Dr. Earl Bernstine, Child and Adolescent Psychiatrist: Coming Home

 

Dr. Bernstine 

Being raised in a physician’s family in a small semi-rural Pennsylvania town In the late 1950s seemed idyllic. The doctors worked together. Their families socialized together and traveled together. And their children went to school together. The two hospitals in town were quietly run by practicing physicians and surgeons (with just a few administrators). And the doctors could live comfortably within a few blocks of the hospital.  

There was no worry about access to medical care. No worry about doctor or hospital bills. It was good. But the subject of this story sorely missed having time with his father. You see, his father, Dr. Earl L. Bernstine, a general surgeon, worked “twenty-hour days.” He “covered everything” from the emergency room, to trauma, to orthopedics, to whatever came along.  The surgeon’s son, Dr. Earl W. Bernstine (one of a long line of Earls--no Dukes, as far as I can tell), is a recently retired child and adolescent psychiatrist. He was kind enough to stop by to tell me his winding tale.  

Earl L. (the surgeon) was, himself, the son of another Earl, Earl H. (a pharmacist).  After he served in the Navy in Word War II, he did dental school for a year before transferring to Thomas Jefferson Medical College for a medical degree. He did his internship year in Williamsport, where his family lived, and where his son, Earl W., the future psychiatrist, was born. 

He then moved the family to York (wisely equidistant from his wife’s family in Philadelphia and his own) for a surgical residency at the York Hospital. The busy practice that followed left him very little time to spend with his young son.

Earl W. (from here on referred to as simply “Dr. Bernstine”) decided early on that he didn’t want a medical career like his dad. Having “missed” his father terribly, he wanted to make sure he had time to be with his own children. Though some of his high school classmates whose parents were doctors went into medicine (and even returned to York to practice) he purposely steered away from the health field and his hometown.

On to the University of Denver

After struggling in high school, he went to the University of Denver to do political science or practice law. Dr. Bernstine, as a visual learner, had trouble memorizing facts and had to read things over and over; his dyslexia had not yet been diagnosed. On the other hand, he was quite good with numbers. His calculus professor and statistics expert George Bardwell told him that his math notes were “very elegant,” and encouraged him to further his math studies. 

View of The University of Denver (from the university)

Dr. Bernstine told me that he “could see numbers in shapes and colors” and “squeeze them through an equation” in his mind (whatever that could mean!) to get the right answer. Realizing his gift, he thought briefly of becoming a theoretical mathematician.

While in Denver, using his skills with numbers, he worked on several local Republican political campaigns (though he was a Democrat, they didn’t mind). He had success and considered doing this as a business.

Return to Pennsylvania

But after two years in Colorado, he decided to return to Pennsylvania. He went to Dickinson College to finish a degree in political science. As a student, he stayed in the family cabin in nearby Pinchot, taught alpine skiing, and “had a motorcycle.” 

Entrance to Dickinson College campus (from The Edvocate)

He wanted to support himself financially and he started helping out in his father’s office. As he talked with patients scheduled for minor surgery he saw that what he was doing quickly relaxed them. He realized that this simple act of communicating had an immediate positive effect.

Some of Dr. Bernstine’s skiing buddies were, he said, “male nurses” (an unusual job for men at a time when gender stereotypes were strong and there was widespread homophobia in York). Nursing could be a reasonable career option, he thought.

And in 1979, in the close medical community, York psychiatrist Dr. Kirk Pandelidis offered Dr. Bernstine a test job as a nurse’s aide on the locked psychiatric unit at the hospital. On his first day there, contact with the struggling patients (including one man who asked him if he had brought a screwdriver with him since everyone there had a loose screw) showed him that “we’re all people.” We all hurt; we all cry. He said to himself, “I can do this!”

Through this brief experience, Earl felt, he said, that “the mind is so fascinating.” 

Now to Upstate New York, Way Upstate

Anyway, he left York again, this time for nursing school in upstate New York, just twenty miles from the Canadian border.  He was one of only three male students. During the summer off he worked on the psychiatry ward in York. He was put on third shift, a time when the visitors and the attending doctors were gone and the nurses took care of most things. 

Snow-covered SUNY Canton Bridge (Photo by McCluskey Photography)

When it was quiet, he could study psychiatric diagnosis or pharmacology (psychiatrists, he noted, would soon become “neuropharmacologists” primarily providing medication management rather than in-depth analysis). The opportunity to observe patients for eight hours, seeing how they responded (or didn’t) to medicines, and what side effects occurred, was far more educational than the books (that Earl, a dyslexic, had trouble with). 

Dr. Bernstine graduated from the two-year SUNY nursing program in Canton in 1981, and he and his girlfriend (with whom he had been living) “parted ways.” Where would he go next? His classmates were recruited to work in Lubbock, Texas. But a few of his friends in Denver lived in Houston, and he thought that city would be “more fun.”  

Though he had no particular interest in treating kids, he landed a job as a staff nurse on one of the first long-term inpatient adolescent psychiatric units in the country. He said that he learned a lot, and as he progressed from staff nurse, to charge nurse, and then to nursing supervisor he gained much confidence. 

Nurse-Bernstine soon concluded that as the on-call attending psychiatrists at night would sometimes rely on his observations and suggestions to determine the patient’s acute treatment, he might as well become doctor-Bernstine and do this himself (and get paid for it). Yes, he was ready for medical school.

Now on to Houston, and Medical School

So, at 25, he applied to several programs in Texas. He was accepted to The Texas College of Osteopathic Medicine (TCOM),  where they were looking for students with
good interpersonal skills. The “campus was beautiful” and the work was “challenging.” 

Dr. Bernstine told me that he was taught that osteopaths have a “different way” of looking at things compared to allopathic (M.D.) doctors (like his father). He said they view all things in the body as parts of a complex system, not in isolation. And that “everything is connected,” he said.  He feels that this broad perspective is especially needed in understanding disorders of the mind.

TCOM (Photo from TCOM)

After five years at TCOM (you see, he and a few classmates had taken an additional year of school beyond the required four), it was time for an internship and residency. 

