RAPHINE, Va. — Dr. John “Rob” Marsh was already more than 12 hours into his workday last Tuesday when he rolled up to a tiny darkened house in Vesuvius, an out-of-the-way town in Virginia’s Shenandoah Valley.
The homeowner, a woman with tired eyes, opened the door and apologized for the clutter. She’d been trying to get the place decorated for Christmas while also tending to her mother, who suffers from dementia and is bedridden by an arthritic knee that grinds painfully.
Marsh went into the back room and bent over the elderly woman, administering some gentle words and a shot of cortisone.
Marsh’s readiness to make nighttime house calls after a full day at the office has been a lifeline for her mother, said Carolyn Terrell.
“His willingness to come out here when we need him — well, it’s the kind of attitude you don’t find that much anymore,” she said. “We’re just fortunate. One of these days he may be coming out to see me.”
Marsh emerged from her mother’s room, delivered some instructions and gently put his hands on Terrell’s shoulders and urged her to take care of herself, too.
Then Marsh headed off along dark country roads in his Chevy pickup. He visited patients in an assisted living facility, made nightly rounds at a hospital in Lexington and then drove 20 miles back to Raphine, to the closer of the two doctor’s offices he maintains, to fill out insurance paperwork. At midnight, he was back in Lexington to admit two patients who’d come to the emergency room. He wouldn’t make it home to his farm and family in the village of Middlebrook until the wee hours.
“It’s just a fairly typical Tuesday,” he said as he drove.
Marsh, 59, is no typical doctor. His willingness to do it all for his rural patients — sewing up wounds at his office, hospital care, home visits at all hours — this month earned him the 2014 Country Doctor of the Year Award. It’s a distinction that has been given to standout doctors in communities of 30,000 or less since 1992 by Staff Care, a division of the medical staffing company AMN Healthcare.
The all-encompassing responsibility of being the only doctor on call throughout a sizable area of the central Shenandoah Valley might be too much for another physician. Not Marsh.
Tirelessness and the confidence to operate alone in a crisis — key requirements for rural physicians — were drilled into him in his previous job as the doctor for the Army’s elite Delta Force antiterrorism unit. From 1986 to 1993, it was his job to deploy with the unit on major operations to patch up wounds and make split-second medical decisions as combat raged.
But he wanted to do more. At Delta Force’s compound at Fort Bragg, N.C., Marsh, who specialized in family medicine at the University of Virginia’s medical school, established the ongoing tradition of providing medical care to operators’ wives and children as well.
He didn’t know it, but he was laying the groundwork at the time for his future work as a civilian community physician.
“What did I like most about the Army? It was taking care of soldiers and their families,” he said. “I liked the people I took care of — I liked the personalities of the families and the people.”
Today he works with farmers and truck drivers. They’re worlds apart from America’s most elite soldiers, but underneath different exteriors, they share similar qualities.
“I get the camaraderie that I felt at Delta — I’ve felt that here in this community,” Marsh said. “We rely on each other. These are really independent people here in a rural area … independent, hardworking people. Dedicated.”
Delta Force legend
Marsh, an enlisted Green Beret before attending medical school, was a legend who might well become surgeon general of the Army someday if he had continued in his career, said Barry Perkins, a former Delta Force colleague. Perkins served as Marsh’s physician’s assistant then, and today works part-time in the same role in Marsh’s civilian practice.
When Marsh recruited him to Delta Force in the early 1990s, Perkins only knew the doctor by the large reputation that preceded him. He also knew that Marsh’s father, former Virginia U.S. Rep. John O. Marsh, had served as Secretary of the Army throughout most of the 1980s.
“I thought I was going to meet a guy with a kind of silver spoon in his mouth, if you will,” said Perkins, who nominated Marsh for the Country Doctor of the Year Award. “I couldn’t have been more wrong about anything my life. He is the epitome of selfless service.”
Marsh didn’t leave Delta voluntarily. A 60mm mortar round during the Battle of Mogadishu in October 1993 blew him off his chosen path.
He had deployed to Somalia with a group of Rangers and Delta Force operators charged with capturing the Somali warlord Mohamed Farah Aidid—a failed attempt would go down in popular history as “Blackhawk Down.” It was bloodiest American engagement since the Vietnam War, and in retrospect, Marsh says, our military’s first time facing off against an enemy that would later become its focus—al-Qaida.
