Virginia Gov. Ralph Northam continues to be under fire for his connection with his 1984 medical school yearbook that includes a photo of a person in blackface and a person wearing a Ku Klux Klan robe.

His former Eastern Virginia Medical School roommate, Dr. John O. “Rob” Marsh, thinks the governor “has no association with that picture.”

“My theory (is) this was a horrible prank played on him,” Marsh said via text message. “But, I don’t know who would’ve done it or why and I cannot prove that. However, I think it would’ve been easy for someone to slip a picture like that into his envelope of pictures. Again, I could do not see him ever being in a picture like that nor wanting to have a picture like that displayed on his yearbook page.”

Marsh, an 1983 EVMS graduate and family physician in Middlebrook, Virginia, said Northam was not that type of person and he wouldn’t make racially insensitive jokes.

“He’s never been nor is he or will he ever be that type of person,” he said.

Northam is continually feeling pressure to resign from Democrats and Republicans following the news of the racist photo breaking on Friday, Feb. 1.

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The EVMS yearbook from 1984 shows the racist photo on a page designated for Northam with other photos of the governor.

Shortly after the photo's release on Friday, Northam apologized for being in the photo, but then on Saturday he said he doesn't believe he is pictured. He called the photo "disgusting, offensive, racist." He did admit to having blackened his face for a Michael Jackson costume.

Marsh was shocked when he heard the news about the racist photo. He spoke with Northam on Saturday, Feb. 2, asking if it could be him in the photo.

He said Northam told him no.

"When I looked at the picture closely, I do not think it is him in either one of those subjects and I have no idea who they are," Marsh said. "That picture may not have been taken during our medical years it could’ve been a photo from somebody’s high school or college past. I certainly do not remember seeing anybody dressed like that at any school function I was at."

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Marsh was Northam’s roommate during medical school from 1981-1983. After Marsh graduated, he left to enter the army, leaving Northam with the apartment.

Marsh became a member of the U.S. Army's elite Delta Force after graduation. He retired from the Army in 1996.

Known as one of the nation's most decorated military physicians, he helps provide health care to Middlebrook, a town with a population of less than 300 people, with his medical clinic.

He also launched a bigger clinic in the middle of a truck stop off I-81 in Raphine, Virginia. This helped Marsh be named Country Doctor of the Year by Staff Care, a physician staffing company, in 2014.

The two physicians met through Marsh’s brother, who knew Northam from their time at Virginia Military Institute. Marsh needed a new roommate after his previous one moved out. The two men quickly got along as they had similar backgrounds and were passionate about medicine.

“We shared a couple passions together; we really liked all old cars specially the (Chevrolet Corvette Stingray) and working on them,” he remembers. “And we enjoyed learning the practice of medicine, and we both had a strong faith in the Lord, and we both felt service to our community and country was important.”

Marsh remembers Northam during their time in medical school as quiet and friendly.

“We were both insecure going to medical school,” the physician remembers. “Neither one of us had the strongest academic background … so we had to study extra hard.”

Marsh explained EVMS is a three-year school and the first two years are condensed into 15 months. He said the stressful environment made things move fast and didn’t leave a lot of free time.

“Ralph got along well with everyone,” Marsh said. “He (would) always help with other students if they had difficulties in an area … he wasn’t a competitive type like you find at some schools. He was a serious dude and hard working.”

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Marsh described Northam as someone who was as committed to helping people as he was very open minded.

"When he began to run for politics I asked him (Northam), 'Why are you giving up such a great practice and pediatric neurology to be a politician?' and he told me because he felt he could do more for people to improve their life as a legislator (and) politician," Marsh said.

Marsh said Northam was always concerned about people’s feelings and he never heard him utter a racial slur or ethnic joke. He also didn’t like being around those who did make racial comments.

When it comes to politics, Marsh doesn't agree with everything Northam says, like his recent controversial comments on abortion, but he does think the governor has helped Virginia with his instrumental involvement in Medicaid expansion.

However, going forward, Marsh does think it will be difficult for Northam to govern.

"But, I would also say Ralph is a very tough, hard-working man and he’s committed to doing the right thing, and if anybody could survive this I believe he can. But it will take some time," he said.

Marsh added: "I however am not willing to say this was a mistake in his past because I don’t think it happened ... I think he has no association with that picture."

Contact reporter Meg Ryan at mryan@delmarvanow.com.

USATODAY contributed to this report.