Orleans County, VT Loses a Medical Legend

Orleans County has lost a true legend, a man who provided healthcare to generations of the people of the border region, and he brought countless numbers of them into the world. Dr. Frank Fiermonte passed away yesterday in South Burlington at 99 years old. Over the years I spent time with Dr. Fiermonte, recording some of his memories, and he has been a guest on my radio show, the Vermont Voice. The following is a several-part series in which he shared memories of his life in medicine. It was published in the Northland Journal in 2015. Please feel free to share your memories of the good doctor. I’m sure the family would love to read your comments.

Rest in Peace, Dr. Fiermonte. And my sincerest condolences to his family. Thank you for sharing him with us throughout the generations.

Dr. Frank Fiermonte: The Evolution of Healthcare in Orleans County

Thinking back to the early days of his medical career, Dr. Frank Fiermonte can still hear in his mind the whooping sound of his young patients suffering pertussis (more commonly known as whooping cough).

“They would start off with a rapid cough then it would end with a whooping sound,” Dr. Fiermonte said. “They’d have spasms, have trouble catching their breath. Their faces would turn red and their eyes would water. Oh to see a child go through that. It was horrible.”

Dr. Fiermonte, a native of New Bedford, Massachusetts, arrived in Derby, Vermont, in October 1945. He eventually bought a home on the village’s Main Street. In time, that home included his medical practice. His now late wife and mother to their three children, Lucille, a registered nurse, shared his mission and passion for providing healthcare to the residents of the border region. That was back in the day when many communities had at least one doctor practicing in it. Among the communities in which he did house calls were Charleston, Derby, Holland, and Morgan. And although he said Newport had many fine physicians, he did a few house calls there as well.

“I knew my patients and their families so well I felt like I was part of their families,” Dr. Fiermonte said. “That was the rewarding part of being a country doctor.”

There was a variety of reasons the community doctor was so important to the health of its residents. In the decades leading up to Dr. Fiermonte’s arrival, doctors typically made their house calls on horseback or buggy, and by sleigh in the winter. Long distance travel, for the doctors and the patients, wasn’t practical, especially during the winter months and during spring mud season. Even by the time he arrived, and cars ruled the roads, travel sometimes proved problematic in this part of the state.

“By the time I arrived, most of the main roads were paved, but many of our house calls were off the main roads, most which were dirt,” Dr. Fiermonte said. “I soon found out that during mud season I’d better make my calls early in the morning before the roads softened up.” At times during mud season, he couldn’t make it all the way up some of the dirt roads, many which led to farms, because they’d been turned to a quagmire of mud.

“Sometimes the farmer would have to help us get to the house,” he said. “We’d drive as far as we could make it then the farmer would come and pick me up with a horse or tractor.”

An interesting fact, Dr. Fiermonte pointed out, was one community that didn’t have a doctor when he arrived although it had a substantial population was the village of Derby Line, a community which borders the Quebec border. That was back when doctors could do house calls on both sides of the border. With some great doctors just across the border, including Dr. Arthur White of Stanstead, Quebec, and Dr. Lappiere of Beebe, Quebec, and later Dr. Giles Bouchard of Stanstead, no doctor was able to make a go of it in Derby Line, Dr. Fiermonte said. However, not only didn’t the doctors on the opposite sides of the border see one another as competitors, but most were good friends and even covered for one another when one was away on vacation. For that matter, Dr. Fiermonte said it was common for him to refer patients who needed more care than one of the region’s small community hospitals could offer, or who needed to see a specialist, to Sherbrooke Hospital in Sherbrooke, Quebec. He sometimes chose Sherbrooke Hospital over Mary Fletcher Hospital (later named the Fletcher Allen Medical Center and recently renamed the University of Vermont Medical Center) in Burlington because Sherbrooke is closer to Derby, and the roads to Sherbrooke were better than they were to Burlington. He also attended medical trainings at the Sherbrooke Hospital with his Canadian colleagues, learning about new medical procedures and breakthroughs.

The cozy relationship of the doctors on both sides of the border began to change as Canada began to move toward a system of national healthcare. Dr. Fiermonte is unable to remember for sure when doctors began to see changes in their cross border travels, but he believes it was in the 1950s. In time, the doctors were restricted to working on their own side of the border. It should be noted that in more recent decades, Dr. Mariam Tatum has operated a medical practice, the Border Health Center in Derby Line. She opened the practice years ago with her now late husband, Dr. Brent Tatum.

Dr. Fiermonte also noted another interesting tidbit about the village of Derby Line, one pertaining to its modern day, beloved pharmacist, Roland “Buzzy” Roy, the owner of Brown’s Drug Store, one of the region’s last old-time pharmacies.

“When I first arrived in Derby, Buzzy was just a little kid running around the store,” Dr. Fiermonte said. Buzzy’s late father, Roland Roy Sr., also a pharmacist, owned the store at the time. That was back in the days when Derby Line was a thriving community with stores that met the needs of people on both sides of the border.

During his medical career, Dr. Fiermonte said he saw just about every kind of injury and illness common in this part of the country, ranging from colds to disfiguring farm accidents. He also brought many babies into the world, some in the hospital, and others in their homes. He noted that back in his early days of medicine, in the days before birth control pills, large families were common, recalling one family with 13 children.

However, he said many of his patients, especially the children, were suffering from communicable diseases such as measles, mumps, and whooping cough, all three which have been almost eradicated by vaccines. The diseases often came in epidemic waves which swept through the region, from one person to the next, into the schools, and throughout the communities.

