When Marcus Martin became the first black graduate of the Eastern Virginia Medical School in 1976, his yearbook included a throwback picture from his first day as a student, making a sharp impression in a suit and striped tie. The caption read, "Better get your smiling done now."
On his personal page was his favorite quote, "Woe is me," referring to the marathon hours he spent studying, as well as a list of his hobbies and his specialty: internal medicine and emergency medicine.
What he calls a "very innocent" yearbook stands in contrast to ones made in subsequent years — most notably in 1984, when Virginia Gov. Ralph Northam attended the Norfolk-based public medical school and included a picture on his personal page of someone in blackface next to another person dressed in a Ku Klux Klan robe.
Another graduate, Michael Breiner, who is white, included a picture of himself in the 1985 yearbook dressed up as Diana Ross and wearing black makeup at a Halloween party.
"I am a big fan of Diana Ross. I love the Supremes. I have a lot of great African-American friends. I still do. And they gave me their blessing that this would not offend them," Breiner, a former plastic surgeon, told a Fox affiliate in Roanoke, Virginia, this week.
But the explanations rankle black alumni who graduated during Eastern Virginia Medical School's early years and who disputed any notion that black students, no matter the year, would have been OK with racially offensive images.
Martin, now 70, said if anyone tried to let blackface or KKK-related pictures through when he was at the school — or had he seen them in his yearbook after it was printed — he would have called it out immediately.
"I know for certain I would have brought it up. I'm not afraid to speak up," he said.
He said the culture he experienced at Eastern Virginia Medical School did not encourage or endorse racism, and if offensive photos were included in a yearbook, it would have been sanctioned by individual students and not an entire class.
"There was no sign of overt racism as far as I'm concerned," Martin, whose graduating class had 23 students, said.
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Northam apologized for having the picture on his page, and later denied being in the photo after initially saying he was part of it. But during a news conference last weekend, he admitted to once darkening his skin with shoe polish in 1984 to dress as the "King of Pop" Michael Jackson for a dance competition.
Dr. John O. "Rob" Marsh, his roommate at Eastern Virginia Medical School from 1981 to 1983, offered an explanation for the image.
"My theory (is) this was a horrible prank played on him," Marsh told the Salisbury Daily Times in Maryland. "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."
Former students who helped work on the yearbook said each person submitted the photos they wanted, but it's not impossible that a mix-up occurred. But Dr. William Elwood, who was a yearbook page designer in 1984, told The Associated Press that he received no complaints after it was published.
Walt Broadnax, one of the handful of black students in the school's 1984 class, told the AP that he doesn't think Northam would have posed for a blatantly racist photo, much less wanted one to be published.
"There is no way anyone would tolerate someone going to a party in blackface," Broadnax said. "If I had known about it then, it would have been an issue."
Aaron Pile, a black obstetrician-gynecologist who graduated from the school in 1983, was a yearbook editor that year and said he never would have tolerated a racist picture. He said his fellow students would also have known better.
"We were old enough, and we were supposed to be the cream of the crop in terms of intelligence," said Pile, now 66 and practicing in the St. Louis area.
The faculty did not micromanage the yearbook staff, who had autonomy over the contents, he added.
"Nobody else could put a picture on your page," said Pile, a native of Brooklyn, New York, whose personal yearbook page included pictures of his home, his family and a poem.
Pile also isn't allowing the negative attention to mar his experience at Eastern Virginia Medical School. He recalls being one of five black students who would study together. While no one showed the group direct disrespect, he said, there was still a feeling of having to prove themselves among their majority white counterparts.
"I wasn't in the party crowd," he said. "I was there to work."
It was a similar mindset shared by Martin, who grew up in the small paper mill town of Covington, Virginia, and whose parents never had the opportunity to attain a higher education.
Martin forged his own path, and has had a long career in medicine that included being the first black chair of a clinical department at the University of Virginia School of Medicine, and the school's vice president and chief officer for diversity and equity since 2009. He announced his retirement last fall, and also saw a diversity award through the Society for Academic Emergency Medicine named in his honor.
He hopes to be a role model in medicine — a field that has historically seen low enrollment by black men.
In 1978, there were 1,410 black male applicants to U.S. medical schools; in 2014, that number fell to 1,337, according to a 2015 study by the Association of American Medical Colleges.
Martin said the cost of medical school, a lack of wider access to scholarships and opportunities, and a failure by institutions to recruit a more diverse student population have hindered growth.
Attitudes matter as well, he added, and the idea that doctors could stomach any form of racism — even as medical students decades earlier — won't help change the narrative today.
In a statement Thursday, the Eastern Virginia Medical School named an independent volunteer board that will help examine both past and present culture at the school and come up with ways to improve diversity and inclusion efforts.
It's a move in the right direction, Martin said, after the fallout from the yearbook photo.
"I was totally surprised ... disgusted obviously, and hurt, like a lot of people," he said. "That image itself has tainted our school, but we'll recover. We have to learn from these lessons, not make these mistakes again."
Erik Ortiz is an NBC News staff writer focusing on racial injustice and social inequality.