Back to Pennsylvania Again; Internship and Residency

Feeling the pull to return again to Pennsylvania, he did a rotating internship year (1990-1991) at the small York Memorial Osteopathic Hospital (where his intimate knowledge of the importance of being “nice to the nurses” came in handy).

Following this, he started a psychiatry residency at Hershey Medical Center under sleep researcher Dr. Anthony Kales. But Hershey didn’t fully accept his D.O. year and he had to do another six months of internal medicine first, including taking nightcall. 

That being done, Dr. Bernstine did three years of psychiatric training at Hershey. This included work in psychotherapy and six months at the Harrisburg State Hospital, formerly called the Pennsylvania State Lunatic Hospital. The sprawling facility housing (yes, simply housing) incurables not capable of living in society closed in 2006 as patients across the country had been slowly “deinstitutionalized” after the very first-ever effective psychiatric medicines were developed in the 1950s and after President Kennedy signed the Community Mental Health Centers Act in 1963.

Dr Bernstine wanted to do general psychiatry, but there was more politicking. You see, Hershey needed to fill their adolescent fellowship slots. And since Dr. Bernstine had insight and skill with kids they “strong-armed” him into taking one of the positions. It turned out that this was a surprisingly nice fit. 

Now to York for Practice

Dr. Stevens

Following his two years of subspecialty training, he once more returned to York. This time to practice.  By then, the child and adolescent psychiatry unit at the York Hospital (on 6 South), conceived and developed by the late multi-talented Dr. Bryan Stevens, was, according to Dr. Bernstine, “phenomenal.” It was the best he had ever seen. He and his two “great” partners and the capable support staff provided the troubled kids with the full range of treatments including family, recreational, and group therapies. Sometimes for many months.

But as they required more staff to meet the growing demand for services the costs mounted. Insurance reimbursements (traditionally poor for mental health anyway) did not keep up. Management began cutting. And cutting more. Eventually, the understaffing compromised care too much, and the unit had to be closed.  (It was reconstituted later on the 2nd floor of the hospital, but it wasn’t the same.)

Over the years, Dr. Bernstine and his partners treated the full range of child and adolescent psychiatric problems. They “covered everything,“ doing both inpatient and outpatient work, unlike in the current system, where you generally do one or the other. He was a WellSpan outpatient psychiatrist from 1996 until his retirement in 2023 and he spent 13 years as a staff psychiatrist at a facility for long-term treatment of adjudicated adolescent male substance abusers. 

Autism and Asperger's Syndrome

I asked him if there was a type of patient that he especially liked to take care of. Without hesitation, he said he enjoyed and was good at connecting with the so-called “Aspies,” the kids with what used to be called Asperger’s syndrome, but is now viewed as the mild end of the broad complex autism spectrum (or, better yet, wheel). We will spend some time with this.

The case study report of four young boys meticulously described by Dr. Hans Asperger in 1944 in Vienna out of more than 200 “difficult children” that he had studied over ten years at the University Paediatric Clinic was his post-doctoral thesis. 

Hans Asperger (on the left) working with a student in the early 1930s
(photo from Pictorial Press)

The boys appeared to be locked up in their own worlds. They were cut off from the environment and, especially, their social surroundings. While non-verbal and verbal communication were impaired, spontaneous language itself could sometimes be precocious (but disconnected). Odd stereotyped repetitive movements were seen and the boys were often awkward and clumsy. 

But special exceptional talents, such as the ability to manipulate large numbers or remarkable feats of memory might emerge. And (writing in Austria during the German leader’s failed effort to eliminate all undesirables from society) Asperger stated that if these individuals had “normal intelligence” and were treated by an “absolutely dedicated and loving educator”  they could find suitable work and “have their place in the organism of the social community,” (Draaisma, p. 313).

(An aside: Well-known Aspergerish autistics likely include Sir Isaac Newton, Charles Darwin, Albert Einstein, Emily Dickinson, James Joyce, Ludwig Beethoven, Bill Gates, Steve Jobs, Thomas Jefferson, Stanley Kubrick, Anthony Hopkins, and Jerry Seinfeld, among many others who have created our world.)     

The autistic’s deficits in social interaction, behavior, and communication may be profound but can sometimes be so subtle that they are viewed simply as personality oddities. In addition to the core features, the kids may have sleep problems, gastrointestinal and eating disorders, seizures, anxiety or depression, immune system disorders, and cognitive impairment (apart from that tied to language). And all of these problems may exist to various degrees, as on the proposed autism wheel.

The new nuanced complex autism wheel,
going beyond the simple linear spectrum
(from ablelight.org)

While we can only guess what’s going on in the mind (the inner experience) of the severely autistic child, those with lesser degrees of autism can introspect and can occasionally tell the psychiatrist (and us) something about what they are thinking and feeling. 

(The autistic Temple Grandin said that when she was young she screamed because she couldn't talk. And she thought that it was the tone of the voice, not the words, that carried meaning.)

Dr. Bernstine found that he could connect with the Aspies by showing interest in whatever interested them and that he could thereby gain their trust. He observed and listened carefully and learned to “talk Aspie” (speech that may be monotone, emotionless, robotic, repetitive, arrhythmic, or too loud, etc.).  Once the child trusted him he could address specific remedial problems.

This lifelong and varied disorder of brain development and interconnections is much more common than previously thought. It is dependent on a wide variety of poorly understood genetic, epigenetic, and environmental influences (but not the MMR childhood vaccination).  

But aggressive and sustained loving treatment may eventually allow the “neuroatypical” child to adapt to the outside so-called "neurotypical" world. A world, to them, that is “relentlessly unpredictable and chaotic, perpetually turned up too loud, and full of people who have little respect for personal space,” (Silberman p. 471).    

Dr. Bernstine was careful to absolve the parents (especially the mother) of any blame at all for their child’s condition (the once-popular “cold mother” theory of autism having long since been abandoned). 

