Dr. Lynn Jensen: ER physician who aimed to hit the right notes

 

Dr. Lynn Jensen

Nearly two years after I asked him for his story, Dr. Lynn Jensen decided that it was time. But his wife, Dr. Leslie Robinson, who relayed the information to me, said that I had to wait until after archery season.  Archery season? I imagined him aiming at a big plump yellow, red, and blue target set up on a tripod as I recall from summer camp (where the flicked bowstring really hurt my forearm). But that was not the archery Lynn had in mind. 

You see, he was going to traipse into the woods, climb up a tree into something called a stand, and use a bow and arrow (yes, an actual bow and arrow!) to hunt for deer. If successful, he would drag the poor dead animal out of the forest and butcher it himself, to be safely stored away for the winter. Have you ever heard such mishegas, such craziness?

Anyway, the hunt being finished, Dr. Jensen finally came by to talk. He started off by telling me that he went to medical school at the University of Michigan and that this is where he and Lesie got together. (Though they were quietly attracted to each other when Lynn was funding his education by working as a painter and was doing Leslie’s parents’ house). 

Sprawling University of Michigan Medical Campus
(From The University of Michigan)

He left Ann Arbor in June of 1975 and promptly began his one-year so-called rotating internship at the York Hospital in July. His initial assignment was the emergency room. And on day one, as the seasoned staff physicians left for home at eleven, Dr. Jensen was the only doctor in the ER until the morning. Fortunately, he noted, he was supported through the night by experienced and compassionate nurses. And he was wise enough and humble enough to listen as they gently guided him. 

Before his time, he said, the nurses would see patients at night without waking, without bothering, the doctor, if they felt they could handle things on their own. They would then have the attending physician sign the stack of charts first thing in the morning.

Lynn admitted that “it was trial by fire.”  An intern in the ER by himself in the late 1970s had to be able to pick up things quickly, to be able to learn on the job, and act confidently without the help of the wide variety of rapid blood test results and advanced imaging studies now available. He said that you had to “use your brain” to make sound clinical judgments. For example, when someone came in with chest pain or belly pain you had to think systematically to generate a list of the most likely diagnoses while making sure not to miss something really serious, maybe life-threatening, even though much less probable. 

Cartoon noting the many causes of chest pain
(From artibiotics by Ciléin Kearns)

Young Lynn found it somewhat surprising that he quite liked the experience. That this type of acute medicine suited him. That it fit his learning style and personality. He said that “when you know you're going to be there (in the ER) by yourself you have a tendency to prepare that you would not have if you were being babysat.” 

In fact, there was no recognized specialty of emergency medicine itself until 1979. Any physician could work in the ER, even residents who needed extra cash.  So, after only a year of formal postgraduate training, Lynn decided to do emergency work full-time. He enjoyed the challenge and he could make enough money to allow Leslie to attend medical school herself (at Hershey, just 40 miles away) without incurring debt.  

He found the sometimes hectic ER work stimulating and rewarding, and he “sat for” and (of course) passed the oral and written Emergency Medicine Board exams. And he was active in the residency teaching program championed and developed by Dr. David Eitel, said Lynn. So, practicing acute medicine in the ER “just kind of stuck for a thirty-five-year career.” 

Dr. Jensen especially liked the demand of trying to meet each person’s specific needs even though he would likely see them only once and not have an ongoing relationship. He appreciated the importance of  “critical thinking” and informed decision-making when dealing with urgent (or even not-so-urgent) clinical problems; often with incomplete or misleading information, and the ever-constant pressure of limited time. 

According to ER physician and writer Dr. Jay Baruch, “to be an emergency room doctor is to be a professional listener to stories. Each patient presents a story; finding the heart of that story is the doctor’s most critical task. More technology, more tests, and more data won’t work if doctors get the story wrong.”

Doctor Who: "Listen" (From the BBC)
(The episode was "a creepy study of fear and loneliness")

So Lynn dutifully practiced his craft and tried to get the stories right as he took care of his patients, quickly establishing a working diagnosis while calming their anxieties and allaying their fears whenever possible. 

He told me that the first twenty years at the York Hospital were good and that he was happy. But things began to slowly change. He lamented, most especially, that the practice of medicine gradually became more and more influenced by corporate bureaucratic interests. And, importantly for the day-to-day practice of physicians like Dr. Jensen, the electronic health record (the EHR) was born.

Sure, paper charts, when they could be located in a timely manner and retrieved from the records room or one of the floors and brought to the emergency department (no longer just a “room”) had their problems. The handwritten progress notes were occasionally nearly illegible, and sometimes several thick volumes with page after page had to be combed through to find what you needed. But dealing with paper was simply the way it was, and it was okay. 

The now-obsolete but familiar paper charts
(From shorelinerecordsmanagement.com)

The first EHRs arrived with the promise of better efficiency and improved accuracy. But they were awkward and seemed to be designed by individuals not familiar with actual patient care. Oddly, the ED, where time may be critical, was chosen as the guinea pig for the new system at the hospital. Dr. Jensen found the chosen version to be needlessly cumbersome and intrusive, and frustratingly time-consuming. Over time, he began to feel that he was practicing medicine while wearing handcuffs. The electronic record was clearly built, he said, for something other than taking care of sick people.

And he gradually realized that the important diagnostic and interpersonal skills he had acquired by talking with and meticulously examining thousands of worried patients were becoming less valued than the results of increasingly sophisticated, but often superfluous, imaging and other tests. Seeing disembodied images became believing; the cold objective numbers from the lab told the tale. No need to listen to, or touch, the patient. This was very disheartening for Dr. Jensen to witness.