In the years leading up to Dr. Fiermonte becoming a doctor, many people died or were left crippled by polio. Some were left with damaged lungs and confined inside iron lungs, huge medical devices used to help sufferers breathe. Although he doesn’t recall growing up in fear of the disease, or hearing his parents fret about it, it was certainly feared by many, and many parents went to extreme measures to protect their children from contracting it. In 1952, Jonas Salk developed a vaccine to prevent people from contracting polio. It worked wonders, Dr. Fiermonte said. People lined up for the vaccine as soon as it was on the market.

“I saw only two cases of polio,” he said. “Both of the patients survived, but both were left with limps.”

Dr. Fiermonte cringes when he thinks back about all the children who suffered from now preventable diseases. He is bewildered by the number of Americans, including some Vermonters, who refuse to vaccinate their children today.

“I think it’s wrong not to vaccinate your kids against preventable diseases,” he said. “I think that people who don’t vaccinate their kids are doing them a disservice. That is my feelings. If they’d have seen a child with whooping cough, they’d be happy there is a vaccine for it today. One has to have lived through that era to realize how bad it could be. It was pathetic to watch those children. Vaccines saved a lot of lives. They are vitally important.

“With whooping cough we couldn’t do much but give them cough medicine,” Dr. Fiermonte said. “We’d give them codeine if it got real bad.” Between the parents and the doctors, they’d watch them for the onset of secondary illnesses, such as pneumonia and middle ear infection. There was also little that doctors could do to help youngsters with measles, other than try to keep them comfortable, watch for secondary illnesses, and hope for the best. He emphasized some of these secondary illnesses could have lasting effects on the sufferers. Some sufferers died.

In an attempt to prevent the disease from spreading from beyond the infected house, once a communicable disease was confirmed, Dr. Fiermonte said the town’s health officer was contacted. He or she then nailed a sign on the casing of the main door to the house, warning potential visitors that the occupants were quarantined and couldn’t accept visitors or leave the house for a certain period of time. In Derby, Dr. Fiermonte played a dual role, doctor and health officer, so he put the signs up himself in that community.

Even something as minor as stepping on a rusty nail could take a life. Although he said he never saw a case of tetanus (also called lockjaw) himself, he said it was all too common in the early days of medicine.

Dr. Fiermonte noted when he became a doctor, penicillin, which was developed in 1928, wasn’t yet in widespread use. Instead, doctors relied on sulfur drugs to treat bacterial infections. “Sulfur drugs had a lot more side effects than penicillin.”

Mass production of penicillin began during World War II to treat injured troops. Today it is typically given orally, but he said in the early years of the drug it required a painful injection. “It stung like hell,” he said. However, he said penicillin, and other antibiotics developed in later years, are only good for battling bacterial infections, not viral infections. He has little doubt the development of penicillin and subsequent antibiotics was the most notable medical breakthrough of his medical career. “It was a major breakthrough,” he said. “They saved a lot of lives.”

Thinking back to the 1940s and ’50s, and even into the ’60s, Dr. Fiermonte said children often suffered a number of communicable diseases to survive to adulthood.

“That all changed with the arrival of vaccines,” he said. “Vaccines cut down childhood diseases dramatically.”

One of the wonder vaccines he mentioned was the DTP. It was designed to build immunity to diphtheria, tetanus, and pertussis, all serious illnesses and all too common to children.

Not only did Dr. Fiermonte celebrate the advent of many of the new vaccines, but he and his wife happily volunteered their time to administer vaccines in some of the area schools in the communities he served. They worked closely with state health nurse Helen Batchelor of Derby Line, who organized the clinics. When asked why he and his wife volunteered their time, Dr. Fiermonte said, “I had seen so many sick kids, some of them so sick, I’d do anything to protect them.” He also commended the children who waited patiently for their shots.

Dr. Fiermonte is a bit troubled by the anti-vaccination movement, people who don’t believe in vaccinating their children. He doesn’t deny every vaccine might pose a limited risk of a side effect, but he said without a doubt the risks of suffering a side effect from a vaccine far outweighs the risk associated with the disease the vaccine was meant to combat. In part, he attributes the movement to the fact that with every passing year there are fewer people alive who remember the horrors of the epidemics.

“Most of them have never experienced that,” Dr. Fiermonte said. “If they had seen a child with whooping cough having repeated coughing spasms, they might understand why vaccines are so important.”

With that said, though, he still thinks parents should have a right to choose whether to vaccinate their children and the government should not involve themselves in that decision. However, he wishes people would make their decisions based on the facts, and not distorted, or even erroneous, propaganda about the danger of vaccines.

Part 2

When Dr. Frank Fiermonte, now 94 years old and living in Venice, Florida, opened his medical practice in Derby, Vermont, in October 1945, there were some huge families in northern Orleans County. He seems to recall that the largest family he cared for included 17 children.

“Boy, that was a lot of kids,” Dr. Fiermonte said. “That was back in the days before birth control pills.”

The first oral contraceptive, Enovid, was approved by the U.S. Food and Drug Administration in 1960 after much debate.

“A lot of farm families had big families,” Dr. Fiermonte said. He surmised that was in part because of the lack of birth control, but he also noted more kids meant more help on the farm. In addition, he noticed Catholics typically had more children, sometimes because of their beliefs about birth control and family planning.

