Randolph T. Holhut/The Commons
The tools of the trade in the examination room of Dr. Robert Backus at Grace Cottage Hospital in Townshend.
Originally published in The Commons issue #395 (Wednesday, February 15, 2017). This story appeared on page 0.
TOWNSHEND—A lot of babies have been welcomed, a lot of humorous stories recounted, and a lot of memories made as Dr. Robert Backus, the ultimate country doctor, gets ready to retire on March 9.
For nearly 40 years, Backus has been the mainstay — some would say the emblem — of Townshend’s treasured Grace Cottage Hospital.
One patient describes how his father died at 2 a.m. and “Dr. B” was at the house an hour later to comfort his mother.
Another tells of having her baby at Brattleboro Memorial Hospital at 7:41 a.m., and, even though it wasn’t his hospital, Backus showed up anyway by 8 a.m. to welcome her daughter and assume his role as her physician.
A third tells how she was emptying her Wal-Mart shopping cart into her car over in Hinsdale, N.H., when she felt something pulling on the back end. She turned and found a smiling Dr. B, ready to take her cart back to the store.
Backus speaks at many of his patient’s funerals, a sign of the respect he has earned from the families of those who died.
“Bob is one of a kind,” said Grace Cottage Hospital CEO Roger Albee. “He epitomizes the old country doctor. Whether there’s rain or sleet or sunshine, he’s always there. He’s involved in the community. He’s part of our everyday life. He’s here on Saturdays. He’s here late at night. The patients come first .... But you don’t just see him when you’re sick. He’s not a white-coat-and-a-stethoscope kind of guy.”
Wiry, intense, outspoken and a little salty, Backus has a sign on his desk that says, “Before you go to bed, give your troubles to God. He will be up all night anyway.”
“Don’t ever say we save lives,” Backus told The Commons. “If your time is up, it’s up. It’s true. We don’t save lives. Lots of docs say they’ve saved lives and thump themselves in the chest. A bigger power than us runs this system. I believe in a power that’s higher than we are. That’s got it together a little better than we do.”
An eye for the telling detail makes Backus one of the best storytellers in Windham County. He places a high value on humor.
And despite a few heart problems, Backus is still fit and energetic. A long-time dedicated basketball player, he’s still playing at the age of 74 — he turns 75 on March 18. “My father’s greatest lament was I was born one day after St. Patrick’s Day,” he jokes.
A flying ace who flew with Eddie Rickenbacker in World War I, Backus’ father moved to Los Angeles after the war and started a successful real-estate business. When World War II came along, he went back into the service as a spy.
“He volunteered again, much to my mother’s abhorrence because he had one son and he hadn’t quite named me yet,” Backus said. “The same night they named me he flew off and he didn’t come back for four years. He was missing in action six times. In actuality, he was a spook with the OSS. Isn’t that cool? Hell of a life. A great man, wonderful sense of humor.”
And his mother? She was a business school graduate who became secretary to the famous Hollywood gossip queen Hedda Hopper.
“[Baseball Hall of Fame outfielder] Ty Cobb was chasing her once and my father took umbrage at that,” Backus said. “They got into a fist fight. My dad clocked him.”
With parents this colorful, you would expect Backus to design an interesting life for himself, and so he has. After a youth spent traveling — the Peace Corps in Brazil, medical internships in Australia — he settled in the West River Valley and took a job working as second-in-command to Dr. Carlos Otis, the revered founder of Grace Cottage Hospital.
Instead of going wide, Backus was going deep. Deep into family practice. Deep into the community. Deep into medical advances as soon as they came down the pike. Deep into commitment to Grace Cottage and family practice.
The hospital, which began as a private practice in a house, now has grown and expanded many times over. Although its lack of a surgical suite required it to stop delivering babies in 2002, Grace Cottage has a 19-bed inpatient facility for acute and rehabilitative care, a strong rehabilitation department, a palliative care suite, a laboratory, a diagnostic imaging department, and a pharmacy.
Right next door is Valley Cares, a 40-unit independent and assisted-living facility.
Grace Cottage has a budget of $25.9 million and employs 203 people. It is a family primary-health practice that knows not only its 7,000 patients but, in many cases, their extended families.
As a nonprofit, Grace Cottage is funded by fees and fundraising, notably the famous Grace Cottage Fair in August on the Townshend Common. Backus spends the entire year collecting items for the fair’s popular auction.
Wishes and bequests make up another segment of financial contribution. Each newsletter has a “wish list” of hospital needs, followed by a page of “wishes granted.”
For example, one couple recently donated funds for a 6-quart commercial mixer for the dietary department and another donated money for the purchase of two commercial digital scales. Generators, pain pumps, large waste receptacles — you name it and someone has donated the money to buy it, often to thank a practitioner for treatment they or a family member have received.
Then there are the fundraising letters. According to board chair Stephan Morse, letters with Backus’ signature on them raise even more money than those without.
“That’s just another indication of how well he’s known and appreciated,” Morse said.
Backus said he knew he wanted to be a doctor ever since he was a little boy.
“I liked to hunt a lot,” he said. “We were living in Napa, and before I’d go to school I’d put my shotgun on a set of planks inside a dry culvert. I’d come home, put my books there, take my shotgun and hunt full time. What I shot I’d take home and dissect and try to figure out. Our local veterinarian was interested in that and he had me come around and help him with stuff. I got really hooked.”
He also knew early on that he wanted to be a family doctor.
