Setting deep roots in the South Dakota soil: Tom and Kathy Dean of Wessington Springs

Tom Dean and I were residents together at the creation of the Family Medicine program at the University of Washington. He was one year my junior, and was a rock-steady farm kid from a place that I'd never heard of and couldn't imagine: Wessington Springs, South Dakota. A number of us in that new residency program had rural roots, but Tom's town seemed in many ways to be the most remote and alien. But all of us were by definition a bit weird for choosing a specialty as untested and improbable as family medicine, and only by cleaving together and supporting one another did we get our residency accepted in an academic medical center that knew little about either family medicine or rural towns.

Our group was also fortunate that Tom managed to dazzle one of the most important people in the hospital: Kathy, the chief obstetrical nurse. All of us were smart enough to know that the nurses were the ones really in charge of the wards where we spent countless hours, and when Kathy extended her grace and knowledge to our fledgling group of family doctors, we all prospered. Tom went further than the rest of us, married Kathy, and moved with her after residency to Hayden, Kentucky, where she became a nurse mid-wife.

When they finished their Kentucky stint, they moved back to Tom's ancestral home of Wessington Springs. There are now 6 generations of Deans who have been baptized ion the small country church near Tom's family's farm, and Tom and Kathy's daughter-in-law is the pastor of the church where the latest baptism occurred. Although Tom began driving tractors at the age of 6, rather than become a farmer he decided to follow in the footsteps of his uncle, who was the solo GP who helped create the remarkably strong and unified health care system that Tom and Kathy inherited and improved.

Over the last 35 years Tom and I have remained friends and colleagues, our bonds strengthened because of our mutual interest in rural health care. Tom has become one of the most influential rural doctors in the entire country, and in addition to the enormous responsbility of providing care to several small towns on this vast prairie, he is currently the first and only rural doctor to sit on Medicare Advisory Committee, one of the most important policy jobs in health care in the entire country. Kathy delivered the majority of children in the area over her career as a midwife, and now looks after Tom and the sixth generation of Deans, 5 of whom live in Wessington Springs.

Tom and I share another bond. He, like myself and Susan Schmitt, developed a rare and lethal cancer about 2 years ago - multiple myeloma. Tom had the same experience as Susan and I - collapsing unexpectedly in his very rural town, and surviving through pluck, luck, and the skill and compassion of family, friends, and the skills of some very good doctors. Tom at this point has gone through a stem cell transplant and is on continuous medication. But you would never know it if you saw him, and he has returned to his work in the clinic, hospital, nursing home, and conjugate care facility that he helped to build during his years in his town.

Trees are only as strong as our roots, and Tom's go deep into soil of this remote and productive land. From that soil he and Kathy have drawn not only strength and nourishment, but the wisdom and insight to devise ways for scores of other rural towns to continue to receieve superb medical care despite isolation and the inanity of our crazy-quilt medical care system. The winds are strong in South Dakota, but these sturdy souls will not be dislodged.