Dr. Tom Dean ’67 gathered good ideas from the greater world, starting at Carleton, then brought them home to South Dakota.
You can picture it: A little town on the prairie, set in a place where the glaciers carved out some hills and a path for water to flow through the surrounding farmland. A historic business district, town celebrations, and lore about long-ago thieves. Sounds familiar, right? No, this isn’t Northfield.
Drive five hours due west, though, and you will find its geological cousin, Wessington Springs, South Dakota. “My great-grandparents on both sides of my family all homesteaded in this county in the early 1880s. I grew up on a farm here and had a very typical rural boyhood,” says Dr. Tom Dean, ’67. “But somehow, I had a very poorly defined urge that there was something more out there. I wanted to have a broader experience.”
And so he left South Dakota—at least for a while. First stop: Carleton College. Despite a similar rural setting, Dean found the transition crushingly difficult. “There were about 30 people in my high school class, and getting all A’s there came relatively easily,” he says. “At Carleton, I was failing German. I thought I would major in math, but math wasn’t what I thought it was. I was lonely and a little intimidated by a lot of much more sophisticated classmates. I really thought there was a good chance I might go back to the farm.”
Dean stuck it out, thanks to a conversation he had with Thurlo Thomas, chair of the biology department. “He said, ‘The students that come from small rural communities usually end up doing well. But they struggle in the beginning. They’re perfectly smart enough, they have lots of common sense, and they’re willing to work. That’s what it takes. You can do this.’ I still remember coming out of that meeting, just walking on a cloud. That made a powerful difference.”
Dean decided to pursue medicine, in part because of the community he found in the biology department, but also because his uncle was a town physician; he could visualize a life as a country doctor. “Gradually, I developed friendships and did better academically, and Carleton ended up being a truly life-changing experience.”
A new way to think about medicine
Dean entered medicine at a pivotal moment: New treatments, technologies, and models of care were about to transform American healthcare. Midway through medical school in Rochester, New York, Dean traveled to London for a yearlong research project. There he observed a different way to be a doctor.
“Family medicine was a brand new idea here, but it was an old idea in Britain. They really emphasized that every patient needed a doctor that was their doctor, and that person would provide the care they needed or arrange for them to see specialists,” says Dean, describing a system that was unheard of here in the early 1970s. It resonated deeply. He wanted to have relationships with patients that he knew as people, not just symptoms. He also saw how healthcare access benefited British society. “It was pure socialized medicine, of course, which is a very negative term in this country. That’s very unfortunate, because their system basically worked; meanwhile ours was fragmented and inefficient, and not everyone could afford care.”
Dean realized that being open to new ideas could help him be a better doctor. As he finished medical school, a residency program began at the University of Washington, teaching the new family medicine model, with an emphasis on rural communities.
“Of course, that fit with my experience, and it just kind of evolved from there,” he says. In Seattle, Dean’s first rotation was obstetrics, and the head nurse, Kathy, “was kind of fearsome. She was the very first nurse that I met as a quivering, frightened young intern. But we got past that.” The couple have been married for more than 50 years.
The Deans moved to an isolated mountain region in Kentucky, where Dean joined the Frontier Nursing Service and Kathy trained in midwifery. By now, Dean had lived in two radically different rural communities, two major U.S. cities on opposite coasts, and England, experiencing diverse people and ideas at every point. And then an opportunity came up in South Dakota to practice the new model of family medicine—back in Wessington Springs.
“A community health center opened up with government funding to support a sliding fee schedule, so we could serve everybody, whether they had money or not. That appealed to me,” he says. “Also, South Dakota had just passed laws allowing nurse midwives to practice. Kathy became one of the state’s first licensed midwives and I became a doctor in my own hometown.”
Those prairie roots run very deep. As it turned out, the “something else” Dean thought he was looking for back in high school wasn’t someplace else; it was a new perspective. Beginning at Carleton, he gathered up the best new ideas he encountered, and then he brought them home.
“The most important thing I learned in college is there’s always another side to the story,” he says. “At Carleton, there was always somebody with a different idea. It gave me a much broader view of the world.”
“At Carleton, there was always somebody with a different idea. It gave me a much broader view of the world.”
His diverse experiences helped Dean become a caring, thoughtful, and skilled doctor, and a change-maker in his own hometown. Over the next half century, he reconnected with his South Dakota roots and helped improve the lives of his neighbors through access to modern healthcare. The Deans raised three children in Wessington Springs—and even sent a couple roots back to Carleton: a son, Dr. Carl Dean ’01, and grandson John Witte ’22. “People think it’s just a school for rich kids, but Carleton works hard to make sure that kids like my grandson, who comes from a farm background, can afford to go there.”
