SEABORN BLAIR, M.D.
Dare County

February 10, 2000

Interviewer: Beth Nelson

Beth Nelson: I want to talk a little bit about your background. What I'm trying to do is to follow something of a format with all of the people that I am interviewing. I know quite a bit of your background from having a copy of your CV and also having that article, but just for the purposes of this interview, please go through a little about your background.

Seaborn Blair: Well, I grew up in Duplin County. My father was a family physician in a small town. Graduated from high school there and went to UNC Wilmington. I went to school for a couple of years and at that time in my life I was more interested in enjoying college than I was in really working. I was at school for about two years and then I quit and I went to work for a boat builder up in New England at Cape Cod and I worked there for over a year and during that year I began to start thinking about what I really wanted to do.

Beth Nelson: I remember reading about your interest in boat building but I didn't realize you went to Cape Cod to do it. I guess in a way that seems surprising that you would choose to go so far away from home.

Seaborn Blair: Well, I had an opportunity to work with somebody who was really great at the time. He had written books on boat building and I had a chance to work with him before he died. He was an older fellow and very knowledgeable about life in general. He took me under his wing and helped me to see a lot of things and find out about myself that probably would not have otherwise happened. I think it was probably one of the coldest winters in the history of New England. I then came back home and went back to School. I enjoyed working in New England but didn't think I could make a living working that hard. I thought about what I really wanted to do and what I could be good at doing. I came to conclude that probably the practice of medicine would be the best thing that I could do. It was something I could be really good at and I felt it was something I had a real knack for and desire to learn. When you grow up in a family full of physicians and a long history of medicine, you go through those years of high school, teen age years with the people in the community saying you are going to be a doctor because your Dad and great Grand Dad was, I sort of rebelled against all of that and decided I was going to do something completely of what I wanted to do and I had no intentions of going into medicine at all when I started college and it was the most further things in my mind. I majored in biology and I liked marine biology. I like the ocean, the surf. When I look back on all of that now it is like in some ways I feel like it is almost genetic. Some people's families like carpenters and they are really good carpenters and they just had a knack for doing it. One of my best friends is a boat builder and his Dad is, and he learned it from his Dad and he loves it and he is really good at it. There is nobody better. I think there are a lot of people who wouldn't agree with me, but I think some things you just are genetically engineered to do better at and I think I am skilled with having a real knack with communicating with people and I am a good listener and I enjoy medicine and once I started pursuing it, I realized that it was the path that I needed to go down. I sort of had to figure that out for myself. People were trying to tell me that it was what they expected of me but I didn't want any part of that but it all came down to me and what I thought I could do and what I wanted to do. I think the decision just took me awhile.

Beth Nelson: What about your Dad at this point? Was it something he felt like he would have loved to see you do and did he speak openly about it?

Seaborn Blair: He never said anything to me about going into medicine. He never encouraged me to pursue it. He never said to work on my chemistry scores if I wanted to get into medical school. He never said anything like that. He was concerned that I really didn't know what I wanted to do with my life at certain points in my life. Growing up we would sit and talk about things like that and I would tell him what I wanted to do in the marine biology field and he would say that was great. I told him I wanted to own a good boat and he encouraged me and told me he would help me with it if I really wanted to do that.

My mother was a guidance counselor and went back to Philadelphia and got her Masters. She is really a very intelligent woman. She always would excel in college. She was a teacher and once she had her family she pretty much stayed home with us. After we were gone she sort of got back on her career track. She went back to ECU and got her Masters in Counseling. Anyway, she is a very loving and supportive mother. She never pushed me to do anything. In fact, sometimes I feel like they could have pushed me a little
harder than they did as far as trying to steer me in the direction for the career concern. I guess they figured I would have just rebelled against that and make it even harder. Mom is such a smart woman. She has always been a good supporter. She grew up on a farm out in the country from Wallace where my brother lives and they had friends close by. She read constantly when she was growing up and she read everything. She read every book in the library and then she went off to college. She has been really happy with what she has done. She loved my father absolutely and completely and it has been real difficult for her. He was her life for the last thirty or forty years. His being gone has left a real void in her life. That is a void that she will never fill. My Dad was diagnosed with cancer in December and died the following September. He was around 73 or 74. He practiced medicine up until about a year or so before he died. He still had some old patients that he would go in to see. He practiced very hard for forty-five of his years.