“When I first arrived in Derby, I did mostly house calls,” Dr. Fiermonte said. “I’d do a house call for $3, maybe $5 if it was further away, such as Morgan, and I’d see patients at my office [located in his house on Main Street in Derby] for $2.” Prices were relative, though, he said, noting that it is true he wasn’t paid much to care for patients, but living was cheaper back when he first began practicing medicine in Derby.

He bought his big, beautiful home on Main Street in Derby in 1952 for $12,000. It’s a house that is worth many times more than that today. Dr. Fiermonte also said for many doctors of his generation, pursuing a career in medicine was less about money, but more about a mission to keep the community healthy. It’s true the people of the Northeast Kingdom, past and present, are not as well off financially as other parts of the state, but he said he found even his poorest patients honest. If they couldn’t pay for his services at the time, they paid for it at a dollar a time until the bill was paid. Other patients paid using crops from their gardens.

“Many of the people were poor, but most of them were honest,” he said. “They paid me what and when they could.”

As for pregnancies, Dr. Fiermonte cared for the expectant mothers for the months leading up to the birth, ensuring that everything was progressing well. “I’d even schedule vacations around my expectant mothers so I could be there when the time came.” The expectant mother chose where she wanted the child, at home or in the hospital, but the cost was the same either way—$35. That amount got the mother several months of care and assistance with the delivery.

“Generally people back then tended to stay away from hospitals no matter what he said. That included childbirth. He figures it was about 50–50 where the expectant mothers chose to have their babies. One way or the other, he said childbirth is relatively uncomplicated.

“Childbirth isn’t hard on the doctor, but it can be hard on the women,” Dr. Fiermonte said, but he added, “Some women who already had had children at home didn’t call me until the last minute, until they were ready to deliver. If they’d already had four or five kids before, they often just pushed the baby out with no problem.” Dr. Fiermonte’s now late wife, Lucille, who was an obstetrical nurse, assisted him with some of the births. “Childbirth is natural. We were there to catch the babies unless there was a problem then we might need to use the forceps to deliver the babies.”

Many women were excited when the first birth control pills hit the market in the early 1960s, he said. Debate about the safety, ethics, and morality of birth control continued throughout that decade, but it didn’t stop millions of women from asking their doctors for prescriptions.

Although Dr. Fiermonte said he never saw a mother not excited to see her baby for the first time, whether it was planned or not, he said most women were thrilled when “the pill” came onto the market. It provided them more control with family planning.

“We wrote a lot of prescriptions,” he said. “It was surely in demand.” Until the pill was on the market, he said there was little in the way of birth control other than condoms. This meant there were many unplanned pregnancies.

He enjoyed bringing new lives into the world, but by the end of the 1950s he had all but stopped delivering babies. Instead, by that time he and many other doctors were directing their expectant mothers to a new doctor in Newport, Dr. Everett “Jeff” Davis. Dr. Davis, who had begun his career as a general practice doctor in the border region, had returned to college for training in obstetrics and gynecology (OB/GYN) care for the needs of women, including pregnancy and childbirth.

“He was a good doctor and a great obstetrician,” Dr. Fiermonte said. “He helped a lot of women.”

There is a growing movement today of people who actively choose to have their children at home, many of them with the assistance of midwives. Among these people are those who feel birth should be treated as a natural process, not as a medical procedure that they feel is the nature of hospital births. Although home births are relatively safe, and he has great respect for many midwives, Dr. Fiermonte said he doesn’t advocate home births.

“Why take the risk?” he said. “Hospitals are equipped to handle complications.” And, he said while many general practice doctors delivered babies in the early days of his career, most of the doctors who now regularly deliver babies are highly trained OB/GYNs. However, he said, “The hospital costs are terrible, too high.”

For a 20-year period there were two hospitals in Newport. This was in the days before North Country Hospital in Newport, which stands today, became reality. The Orleans County Memorial Hospital, which was located on Highland Avenue in Newport, opened its doors on July 1, 1924.

“The Orleans County Memorial Hospital was a good hospital,” Dr. Fiermonte said. He spent countless hours there with his patients, some as they began their lives, others as they were ending. Others were there in hopes of getting better.

Today many people use emergency rooms (ERs) as their source of primary care, and not for true emergencies, Dr. Fiermonte said. That wasn’t the case during the early decades of his career.

“In the old days people didn’t want to go to the hospital,” Dr. Fiermonte said. “When I told patients they had to go to the hospital, they often thought they were dying. They didn’t want to go.”

There were so few visitors to the ER, he said, there wasn’t even a doctor on duty 24 hours a day, 365 days a year, as is the case today. If he recalls correctly, there was a nurse or two on duty in the ER while doctors were on call if they were needed. Most people who showed up at the ER were in rough shape, he said. They were either suffering from a major medical event, or they’d been involved in an accident, usually a car or a farm accident.

Part 3

By the 1960s, healthcare in the Northeast Kingdom was changing. The Northeastern Vermont Regional Hospital (NVRH) opened its doors in St. Johnsbury in 1972. That was followed by the opening of North Country Hospital (NCH) in Newport in 1974.

