Friday, March 27, 2020

Dr. Leslie Robinson:Fille rencontre garçon; La femme rencontre l'homme

Leslie Robinson, M.D.
(from a 1983 clipping

as she joined the staff)
She was eleven when she initially met her new minister’s son at the Valley Forge Presbyterian Church. He was four years older, and she didn’t really “know” or “like” him then, she said. Years passed, and during the summer before her junior year in high school, they met again. He had just finished his sophomore year at Harvard and was hired to paint her parents' house. 

Leslie knew him as “one of the three Jensen boys,” and Lynn knew her as “one of the three Robinson girls.” As he carefully painted, she carefully watched. He was cute, she thought to herself. She offered him a cool glass of lemonade. And while she was “reading” she quietly moved around to where she could see him. 

Of course, she knew that he was “totally unattainable” and that what she was feeling was just an “infatuation.” Nothing happened, and he returned to Cambridge. 

But the next Christmas, she dragged her younger brother to “the manse” (the term for a Presbyterian minister’s house). She was a little more confident now; maybe the scholar-painter would join them in caroling. He did.

So, as the story unfolds, and with a twist on the tired formula: Girl meets boy. Girl meets boy again. Girl meets boy once more. (And, as we will see, they stay together.)

The girl? Obstetrician/Gynecologist, Dr. Leslie Robinson. The boy? Emergency Physician, Dr. Lynn Jensen. They practiced medicine in York, Pennsylvania, and are both retired. Leslie, now 66, left medicine five years ago. 

She trudged 35 minutes through new wet slushy snow one Saturday afternoon to sit in my living room and tell me her tale. The fireplace was going, I brewed her a small pot of my favorite English tea, and our dog Toby (a Blenheim-colored “Cav”) sat on her lap, pleading for attention. 

After breezing through high school she thought she wanted to go to Radcliffe. She didn’t get in, but she had several other good choices; Penn State was too close to home, and Wellesley was “all women,” so she decided to go to the University of Michigan, where she was accepted into the Honors College. She thought of going into teaching, like her parents.
It just so happened (surprise!) that Lynn was in his first year at the University of Michigan medical school. They got together (that wasn't the plan when she decided to go to Michigan), and one day he took her to the lab showed Leslie the cadaver he and his partners were slowly taking apart for their anatomy studies. 
The University of Michigan, Ann Arbor
When she looked down at the opened-up lifeless grey body she saw how “cool it was that everything fit together.“ With that, she recognized that she had the ability to think three-dimensionally. And that’s when, she told me, she was “bitten by the bug.” 

So she put “physician” on the short list of what she might want to become, adding this to, maybe, being a teacher, or a psychologist (or perhaps she could squeeze in all three). 

Leslie majored in Botany (there was no Biology major), took the required premed courses, and applied to medical school.  She and Lynn were already married by that time, and they had to coordinate her school choice with his residency. She said that things were “pretty competitive back then” but she applied to the one school they were both most comfortable with. She became one of only ten women in the entering class of 100 at Penn State Hershey that year. 
Matthaei Botanical Gardens at UM
It was 1975, more than a decade into the “second wave” of the feminist movement (concerned with equality between the sexes, not just voting rights). She felt “honored and privileged” to be accepted into a discipline that was dominated by men. 

But Dr. Robinson told me that while she certainly was, and still is, a feminist, she is “not a radical feminist.” She said that even now she “can't remember feeling overt prejudice” (that she was a woman in a man’s field).

I asked her how she came to her chosen focus within medicine. She said that she was first exposed to women’s healthcare issues when she was a student in Ann Arbor. She volunteered at a rape crisis center where she was trained to help women who had been assaulted. It was here that she became acutely mindful of the emerging and controversial birth control and abortion issues.

She said that she had not been raped, but that she was motivated by a frightening experience she had as a college freshman. One warm evening she was walking from her dorm to meet Lynn (who lived off campus) when a car slowly passed by her and then circled back several times. The men whistled at her and she was “scared shitless.” 

She reacted quickly. She ran as fast as she could and stumbled down an embankment to an empty parking lot to escape. She could breathe normally again only after she spotted Lynn heading towards her. 

While in medical school, Leslie was “on the fence” between going into pediatrics or obstetrics and gynecology, the only rotations where she “didn’t mind being up at three o’clock in the morning” taking care of patients. 

But as she did her brief OB stint at the York Hospital (where Lynn did his internal medicine training and was already working as an Emergency physician) she “loved it.” She did 18 deliveries as a student (an unusually big number, she said) and she enjoyed being in the operating room. However, she wasn’t confident that she could be a part of that world. While she cherished the OR experience, she also loved all of the other aspects of caring for women. 
Nicolas Simon, M.D.

