Up the hill from Nantucket’s hospital, the epicenter of saving lives on the island, sits a house with a startlingly voluminous collection of implements invented to kill. Guns — some 200 rifles, pistols, shotguns — are stashed in a basement safe and vault, a locked upstairs cabinet, and even a locked wooden box labeled “dog toys” in the kitchen. More surprisingly, the house belongs to a man who handles a vast portfolio of the island’s healthcare needs: Timothy J. Lepore, surgeon, family doctor, hospital medical director, tick disease expert, school physician, medical examiner, informal psychologist, and occasional unofficial veterinarian.

It’s not the only way that Lepore, 68, the subject of my book, Island Practice, is a colorful, contrarian anomaly. In a world of corporatized health care, where doctors’ time with patients is logged in “relative value units,” Lepore is a never-say-no physician who accepts payment in oatmeal raisin cookies, lets patients bring themselves, or their animals, to his home at all hours, and makes house calls, even to a hermit squatting illegally in swampland whose house is a “twigloo” made of vines. Lepore stole hospital supplies to treat a horse with suspected cyanide poisoning in the middle of a field. He commissioned a pot-smoking patient to illegally bake marijuana cookies for cancer sufferers. And he’s subjected himself to threats by being perhaps the only doctor between here and Boston to perform abortions, though he is ideologically against them.

But in Massachusetts, bluest of blue states, being a gun fanatic and National Rifle Association member is in its own category. Lepore not only listens to Rush Limbaugh but plays Limbaugh for his dogs. He protects his guns with tear gas on a tripwire, once accidentally tear-gassing the island fire chief in the face. His doctor’s office is decorated with a pistol, pictures of muskets, and posters of ammunition. His exam rooms are named Colt, Winchester, Smith & Wesson; the bathroom is named P-Shooter. “Guns: I never met one I didn’t like,” Lepore muses. “They’ve all got panache.” Lepore takes his guns hunting or to the police shooting range as often as he can. And “if I can’t go out shooting for a variety of reasons — social, political,” he says, he’ll fire air rifles at a mattress affixed to a basement wall. He even made a “potato gun” out of PVC pipe, a long white tube resembling a rocket launcher that can fire anything from russets to Idahos.

A gun hobby like Lepore’s can seem even more jarring now, in the shadow of the terrifying massacre of 20 schoolchildren and six educators in Newtown, Connecticut, the mass shootings in Aurora, Colorado, and Tucson, Arizona, and other frightening cases of gun violence. Lepore is repulsed and shaken by these events. After Newtown, he emailed me: “There is no explanation for the horror of the shooting.” He understands the mounting anti-gun sentiment, and he favors stricter screening of gun buyers. He’s less convinced about tightening gun laws in other ways, saying that some places with “loose gun control,” like Vermont, have had “no real issue,” while what he calls Chicago’s “draconian gun laws” have not prevented a steady loss of life. He also faults video games as “unneeded stimulus for adolescents who cannot tell real from video,” and movies in which we never see the aftermath of real shootings. “We desensitize our youth with these things and expect them to under- stand the difference. Glamorize thug life and not the real things of life.”

Lepore knows that his gun passion strikes some as contradictory and offensive. But to him, they represent some of the same values that drew him to Nantucket 30 years ago: history, ingenuity, independence. Nathaniel Philbrick, the author and Nantucketer, also thinks guns allow Lepore to connect with a segment of the population that he thinks most doctors would not otherwise have interaction with.

Lepore is not much for railing about self-defense or the Second Amendment. He’s not an expert marksman, and he’s a lackluster hunter. But he loves to shoot, and he loves the stories behind his guns. Pepperbox revolvers from the California Gold Rush. Civil War era single-shot-action Ballard rifles. An M1 Garand, the first semiautomatic rifle to become regular army equipment.

There’s a Browning Superposed shotgun called an Over/Under, a 1920’s German “Bolo” Mauser semiautomatic pistol, and several Russian Mosin Nagant sniper rifles. Lepore has a Smith & Wesson double-action revolver that belonged to his maternal grandfather, a Greek man who disapproved of his daughter dating Lepore’s Italian father. Had he lived until the wedding, “this was the gun that my grandfather would have used to pop my father,” Lepore believes.

And Lepore still has his first gun, a Marlin .22 lever action Model 39A that his father gave him when he was 16. Lepore’s father was disinterested in weapons but Lepore loved them all, starting with BB guns he used to shoot flies and then pigeons from the roof of their house in Marlborough, Massachusetts, and branching out to a bow and arrow he used to hunt frogs in a swamp. Now, he carves bows and arrows, and prehistoric spear-throwers called atlatls.

But he can never have too many guns. Amid crazily-piled stacks of books and such oddities as didgeridoos, Lepore grabs a Winchester Model 97 shotgun, pumps it, and says “You hear this, you best be behaving yourself.” Caressing a rifle with a rear sight known as a tang sight, he grins. “I am a [sucker] for tang sights.” Hoisting another, he boasts, “I could shoot a dinosaur with this thing. You don’t see any dinosaurs on this island, do you? I’d like to think I can take some credit for that.” He loves refurbishing guns, scrounging up obscure parts. And he makes bullets, melting lead and other metals, something he used to do in the hospital near the emergency room. Occasionally he’ll still bring guns into the hospital, if he’s hunting or shooting when a medical emergency occurs. It’s illegal to leave them in his car.

Despite Lepore’s goofy bravado, he isn’t reckless with guns. In fact, he believes shooting guns takes such care and precision that it’s the only activity that requires as much concentration as performing surgery, “controlling where you want to hit, doing it right, and doing it repeatedly.” Lepore says shooting helps keep him from constantly rethinking his last surgical operation, second-guessing whether he did everything he could have for his patients. And when he hunts, he doesn’t have to try to “fix anything I’ve shot,” he says. In that realm, it’s okay for him to let a living thing die. “If I’m shooting, I’m not thinking about operating,” Lepore says. “Shooting, I’ll tell you, it sort of wipes the slate clean for that period of time. The stress, when I’m shooting—that all falls away

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