Neurologist Dr. Oliver Sacks, champion of neurodiversity before there was such a word, writing movingly about autism and the remarkable animal behaviorist Temple Grandin, said: 

And yet the parents of an autistic child, who find their infant receding from them, becoming remote, inaccessible, unresponsive, may still be tempted to blame themselves. They may find themselves struggling to relate to and love a child who, seemingly, does not love them back. They may make superhuman efforts and to get through, to hold onto a child who inhabits some unimaginable, alien world, and yet all their efforts may seem to be in vain. (Sacks, p. 248-249.)

Connecting compassionately with frightened tired parents and their autistic child requires lots of skill, as the therapies are arduous and progress is painfully slow. But there can never be too much therapy for these vulnerable children, said Dr. Bernstine. 

Elements of Psychiatric Practice

Dr. Bernstine said that timely diagnosis of autism or any of the mental problems that begin in childhood and adolescence is vital. In addition to autism, these problems include major depression, bipolar disorder, anxiety disorders, conduct disorders, learning deficits such as dyslexia, a variety of eating disorders (not just being a picky eater), substance abuse, and gender identity issues, among others. There is plenty to keep the doctor busy.

There are, as yet, no blood tests or imaging studies that can be relied on to confirm most disorders managed by child psychiatrists. So the diagnosis mostly remains a so-called clinical one and may take time to establish with certainty, as the needed DSM-5 criteria gradually emerge. 

As physicians observe the patient and collect information from the parents and other family members, the child’s teachers, psychologists, social workers, and other sources (speech, occupational, and physical therapists, etc.), they must also explore the social and cultural contexts to provide a reasoned diagnosis and a comprehensive treatment plan. And as Dr. Bernstine had advised me, “Everything is connected.” An effective child psychiatrist finds the connections. And he is an able communicator who can reassure parents and work well with a diverse team. 

Dr. Bernstine enjoyed his varied practice over the years within the growing WellSpan Health System. But after he went through therapy himself during the divorce from his first wife he gained insight into “what makes you a good physician.” After that, he decided to change his practice; he limited the number of new patients he would see and set aside time daily for emergencies; he decided to protect himself.

Outside Interests

Toward the end of the interview, I asked him about his interests outside of medicine. He said he likes outdoor activities such as hiking, bike riding, fishing, and skiing. He walks his three dogs regularly, sometimes at a small hilly county park adjacent to his neighborhood close to the hospital (where I first met him on a daily morning walk as he introduced himself). He has a busy family life, with a son ( Earl J.) from his first marriage, and three adult children of his wife's.

Dr. Bernstine and his family

He joined (of all crazy things) a really good York-Lancaster rugby club when he was 52 (the other members, he said, were half his age). He didn’t play much initially, but he went with them to Nationals as a trainer that first year. He was a starter after that; he was a “small” guy, but he was fast and could reach in to steal the ball from the other team. But it was hard for him to master the intricate playbook. 

Through the intense (and dangerous) sport of rugby, Dr. Bernstine lost 60 pounds and kept it off. Despite better nutrition, he had a heart attack three years ago and needed a stent. He is okay now and is looking forward to an active retirement. 

What about less physically demanding pastimes? He said he doesn’t read a lot of books but he thought a minute and then mentioned The Alchemist by Brazilian author Paulo Coelho. This short worldwide bestseller tells a story that is a variation on the ancient folk-tale theme that the treasure you dream of, that you seek far and wide is, in the end, found at home. I like that.

References and Readings

1. Coelho, Paulo, (Translated from Portuguese by Alan R. Clarke). The Alchemist; 25th Anniversary Edition. HarperOne. New York, 1993. (Twists, turns, and trials when traveling from Andalusian Spain across the Sahara desert to the Egyptian pyramids and back home.) 

2. Draaisma, Douwe, (Translated from Dutch by Barbara Fasting). Disturbances of the Mind. Cambridge University Press, Cambridge, UK, 2009. (Detailed background stories of 13 conditions bearing the names of those that first clearly identified and described them...Parkinson's, Alzheimer's, Tourette's, etc.) 

3. Sacks, Oliver. An Anthropologist on Mars; Seven Paradoxical Tales. Alfred A. Knopf. New York, 1995. (Another one of his remarkable explorations into the unending mysteries and strengths of the human brain and spirit.)

4. Silberman, Steven. Neurotribes; The Legacy of Autism and the Future of Neurodiversity. Penguin Random House. New York, 2015. (A lively easily-read "tour de force" history of the condition, its modern understanding, and its immense but often unrecognized societal impact.) 

5. Valentine, Vikki and Hamilton, John. "Exploring Language; Temple Grandin on Autism & Language"  NPR July 9, 2006. (https://www.npr.org/templates/story/story.php?storyId=5488844)

One of my husband's favorite trees in York's Reservoir Park in the spring
(Photo by SC)

By Anita Cherry 12/25/23

Dr. Rita Van Wyk: A South African Advocate for Social Justice

Dr. Rita Van Wyk

I recently learned about the legend of the Lamed Vavniks from a Rosh Hashanah sermon streamed from New York’s Central Synagogue. According to a Talmudic story, there are (at least) 36 righteous people living among us at any given time upon whom the continued existence of human life depends. We don’t know who they are. They, themselves, are not aware of their critical role in the world. And anyone you meet (even you) may be one of them, perhaps for only a fleeting moment. 

As we sat together, Dr. Rita Van Wyk began the interview with her story of being a two-year-old during the polio epidemic in South Africa in the mid-1940s. She paused to ask how much time she had. “As much as you want,” I replied. (Knowing that the stiff new chair she was sitting on was not the most comfortable one in the room.)

Rita had the “ascending” form of the dreaded disease, she said. As it traveled up her body and the chest wall muscles were affected she couldn’t breathe. She had to be encased in an iron lung to save her life. The prognosis was poor for many such toddlers, and her working-class parents were coldly informed that she “might be a vegetable” if she survived. (Use of Jonas Salk's polio vaccine  would have to wait until 1955.) 