When Dr. Frank Fiermonte, now 94 years old and living in Venice, Florida, opened his medical practice in Derby, Vermont, in 1945, a few hospitals dotted the Northeast Kingdom, and many of the more sizable communities in the region had a least one doctor practice. Two hospitals Dr. Fiermonte worked in that have since closed were Orleans County Memorial Hospital, and Broadview General Hospital, both located in Newport. (Both were written extensively about in the August issue of the Journal.) The arrival of NVRH and NCH brought the end of an era for healthcare in the Northeast Kingdom and the beginning of a new one. He went on to care for patients at NCH, but he was never affiliated with NVRH.

“The new hospital [North Country] was nice, but I didn’t think the other hospital [Orleans County Memorial Hospital] was too bad either,” Dr. Fiermonte said. “It needed to be updated a bit. I’m not sure what they were thinking when they decided to build a new hospital, but maybe there was a good reason.” He noted he wasn’t in a position at the time to know what the hospital administration and the board of directors were thinking. However, he is fairly certain the doctors and medical staff couldn’t provide any better care in the new hospital than they did in the old one. He is also doubtful the new hospital attracted additional patients to help offset the cost of building it.

Dr. Fiermonte praised North Country’s first president and CEO, Tom Dowd. “Tom Dowd was a very good administrator. He really knew what he was doing.”

As he did in the two old Newport-based hospitals, Dr. Fiermonte did rounds in the new hospital, visiting his patients. However, unlike the Orleans County Memorial Hospital where family practice doctors took turns being on call to respond to the emergency room (ER) for emergencies, (doctors weren’t in the ER 24/7 like they are today, and he doesn’t recall Broadview Hospital having an ER), the new hospital hired specially trained ER doctors to work in its ER.

Although he appreciated the comforts of the new hospital, when NVRH and NCH were little more than ideas, Dr. Fiermonte said he remembers wondering why build two community hospitals and not one sizeable medical center centrally located in the Kingdom.

“I think that would have made more sense,” Dr. Fiermonte said. “We could have had a medical center that competed with the medical centers in Hanover and Burlington.” Instead, what the Kingdom got was two nice little hospitals with competent staff, but ones which to this day require area residents to travel outside of the region to such places as the University of Vermont Medical Center in Burlington or Dartmouth Hitchcock Medical Center in West Lebanon, New Hampshire.

“Major surgeries should not be done in most local hospitals,” Dr. Fiermonte said. “Most local hospitals were not meant for that.” Instead, he said, they were meant more for emergency medical care and routine medical care as well as relatively minor surgeries such as appendectomies, tonsillectomies, gall bladder removal, and the repair of some broken bones.

To this day he opts to have surgeries at medical centers versus community hospitals. Dr. Fiermonte emphasized it isn’t that the doctors in smaller hospitals are incompetent. Instead, he said, many community hospitals, including in Vermont, lack a support team of medical specialists, including a pulmonologist or a cardiologist, to assist in emergencies that might occur on the operating table, especially during complex operations. In most cases, he explained, it isn’t that the administration of small hospitals doesn’t want the array of medical specialists often found in medical centers. Instead, it is the lack of potential patients to draw from that makes hiring them financially infeasible.

“You want the specialists right on hand, not 80 miles down the road,” Dr. Fiermonte said. Instead of building a single, centrally located, full-service medical center, and possibly a small urgent care type hospital in Newport and St. Johnsbury, NVRH and NCH were built—both hospitals trying to woo the limited number of patients who live in the Kingdom.

With the construction of I-91 in the late 1960s and early 1970s, which directly connected Newport and St. Johnsbury, building such a medical center would have been perfect timing. The interstate would have provided direct access to the center for many residents of the Kingdom as well as ambulances.

Dr. Fiermonte leaves no doubt he loved being an old-time country doctor in which he cared for some patients from birth to death. By the 1960s, he said he realized, for good and bad, the era of the country doctor—where the doctor was more than a doctor, and often part of a patient’s extended family—was coming to an end as medicine and the way it was administered began to rapidly change. Dr. Fiermonte didn’t just sit back and watch the changes happen. He became part of some of the changes.

“Medicine keeps changing and doctors need to keep up with the times,” he said. To stay up on medical advancements, he often used his days off, usually Wednesdays, to attend medical meetings in Sherbrooke, Quebec. He continued his education first in cardiology and coronary care, and in the 1960s, he studied anesthesiology at the Fletcher Allen Medical Center (now the University of Vermont Medical Center) in Burlington. When he began administering anesthesia as a physician anesthetist at Orleans Country Memorial Hospital, he said, they were still “dropping ether” to sedate patients.

“It was vile and smelly,” Dr. Fiermonte said. “It worked, but ether was a horrible anesthesia.” When most patients awoke, they were violently sick to their stomach because of the ether.

By the time North Country Hospital opened in 1974, he said he’d abandoned ether and helped welcome in a new era of anesthesia to the region. He was involved in introducing halothane, a gas inhaled to sedate them. “Gas was far better than ether,” he said, noting patients no longer awoke violently ill.

“Administering anesthesia is an art,” Dr. Fiermonte said, “but it was repetitive. I preferred family medicine and working with people.” In time, he returned to his focus of family medicine.

Part 4:

The construction of Northeast Vermont Regional Hospital (NVRH) in St. Johnsbury in 1972 and North Country Hospital in Newport in 1974 were two of the many changes Dr. Frank Fiermonte witnessed during his long medical career in the Northeast Kingdom. Many of the changes were good, Dr. Fiermonte said, but not all of them, at least in his opinion.

