Dr. Tex Landis: The Importance of Being Earnest

 

Dr. Landis

The highlight of Tex’s day in college was peering through the small glass window of his box in the mailroom and finding a handwritten letter from his girlfriend back home, a thousand miles away. She wrote to him nearly daily; he replied about once a week. He was busy, and trying to find his way in the world. 

His father (William Landis) served as a flight surgeon in the military so the family moved around a lot. They were in Texas when he was born. Christened William, he immediately acquired the nickname “Little Tex.” The family can trace its roots in Lancaster County, Pennsylvania to the  1700s. So after spending time in Texas, they returned north to settle in a rural farming community outside of Marietta. Tex recalled that “you couldn’t see any neighbors” then. But there were streams to explore and plenty of interesting animals for a young boy with a curious mind to watch and “rescue.”   

He was happy. But when he was in the fifth grade someone had the nerve to build a house across their field, blocking his grand view of the natural world. How close was it you ask? It was nearly a quarter of a mile away; maybe within hollering distance, if the wind was just right. Tex was peeved.  

Lancaster County landscape (Credit: Wine-Searcher.com) 

But it wasn’t as bad as all that. You see, the man and his wife had two daughters and the younger became the letter-writer, and then Tex’s wife. So what seemed at first to be not so good became “one of the greatest blessings.”  Interesting lesson learned.  

Dr. William “Tex“ Landis told me he is very grateful for the people in his life, particularly his parents and his wife Desi (who sat next to him during our interview). His quietly stern father wanted his son to be bigger, tougher, and stronger than he was. His mother was unfailingly supportive. Together, they set safe boundaries for their four children (with four dogs) on the five-acre farm. 

As noted, Tex found particular pleasure in tending to wounded or abandoned animals he might come across. The list included a sparrow, a crow, a few rats, and even slithery snakes. His first job (at age 12 or 13, and for 25 cents an hour) was in a pet store. He liked the work and even thought he could have a career maintaining aquariums.

But it was not all nature. The house was full of books, and Tex would often pick out a Time-Life volume to read in bed. He did very well academically and dutifully learned to play the violin and (the ever-popular) clarinet. But he “lived” for sports, especially soccer and wrestling. He was pretty good at both, and they were formative; soccer taught him the importance of teamwork and wrestling gave him confidence and taught him to seize an opportunity (to make his “move”) when it is presented (since the steadily-ticking time clock might run out before he’s offered a second chance).

High School  

His 1975 Donegal High School wrestling team was undefeated and he lost only two matches. He is remembered (even 50 years later) for his quick recovery from a misstep that could have been terribly embarrassing. As he ran out to the center of the mat his foot caught the mat’s edge and he nearly fell face forward. But instantly, and without conscious thought, he did a flip and landed securely on his feet. Everybody watching was impressed; Tex was relieved.

A few "interesting" wrestling moves and holds-ouch! (Credit: scientificwrestling.com)

But let’s get back to Desi. Early on, young Tex wasn’t interested in either of the neighbor’s girls when they came over to skate on the Landis’s frozen pond or to swim in the pool. But by his junior year in high school, things looked different. At 16, in his underpowered 1951 Chevy pickup (that struggled to climb steep Chickies Hill Road by the Susquehanna River), he asked Desi for a date; would she go to the prom with him?  She accepted, of course, and their romantic relationship began. But it was soon time to decide on a college and a possible career.

At that point, Tex was still interested in pursuing marine/aquarium work and was still intensely sports-oriented. He realized that there were, as he said, some “dysfunctional” elements at home ( his successful family-physician father liked to drink) and he had to get away to grow. 

College

He decided to go to the Florida Institute of Technology (Florida Tech) in Melbourne. He would study biology. Maybe, he thought, he could even play soccer as a “walk-on.” 

Things were shaky at first. Tex drove down to the school in his Vega and briefly lived in the small car until he found a place to stay. The school’s admission policy was very liberal but the coursework (designed for nearby NASA scientists) was demanding and only 36 members of his freshman biology class of 300 graduated. As in high school, Tex was driven to excel, deciding not to settle for anything less than an A. He put his mind to it, worked hard, and finished at the top of the class. 

Olin Physical Sciences Center at Florida Tech (Credit: newsfit.edu)

(Why did he push himself? Tex innocently recalled that his drive to be the best “wasn’t discouraged” by his parents. His wife, as a somewhat more objective outsider, rather saw that it was “strongly encouraged.” Rashamon, once again.)

Questioning

Yet Tex craved more than worldly academic and athletic success. At 18, that critical time of questioning, he was thinking deeply about who he was, where he was going, and what might be his purpose in life. A key moment, perhaps “the key moment” in this quest occurred when a friend spoke passionately of the Bible and Christian Faith. This resonated with Tex and he eventually felt a strong need to “believe the Bible and to trust God.”  The beginnings of a maturing spiritual faith, the internal mandate that would guide his inner life.

As Tex studied the sacred texts, especially the succinct ethical sayings in the "wisdom" book of Proverbs, he realized that "serving God through serving others was a noble cause.” Actually “the cause.” How that might play out for Tex would take time; despite much success in college and finding the recognition he sought he still lacked a clear direction.  