Children affected by paralytic polio (from polioeradication.org)

She soon regained the ability to breathe on her own, but she wasn’t the same. Her right leg was severely weakened and she couldn’t walk. What would happen to her?

Rita had two much older brothers. Her parents hadn’t planned on another child, and taking care of a daughter with serious neurological and orthopedic problems was a burden they couldn’t handle. You see, girls in South Africa (as elsewhere, it seems) were supposed to be pretty and lively so they could marry up. This was more important for a family from “the wrong side of the tracks.” But Rita was a burden; she was saddled with problems. So she was sent to “The Hope Home For Crippled Children.” (“Hope” was the founder’s wife’s name, not what they were offering.)

The Family

What was her family background? When Rita’s Afrikaner father left school after the tenth grade he was recruited to work for DeBeers overseeing the experienced black mine workers. Later, during the war, he learned Morse code and joined the Air Force as a radar operator. After the war, he worked in civil aviation. He eventually became the manager of the Johannesburg International Airport. After Rita’s mother finished the eighth grade, she toiled in a sewing factory. In time, Rita’s parents’ combined salaries gradually lifted them out of poverty. They were able to hire an Indian housekeeper who taught Rita how to cook. Curiously, Rita’s father “never” actually called her by her name; for him, she was always “di-da-di di-di da di-da!”

At the "Hope Home," there was grueling physical therapy, with very little reading, writing, or arithmetic for the youngster with a curious mind and (as Dr. Van Wyk later learned) attention deficit hyperactivity disorder. 

The "Hope Home and Convalescent Center for Children"
on exclusive Westcliff Ridge overlooking Johannesburg
(from hopeschool.org.za)

rBut her “Auntie Sis” (the oldest of 11 children and a teacher) stepped in and was a blessing. She taught the bright little girl how to knit, crochet, and embroider. Keeping Rita’s hands busy in a “well-rehearsed and well-controlled manner” had a “fantastic effect” on her “frustration, restlessness, and impatience.” 

She picked up things quickly, and when she graduated from the "Hope Home" (and School) at 11 the standard exam placed her in the tenth grade. She wasn’t really prepared; her interpersonal social skills were poor and she was “unsophisticated.” And as she was still relying on bulky crutches to get around she would certainly get in everyone’s way, she thought. Yes, she felt awkward. This isn’t going to be good, she said to herself.

High School and Beyond

But rather than wallow in self-pity, Rita would “bust everyone’s balls” and excel. Her goal was to know (get this) more than the teacher. So she studied the published curriculum before class to try to stump the teacher with a tricky question. That was her “adaptation” to the situation, she told me; shove the despair aside and be brilliant.

As the paralytic polio left her right leg weak and shortened she had a series of orthopedic procedures to try to improve her gait. At one point, her foot became infected and she developed gangrene. The surgeons wanted to amputate it but her parents refused to give them permission. The wound slowly healed but she ended up with a “really painful scar” and a limited range of motion. So Rita still has a shorter right leg and is unable to push the foot down, she has no “plantar flexion” she said.

After high school, Rita took the national exam for college matriculation and “did really well.” By that time, she had already decided on a career in healthcare. But where would she fit in? The physical therapists who worked on her were “mean and bullying” and burned out by the heavy workload during the epidemic (no good). The nurses had to take orders from the doctors (not her style). The doctors gave the orders that others followed (perfect). 

It happened to be that Rita’s family doctor’s wife was also a physician (quite unusual at the time) and it was she who became a role model for the strong-willed teen. Dr. Wagenaar had dedicated herself to helping people who could not afford medical care. These disadvantaged souls were the native black Africans, the victims of apartheid (the Afrikaans word for “apartness”). 

Apartheid

Starting in 1948, (and until 1994 when it was peacefully and democratically ended) there was a legally mandated separation of people. Where you could live, where you were actually forced to live, was determined, in essence, by the color of your skin; whether you were pure black (of African heritage), white (mostly European), or colored (mixed). The blacks were compelled to return to their ancient tribal lands while the whites alone would populate the modern prospering cities. (Another category, Indian, was added later.) The effect (if not the stated goal) of this creul system was to continue to exploit the majority indigenous black population for the economic benefit of the very small minority white ruling class. And there was fear.

Cautionary sign during apartheid in South Africa
(from history.com)

The poor displaced individuals that the compassionate white physician treated in a makeshift clinic in her garage were black. Grateful patients rewarded her kind services with a few precious tomatoes or a nice bunch of bananas, said Rita, who thought that this type of medical practice was “fantastic.”

Thus inspired, learning by example, Rita came to feel that those who have much must give to those who have nothing. But when she enthusiastically shared this idealistic insight about social justice with her family they branded her as a “bloody communist,” she said. She soon decided to get away from her “nasty bush family.” She would henceforth be “self-reliant.” And she would “never get married,” fearing that a husband would try to control her (fat chance, I think).

(It wasn’t until quite late in the interview that Dr. Van Wyk disclosed that she had been witness to repeated domestic violence, including extreme physical violence, in the chaotic household of her childhood. And that her mother suffered from a severe undiagnosed mental illness.)

Medical School and A Year of Obstetrics

Anyway, Rita received acceptance from all of the medical schools she applied to and chose to attend Pretoria University (on a full scholarship). The program, like the others in South Africa and parts of Europe, ran over six years. She did not say much about those years (actually, nothing) so they will remain a mystery. She did let on, however, that she was one of only three women in her class of 117 (and she suspects that one was a feminized male with an extra X chromosome, a Klinefelter’s).

University of Pretoria (from up.ac.za)

As she was finishing up medical school in 1969, her friend Johann wanted to go to the U.S. and he urged Rita to join him in taking the ECFMG exam (the American test for graduates of foreign medical schools). Johann knew that she absolutely loved Indian food and after he offered her the enticing bribe of an authentic Indian dinner, she agreed. 

She passed the exam easily, so she was, she thought, “good enough for America.”  However, she had no real interest in going to the States but rather liked the idea of possible training in England. She decided on a year of internship in obstetrics (the miracle of fetal growth and birth being, she thought, “the most exciting thing in medicine”. (Though Rita, at 21, decided never to have children of her own.)