Now 94 years old and living in Venice, Florida, Dr. Fiermonte said when he went to medical school, then opened up his family medicine practice in Derby, Vermont, in 1945, his mission in life was to care for people, not to shuffle papers. However, he said, beginning as early as the 1950s, paperwork was slowly encroaching on his time with his patients.

“When I first opened my practice, doctors didn’t have much paperwork,” Dr. Fiermonte said. “We just worried about practicing good medicine.”

Many of the family doctors of his time here in the Kingdom, including himself, had their offices in the communities they served. Most were located in their homes. Because of the lack of overhead, and not much in the way of paperwork, they were able to provide good medical care at a reasonable price.

“Back then the bills were often so small patients typically paid in cash,” Dr. Fiermonte said, “and I certainly never asked if they had money to pay before I cared for them. People were mostly honest. If they had money to pay me, they did. If they didn’t have the money, most paid me when they could…When a person is sick you can’t do nothing because they don’t have the money.”

Then insurance companies arrived along with their endless demands, questions, and paperwork. The state and federal government also heaped on a slew of mandates for doctors. This meant even more paperwork, robbing doctors of precious time to care for patients. Many of the family doctors—many who had often worked alone without a staff—were now forced to hire an assistant or two.

Healthcare was becoming big business with profits to be made, but often at the expense of the patients, Dr. Fiermonte said. Everybody wanted a piece of the action, including pharmaceutical companies, medical device manufacturers, even hospitals. The cost of healthcare began to steadily increase, sometimes out of the reach of people, especially those without insurance. Some people began to refuse to seek healthcare when they needed it, fearing going into debt. A delay in seeking care sometimes proved catastrophic for patients.

“Healthcare is now big business,” he said. “Too much about it is how much money can be made and too little of it is about patient care.”

The changes took a toll on the doctors. When a family doctor in the Northeast Kingdom—during the 1950s and 1960s, especially in one of the more rural communities—retired or left the community for another reason, it sometimes proved impossible to find a replacement. To survive, and to maintain healthcare in the region, other doctors, especially in larger communities, joined their practices, sharing an office staff to handle the paperwork and other administrative duties.

“I experienced a lot of change in medicine in my years in practice,” Dr. Fiermonte. Many of the changes were good, he said, especially the arrival of new medications to battle a wide array of illnesses and diseases. (In previous segments of this series, he told about some of the large array of lifesaving and life altering medications and vaccines he saw come onto the market during his long career in medicine.)

As far as technology, one of the biggest and best changes he experienced was probably the electro cardio machine, Dr. Fiermonte said. “That was very important to us. Then there were the upgrades in radiology such as the arrival of MRIs and CT scans. Technology kept getting better all the time. It helped us make better diagnoses.”

Although he appreciated the new technology, and he thinks it saved and continues to save many lives, he said technology does not replace quality one-on-one time between doctors and their patients.

“Talking to the patients is an important part of medicine,” Dr. Fiermonte said. “I talked to people. We depended a lot on listening to the patients, and we depended on our diagnostic skills. Tests were typically ordered to confirm our diagnoses but only when necessary. I tried to treat the whole person.” For that matter, during much of the 1940s and 1950s, there was little in the way of mental health care in the Northeast Kingdom. Some of the people with severe psychiatric issues were admitted to the state hospital which for decades was located in Waterbury. Family doctors handled some of the less severe cases of mental health issues.

“If the patients were suffering from anxiety or depression, I’d talk to them about maybe changing their lifestyles or reducing stress,” Dr. Fiermonte said. “I’d try to help them find a suitable solution.” Other times, he’d direct them to talk to their family’s minister or priest.

He said the arrival of Northeast Kingdom Mental Health (now Northeast Kingdom Human Services) in the early 1960s was a godsend to the region. For the first time, there were trained mental health professionals in the region to help meet the mental health needs of the people of the region.

In an attempt to handle the increase in workload in his office, Dr. Fiermonte hired Claire (St. Marie) Currier. He seems to recall it was in the 1960s. Currier lived a couple houses away from his home–office on Derby’s Main Street. Included among her many duties were maintaining the increasing paperwork, drawing blood, performing urinalysis, and weighing babies.

“She was a good, loyal employee,” he said. He told how when Currier had a baby she’d sometimes bring the child to work, and his wife would babysit while Currier worked in the office.

Finally, in 1976, because of the constant changes in healthcare, Dr. Fiermonte gave in and closed his private practice in Derby and went to work for North Country Hospital. He also said the move came at the urging of hospital administrators who wanted him to work for them in the newly constructed Medical Arts Building located on the hospital campus. He and his wife, Lucille, who had served as his nurse, sold their home and bought a house on Allendale Street in Newport, a short walk from the hospital. Dr. Fiermonte, Dr. James Holcomb, and Dr. Alan Covey became a team in the office complex.

Dr. Fiermonte said he was reluctant to join the hospital, but at that point in time he felt it was his only option. However, he said, it wasn’t long before he realized he’d made the wrong decision.

“I didn’t like how the hospital was run,” he said. “I didn’t want to be told how many patients I had to see a day and how long I could spend with them. I was getting sick and tired how medicine was being run. I wanted to practice medicine, and I couldn’t treat people when I wasn’t given time. I was just fed up. Practicing that kind of medicine wasn’t gratifying at all. It seemed more like a 9 to 5 job. It wasn’t like when I had my own practice. Then I felt like being a doctor was more than a job. I felt like I was part of my patients’ lives and families.” He also said he was feeling healthcare had become more about profit than about patient care.