The York OB/GYN residency director, Dr. Nicolas Simon (1935-2016), took a liking to her as a student, and he later facilitated her acceptance into the program. And only two weeks into her rotating internship she “knew” that she made the right decision as she soon “could (confidently) do a C-section.” Though 95% of gynecologists at that time were men, this was clearly destined to be the specialty for Leslie.

She “loved” delivering babies, but obstetrics was just the icing; the broader issue of women’s health overall was the cake. To her, answering women’s questions was “just as important” as performing surgery. Questions, for example, about birth control, or unwanted pregnancy, or breast cancer, or issues of infertility, or sexually-transmitted diseases, or sexuality, or whatever was on their minds as women

She believed that she could act as the “liaison” between women and what is known or understood about women’s health; she could explain things, she could educate.

Hearing this, I reflected on my own experience in gynecologist’s offices in the early 1970s. I wondered if they were typical; they were certainly not very pleasant. I had sweaty palms and shivered in the flimsy cotton gown as I nervously looked around the chilly exam room waiting for the doctor. There was a wall poster showing the female reproductive organs, another explaining endometriosis, and yet another revealing the feared effects of gonorrhea and syphilis. 

And then there was that take-apart model of a woman with a big-headed upside-down baby inside her waiting to be born into the world. 

There was no discussion of any of these interesting things by the doctor, and I was too anxious to ask him the right questions. That, my friends, was the extent of my “formal” women’s health education; a few colorful and mysterious wall posters and a plastic replica of a woman ready to deliver. 
An early edition

(Note: The revolutionary book Our Bodies, Ourselves, tackling taboo subjects important to women’s health wasn’t published until 1973 and I don’t recall seeing a copy of that controversial book at home, but we knew about it.)

Leslie, almost exactly my age, agreed with my recollection of how it was then, that ”many doctors would not take the time to listen” to women’s concerns.  She wanted it to be different, and she knew it could be. In fact, she told me that one of her important mentors during residency, Dr. Detlef Gerlach, was an exception, as he did listen.  

After decades in medicine, she was often dismayed when she heard a patient say, after the first visit with her, that they had not previously had the experience of a physician listening to them the way she did.

She completed her residency in 1983 and joined Dr. Marsha Bornt in her practice. Dr. Bornt would limit herself to gynecology and Leslie would do the obstetrics. But this arrangement soon turned out to be too demanding as she had to be available every day and every weekend without any help. She didn’t know what to do.

During this stressful time, she and Lynn hoped to start a family, but there were fertility issues and she was given only a 15% chance of getting pregnant. 

After Leslie decided that she needed to part with Dr. Bornt she was delighted when there was the prospect of joining Dr. Gerlach and his partners, Drs. James Smith and Jay Jackson, in their busy practice.

She still hoped to get pregnant and when one of the three men asked about her plan should she conceive (a question that should not have been asked then, and cannot be posed now) she innocently replied that she would want to work part-time for a while. But they didn’t want a part-time partner. She respected them and felt that their practice was a wonderful opportunity, so she joined the group and agreed that she would not seek special treatment because of her gender. (She told me that this was the only place where, as she eventually realized later, sexism, “institutionalized sexism,” truly affected her life.)

Three months passed and, defeating the long odds, Leslie became pregnant with her daughter Annie.  

No excuses, she worked full-time during the pregnancy. She had morning sickness with vomiting until late in the pregnancy, and it was tough. The “three guys and a girl” delivered up to 90 (yes, 90!) babies a month, and there were grueling three-day weekends without defined back-up, even if there was sometimes too much going on for one person to handle. 

This went on for a while, but when Annie was a year old Leslie went to her colleagues and said that she really needed to work fewer hours so that she could fulfill her roles as mother and wife, as well as that of physician/surgeon. They agreed to let her work a bit less (but on salary, off the partnership track) for a couple of years. 

She eventually returned to being full-time and became a partner in the practice. She enjoyed the work immensely, but she still felt that she needed more time for her husband and her two young children, now seven and nine. She needed more balance in her life.

But this time she and her partners couldn’t work things out, and as she felt that she no longer had a “voice in the practice” she left them in 1993. (More than 25 years later, the pain of that separation is less, but the wound has still not fully healed.)  

Leaving the group and her close relationships, however, lead to an unanticipated turning point in Dr. Robinson’s career. Dr. Simon offered her the position of Associate Residency Director for the York OB/GYN program. She took the job and “ended up being a teacher, and having a much more reasonable schedule.”  

Dr. Simon saw that there was a growing need to have someone who had expertise in the common, but complicated, issues of bladder, uterine, and rectal prolapse, and incontinence.  So Dr. Robinson took additional training in this area with Dr. Hilary J. Cholhan in Rochester, New York.  