Going against her earlier vow to remain single, she got engaged to be married, but this fell apart early during her training.

Politics Intervened

She had put away her dream of foreign travel for practice when she stumbled into some political trouble. It was July 4, 1970 (exactly two months after the shock of Kent State). “all eyes were on America,” said Dr. VanWyk as 350,000 of President Nixon’s staunch pro-war supporters rallied in D.C. at the Lincoln Memorial for the so-called “Honor America Day.” But thousands of idealistic young people waded into the iconic Reflecting Pool in protest.  (The previous day, counter-demonstrators had drowned out a Nazi rally speaker who blamed America’s troubles on blacks and Jews.)

So Rita and a group of her liberal Jewish friends, interns, decided to do a peaceful sit-in. They would argue for fair and equal salaries for their black and Indian counterparts, for a show of South African social fairness. The expected press coverage didn’t materialize, but the chief hospital administrator did appear, and he simply handed out pink slips. Everyone was fired; Dr. VanWyk was out of a job.

By sheer luck, Rita already had a passport and a visa. Her less fortunate colleagues were denied such documents, and because they didn’t complete their internship year, they could not practice medicine in South Africa. Perhaps she could go to America where there is “equal opportunity and no racism” to “polish” her education before returning to South Africa to be “the poor people’s doctor” thought Rita. (She believes that this “escape route” was “divinely inspired.” )

Travel to the States

One of her brothers was a PanAm pilot and lived in (of all places) Lancaster, Pennsylvania.  She would stay with him and his family for a while and travel around by Greyhound bus. However, her brother’s friendly neighbor was the Director of Medical Education at Lancaster General Hospital and he had an urgent problem that Rita might help solve. 

It was July, the start of the year for interns and residents. Well, wouldn’t you know, one of the 12 prospective interns had finked out at the last minute? The eager South African visitor without a job was informed that she could fill that slot if she got an Immigrant visa. Rita was interested. Strings were pulled and the work visa was granted. But her gratitude was mixed with guilt as life fell into place so easily for her.  

She quickly found that 1970s medicine in the U.S. was different from that back home. She was accustomed to “wild rough and tumble hands-on bush or jungle medicine” where “you do what needs to be done.”  For example, her first delivery as an intern had been in a South African leper colony.  Where people with the ancient disfiguring disease are discriminated against, shunned, removed physically from society, and feared. It was two hundred miles from the nearest hospital. No matter what the situation, it was up to her ”to get the baby out,” she told me.

Batsutoland Leper Colony (from leprosyhistory.org) 

Whereas in her new position, she was “fearless and confident,” having been tested in the field, in the veldt, her fellow interns were (let’s just say)…not.  They understood the more esoteric academic matters while she had hands-on experience. (Though she had to admit that she struggled with medical English, Afrikaans being her native tongue.)

After Lancaster; Obstetrics and then Planned Parenthood

After the internship in Lancaster, she later began an OB/GYN residency at the York Hospital just thirty minutes west. But, sadly, everything she had learned in South Africa, everything she had loved about obstetrics, was absent.  She was trained to make eye contact with vulnerable human beings, with women carrying their unborn children. The American-educated residents made “eye” contact with the beeping flashing electronic fetal monitor. 

Even the attendings whom she considered to be kind and “real mensches” typically looked at the monitors in the labor hall, not the women ready to deliver. While she appreciated that monitoring assured better outcomes, the impersonal aspects of the experience did not satisfy her deep need to help people. She couldn’t continue like this. She had lost interest in modern de-person-alized obstetrics.

So she changed direction and worked for Planned Parenthood, pretending to be Dr. Wagenaar treating the mostly non-white and poor clientele. She was quite happy there until the issue of pregnancy termination “became a big deal.” Though she believes that women have the right to choose, she could not deal emotionally with late-term suction abortions. Nevertheless, Dr. Van Wyk stayed with Planned Parenthood for eight years. The work eased her internalized “collective (white) guilt very much” she noted.

She Doesn't Like the Cold

But each year she was “dying” with the Pennsylvania cold winter, where readings below freezing are typical for months. The average winter temperatures in Johannesburg don’t dip below freezing at all, and the daily highs are usually in the pleasant 60s. You see, she said, one of the residual effects of polio may be intense cold intolerance. 

Typical late effects of having polio as a child, or the post-polio syndrome, include progressive muscle weakness, fatigue, and pain. In addition, the ability to regulate one’s core temperature may be impaired as a result of damage to the body’s thermostat in the hypothalamus. The limbs originally affected by polio may feel especially cold as surface blood vessels don’t function normally in response to the ambient temperature. People like Rita may need to dress in multiple layers because it feels to them as if it’s 20 degrees colder than it really is. They need heating pads, warm blankets, and long underwear.

So her body “craved the dry desert heat” of South Africa. Arizona might come close to that, she thought. So she applied to work in the Indian Health Service (again, assuaging her guilt regarding white privilege). But they didn’t need more obstetricians, they needed general medicine or pediatric help.

Dry South African Veldt

Dr. Van Wyk was up for a mid-career change and she decided to take up family medicine to make her way to the warm dry Southwest. She got a residency position with the York Hospital program and as she progressed through the rotations she found that enjoyed her time in psychiatry the most. She said, affectionately, that she loved “being around crazy people.” 

(Her therapist has told her that because she grew up in such a crazy family she feels at home in that setting, though she had to escape.)

When Rita Met Chris

Throughout her busy three-year residency, she remained free and unattached. But one fateful day she “looked into a pair of blue eyes” belonging to the “most interesting human being” she had ever met. The “really smart, quirky” and “painfully shy” intern (14 years her junior) was Dr. Christopher Due. They connected and were good friends for about a year before they “stopped being platonic and wanted to be together forever,” Rita gushed (sort of). 