“A good general practitioner needs to know what he can do, what he can’t do, and when he doesn’t have the answers,” Dr. Fiermonte said. “He also needs to be the captain of his own ship, and you can’t worry about how much time you can spend with a patient.”

Out of frustration, Dr. Fiermonte retired from medicine in 1983 at 62 years old. The way healthcare was administered had changed too much, he said, and it wasn’t only at North County. He said he’d love to have worked a few more years, but he wasn’t going to sacrifice his principles and medical ethics and not give his all to his patients.

Since he retired, many other doctors in the Northeast Kingdom, and far beyond its borders, have chosen to join hospital-owned practices. With the changing times, he said he understands why doctors choose to join a hospital practice versus operate a privately owned one. There is the cost of renting a space, insurance, including malpractice insurance, and the cost of employees. However, as a doctor, Dr. Fiermonte said it troubles him to have hospitals owning practices, noting he feels it is a bit of a conflict of interest, especially when it comes to patient care.

He said big business, including pharmaceutical companies, are some of the driving forces for the ever increasing cost of healthcare, however, he said, they are far from the only culprits. Hospitals throughout the country also play a role, he said. For example, he points to the amount of advertising many hospitals do as both a sign of squandering precious money while at the same time trying to generate revenue from increased consumption of medical services, especially state-of-the art technology. He said most advertising has little to do with patient care and more to do with hospitals generating revenue and competing against rival hospitals.

“I think hospital advertising is terrible,” Dr. Fiermonte said. He likened hospitals peddling their services through ads—in print, radio, television, or social media—as to that of pharmaceutical companies that use ads to encourage people to use their drugs, including drugs the patients might not need. In the case of hospital advertising, he said much of it is geared toward promoting services, some which patients don’t need. That is done for a couple reasons, he said, including to justify and to pay for medical equipment they may not have been able to afford.

There are few reasons for advertising hospital services, Dr. Fiermonte said. Healthcare is between doctors and their patients.

Although Dr. Fiermonte has a love–hate relationship with some of the changes in healthcare, he is unwavering when it comes to his support of doctors, especially those who practice his once beloved medicine, family medicine.

“Today’s doctors are well trained,” he said. “The problems in healthcare are not about the doctors. It is the system.”

Part 5

“I wouldn’t want to practice medicine today,” Dr. Frank Fiermonte said, reflecting on his career as an old-time country doctor. “Today it’s about big business and not patient care. It’s an entirely different ballgame. For me it doesn’t seem like it would be very rewarding today.”

Dr. Fiermonte, who is 94 years old and living in Venice, Florida, began practicing medicine in his home office in Derby in 1945. He was a true country doctor. Being a doctor for him wasn’t a 9 to 5 job, but an around-the-clock mission. He joined North Country Hospital in the 1970s, but frustrated by the changes in how medicine was beginning to be administered in this country, Dr. Fiermonte retired in 1983 at 62 years old.

He makes it clear he thinks many of today’s primary care doctors (and most doctors in general) are highly trained and dedicated. However, he said big business, including the insurance and pharmaceutical companies, and sometimes the hospitals themselves, make it increasingly difficult for doctors to provide quality personal care. Instead, he said, many primary doctors (also known as family doctors) must now practice “cookbook” medicine, medicine reminiscent of the set of steps found in a food recipe. When cooking a meal using a recipe in a cookbook, it’s almost certain if the steps are followed a tasty meal will result.

“Cookbook medicine is going just by the book,” Dr. Fiermonte said. “If you go in with a certain complaint, the cookbook (medical book) says you order this test or you order that test.” Too often this method views patients as a series of symptoms, not as a whole person as he said he liked to treat his patients. While such a process often works well in cooking, he said because of the individuality of human bodies, practicing medicine like following a recipe doesn’t have the same success rate.

Because of the short time many doctors are allowed to spend with patients—especially those employed by practices owned by institutions—Dr. Fiermonte said he understands the rise of “cookbook medicine.” They are doing what they can do with the limited time, sometimes as short as 15 minutes, to make possible life and death decisions. Ideally, he said, doctors need more time to not only exam patients, but to truly listen to them. From his personal observations as a patient, he said too much of some doctors’ precious few minutes with a patient are spent looking at a computer screen, and not into the eyes of a patient. While he appreciates the wonders of computers, and is even computer and internet savvy himself, as a doctor who cared for thousands of patients, he said a doctor can learn so much about a patient, including health issues, by taking time to listen.

Patients who feel they are being listened to are more likely to feel comfortable about sharing their health concerns, especially personal ones. Patients don’t want to feel like they are only a number. Besides that, in listening to patients, sometimes doctors can uncover underlying factors contributing to a variety of health issues including high blood pressure, high cholesterol, and anxiety. Such issues sometimes respond well to a change of lifestyle, such as healthy diet, increase in exercise, and the reduction of stress.

Having practiced during a period of time in which many wonder drugs, such as penicillin and other antibiotics, arrived on the market, Dr. Fiermonte understands the amazing, sometimes life-saving benefits of pharmaceuticals. However, he thinks many of today’s doctors prescribe far too many drugs, even when there are other options.

“Too many people are taking medicine for this and medicine for that, a pill for this, and a pill for that.” he said. “We are doping up the system with a whole bunch of medicine.” This is true of adults and children.

