5 •A Better Life

In1991,inthetinytownofNewBerlin,inupstateNew

York,ayoungphysiciannamedBillThomasperformed
anexperiment.Hedidn’treallyknowwhathewasdoing.
Hewasthirty-oneyears old,lessthantwoyearsoutof
familymedicineresidency,andhehadjusttakenanew
job as medical director of Chase Memorial Nursing
Home, a facility with eighty severely disabled elderly
residents.Abouthalfofthemwerephysically disabled;
fouroutoffivehadAlzheimer’sdiseaseorotherformsof
cognitive disability.

Up until then Thomas had worked as an emergency
physician at a nearby hospital, thenear opposite of a
nursing home. People arrived in the emergency room
withdiscrete,reparableproblems—abrokenleg,say,ora
cranberryupthenose.Ifapatienthadlarger,underlying
issues—if,forinstance,thebrokenleghadbeencaused
bydementia—hisjobwastoignoretheissuesorsendthe
person somewhere else to deal with them, such as a
nursinghome.Hetookthisnewmedicaldirectorjobasa
chance to do something different.

Thestaff atChase saw nothingespecially problematic
abouttheplace, butThomaswithhisnewcomer’seyes
sawdespairineveryroom.Thenursinghomedepressed
him.Hewantedtofixit.Atfirst,hetriedtofixittheway
that,asadoctor,heknewbest.Seeingtheresidentsso
devoid of spirit and energy, he suspected that some
unrecognized condition or improper combination of
medicinesmightbeafflictingthem.Sohesetaboutdoing
physicalexaminationsoftheresidentsandorderingscans