And so they got married. A Unitarian Universalist minister officiated at a Bed and Breakfast in Muddy Creek Forks in the southern part of the county. She wore a peasant-style wedding ensemble, a top, and a long skirt, that she fashioned herself from “Aunt Lydia’s” crochet yarn. They could now move west. But Chris wanted to stay near his “nurturing, supporting” family, so the inviting Arizona desert was out. They have been married for 35 years and were looking forward to another trip to South Africa after the interview.

A Muddy Creek Forks Landmark

More Career Changes

With her family practice training finished, and a persistent urge to minister to the poor, she took a position with the (oddly-named) York Health Corporation in downtown York. Once again, many of her patients were non-white, and had little money, soothing her conscience regarding privilege. She loved working there. But (surprise!) that would not be the last phase of her varied career.

It turned out that the head of Psychiatry at the hospital, Dr. Kirk Pandelidis, wanted input from their primary care physician when a patient was admitted to the Psychiatry Service. Dr. Van Wyk, drawn to psychiatric patients, offered to do this on weekends for those without a personal doctor. 

The psychiatrists liked her work, and the part-time job became a full-time position. She would do the admission histories and physicals and follow up on any relevant blood work or imaging studies. Rita said that she “loved being the medical liaison on Psych for 21 years.” Little by little, she learned about the wounded spirit. How early painful experiences left their marks. And she felt useful and appreciated. 

In fact, she enjoyed listening to the patients so much, even those with full-blown psychoses or those with a tricky personality disorder, that she even considered doing a psychiatry residency!

We Stopped After a Text

(At this point in the interview, my husband Scott received a text. Former family court judge, The Honorable Penny Blackwell, who had been lingering with progressive parkinsonism with dementia, had passed away. We stopped talking and sat in silence for a few moments; the energy in the room was drained. We thought of her husband, Dr. John Sanstead. Jack, now retired, was my internist for years. He would gently hold my feet in his hands during a routine exam. He cannot be replaced. Dr. Van Wyk noted that in their periodic discussions on general medicine during her residency, Dr. Sanstead taught her some of the most important things she needed to learn to take care of patients skillfully.)

Family, Mental Health, Climate Change, Spirituality, and Racism

After this sadness, we talked a bit more about Rita’s dysfunctional family and how living through that helped her understand troubled psychiatric patients from impoverished and deprived backgrounds. And how, as a young child who couldn’t walk she would sometimes be placed in her seamstress-mother’s wicker basket of fabric scraps. And how her Auntie Sis showed how to sew the scraps together in a quilt to turn “trash to treasure.” (She still collects the discarded material from others when she attends retreats for serious quilters.)

We talked about how mental health services are woefully underfunded. We talked about how primary care physicians, including her internist-husband, are not allotted enough time to adequately take care of their complicated patients. We talked about the fact that the “main thing” in the clinic now is the ever-present computer. And how the system can wear you down and change you if you give in.

Rita's attempt to understand mental illnesses graphically
(scribbled in her copy of Psychiatry for the House Officer)

We talked about Rita’s despair regarding critical climate change spelling the possible end of humanity. And that while things may appear hopeless “there is always hope,” she said, but she “could be totally wrong.”

And we talked about spirituality. She believes that photosynthesis, whereby plants (she loves plants) receive light energy from the sun and store this as chemical energy for growth as they release oxygen proves, beyond any doubt, that there is a God. And she told me that she’s been a member of the Unitarian Universalist Church/Congregation of York since 1978, spreading “love and kindness, and understanding.” And that racism exists and hurts.

You see, there is increasing recognition of the importance of so-called social determinants of health and well-being. These are (according to the WHO) “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping daily life.”  

Racism, that is, bias against, and discrimination of, people on the basis of perceived but non-existent differences, is one of these determinants. It profoundly impacts physical and mental health. It must be addressed openly and honestly. It is present in South Africa and it is present and pervasive here. We need people to fix this. We need the Lamed Vavnicks.    

References and Suggested Readings

1. Paton, Alan. Cry, the Beloved Country. Charles Scribner's Sons. New York. 1948.  (The famous sad South African novel.) 

2. Rubin, Rabbi Lisa, "One of the 36." (Rosh Hashanah sermon on the Legend of the Lamed Vavnicks who "exemplify kindness, selflessness, and humility, 2023. (Click to watch the wonderful video.)

3. Tomb, David A. Psychiatry for the House Officer: Second Edition. Williams and Wilkens, Baltimore, 1984. (My husband had this small book--Rita's discarded copy!-- in his collection.)

4. Sima, Richard. "Racism takes a toll on the brain, research shows: The chronic stress of structural racism and discrimination damages brain circuits and mental health." Washington Post 2/16/23. (Link to the story)

5. Wilkerson, Isabel. Caste: The Origins of Our Discontent. Random House, New York, 2020.  (A broad exploration of the dangerous worldwide problem.) 

One of my 15 thriving African Violets

By Anita Cherry (10/22/23)

Dr. Jeffrey Lander, Ophthalmologist, Tries Not to Make Any Mistakes

Dr. Jeff Lander

York ophthalmologist Dr. Jeffrey Lander admitted that he has a Type A personality and is a perfectionist. Born and raised in Warren, Ohio, not far from Youngstown, he went through primary school as a mediocre student. He had no direction in the small town that was dominated by steel production (he worked for a summer in one of the dangerously hot mills). But Jeff’s canny sixth-grade teacher, an imposing former basketball coach, wanted his students to excel, so he spent the entire year warning them that they needed to “hit the ground running” when they got into the seventh grade or they would surely fail. 

Dr. Lander told me he was the only kid “stupid enough” to actually believe the teacher. So he studied all summer to avoid flunking out the following year. And he found out that he was pretty okay at learning if he put his mind to it. 

He continued to do well academically through high school in the late 1960s and early 1970s. At age sixteen, his aunt asked him what he was going to do with his life. Having no clear path in view, he ventured lamely that he would, perhaps, study German or maybe go to medical school.

Part of the abandoned Warren Steel mill in Warren, Ohio
as many heavy manufacturing businesses collapsed
  (From "Architectural Afterlife")

“Jeff! Are you crazy?“ she said.