And as the ED became more and more crowded, more overloaded, Lynn eventually became tired of coming into work in the mornings and apologizing to patients who were being kept overnight in make-shift beds in the hallways.  Having to apologize for something that was not his doing.

The Maimonides ER after Hurricane Sandy 
(From The New York Times)

Regarding this very common scenario, Dr. Jay Baruch notes that:

Crowding and prolonged waits in the ER are more than an inconvenience; they’re linked to grave medical consequences, including higher inpatient mortality, longer length of stay in the hospital, increased medical errors, more harmful cardiac outcomes, and delayed treatment for pain. (p. 108)

So, at some point, Lynn decided that he had enough. And Dr.  Baruch has this to say about "burnout," or moral injury and disengagement: 

Many influences contribute to burnout in medicine. They include lack of control over the work environment, a disparity between personal values and those of the system, more time spent with electronic health records then with patients, and a sense of not making a difference. (p. 102)

We can readily see some of these factors playing a role in Lynn’s story and his decision to retire early. So he left clinical medicine at 62. Since then, he has had dreams of being back at the hospital. In some of these dreams, he’s frustrated as he deals with the cumbersome EHR. In others, everything ”goes to hell” and he has to reassure his beleaguered coworkers and nursing staff that they are just in his dream and that things will be okay. 

And in these lucid or sentient dreams, as he is aware that he is dreaming, he has sometimes wondered why he even agreed to take the shift in the first place, knowing that he no longer had privileges at the hospital and was not allowed to see patients at all! Lynn said that, ironically, he did not recall dreaming about the ED when he was actually working there.

The pattern of 40 Hz brain activity in lucid dreaming 
(From "New Scientist)"

Dr. Jensen told me that he would have probably continued to practice to age 70 if he felt he was still able to deliver what he considered to be high-level care. And he said that as he got older he cared more. Anyway, he did a few years of didactic teaching after retiring from hands-on work but decided to give that up as well when he sensed that he no longer had “credibility,” when nobody knew him anymore. 

Reflecting on his experience, he said that while manning the ED with talented colleagues suited him well overall he would not make the same career choice now. What would he have done instead? He thought a moment and offered that he might have gone into ophthalmology.

This brings up the question of how Lynn decided to go into the medical field in the first place. Nobody in his family was in medicine. His father was a Presbyterian minister in Valley Forge and his mother had a degree in home economics. Both of his parents were strong advocates for social justice and international peace. So Lynn was raised in a culture in which getting an education was important, and providing service to people, providing something of real value to others, was expected. And Lynn thought that he should also be a good provider for his family.  

Valley Forge Presbyterian Church, King of Prussia in 1956
(From the Presbyterian Historical Society)

He was certainly smart enough, as he was the first student from his high school, Upper Merion, to attend Harvard, and a career in medicine as a way to help people was an obvious good choice in the idealistic late 1960s. Becoming a professional poker player, to take a trivial example of another option, would not be an acceptable career choice (though he admitted that enjoys the game) since it gives nothing to others, he said, apart from a bit of light entertainment. 

(Lynn comes from a family of four and his older brother chose the same path and is a primary care doctor.)

So Lynn and his wife, OB/GYN-turned-urogynecologist Leslie Robinson (her story can be found here), were able to successfully navigate two active medical careers while raising their two children (Annie is a pediatric ophthalmologist and Dane is a clinical psychologist). And they brought two complementary styles to the task, noted Lynn. How so? For example, take the simple task of packing a dishwasher as an insight into people. Dr. Jensen said that he will carefully read the directions and make sure that everything is fitted into its proper place to avoid “shadowing.”  Leslie, on the other hand, will just cram in everything she can, filling every possible crevice until there’s no room for anything else. (What does your dishwasher style say about you?)

"First and foremost, load the dishes with the dirty side down and
at an angle toward the center of the dishwasher; don't overload it."
(From WikiHow)

And in retirement, Leslie (in line with the above) fits more into a day than anyone Lynn knows; he can’t keep up with her, he said, though he is busy, too.  He hunts for deer (when in season), plays pickleball (having given up the more strenuous racket sports), does close sleight-of-hand card magic (no self-working tricks for him), reads critically (non-fiction), and keeps up a daily routine of practicing the piano (especially enjoying the classical works of Schubert and the modern difficult 12-tone compositions by Samuel Barber). Yes, Dr. Jensen still seems to like doing stuff that requires lots of patience and focused hard work.

Well, after the pleasant ninety-minute interview came to a close my husband walked Lynn back to his car, at which point Dr. Jensen admitted that maybe he was getting a bit too old to be deep in the Pennsylvania woods by himself strapped high in a tree in chilly November waiting for a suitable target for his sharpened arrows. But maybe not.

Archer Dr. Lynn Jensen perched securely and scanning for prey.
(How did he get up there? And how will he get down?
And who took this photo?)

Readings and references:

1. Baruch, Jay. Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER. MIT Press. Cambridge, Massachusetts, 2022. (A very candid series of short takes on ER work.) 

2. Ceresi, David. "Aim for safety in your tree stand." Mayo Clinic Health System Oct 7, 2022 (3,000-4,000 hunters are injured each year in the US falling from tree stands; Dr. Cresi explains how to prevent this.)

3. Talbot, Simon G. and Dean, Wendy. "Physicians aren't 'burning out.' They're suffering from moral injury." STAT+. July 26, 2018. (Moral injury involves knowing what care patients need but being unable to provide it due to constraints beyond one's control.) 

One of my paintings from the 90s

By Anita Cherry 2/17/23