As he made his way through his studies he began to feel that God was truly looking after him and protecting him. He liked “biology stuff” and his bio mentor asked if he ever thought about medical school. Tex reflected on his father’s work and saw that it was good. So he decided to pursue a medical career of his own. He took the few additional required courses and applied to medical school. He was accepted at the University of South Florida in Tampa while still in his junior year.

University of South Florida Medical School (Credit: health.usf.edu)

He proposed to Desi over Christmas during his senior year in college and they were married a week after graduation in June 1979. When Tex entered medical school ten days later, he and Desi “had nothing” (not even a kitchen table) but they were happy. She worked to support them while he studied and they had “enough to survive.” 

Medical School

During his intense three years of medical school (no summer breaks), Tex played intermural soccer for a while, but the rest of his time was “totally about study.” Again, he pushed himself and yet he was surprised when his friends told him that he, once more, graduated at the top of the class. He had enjoyed general hospital work and the challenges of the ICU and decided to pursue a career in internal medicine.

His advisor (who did not know him at all) didn’t like his plan to look at community as well as academic programs for a residency, and firmly recommended he stay at the University. Desi’s family was “relational” (Tex’s was not) and since both families resided in Pennsylvania Dr. Landis decided to leave Florida do his internal medicine training close to home.

As he looked at community programs in York and Reading, and at Geisinger, and the academic programs at Jefferson and Penn, he wanted to find “the best director.” By that time, Tex had learned that who he worked with became the most important factor in his education. The people were decisive.

Reading Hospital (the way it was) (Credit: Tower Health)

When he met with the illustrious, humane, and humble Dr. Eugene (Pat) Hildreth in Reading Tex knew he had found what he was looking for. Dr. Hildreth (as my husband, who was also trained in internal medicine in Reading before studying neurology, reminded me) surely had an unmistakable strong moral presence.

Residency and a Scare

So Tex began his General Internal Medicine residency in West Reading in 1982. He (like many other eager trainees) sought to emulate, to, in a sense, imitate, “The Chief” at first, but eventually (as others did before him) found his own style. Dr. Landis remarked that he was “extremely” influenced by Dr. Hildreth. And he liked the idea of being a general internist, treating the whole patient, rather than specializing in one organ system or discipline.

According to the American College of Physicians (of which Dr. Hildreth served as president, one of his many prestigious leadership roles): "Internal medicine physicians are trained to handle the broad and comprehensive spectrum of illnesses that affect adults, and are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention.”

In his third year of the residency, Desi (who already had a daughter) became pregnant again. But in the seventh month, she was at home when her water broke, the protective amniotic sac ruptured. At 32 weeks, it was a bit too early to deliver a baby safely since the so-called artificial surfactant that would help the immature lungs function better wasn’t available yet. Desi needed to be rushed sixty miles to Hershey Medical Center where they could do the delivery and take care of the fragile preemie.  

Hershey Medical Center (Credit: OnwardState.com)

Aware of the seriousness of the problem, Tex (who was working) left the Reading hospital and headed to Hershey to meet his wife for the birth. Losing the usually calm demeanor that he had when tending to critically ill patients, his heart pounded wildly as he imagined the worst, the potential future health issues. 

He drove as fast as was safe, but it wasn’t helpful; the baby came into the world in the ambulance on the Pennsylvania Turnpike. When he got to Hershey his newborn daughter was in the NICU on a ventilator. Things were quite rough for a while. But Tex found that simply talking with the neonatologist immediately calmed him. Another lesson; the anxiety and fear that inevitably accompany illness can be softened by compassionate empathic communication.

(Tex and his wife were reluctant about having a third child but their obstetrician in York, Dr. Leslie Robinson helped them work through their fears and all went well. However, his faith was severely tested–but sustained him–when, years later, his first grandchild died shortly after birth. This was, he said, “the saddest day” of his life.)  

Dr. Hildreth

Tex chose to stay in Reading for a fourth year as Chief Resident. The one-on-one mentoring relationship he enjoyed with Dr. Hildreth (whose patients he managed while Dr. Hildreth was away) greatly boosted his confidence in his abilities as a physician. And, foreshadowing things to come later in his career, his experience managing other physicians, learning what it meant to be a leader, was “rewarding and challenging.”

After that, Dr. Landis hoped to stay in Reading for practice but there were few good opportunities. While deciding what to do, he got a call from Dr. Ben Hoover in York. Would he like to interview for an unexpected opening for a partnership position with Brockie Internal Medicine? Tex was interested. He was suitably impressed by Dr. Hoover, liked the idea of becoming a partner rather than an employee, and joined the group. 

(Over the years, he learned a lot from Ben about taking care of patients as people, but also about the business of a thriving medical practice.)

Practice and Another Scare

With his Brockie partners, he did 75% inpatient work at the York Hospital (managing patients on the general floors and in the ICUs) and spent 25% of his time in outpatient practice (office, nursing home, and home visits). Dr. Landis cultivated an easy rapport with the busy ER physicians who called him in to admit patients. He was tireless and enjoyed the increasingly heavy and complex workload. Yes, he kept a positive attitude when his spirit could have easily been tested as the stresses of the ever-larger inpatient practice mounted.

