Being Mortal: Medicine and What Matters in the End

Now that’s the crux of the difference between Dr. Thomas and me.

 

The other three that were sitting in the room, their eyes were bugging out of their heads now, and they were saying, “Oh my God. Do we want to do this?”

 

I said, “Dr. Thomas, I’m into this. I want to think outside the box. But I don’t know that I want to look like a zoo, or smell like a zoo.” I said, “I can’t picture doing this.”

 

He said, “Would you just hang with me?”

 

I said, “You’ve got to prove to me that this is something that has merit.”

 

That was just the opening Thomas needed. Halbert hadn’t said no. Over a few subsequent meetings, Thomas wore him and the rest of the team down. He reminded them of the Three Plagues, of the fact that people in nursing homes are dying of boredom, loneliness, and helplessness and that they wanted to find the cure for these afflictions. Wasn’t anything worth trying for that?

 

They put the application in. It wouldn’t stand a chance, Halbert figured. But Thomas took a team up to the state capital to lobby the officials in person. And they won the grant and all the regulatory waivers needed to follow through on it.

 

“When we got the word,” Halbert recalled, “I said ‘Oh my God. We’re going to have to do this.’”

 

The job of making it work fell to Lois Greising, the director of nursing. She was in her sixties and had been working in nursing homes for years. The chance to try a new way of improving the lives of the elderly was deeply appealing to her. She told me that it felt like “this great experiment,” and she decided that her task was to navigate between Thomas’s sometimes oblivious optimism and the fears and inertia of the staff members.

 

This task was not small. Every place has a deep-seated culture as to how things are done. “Culture is the sum total of shared habits and expectations,” Thomas told me. As he saw it, habits and expectations had made institutional routines and safety greater priorities than living a good life and had prevented the nursing home from successfully bringing in even one dog to live with the residents. He wanted to bring in enough animals, plants, and children to make them a regular part of every nursing home resident’s life. Inevitably the settled routines of the staff would be disrupted, but then wasn’t that part of the aim?

 

“Culture has tremendous inertia,” he said. “That’s why it’s culture. It works because it lasts. Culture strangles innovation in the crib.”

 

To combat the inertia, he decided they should go up against the resistance directly—“hit it hard,” Thomas said. He called it the Big Bang. They wouldn’t bring a dog or a cat or a bird and wait to see how everyone responded. They’d bring all the animals in more or less at once.

 

That fall, they moved in a greyhound named Target, a lapdog named Ginger, the four cats, and the birds. They threw out all their artificial plants and put live plants in every room. Staff members brought their kids to hang out after school; friends and family put in a garden at the back of the home and a playground for the kids. It was shock therapy.

 

An example of the scale: they ordered the hundred parakeets for delivery all on the same day. Had they figured out how to bring a hundred parakeets into a nursing home? No, they had not. When the delivery truck arrived, the birdcages hadn’t. The driver therefore released them into the beauty salon on the ground floor, shut the door, and left. The cages arrived later that day, but in flat boxes, unassembled.

 

It was “total pandemonium,” Thomas said. The memory of it still puts a grin on his face. He’s that sort of person.

 

He, his wife, Jude, the nursing director, Greising, and a handful of others spent hours assembling the cages, chasing the parakeets through a cloud of feathers around the salon and delivering birds to every resident’s room. The elders gathered outside the salon windows to watch.

 

“They laughed their butts off,” Thomas said.

 

He marvels now at the team’s incompetence. “We didn’t know what the heck we were doing. Did, Not, Know what we were doing.” Which was the beauty of it. They were so patently incompetent that most everyone dropped their guard and simply pitched in—the residents included. Whoever could do it helped line the cages with newspaper, got the dogs and the cats settled, got the kids to help out. It was a kind of glorious chaos—or, in the diplomatic words of Greising, “a heightened environment.”

 

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