|Author: Bettijane Eisenpreis|
|Nephrology PA Combines Science, People Skills|
|Blaine Paxton Hall, PA-C, is a man who embraces challenges. A skilled Physician's Associate, he has chosen to make his career in a highly specialized area of nephrology. "I work 100% of my time in the hospital supporting the Acute Renal service, the Transplant Renal and General Medicine Renal Services." In addition to being a PA, he has previously taken on the challenges of being an ordained minister, a licensed pilot, and a published author.
A prominent theme which runs through Hall's life and work is helping people. "I was a full-time, in-residence seminarian and postulant for the priesthood, with a hospital ministry when I realized that I was needed more in the medical profession than in the cloister of the church. Several friends and family members urged me to consider the PA profession. I immediately saw it as the best niche for me. I briefly considered physician training, but decided against it in favor of PA school," Hall explained. "Additionally, I've had several life experiences which have afforded me with a keen insight into the disadvantaged, marginalized, broken-spirited person in a health care crisis."
In addition to his BS and PA degrees, Hall has completed one-third of the requirements for an MBA, chemistry and physiology courses, and 38 hours of math. He worked for six years as a PA in general internal medicine before receiving his current appointment as a Physician's Associate in the Department of Medicine/Nephrology at Duke University Medical Center, Durham, NC. There, he specializes in the placement of vascular access dialysis catheters for patients in acute renal failure. "I like this specialty because it is intellectually challenging with the associated physiology, chemistry and math. I also get to use my hands doing the vas cath procedures and I get to spend a lot of quality time at the bedside," he says. "Vascular access dysfunction occurs when the means through which the patient normally receives dialysis fails."
"My day-to-day responsibilities include being on call to place the catheters for patients needing acute hemodialysis and to coordinate the care of patients with malfunctioning vascular access from our outpatient dialysis centers, which include over 550 patients. We also see many patients from outside of our service area who come to Duke for vascular access placement with our vascular surgeons, or for appointments with other specialties. We encounter patients with many medical diagnoses, the most usual being acute renal failure or end-stage renal disease, clotted AV (arterial-venous) grafts and malfunctioning perm caths."
The term "perm cath" (permanent catheter), he points out, is "kind of misnomer because the catheters are designed to be used for roughly six months. The catheters that I place are strictly temporary, because they are for people who need immediate dialysis. We can't wait to schedule them in the operating room, or scheduling them in vascular radiology to get a perm cath. It has to be done now."
The patients Hall treats are marginalized both physically and psychosocially. "First of all, from a health point of view, they have several comorbidities. Almost all of them have diabetes, hypertension, coronary artery or peripheral vascular disease." He also lists HIV, alcoholism, IV drug abuse as other comorbidities which make this one of the most challenging specialties in medicine.
"In addition to their complex medical status, many of our patients have great psychological, spiritual, social and economic needs. Here I can use my skills of empathy and patience and other insights gained from my religious training and my own life experiences," explained Hall.
Supporting all Duke's renal services -- acute, transplant, and general medicine -- presents Hall with some major challenges. "Frequently we take care of the patients that nobody else wants," he says. "If they come through the emergency room, we have to take care of them. Often, they are difficult to deal with. They may be noncompliant or verbally abusive. It doesn't matter. If you want ministry, then this is it!"
"Another challenge I face comes from the fact that we don't see people on a continuous basis. We're just putting out the fires and it's very unrewarding. It's a revolving-door, three-ring circus. You put out the fire and then run to the next disaster. I don't get the reward of seeing a person on a continuous basis and developing a rapport. That does make it challenging. The greatest challenge I face with my job," he admits, "is to keep my own spirits up and to avoid cynicism."
Hall fights the battle against burnout on many fronts - teaching, research, consulting and professional affiliations among them. Among his day-to-day responsibilities is teaching physicians-in-training how to place catheters. "I am the Co-Principal Investigator of a study involving a catheter similar to one we are already using. We are working toward catheters that would be easy to insert and that would minimize infection."
In 1994, he was appointed in 1994 by the North Carolina Superior Court as a Physician Assistant in Medicine and has testified as an expert witness before that court on several occasions. As a result of his witness experiences, he has also served as a medical-legal consultant. He is a reviewer for several professional journals and was invited to the Editorial Advisory Board of Nephrology News & Issues.