“Okay, I will go to med school,” he replied, reacting swiftly to the tone of his aunt’s stern response. (This was an example, said Dr. Lander, of his inclination to make important life decisions without a lot of conscious thought, “without thinking very hard.” Decisions that usually turn out quite well... though not always.)

There was intense competition for spots in medical school, so Dr. Lander studied his “butt off” in high school. And he did a few things in those important adolescent years of rapid brain change that (it turns out) helped prepare him for his work as an eye surgeon: he built model airplanes, liked to draw, and played the piano (where his “four limbs were doing different things at the same time”). And his church pastor (possibly agnostic, thought the perceptive student) taught Jeff critical thinking, the skill enabling one to look carefully, to see things as they are. This became a lifelong habit.

Though not a Catholic, Jeff decided to go to John Carroll University in Cleveland, since they had a good track record (about 50%) of getting people into medical school (mostly by weeding out a bunch with especially difficult courses early on). The Jesuits (“the intellectual force of the Catholic Church during the Reformation,” said Dr. Lander) strengthened Jeff's analytical bent. 

John Carroll University (From JCU)

He had “laser focus” in college and received letters of early acceptance to two medical schools on the same day: he was offered a position at the prestigious University of Washington, St. Louis, and one at the state-sponsored “free” Medical College of Ohio, three hours from home. It was a no-brainer; he stayed in Ohio.

Jeff wanted to be “the best doctor” possible. So he “did nothing but study” just to land “in the middle of the class.”   Surprisingly candid, he said that his experience in medical school “was  awful.” The academic work came easily but the clinical rotations were challenging. 

The first class of the Toledo State College of Medicine,
later named Medical College of Ohio, in 1969
 (From the University of Toledo)

No attending he worked with, he wryly noted, wrote in their review of him that, “Student Lander was one of our best medical students ever!” Yet he did manage to receive “honors” in a few of the specialties. During his psychiatry rotation, for example, he sat down with a hospitalized patient and she opened up and told him everything. The attending remarked the next day that the woman greatly enjoyed being interviewed by him. But she thought Jeff was a priest and was horrified to find out that he was only a medical student. (He had taken the time to listen to her.) 

Yes, Type A Jeff felt a lot of anxiety in medical school. And he soon realized (among other things) that the brain (his brain) doesn’t work so well without enough sleep.

Anyway, in the late 1960s and early 1970s, as his fellow students were doing their darndest to be “melllow,” to fit in with the times, Dr. Lander clearly saw himself in a different light. He was not calm or easy-going, he said; he was a hard-working serious young person with a defined goal. In time, he concluded that it was okay to be himself.

The young medical school (it was established in December 1964) had an unusual curriculum. For the first two years, they studied a single system (such as the cardiovascular system) from the basic science to the pathology and the clinical aspects before moving to another system (such as musculoskeletal) in the classroom. 

The clerkships came in the third and final year (there were no summers off).  Most other US medical schools had a four-year program, two years of basic science, then two clinical years. Dr. Lander and ten of his classmates chose to take a fourth year of (also free) training. They knew they weren’t yet prepared to be responsible for taking care of patients. 

University of Toledo (previously the Medical College of Ohio)
 (From UT)

His initial plan (in line with the school’s primary care mandate) was to go into family medicine. When the students were (early on) given the opportunity to choose to spend time with (or “shadow") a physician in the community to get a feel for things the primary slots he wanted were already filled (they worked through the alphabet from both ends and "L" was near the middle) and he was matched with an eye doctor. 

That unexpected experience put the ophthalmology bug in his head despite the fact that he had already been leaning away from family practice and toward academic internal medicine, where keen diagnostic skills and knowing “everything”  (“like Dr. House,” he said, but without the edge) were prized. 

A TV physician/role model:
The imposing and intense Dr. Gregory House with his team
(From Cinemablend)

The two-week clerkship in ophthalmology changed his mind. You see, the eye clinic visits were short, the surgeries were quick, you could take morning coffee breaks, and you didn’t have to be up all night. You didn’t have to deal with people who were actually sick. And it’s “impossible to kill somebody,” said Dr. Lander. Since the body of knowledge and the skills to be mastered were limited (though still substantial and exacting) it was an ideal career choice for a self-described seeker of perfection. 

So Jeff decided to go for it. When he and a fellow colleague were casually advised by a resident that they couldn’t possibly get an ophthalmology training position because they were just too competitive, Jeff instantly shot back: ”Just watch!”

So he spent a year preparing to get into an eye program. He matched at Geisinger (his fourth choice of 16). Before starting, he did a required year of a rotating internship (1980-1981) at Mt. Sinai in Cleveland. This was, he said, “a wonderful place.” And he saw “tons of pathology,” when he was in the inner city hospital providing care to the urban poor. (The hospital had to close in 1996 due to economic pressures.)

Dr. Lander fondly recalled a two-month block in neurology with the bow-tied Neurological Institute-trained Dr. Howard Tucker. Jeff “loved” the civilized, academic, mild-mannered, and warm-hearted neurologist. (Jewish Dr. Tucker is still teaching residents twice a week at St. Vincent’s Charity Medical Center in Cleveland. And at age 101, he still–in 2023–holds the Guinness Record as the world’s oldest practicing physician, awarded to him in 2022; he has no plans to retire.) 

Dr. Howard Tucker with his Guinness plaque
(from "The Today Show" 8/10/22)

After the busy internship year in Ohio, Jeff was off to rural northeastern Pennsylvania for his three-year residency at the rural Geisinger Medical Center in Danville. All of his attendings were competent, but they were “oddballs.” Nobody, he recalled, taught him how to refract (for eyeglasses or contacts) and there was pitifully little instruction on actually doing cataract surgery. He felt that he almost had to teach himself ophthalmology. 

(Incidentally, looking back, Jeff feels that medical school information was “so useless” and that everything he needed to know could have been taught in one year.)

