In 1975 I was working on a dairy farm in Washington County and I stepped on a nail. As it had been a while since I had had a tetanus shot, I went to the small clinic in Lubec. At the time it was a house in downtown Lubec that had been converted to a doctor’s office. Dr. Robert MacBride and his physician assistant Dennis Lewia staffed it.

I saw Lewia that day and he gave me a tetanus shot. He told me to get a six-pack of beer and soak my foot frequently for the next few days, and if it got worse to get back in touch with him. It was personal, friendly service with an edge of humor.

Last Tuesday, Lewia passed away and with him passes a legend in rural health care. He typified what was best in rural medicine in America. He was probably the most dedicated, caring, compassionate, edgy, humorous health care provider I have met in 25 years of medicine.

It didn’t matter whether you were a snotty nosed 2-year-old with a cold, a drunk teenager with buckshot in your leg from your hunting buddy, a fisherman blown out of his boat by an explosion or a member of the Muskie family visiting Campobello, Dennis was there and he treated you like royalty. That was the difference between Dennis and the rest of the health care profession today.

He didn’t care whether you were dirt poor or the king of England; he treated you like you were the last person on Earth. He didn’t care whether you could pay or what your insurance was or whether your plan covered this procedure or that procedure. He took care of you to the best of his ability and if he didn’t know the answer he would find someone who did.

In rural Washington County, when the percentage of Medicaid and uninsured patients ranged upwards of 75 percent, there were health care providers like Dennis who didn’t care how much they got paid, whether or not they had health insurance, a retirement account or life insurance. They were willing to dedicate themselves to providing the best health care they possibly could and quite literally sacrifice their lives to the cause. I have no doubt that both MacBride and Lewia died because they put their heart and soul into providing quality care to the town of Lubec and there was no more that they could give.

In 1986, after medical school and residency I went back to Lubec and practiced for 10 years. During the intervening years since 1975, the medical center had grown to a large building on the outskirts of town but it had retained its down home appeal. Lewia and MacBride and their staff put in blood, sweat and tears to get that new building built. They were intimately involved with the funding, design and construction of the new center. They were the backbone of rural health care.

Over the more than three decades that Lewia worked at the medical center in Lubec he watched it grow to the largest rural health care center in the state. He watched more than 20 physicians come and go. He saw administrators, physical therapists, nutritionists, health educators, podiatrists, fitness instructors and grant writers come and go. Lewia, his wife-nurse Maureen, and all the other nurses and staff hung in there, put their noses to the grindstone and kept focused on their top priority, providing quality health care to the people of Campobello and eastern Washington County.

That level of dedication doesn’t exist anymore in this day and age. Health care has become so driven by the insurance companies, the costs of providing the care, the collecting of bills, the on-call schedules, the administrators pushing providers to see more and more patients, the threat of lawsuits and the expectations of the patients, that it is no longer possible for health care providers like Lewia to give every patient quality health care and treat them like royalty.

The local hospital in Machias has been desperately trying to recruit new physicians to Washington County, but because health care has become global they are forced to offer competitive salaries that they can’t really afford. Nine times out of 10 that the physician comes, the spouse is disillusioned with rural lifestyle and they leave after a year or two.

We need a revamping of the health care so rural America can get the quality health care they deserve and providers like Lewia and MacBride can be adequately compensated for treating people and give them the care they deserve regardless of their ability to pay.

With the passing of Lewia, we also mourn the passing of an era when doctors and physician assistants of rural areas could provide empathetic, compassionate care with humor and grace to their patients. In my mind, Lewia was the last prince of rural health care.

Benjamin Thompson, M.D., practiced medicine in Lubec for 10 years. He now lives in South Portland.