Ralph S. Northam read Noah’s electroencephalogram and sent the 7-year-old home from the hospital with a dose of powerful anti-seizure medication and instructions to return for more tests.

Northam’s work as a doctor is a far cry from his other day job, presiding over the Virginia Senate, where he welcomes visitors to Mr. Jefferson’s Capitol and enforces the chamber’s arcane rules.

Most Virginians don’t know that the lieutenant governor spends much of his time treating sick children as a pediatric neurologist. More to the point, most Virginians don’t know who the lieutenant governor is.

Northam (D) is the latest in a long line of politicians toiling in relative obscurity in a largely ceremonial post for a chance to become the commonwealth’s next governor. He’s first in line to take over should anything happen to Gov. Terry McAuliffe, a fellow Democrat. But he has a steep hill to climb to win the job in an election.

A native of the rural Eastern Shore with a distinctive drawl, a military background and hunting skills, Northam ascended to the statewide stage at a tumultuous moment in Virginia politics.

Virginia Lt. Gov. Ralph Northam stands behind Deborah L. Stitzer-Brame as the staff of EDMARC, a child hospice center, begins to gather for a routine staff meeting at its headquarters in Portsmouth. Stitzer-Brame is the executive director of the organization and Northam volunteers as its medical director. (Timothy C. Wright/For The Washington Post)

In a state party that is tilting left to appeal to a growing base of young, urban and nonwhite voters, Northam has a centrist image that can look out of place at first blush. As a state senator, he revealed an independent streak that occasionally irritated other Democrats.

Last year, Northam ran for statewide office on a record of supporting women’s reproductive rights, gun control and Medicaid expansion — playing up his progressive side and a doctor-soldier bio that won over even the state’s liberal Northern Virginia electorate during the Democratic primary.

Far from the most dynamic guy to hit Virginia’s political stage, Northam must find a way to emerge from the shadow of the two other Democrats who have monopolized the political stage since they all assumed office in January. McAuliffe has dominated headlines in partisan battles with the Republican-controlled House of Delegates over expanding Medicaid under the Affordable Care Act.

And Attorney General Mark R. Herring, another former state senator with a centrist reputation, has taken controversial positions in support of gay marriage and providing in-state tuition to some undocumented immigrants.

In contrast, Northam has maintained the same methodical, steady-hand-on-the-tiller approach that he brings to other aspects of his life.

“My job is to reach out to people on both sides of the aisle on the issues that I feel strongly about,” he has said more than once.

But Northam appears acutely aware of his challenge: He doesn’t have to run against the term-limited McAuliffe to become governor, but Herring is a likely rival for the Democratic nomination. Northam is collecting chits by helping fellow Democrats raise money, and he has adopted issues newly relevant to Virginia’s changing electorate that could position him for a gubernatorial bid in 2017.

Virginia Lt. Gov. Ralph Northam drives his Toyota Prius back to his office after meeting patients and medical residents at the Children's Hospital of The King's Daughters in Norfolk. Seated in the back seat is his policy director, Holly Coy. (Timothy C. Wright/For The Washington Post)
Onancock beginnings

Northam, 54, grew up hunting and fishing on the Eastern Shore. He and his wife, Pam, raised their children, Wes and Aubrey, not far from the Chesapeake Bay-side Onancock farm where his parents, a commonwealth’s attorney-turned-judge and a nurse, raised him.

At Onancock High School, he was voted “Most Likely to Succeed,” played the French horn and was “one of the few white guys on the basketball team” in his predominantly African American class, said the Class of ’77 president, Carla Y. Savage-Wells. An obsession with fixing up old cars started about that time with a ’53 Oldsmobile (he still has it) and continues today with a ’71 Corvette.

Shortly after he was elected to the Senate in 2007, Northam angered some Democrats when he crossed party lines to end an impasse over judicial appointments. Thinking they had a sympathetic ear, Republicans asked him to switch parties. He declined.

Sen. Thomas K. Norment Jr. (R-James City), who became the majority leader after control of the chamber shifted in early June, said Northam has been more in line with the Democratic Party since winning statewide office.

“That’s not a criticism. That’s just a reality of politics when you get to that level,” said Norment, who bonded with Northam over their alma mater, the Virginia Military Institute.

As a state senator, Northam executed a partisan political coup for Democrats in 2012 by igniting a national firestorm over a weak spot in Republican legislation that called for women to undergo ultrasounds before an abortion. On the floor of the Senate, Northam explained that the bill would require invasive “transvaginal” ultrasounds in most cases because standard abdominal ultrasounds show nothing in the early stages of a pregnancy, when most abortions are performed.

“I might as well put the ultrasound probe on this bottle of Gatorade,” Northam said at the time, holding up the drink. “I’m going to see just as much.”

What had seemed like the kind of abortion regulation — such as parental consent and 24-hour wait times — that many Virginians support had morphed into a government invasion of women’s bodies.