Geisinger Medical Center in Danville, PA (postcard)

A break for a social-historical tidbit. Jeff said that his decision about a career in medicine (after the not-so-subtle nudging by his wise aunt)  was influenced by the popular late 1960s and 1970s TV show “Marcus Welby, M.D.” According to encyclopedia.com:

 Much of the appeal of the program surfaced in the way that Welby treated his patients. In 1965 President Lyndon B. Johnson signed the Medicare Bill, raising many questions about the degree and quality of health care offered in the United States. Americans worried that they were going to be lost in the bureaucracy of the medical system and that their health would suffer for it. Marcus Welby allayed these fears of depersonalization (as he) had an old-school work ethic and treated his patients with respect. (from https://www.encyclopedia.com/media/encyclopedias-almanacs-transcripts-and-maps/marcus-welby-md)

Anyway, after Dr. Lander finished his residency in 1984 he wanted to practice in a small town. York ophthalmologist Dr. Gordon Pratt, only 50 then, was diagnosed with a brain tumor and offered to sell his busy practice “for a song,” said Jeff. Dr. Lander wisely kept Dr. Pratt’s office staff in place, and they helped ease him into the work. And he was warmly welcomed into the small tightly-knit eye community since the doctors were “swamped.” 

There was an easy camaraderie among the local ophthalmologists as they gathered once a month at each other’s homes to talk about new developments and to get help with difficult or troublesome cases. This comforting routine of sharing continued for nearly 30 years.  Sadly, this doesn’t exist anymore, said Dr. Lander, and he feels isolated professionally.

Jeff admitted that doing exacting surgery on the eye is stressful. In fact, he still gets nervous and he said that his “stomach goes into a knot” for the first few cases of the day.

“No case is routine until it’s over,” said famed Cincinnati cataract surgeon and innovator Dr. Robert Osher. And Dr. Lander knows that. So when already-prepped patients in the OR ask him at the last minute if he’s relaxed he replies: “Definitely not!” He knows that being slightly on edge and being slightly anxious generally improves performance, the Yerkes-Dodson law, (at least it does for him). 

There is an optimal level of arousal (in yellow) for difficult tasks

He said that one of the ways he deals with stress is through a strict exercise regimen. An optometrist in Danville had introduced him to Dr. Kenneth Cooper’s program in 1987. Dr. Cooper was the Air Force physician who, in 1968, invented the term “aerobics” for the endurance exercise deemed most important for heart health. He recommended a total of 30 minutes of sustained physical activity most days of the week. Dr. Lander, a self-admitted “exercise maniac,” has unswervingly followed this advice since 1987.

Another way for Jeff to cope with the stress of performing the delicate surgeries was to continuously hone his skills, even (especially) as the highly precise procedures evolved. The first major change happened halfway through his residency. And in 1991, the technique still used now, phacoemulsification, breaking up or emulsifying the clouded lens while simultaneously sucking the broken pieces of it out of the eye and making sure the pressures within the eye remain stable, was the new standard. It had to be learned by surgeons already in busy practices, so Dr. Lander took a “weekend course.”

An ophthalmologist doing precise cataract surgery
(From AARP and getty images)

As he adapted to these changes, cautious Jeff didn't want to hurt anybody by missing something critical for a lack of medical knowledge, not simply inadequate surgical technique. So he has repeatedly tested himself with a homemade deck of question-and-answer 3x5 flash cards. (Somehow, I doubt that many other doctors–or any other doctors, for that matter–do this type of reviewing so consciously, so deliberately, so humbly.)

And so, after nearly 40 years in private solo practice, Dr. Jeff Lander would like others to benefit from his experience. He put together a detailed 50-page book on cataract surgery for residents, a book he wished he could have had, himself, while he was in training. A work complete with his own (touched-up) drawings. A how-to-do (but not DIY!) manual  that he will sell on Amazon for, say, “$19.95.”  

But taking out our worn-out lenses (over half of us will develop cataracts by age 75) and replacing them with brand new clear acrylic or silicone versions while making sure that nothing goes wrong (it very rarely does) is only one of the "three legs” of Dr. Lander’s independent practice. 

He enjoys doing general eye care (often with continuity, “like a family doctor” who likes his patients and talks easily with them), of course, does the lens replacement surgery and performs laser treatment for glaucoma, and has a good-sized optical dispensing area with an optometrist, Dr. Howard Hartzell III. He said his practice is purposely diversified, should something unexpected happen in the future. 

His tireless wife (the practice administrator) “works 70 hours a week” running things and keeping the books. His son (diagnosed with what used to be called Asperger’s) also works in the office and is well-liked by the patients. 

Dr. Lander recently cut back on his office hours (just a little bit) but he has no plans to retire (unless his wife decides she’s finished). And, in the future, he would like to have the opportunity to do some clinical teaching to pass on what he has painstakingly learned and tried to get right, to get perfect, for the past 39-plus years in York. 

Well, I thought that was the end of our doctor's story, but no, there is more:

As the post was being put together it was already mid-September; the interview with Dr. Lander was in April. The unexpectedness of life may slow the writing process, but what happens along the way is often material for another tale. And, as Jeff has said to me, sometimes a story is just so interesting the way it turns out.  We may be surprised, and find that we’ve been completely duped, we had missed the point. 

So when I texted Jeff to let him know I would be sending him a draft for review his reply provided an unanticipated twist: he had stopped doing cataract surgery in May.

You see, he had awakened from sleep one day with severe right shoulder pain. As he went to write himself a note his hand did not work. He had a compressed nerve root, a pinched nerve, in the neck. He needed urgent surgery. After that, he took two weeks off and decided it wasn’t safe to do cataract extractions anymore; he would put down his scalpel and just practice medical ophthalmology. His wife was happy with that plan. 

And a friend of his wants to put together a blues band. So Dr. Lander said that he needs to learn how to improvise on the saxophone. He thinks this is going to take a while.

The original Blues Brothers Band (before Belushi and Aykroyd)
 (Photo from "The Echo" by Pepe Botella)

By Anita Cherry 9/24/23