He helped her as she sought to understand the complexities of surgery of the pelvic floor and the new specialty of urogynecology. Dr. Cholhan helped her so that she could, in turn, pass along important information and skills to the York residents.  After a while, she developed her own private Uro-Gyn practice and did surgeries one full day a week.  

[The anatomy: The floor of the pelvis is the boundary on which the pelvic and abdominal contents rest. It is composed of several muscle groups and ligaments connected at the perimeter of the bony pelvis. Defects may occur as a result of childbirth, with stretching and tearing of tissues. Pregnancy itself, without vaginal birth, is a risk factor as well. Other conditions that may result in prolapse are obesity, chronic pulmonary disease, smoking, and constipation. Urinary frequency, urgency, or incontinence are common symptoms. Pelvic muscle exercises and vaginal support devices (pessaries) are the main nonsurgical treatments for women with pelvic organ prolapse. Randomized trials provide no evidence that improvement of pelvic floor muscle tone leads to regression of pelvic organ prolapse. Thus, the need for surgery. Adapted from Medscape
Female pelvic floor anatomy (from "Nursing Times")
And with her varied and interesting work schedule, “things worked out well” and Leslie told me that she had a “very rewarding and satisfying professional career.”

Now retired, she has a few interests. Her younger sister Jane,  a hospice nurse, developed acute myelogenous leukemia 16 years ago. Leslie and her sister Tracey were with her when she died in a hospice setting at age 50. 

The two became involved in hospice work to ease the pain of losing their sister and to carry on her work.  Leslie met Beth Gill-MacDonald of the Healthy York Coalition, who was convinced there could be a local “social or community model hospice” not owned by a hospital or a for-profit agency. 

It took ten years for the “compassionate end-of-life” hospice facility, Pappus House, to be developed from an idea. Leslie helps support the mission and volunteers there twice a week. 

She also belongs to two quilters' guilds (in York and Camp Hill) and, through this, she became involved in an international effort called “Days for Girls.” This program, started in 2008 in Bellingham, Washington, aims to “empower women and girls worldwide through providing sustainable menstrual care and health education.” The colorful hand-sewn “DfG” kits are donated to girls and women across the globe. (Leslie, it seems, is drawn to needle and thread.)
Girls celebrating their DfG kits in Nepal (photo by Sarah Webb)
Is she athletic? Yes. Leslie has a goal of walking or hiking 14,000 steps a day (thus, the trek to my house, and the insistence on walking back at least half-way despite the nasty weather and slippery terrain through the woods). She also does yoga (mostly, she said, to improve balance), and she sometimes takes a heart-pounding spinning class or a leisurely mile swim at the York JCC.

Throughout her career, her husband Lynn has been unfailingly supportive. He never questioned her right to do what she was doing, even when life was "really hard." He shared fully in caring for their children, and he took care of her and was always proud of her accomplishments. 

Her son Dane, now married and the father of a young son, went to Vassar and has a Ph.D. in Clinical Psychology from Temple, and practices part-time. Her daughter, Annie, a mother of two, did a pediatric ophthalmology fellowship at Penn and was recently offered the first (yes, the first-ever) part-time contract with Children’s Hospital of Philadelphia. They can both raise their own families with treasured balance.  

As Simone de Beauvoir said in 1949: “It is through work that woman has been able, to a large extent, to close the gap separating her from the male; work alone can guarantee her concrete freedom...There is no longer need for a masculine mediator between her and the universe” (The Second Sex, p. 813).

And as Leslie noted, Marie Shear (1940-2017) said that “Feminism is the radical idea that women are people.”
Leslie and Lynn

And as she reminded me: “Men and women are equal, but not the same.”  She was “excited” when she realized that “true liberation is getting to do what you want,” that she and Lynn did not have to share each and every task equally, that they could follow their natural inclinations and complement each other, pursuing equity.

And now, more than fifty years after Lynn and Leslie first encountered each other, boys and girls, men and women meet together, and work together, on a more level playing field.

(And for a bit of forgotten history: The Equal Rights Amendment to the Constitution was first proposed in 1923. It didn’t catch on. Interest in it was revived in the 1960s, and by 1977 it was ratified by 35 states, with only three more needed for passage. Conservative women mobilized against it, and five states rescinded their ratifications. The deadline for passing this was extended to 1982. The amendment has been raised again in every session of congress since but has not come to a floor vote.)


Untitled (by Anita Cherry 1983)
Reference:

Beauvior, Simone de. The Second Sex (translated by Constance Borde and Sheila Malovany).New York: Vintage Books; 2011.


Anita Cherry (03/27/20)

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