The bill’s chief sponsor, state Sen. Jill Holtzman Vogel (R-Winchester), looked dumbstruck by what Northam said, state Sen. George L. Barker (D-Fairfax) recalled.

Northam also raised his profile by spearheading the state’s smoking ban and says he’ll push a bill to legalize a specific strain of medical marijuana for sick children. He also lamented the General Assembly’s relative powerlessness in combating childhood obesity. Walking past soda machines in the hospital, he said, “I’d like to get rid of those.”

Northam won’t entertain questions about a potential gubernatorial campaign or his long-term political strategy, but he appears to be preparing for the next step.

His chief of staff, Clark Mercer, was political director for the state party during last year’s Democratic sweep of three statewide races, and his PAC has raised about $140,000. Northam is headlining fundraisers for legislative hopefuls from Arlington County to southwest Virginia, making himself known to activists and donors.

And he showed that he can win over voters in the Democratic stronghold of Northern Virginia, where he narrowly beat tech guru Aneesh Chopra — President Obama’s pick as the nation’s first chief technology officer — in last year’s Democratic primary.

“He has a nice folksy style, but he uses that style to convey pretty strong progressive values about women’s reproductive rights, for example, or gay and lesbian rights or whatever the issue might be,” said Rep. Gerald E. Connolly (D-Va.). “It’s almost jarring. With that drawl, you don’t necessarily expect to hear those kinds of sentiments.”

Soldiers and children

Northam’s work in health care is one source of that authenticity. He entered VMI bent on becoming a fighter pilot, but a failed vision exam led him to Eastern Virginia Medical School, from which his son just graduated. After completing his pediatric residencyat Brooke Army Medical Center in San Antonio and a child neurology fellowship at Walter Reed Army Medical Center, Northam was sent to Germany, where he treated Gulf War wounded.

Northam was discharged in 1992 as a major; he still wears his dark hair cropped short, and suits hang off his slim, 6-foot-1 frame.

About four days a week, he sees up to 20 patients a day in Norfolk at the specialty practice he helped found in 1998 at Children’s Hospital of the King’s Daughters.

This is where Northam seems most at ease, confidently strolling the halls, doling out “How are ya’lls?” and “Yes, ma’ams” to the staff. His exam rooms are decorated with fish decals and his office door declares, “Gone Fishing.”

In a recent meeting with students, Northam explained that strokes in kids are uncommon — “rarer than hen’s teeth,” in fact.

For 16 years, Northam has also been the volunteer medical director for Edmarc Hospice for Children in Portsmouth, a nonprofit organization that serves children not expected to survive into adulthood.

After a recent examination of a 4-month-old, Northam ordered a genetic test to confirm his hunch about the baby’s condition before telling the parents that she would probably die. But the insurance company refused to cover the test, wouldn’t entertain an appeal from Northam and delayed the diagnosis for weeks.

“It pulls the rug right out of the relationship with doctor and patient,” he said.

His daily frustration over insurance companies’ influence on medical care motivated him to enter politics.


Northam juggles the demands of his practice with presiding over the Senate and traveling the state in a white Prius. But doctoring often trumps politics — at least for now. Northam planned to join McAuliffe and Herring as they worked the crowd at a three-day medical-dental clinic set up at a county fairground in far southwest Virginia recently, but the real-life doctor had to see his own patients.

Lieutenant governor is technically a part-time job and pays $36,321 a year. When the General Assembly is in session, Northam sometimes sleeps on a couch near his office.

With few constitutional obligations, he is focused on issues that remind voters of his medical expertise and are just newsworthy enough to yield benign statewide attention while showing his Hampton Roads base that he hasn’t forgotten them.

Northam heads the governor’s task force on mental health, formed after the son of state Sen. R. Creigh Deeds (D-Bath) stabbed his father before taking his own life. Northam supports universal pre-kindergarten in public schools and is committed to redeveloping the decommissioned Army base at Fort Monroe in Hampton.

His legislative priorities pale beside Herring’s headline-grabbing refusal to defend the state’s gay marriage ban and decision that some undocumented immigrants brought to this country as children could qualify for in-state college tuition.

Bill Bolling, a two-term lieutenant governor who was outmaneuvered for the GOP nomination for governor last year by then-Attorney General Ken Cuccinelli II, said it’s tough to gain political or policy traction in the post.

The last time a lieutenant governor won the top job over an attorney general of the same party was in 1989, when Democrat Mary Sue Terry moved aside for L. Douglas Wilder.

But Northam marches on. One morning this spring, he rode an elevator to the top floor of a downtown Richmond high-rise to attend a breakfast fundraiser for Del. Sam Rasoul (D-Roanoke). When he asked a receptionist for directions, she explained that he was in the wrong building. He smiled and thanked her, unfazed that she didn’t recognize him.

Bolling remembered similar moments when he held the office. “It was amazing to me,” he said, “how many people didn’t have a clue who I was.”