Atul Gawande in The Telegraph:
In 1991, in the tiny town of New Berlin, in upstate New York, a young physician named Bill Thomas performed an experiment. He didn’t really know what he was doing. He was 31 years old, less than two years out of family residency, and he had just taken a new job as medical director of Chase Memorial Nursing Home, a facility with 80 severely disabled elderly residents. About half of them were physically disabled; four out of five had Alzheimer’s disease or other forms of cognitive disability. Up until then Thomas had worked as an emergency physician at a nearby hospital, the near opposite of a nursing home. People arrived in the emergency room with discrete, reparable problems – a broken leg, say, or a cranberry up the nose. If a patient had larger, underlying issues – if, for instance, the broken leg had been caused by dementia – his job was to ignore the issues or send the person somewhere else to deal with them, such as a nursing home. He took this new medical director job as a chance to do something different. The staff at Chase saw nothing especially problematic about the place, but Thomas with his newcomer’s eyes saw despair in every room. The nursing home depressed him. He wanted to fix it. At first, he tried to fix it the way that, as a doctor, he knew best. Seeing the residents so devoid of spirit and energy, he suspected that some unrecognised condition or improper combination of medicines might be afflicting them. So he set about doing physical examinations of the residents and ordering scans and tests and changing their medications. But, after several weeks of investigations and alterations, he had accomplished little except driving the medical bills up and making the nursing staff crazy. The nursing director talked to him and told him to back off. ‘I was confusing care with treatment,’ he told me. He didn’t give up, though. He came to think the missing ingredient in this nursing home was life itself, and he decided to try an experiment to inject some. The idea he came up with was as mad and naive as it was brilliant. That he got the residents and nursing home staff to go along with it was a minor miracle.
…Thomas believed that a good life was one of maximum independence. But that was precisely what the people in the home were denied. He got to know the nursing home residents. They had been teachers, shopkeepers, housewives and factory workers, just like people he had known growing up. He was sure something better must be possible for them. So, acting on little more than instinct, he decided to try to put some life into the nursing home the way that he had done in his own home – by literally putting life into it. If he could introduce plants, animals and children into the lives of the residents – fill the nursing home with them – what would happen?
More here.