Two U.S. helicopters were shot down, 18 U.S. troops died, scores more were wounded and two Delta Force snipers — Master Sgt. Gary Gordon and Sgt. 1st Class Randy Shughart, who’d insisted on being dropped in the middle of the city to defend the wounded — received posthumous Medals of Honor.
Though Marsh had trained years before as a Special Forces medic, now he was a doctor, and that meant he wasn’t in the thick of battle. Nevertheless, he spent the most intense 24 hours of his life providing emergency care to friends and colleagues.
“Usually when I’d see a casualty, they were already bandaged up because my medic had seen them,” he said. “Now I was seeing fresh casualties, lots of them.”
The following day, what Marsh says was simply a lucky shot for some unskilled Somali mortar crew landed in the midst of a group of soldiers with whom he’d been standing, killing one elite U.S. fighter and inflicting devastating wounds on Marsh’s lower body and legs.
Quick thinking by his comrades in arms prevented him from bleeding out on the spot, he says, but Marsh would never again deploy with Delta and retired in 1996 as a lieutenant colonel.
“I never regained the physical skills I needed to stay on jump status,” he says. “I probably could have stayed in Army medicine, but I just didn’t feel that calling, I felt another calling, that I wanted to come do family medicine practice back in Virginia, where I grew up.”
Home in the valley
Marsh, a devout Christian, said he felt he was following God’s direction for his life when he returned to Virginia for good in 1996, but he still had some doubts. He opened a clinic in remote Middlebrook — near his newly purchased farm and just five miles from the place his grandmother was born — and began taking patients.
“I was a little worried how that transition was going to be,” he said. “You know — doctor of the high speed army unit coming back here.”
But the transition felt natural, he said, because once he settled in, the amount of responsibility that immediately fell on his shoulders was huge. Today he has 3,500 active patients. Not only is the number far higher than the typical primary care doctor’s 2,300 patients, his range of services for his patients is wider than normal.
“I think being in a rural area, one, your patients want you to do as much for them as you can,” he said. “By that I mean, they don’t like to be referred” to other, distant doctors.
As a result, Marsh was handling more complex cases than do most primary care physicians in an age of hyperspecialization. And it felt kind of like the Army.
“Instead of gunshot wounds,” he said with a chuckle, “chainsaw injuries.”
One of the advantages of civilian life back in 1996 was going to be more time with his wife and four children, now high-school and college age, he says. But his practice in Middlebrook—which grew enough that he in recent years opened a new office next to a giant truck stop on the interstate in Raphine—has become as absorbing as his Army work ever was.
His wife, Barbara, a registered nurse who works in the Middlebrook office, grew up in the suburbs of Newport News, Virginia, and said the practices of country medicine took came as a surprise.
“Sometimes it was a shock back when we moved here that people would call any time of the night or day and think nothing of it,” she said. “We’re used to it now.”
Patients and friends
His legend has grown around the community just as it did in the Army, with neighbors passing along stories about his constant work — not just at doctoring but as a Sunday school teacher, church elder, hospital board member and University of Virginia faculty member.
Marsh has a way of knowing what’s happening with his patients and showing up right when he’s needed, 88-year-old Middlebrook farmer Gene Sensabaugh said.
“I went into the hospital because I had some dizziness, and the doctor there said, ‘We’re taking your driver’s permit,’ ” Sensabaugh said. “I said ‘Doc, you can’t do it, I’m a farmer, I have to be able to drive.’
“Well, late at night, about 1 o’clock, Dr. Marsh shows up at my bedside and says “Gene, I’m going to stop them from taking your driver’s permit,’ ” Sensabaugh said. “What he did was he showed that the dizziness was caused by one of my medications. They change my medication and the other doctor, he said ‘OK, you can keep your driver’s permit.’ ”
Although many suspect Marsh simply needs little or no sleep, Paul Holliday of nearby Greenville saw Marsh asleep behind the wheel of his parked truck early one morning when he went to the local hospital for a test.
“When I came back out a little while later, he was gone,” he said. “I think that’s how he does it — he knows how to take a power nap and keep going.”
Holliday’s wife, Jane Holliday, said many of the patients in the community appreciate that Marsh not only provides medical care but spiritual care as well. Her church pastor, she said, woke up in the hospital late one night to find Marsh bowed in prayer beside his bed.
What does it mean to his patients, that Marsh has been named America’s top country doctor?
“I’ll tell you what ‘country doctor’ means — it means help, anytime you want it and whatever you need,” Paul Holliday said. “That’s what he does every day.”