“I have no idea how I knew,” Backus said. “I was just blessed with that.”
He also got hooked on southern Vermont.
“I came back from the Peace Corps for [medical] school in the U.S.,” Backus said. “I was driving cross-country from California and came over a hill and I just felt at home. All of a sudden, this was home. It’s never wavered.”
Backus completed his premedical studies at the University of Massachusetts and Dartmouth College, and took his medical degree from the University of Vermont. To feed his young family, he worked as a day nurse, a BMH orderly and on the Rescue squad. After his internships in Australia, he came back to southern Vermont.
“Carlos Otis was looking for somebody to help him,” Backus said. “He ran a lot of people off, so I was told, ‘If you can stand it, this is going to be a wonderful place to practice.’ He took me around the hospital and the valley and I was totally hooked.
“This is the greatest community-development project I’ve ever seen. I saw this very small community supporting this very small hospital and this hospital had tons of potential. And it’s lived up to its reputation. People line up to get work here. We’ve had our ups and downs and some of us are grumpy, but people are the highlights. The patients. It’s been quite a ride.”
“Dr. B” is adored in the West River Valley, but he just snorts and says “bullshit” when he’s asked about his saintly reputation.
“There are three big disadvantages to the work I do,” he said. “One is believing your own bullshit. You really get to think you’re something. When you think you’re good, you’re dangerous.
“Second, you can get out of touch. You’ve got to read, you’ve got to take courses, you’ve got to experience different horizons even though you’re busy in the practice. If you don’t, you become this person who’s trading on old stuff. It doesn’t mean the new stuff is the best. A lot of it is crap. But it means you’ve got to keep on top of things and bring the best back to your patients.
“Number three is the burnout. If I have any regrets, it’s that I do not feel I gave my kids enough of my time. My kids say bullshit, but they’re being very nice to me. It took 100-hour weeks to build Grace Cottage up to where it is. It wasn’t easy.”
Backus believes that the combined forces of government, the insurance industry, and the pharmaceutical industry have come between doctors and their patients.
“We’ve never had a coherent health-care system since I’ve been in medicine, so there’s an opportunity for people of all stripes, well-meaning and not well-meaning, to interfere. So if you have a little pencil pusher in Washington who wants to make a rule and they can get it through Congress, then another set of rules comes out.”
He used the generic drug doxycycline as an example.
“It’s a tetracycline drug,” Backus said. “The Germans developed it in the 1930s. It was one of the first real antibiotics. That is an old generic. So you come in with your Lyme Disease and it is treated with 100 mg of doxycycline taken twice a day for two weeks.
“That prescription used to cost $27. And now? How about $300 and change? That happened suddenly about a year and a half ago. It was public domain and somebody did a little something to the formula and, poof, got a little something through Congress and, poof, it happened. Big Pharma is incredibly clever.”
Backus gets his own medicines in the mail from Canada. Even though Grace Cottage runs a pharmacy, he encourages others to do the same. The company he uses is Global Pharmacy Plus (www.globalpharmacyplus.com) and he said their drugs are made to the U.S. standard.
“Take Viagra,” Backus said. “Here’s the deal. One-hundred milligrams. You break them in half and take it a half an hour before you want to make love. Here in the States, $450. In Canada, $65. You can just go down the price list, one after the other.
“When it comes to pharmaceuticals, we’re [being abused]. I have about a third of my patients buying their drugs from Canada. And the pharmacist knows it and understands it.”
Backus said he is worried about what a Republican government will do to health care, and of course he has his own ideas about what should happen: single payer.
“I don’t see a plan from the Republicans yet,” Backus said. “I don’t know what the hell they’re going to try. Were I they, I’d do that ‘Medicare for All’ and take credit for it. If they were smart politicians, they’d do that. It’s where we’re going to wind up eventually or we’ll crash. It’s stupid not to do it.”
Backus has tried — and failed — to retire before.
“There were no serious attempts because doctors and nurse practitioners left, and my patients started bouncing back immediately,” he said.
This time he means it.
“I’m retiring because it’s time,” Backus said. “If I don’t, I’ll be standing in the way of progress. There are a lot of young people who want to do what I’m doing. You’ve got to get out of the way and let the young people come up. If they don’t see any opportunity, they won’t come. Also, your brain isn’t as quick. I stopped doing night calls about six years ago. I said, ‘You’re not as sharp on the night calls, let the younger people do it.’”
But Backus’ retirement doesn’t really sound like a retirement.
“I’ve been asked to do a couple of weeks in Mexico, medical volunteer stuff,” he said. “I’ll still work on fundraising, and try to get a gerontology practice going at Grace Cottage. We’ll have the first one in the state.”
“He’s retiring from full-time medical practice but not from Grace Cottage Hospital,” Albee said. “His heart and soul and everything else is here.”
Retiring has been very emotional for Backus.
“I’ve had these people for 38 years, going on 39,” he said.
Backus doesn’t want any farewell parties.
“I just want to walk out of here on the night of the 9th, take these ladies who’ve been with me all this time and my wife to dinner, and then get out of town,” Backus said. “I’m going away for a month.”
Being a small-town family doctor isn’t rocket science, Backus said.
“It’s taking care of people and loving them,” he said. “Being consistent, being loving, give them a break if you can and, if you can’t, be honest about it. Work the system in their favor all the time, as best you can. But it’s getting harder to make the system work for us. Grace Cottage is the only family-practice-run hospital in Vermont. No one does it. We’re really different. We’re quintessential Vermont.”
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