"I am certified by the National Commission on Certification of Physician's Assistants (NCCPA), but my job title here is Physician's Associate," Hall explains. "Duke is the home of the PA profession, and Dr. Eugene Stead who with Dr. Estes founded the profession over 35 years ago, called us physician's associates. At the age of 90, Dr. Stead still has a presence here at the medical center. Our legal title is physician's assistant, so the two have become interchangeable. I've also been called a physician's extender in a previous job."
Hall founded the American Academy of Nephrology PA's in l996, just months after he took the position at Duke Nephrology, because no nephrology PA organization existed. The American Academy of Nephrology PA's is now a specialty organization of the American Academy of Physician Assistants (AAPA). He also founded the Society of PAs in Mensa, (SPAM), who are also members of the international high-IQ society, MENSA, and a member of COLLOQUY, the on-line high-IQ Society. Among his many activities in the AAPA are: Charter Member in the PA Foundation Legacy Circle, PA Foundation Diamond Circle Benefactor and AANPA Chief Delegate to AAPA House of Delegates, 1999.
Hall is a member of the Henry Benjamin International Gender Dysphoria Association (HBIGDA), Inc., an international professional association that includes physicians, PA's, surgeons, lawyers, social workers and other professionals interested in the persons with gender identity issues. "While transgender individuals may have physical problems, dysphoria is more of a psychological, spiritual issue," Hall explains. "The physical aspect is just whatever it takes to get their bodies in line with their psyches."
His extracurricular accomplishments are many and impressive. He has several published works, both poetry and prose, to his credit. Among these are: "Intensive Care Unit," published in They Wrote Us a Poem, Vol. IV, which received an Honorable Mention award in 1999; "A Baby for Mary," published in The North Carolina Medical Journal, August 1994; and a creative non-fiction piece, entitled "Learning The Thunder" appearing in the January/February 2001 issue of the North Carolina Medical Journal.
His accomplishments as pilot and long-distance runner reflect aspects of his view on his life and career. "When you run long distance you have to plan it, just like you have to plan your life," he says. "When you're in your twenties and thirties you have more energy but less wisdom; you may run faster but not as well. When you get to the end of the race, which might be analogous to your eighties or nineties, you have to run more wisely and know how to conserve your energy. You have to know yourself and you can't just get out there and blow it all out like people do when they're in their twenties. They get out and go full throttle without thinking about conserving or measuring their pace for the race. And then sometimes you feel totally dispirited and can hardly force yourself to go on. It's not only the physical, it's the spiritual aspect as well."
He sees flying as a test, not only of skill, but also of character. He took his first solo flight in October 1979 and passed his private pilot's license written exam in 1980. "When you learn to fly an airplane," he says, "you learn very quickly your strength and your limitations, because if you misjudge you're going to crash. If you don't give yourself enough credit you're never going to get off the ground, you're never going to solo. You've got to know exactly where you are and not overestimate or underestimate. I think flying helps you do that. At least it did for me. You have to learn self-confidence but if you have too much self-confidence you're going to crash."
Asked where he would like to be in ten years, he replies with conviction, "In a professional venue, I am very happy where I am." He will continue to promote high standards, both in regard to technical and people skills, for other nephrology professionals.
For Hall, nephrology is more than a profession. "I remember when I was first interviewed by the registrar of my PA program, who has subsequently died," he says. "I asked what were the requirements to be a PA and, of course, she listed all of the technical, educational, and experiential requirements. Then at the very end she said, `And, you know, I really hope that a person also has a sense of calling.' That really stuck in my head because I feel absolutely that I am called to do what I'm doing. Everything in my life has brought me to this point, and I hope that others - both PA's entering the field and those involved in their education - feel the same way that I do."
Blaine Paxton Hall, PA-C, received his BS, as well as credits toward an MBA, from Roosevelt University in Chicago. He earned his PA degree from Wake Forest University School of Medicine and his certification from the National Commission of Certification of PA's, with Special Recognition in Primary Care.
Bettijane Eisenpreis is a freelance writer from New York City, and is on the Editorial Staff of NEWS-Line for Physician Assistants.