Although he said he doesn’t have evidence to prove it, Dr. Fiermonte wonders if there is a correlation between doctors not having enough time to spend with their patients, and the increase in prescribing medications, some which might not be necessary if they had more time to spend with their patients.

On the topic of pharmaceuticals, he said he finds it troubling that some large retail pharmacies now have medical professionals on staff to diagnose and possibly treat minor ailments. In itself, that isn’t a bad thing; however, he wonders what percentage of those patients go home with a prescription, possibly ones not needed, because the provider works for the drugstore.

To complicate matters, often because of a shortage of primary care doctors, including in the Northeast Kingdom, Dr. Fiermonte said too many patients don’t get to see their doctor when they are ill. Instead they might see a different doctor, or another medical professional, each time they go to the doctor.

“You need to see the same doctor each time, not this doctor one time and another doctor the next,” he said. The reason for this, he said, is because patients need to form a relationship with their primary care doctor so he or she can build a trust and comfort in the doctor, and for the doctor to view patients as more than symptoms, but as whole humans.

He also theorizes the large number of people who seek medical care in emergency rooms for non-emergency illnesses or injuries is often driven by a shortage of doctors and/or doctor appointments being scheduled so close together there is no room to fit in patients with non-emergency issues.

“A simple doctor’s visit then turns into a $2,000 trip to the emergency room,” he said. People go into debt when a visit to his or her family doctor would have done the job. It also increases the overall cost of medicine.

Dr. Fiermonte said he doesn’t understand the rise of the use of hospitals using hospitalists to care for hospitalized patients. These specialized doctors care for many of the day-to-day needs of patients admitted to the hospital. Traditionally, including when Dr. Fiermonte was practicing, a patient’s primary care doctor visited his or her patients when they were hospitalized. Typically, that is no longer the case with hospitals with a hospitalist program. Instead, hospitalists care for the patients as long as they are hospitalized. The hospitalist stays in touch with the patient’s doctor, and the patient’s doctor takes over when the patient is discharged.

“I think hospitalists are fine, but I think a doctor should see their own patients when they have to be in the hospital,” Dr. Fiermonte said. “If you’re sick you don’t want to see a stranger. You want to see your doctor. That is the way it is.” As a side note, hospital stays today are far shorter for many medical procedures than when Dr. Fiermonte was a doctor. Some procedures which required a few days stay in the hospital, are now outpatient procedures, in and out the same day.

So why are fewer medical students pursuing a career in primary care? That is a complex question, Dr. Fiermonte said, and he can only speculate. He suspects the nature of the way primary care medicine is practiced today scares away some aspiring doctors. Then there is the amount of paperwork and other non-medical duties and politics associated with the job. While he thinks it is a bit of a conflict for hospitals to own medical practices, he said the paperwork, politics, and regulations have made it nearly impossible for doctors to own their own practices, although he appreciates the doctors who make a go of it on their own. Also, more medical students are pursing careers in more lucrative medical specialties.

Because of the shortage of primary care doctors, there is a rise in nurse practitioners (NP) and physician assistants (PA). That’s fine, Dr. Fiermonte said, as long as they are working under the guidance of a competent doctor. For that matter, he wonders if NPs and PAs will eventually take over the role of much of the primary care medicine in this country.

Today’s healthcare providers, including primary care doctors, face challenges his generation of doctors didn’t face, he said. The epidemic of heroin and painkiller abuse sends many drug seekers to the doctor’s door in hopes of conning them into prescribing painkillers they don’t need, other than to feed their addiction. Back when he was a doctor, Dr. Fiermonte said, particularly in his early days, there was little in the way of painkillers, and it seems to him people understood that sometimes life came with a little pain, especially short-term pain.

“In many cases I’d typically first give out aspirin,” he said. “If it didn’t help, I’d give codeine. If a person was in severe pain I could use Demerol or morphine for the pain, but that was only for patients who were bedridden at home or in the hospital.”

Another topic doctors in Vermont and a few other states now face is the issue of “doctor assisted suicide,” known by some as “death with dignity.” Terminally ill patients with six months or less to live can request from their doctor a lethal cocktail of drugs to kill themselves. No matter what one calls it, Dr. Fiermonte said he would want no part of taking a patient’s life.

“I really do think hospice is the answer,” he said. With today’s modern painkillers there is no reason for patients in their final weeks and days to suffer. They can die painlessly and with dignity surrounded by their family, often in their own homes.

Although Dr. Fiermonte hasn’t practiced medicine for more than three decades, he has never lost interest in healthcare, including the administration of it and how it is funded. He also follows the politics of medicine. This has been made easier by the fact that his daughter Paula is a nurse, daughter Judy is a psychologist, and his son, Phillip, is Senator Bernard Sanders’ longtime right-hand man, including for the senator’s campaign for the presidency.

Dr. Fiermonte credits Senator Sanders for trying to make healthcare affordable and accessible. Among the senator’s successes he pointed out was helping develop federally designated community health centers, including here in Vermont. “At these centers you pay only what you can afford. I think that is the way to go in healthcare.”

As for the Affordable Care Act (aka Obama Care), it was designed to provide reasonably priced health insurance to people, particularly for those who couldn’t otherwise afford it, Dr. Fiermonte said. “I think Obama Care is a start, but I don’t think it goes far enough. We need a single-payer system. Having healthcare is not like having a boat or a car. It is a necessity. It’s not a luxury… We are the only developed country in the world that doesn’t have it. Part of the reason is big business doesn’t want single payer.”