He also represented rural perspectives on the national stage, serving on the Medicare Payment Advisory Commission, a group of doctors, economists, and politicians that advise Congress on Medicare policy. “This program serves our huge country with its tremendous diversity,” he says. “Providing care in western South Dakota is very different than providing care in downtown Minneapolis. And yet we need to do it.”
Dean’s work has led to many recognitions, including Practitioner of the Year by the National Rural Health Association, the Robert Hayes Memorial Award for Outstanding Rural Health Care Provider, Family Doctor of the Year by the South Dakota Academy of Family Physicians, and a Distinguished Achievement Award from the Carleton Alumni Association. In 2023, he was inducted into the South Dakota Hall of Fame.
Across his long career, Dean has seen the transformative impact modern medicine has had on the lives of his patients—and experienced it himself, when he was diagnosed with multiple myeloma bone marrow cancer in 2008. “At that time, the average life expectancy after diagnosis was something like three to four years. I have been extremely fortunate and have benefited from some remarkable medical advances. I am still in remission after 16 years.”
Those extra years have been meaningful. Dean continued to work as a doctor into his 80s, only retiring a couple of years ago. He watched his grandchildren grow up. He and Kathy have been very active volunteers. “A small group of us worked to get Wessington Springs declared a Tree City USA by the Arbor Day Foundation,” he says. “The town is now one of 25 in South Dakota with that designation, and one of the smallest to do so. I’m proud of that.”
Those young trees help preserve the life-sustaining seam of green that Dean’s ancestors encountered on the prairie. Now, through his efforts, new roots reach across time and into the future.
Caring for the rural future
Wessington Springs, like many rural American towns, has lost half of its population since Dean’s childhood. He has watched, with great concern, the town lose young people and aspects of community life that made it such an appealing place to grow up in, and to come back to.
“This is a wonderful place in so many ways. There is sense of community and connection with our neighbors, and that is so very important. A couple years ago, the Surgeon General issued a report saying the biggest threat to the health of our society is loneliness, and I believe it. I see it,” he says. “I am especially worried about our young people. They are not developing connections. They are closing themselves off from other people and other ideas, and that ultimately harms society.”
“A couple years ago, the U.S. Surgeon General issued a report saying the biggest threat to the health of our society is loneliness, and I believe it. I see it. I am especially worried about our young people. Too often they are not developing those connections.”
Dean believes one solution lies in education. He has seen the broad liberal arts education he received in high school and college become smaller and more restrictive. “I am deeply connected with this small community and I have great affection for it. But there’s not always the willingness to examine more diverse ideas. And there is a real loss there,” he says. The perceived value of a broad college experience has also diminished.
“South Dakota, especially, has been very stingy in supporting higher education, and so college costs have escalated dramatically. The investment now is in vo-tech, or trade schools, where they teach only what’s needed to make money. They do a good job of it, and these are important jobs. But there is more to life,” he says. “If you’re really going to try to understand what’s happening in the society around you or in the world, you need to connect with new people and new ideas. You need to know something about history, culture, and literature. I didn’t do nearly enough of that in college, and now I realize it’s so important—I’ve kicked myself over that.”
Today, Dean writes commentaries for the online publication, South Dakota Searchlight. It’s one way he is extending new ideas to his neighbors, applying new ways of thinking to the pressing issues that impact life in South Dakota today. In them, he brings his doctor’s perspective to topics like the commodification of healthcare, escalating medical costs (South Dakota has the nation’s second-most expensive medical costs), the crisis facing rural hospitals, and looming specter of private equity, which he worries will diminish the quality of care and ultimately harm already vulnerable rural communities.
He also takes on divisive topics—as he said, there’s always another side to the story. He has written about gun violence, abortion, and cannabis, turning these complex issues around and considering them from multiple vantage points.
Dean encourages his readers to think about these issues a little more deeply, and to understand that what happens even in the smallest community is connected to everyone else out in the great big world. That’s something he learned at Carleton.
“Carleton is a community and the connections that people develop there are real and rewarding. I am still close to people I met there, and those connections extend outward to all kinds of good things,” he says. “I live in a very welcoming, positive, small community. Kathy and I say, ‘We’re here. We are home. We’re not leaving, ever.’ But we understand that it’s connections with others and the larger world that make our life better.”
Amy Goetzman writes about inspiring people for publications including MinnPost, Minnesota Monthly, Architecture Minnesota, Citizens League Voice, and others.
McNair Evans is a photographer based in Richmond, Va.