Image for CJ.
135 reviews
October 13, 2012
The character was truly interesting and the writing drew you in, but the organization was lacking. In dire need of better editing.
Displaying 1 - 30 of 110 reviews

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