In addition, he said he doubts many hospital administrators want it because a well-designed single-payer system will also have to reign in unnecessary costs in healthcare if it is going to work.

Looking back on his healthcare career, he finds comfort in all the people he helped, but he said he sometimes wonders if his family, particularly his children, paid too great a price for his dedication.

“One thing I regret is the time I missed with my family,” Dr. Fiermonte said. “That hurts me. I should have spent more time with them. Being a doctor was a 24-hour, 365-day-a-year job.”

When all is said and done, though, he said he has lived a good life and takes pride in the fact he is one of a dying breed of doctor—the old-time country doctor. Whether he likes to admit it or not, he is a true medical legend in Orleans County.

This is a separate piece I published about Dr. Fiermonte:

Dr. Frank Fiermonte was honored by the Lion’s Club in Derby in 1979. The following is a speech given by the now late Dr. Leo Seagal of North Troy.

Dr. Leo Seagal Honors His Friend and Colleague, Dr. Frank Fiermonte

It’s my honor and privilege to say a few words about my lifelong friends, Dr. & Mrs. Fiermonte. I’m going to talk about little episodes in his life that maybe some of you do not know.

Dr. Frank appeared here in October 1945, a single man. How he escaped all you single gals in this area is beyond me. He opened his practice that year in Derby Center using the Congregational parsonage as his home and office. Mrs. Carter, the widow of Dr. Carter, who practiced in Derby Center before Frank, kept house for him for almost a year.

Dr. Frank continued his love for baseball, which he had played in school, by playing third base with the Derby Line Town Team, who played at Baxter Park. How good his batting average was I do not remember, but knowing Frank I’m sure he did well. He played with the team a few years.

Dr. Frank appeared here at an interesting era medically. It was just after the so called horse-and-buggy doctor and the advent of antibiotics. From 1914 to the mid-20s, medical schools over the country produced a great number of doctors. And in our Northeast Kingdom, because of poor roads and poor travel facilities, it ended up that each town or large village had a doctor of their own. At that time, economically a 15-cow farm could support a growing family and a good sized town could support a physician in a most modest manner. Vegetables and eggs as payments were not unusual, and I can assure you that the fees in those days were very very low.

So, with Dr. Lapierre in Beebe, Quebec, Dr. White in Stanstead, Dr. Davignon in Rock Island, Dr. Larose then Jasper Knox in Derby Line, Dr. Parlin in the Charlestons, Dr. Macbride in Island Pond, Dr. Templeton in Irasurg, Dr. Buck in Barton, Dr. Cleasby in Orleans, and the group in Newport, which at that time consisted of Drs. Piette, Rublee, Schurman Sr., Peabody, and Emmons, we had a lot of doctors in this area, and so without even considering the physicians in my area of the Northeast Kingdom you can see there was quite a bit of competition for a new young physician in Derby Center. It was not exactly easy for Dr. Frank to get started, but with his innate brightness, knowledge of medicine, his feeling towards all people, and his wonderful sense of humor, he persevered and succeeded in his profession.

In 1946, he married Lucille who made him a lovely wife and who was a great aid to him throughout his career. They continued to live in the parsonage where Frank had his office. In 1948 their first child, Judy, was born. At that time we first met Dr. Frank’s lovely parents and Lu’s lovely mother.

During these years Dr. Frank, like the rest of us, made house calls all over the area for the ill and the housebound. He learned what snow would do to our highways and he knew what the mud season meant in the spring when our roads become an impenetrable morass. He learned how we lived and he learned who we were. Dr. Frank had his share of home deliveries, which often meant a whole night without sleep. Dr. Frank did a beautiful job in the area, and it was not long before we in the medical profession realized we had an outstanding physician in Derby Center.

In 1952, Frank and Lu bought that lovely home in Derby Center where he practiced and lived until just recently. I could never pass that house day or night without seeing a long line of cars in front of his office. There he had a beautiful office and home while living there. Paula and Phillip were born and brought up along with Judy. They all went to Derby Academy and all graduated from the University of Vermont.

During this era, medicine progressed at a rapid rate and Dr. Frank was foremost in this area in continuing his education and keeping up with the progress. At first it was cardiology and the use of the electrocardiogram and coronary care, and Dr. Frank became quite an expert at all this. Dr. Frank had the intelligence and the desire to keep up with all facets of medicine.

In the 1960s he went away to the Medical Center of Vermont and took up anesthesia and had an excellent training in that field. He did just about all our anesthesia at the North Country Hospital until the arrival of the present anesthesiologist. Soon afterwards the rates for malpractice insurance for a part-time anesthetist became so prohibitive that Dr. Frank had to give it up. I know of no anesthesiologist that I would rather have if I had surgery than Dr. Frank. And I’m sure any of us here who ever had anesthesia by Dr. Frank would feel the same way. I know our local surgeons enjoyed his work very much and miss him badly now.

In 1976, with his children grown and gone from the area, he moved his office to the Medical Building of the North Country Hospital, from which location he could better serve the people of our Northeast Kingdom.

During his career Lucille has always been beside him and was always helping him over the many rough spots that occur in a physician’s practice and doing a great job in bringing up the children.

This is no eulogy or retirement speech; it is just a friendly pat on the back for a fine physician and his wife, and we can visualize many more fruitful years for Dr. Frank in the medical profession.

But wherever Dr. Frank lives or practices in the future, to me he will always be Dr. Frank of Derby Center, Vermont.