But there was another more important test. When Desi was 37 she had a suspicious breast lesion. After it was biopsied, Tex reviewed the tissue slides with the pathologist. The lesion was a cancer. He came home prepared to tell his wife. As he hugged her tightly he could hear their hearts beating together; without words, she knew the ominous result. Tex had to devote more time to his family and a bit less to his career. The painful experience helped him become a more sympathetic (and empathic) physician. And a better husband, and father. 

New breast cancers by age; noting the need for earlier screening
(Credit: National Cancer Institute)

Back to the practice with Brockie. The inpatient demands were balanced by the less-stressful and more personal outpatient work. This part of the practice was emotionally rewarding for nearly 20 years as Dr. Landis developed warm friendships with his patients, and he and they experienced mutual abiding trust. But running back and forth from the office to the hospital (though it was only three traffic lights and less than a mile away) became cumbersome, especially as caring for the patients became more complex, highly technical, and increasingly time-consuming.  

Trust

Regarding the importance of trust in healthcare settings, Tex told a brief personal story in which it was abruptly lost. His wife had seen a specialist for heart problems. There was a significant abnormal finding on the CT scan. This was not addressed during the visit, even after direct questioning. No explanation for her symptoms was found and she was sent on her way. 

The official record of the encounter included a detailed physical exam, an exam that Tex knew was not done. Dr. Landis could no longer trust that physician with his wife’s health; he sought a second opinion for her problem. He is discouraged by the increasing lack of trust he sees within our health system. 

What are the elements of trust? In a 2023 article in The Hospitalist about building trust the writer notes that “trust consists of a belief that a person will behave in certain ways; an abstract attitude toward a proposition that someone is dependable; and a feeling of confidence, reliance, and security that the other person cares. And that to trust someone is to become vulnerable and dependent on the other person’s intentions and motivations.”  And that “as difficult as building trust can be, it comes down to two simple things—listening closely and caring about others.”

Hospitalists

By 1996, as an answer to the technical difficulty of tending to sicker and more complicated patients in the hospital while maintaining an efficient office practice in the era of so-called managed care (actually managed payment), the term “hospitalist” was coined. A general internist could decide to be a hospital-based specialist, with a full career devoted to doing complex inpatient medicine.  

The new idea caught on quickly in both community and academic centers. A ”large nationwide study of over 3,600 hospitals in 2005–2006 found that hospitals with hospitalists had higher quality of care in terms of diagnosis, management, and counseling/prevention for three common inpatient conditions: acute myocardial infarction, congestive heart failure, and pneumonia,” (Kulkarny and Wachter, 2024). 

Hospitalists have been active in teaching roles, in taking care of patients without housestaff, and in broad leadership positions developing diagnostic and therapeutic protocols and guidelines, and in enhancing communication among the increasing number of individuals involved in a patient’s care. Good communication, Tex emphasized, is vital, and a skill that can be learned; it requires sharply focused and sustained attention and awareness. And a commitment to getting it right, through practice.

As Dr. Landis foresaw the coming hospitalist movement he embraced it fully and became one of the first dedicated hospitalists at the York Hospital. The novel position was soon accepted by the general staff. In time, Dr. Landis took on more responsibilities. He served as the Medical Director of the WellSpan Hospitalists and in this “challenging” leadership position he managed 120 practitioners across several hospital sites. Expectations were high and could not always be met. But Tex has had an enduring belief in the still-evolving project.

Stepping Down 

By 2017, his full-time position (the highest clinical post in WellSpan) took a toll personally and professionally and (with a successor in place) he stepped down from his directorship. Tex has continued to fill in by doing strictly clinical work when it’s needed. As a result, he now has much more time to spend with his immediate and extended family.  And as he and Desi sat at the Thanksgiving table with ten members of their family Dr. Landis realized that “everything that was really important” for him was “right there, and the best thing” in his life. 

(Incidentally, before I send these tales out into the world the doctors profiled review them. My hope is that there is enough trust between us to allow the stories to be told faithfully and with compassion.)  

References and Selected Readings:

1. Collins, Thomas R. "Rebuilding Trust: A Top Priority for Hospitalists." The Hospitalist, November 14, 2023

2. Kulkarni, Shradha A., and Wachter, Robert M. "The Hospitalist Movement 25 Years Later." Annual Review of Medicine, Vol75; 381-390 2024.

3. Maxwell, John C. How Successful People Lead; Taking Your Influence to the Next Level. Center Street, New York, 2013. (Tex was influenced by Maxwell's popular teachings.)

4. Allport, Gordon W. The Individual and His Religion: A Psychological Interpretation. The Macmillan Company, New York, 1950. ("It is religion's peculiar secret that it brings to the individual a solemn assurance unlike anything else in life, an ever-present help in trouble, that makes next steps easier no matter what mesh of circumstances may entangle the life." p. 158)

By Anita Cherry 7/28/24

Toby (2010-2024)