Beth Nelson: Tell me a little bit about what you remember about your Dad's life as a family physician.

Seaborn Blair: When we were young, Dad was gone a lot. He was the only doctor in town for a long time and then he was one of two for a long time. When he first started practicing he delivered children at home. Anything that happened anywhere in town they would call him and he would get in his car and he would drive out there to the house and see what was going on. I used to go on calls with him a lot. He would take me along with him a lot of times and I always remember those times. We would always go in and visit with the family and he would see whoever was sick and then I played with whoever there was to play with. He would take time off and we would take trips with the family. Betsy, my sister, is the oldest and she lives in Greenville now. She is a pediatrician and went to school at Chapel Hill. She goes by the name of Elizabeth Blair. I am the oldest son and Mott the youngest. I am three years older.

Beth Nelson: What influenced Mott. Do you think anything you did in your position had anything to do with influencing with Mott over his decision?

Seaborn Blair: Mott always wanted to be a doctor. From the time he started school he always wanted to practice medicine and come back to Wallace and practice with Dad and take over that practice.

Beth Nelson: Did you ever consider doing that?

Seaborn Blair: I did. I thought long and hard about it and when Daddy had heart surgery I went back. I was a resident at Pitt when Daddy had the bypass surgery. I went back and worked in his office a couple of days a week and kept things going there for awhile until he got up to speed. I just didn't want to live in Wallace. I love my brother but I don't think he and I could be really happy partners in the same practice. I always loved the coastal life anyway and I love to be on the water.

Beth Nelson: After you got your biology degree didn't you then go and get your Masters?

Seaborn Blair: What I did was I went back to school at UNC in Wilmington and got my degree but my GPA was in such poor shape after those two years of partying and playing that I was barely getting by.

Beth Nelson: You strike me as more intense person and someone who could truly have a good time but would always come to the light at the end of the tunnel.

Seaborn Blair: Well, I didn't see any light. I surfed-that is what I was there for and that's what I wanted to do and that's it. Sailboat racing and surfing, everything else was secondary. I would excel in both of those things. I was a standout. Going to college was a vehicle to get me access to do the things that I really liked to do. That is absolutely why I chose UNC Wilmington. Thinking back, if I had any idea about things I would have probably gone somewhere like University of Hawaii or something but I didn't like being that far away from home at the time. I had a great social life. I was smart enough in school that I didn't to do a lot to get by. I really didn't have to work at it. Went to UNC Wilmington for two years and was making a 2.0 for two years and then when I went back to school I made 4.0 for the last two years so that brought my GPA up to 3.0. I still wasn't good enough to get into medical school so I went to ECU and got my Masters. I went and talked to Dean Hayek in Admissions. I went in and applied and got turned down. I just figured they would overlook my poor performance and take me as the person I was and the potential I had and go ahead and let me in. They didn't see it that way. I was scared to death of Dean Hayek and it took all the courage I could muster to go and talk to him about why I had been turned down and what I needed to do to not get turned down again.

Beth Nelson: Now for you to go in and get turned down, was there any influence on your Dad's part in telling you to go and find out why you didn't get it or that you wanted to go and you were going to do it on your own?

Seaborn Blair: No, I got upset with my Dad because he had a lot of connections in Greenville at that point and he was working a lot with the medical school but he would not do anything to help me. He wouldn't go talk to anybody, he wouldn't make any phone calls and that became a sore spot because I was knocking myself out trying to get into medical school and he wasn't doing anything to help me. Finally I asked and he told me he was supporting me and behind me and that if I wanted to do it then I had to do it on my own and that he would surely put in a good word for me and he had never put in a good word for me because I had never asked him. I moved to Greenville and got into a Masters program and I worked with a really great advisor on the main campus. He told me more or less what I needed to do. Dr. Hayek told me what I needed to do and I had a feeling about him-I felt like Dean Hayek told me to do this, this and this, and I did it and he was at hand. That's more or less what happened. He said I had to bring my scores at least up to minimum and you have to do this with your GPA and you have to get into a Masters program and finish your Masters and don't expect to get into Medical School and not finish your Masters. He said to go work at the Medical School and get your foot in the door in the School of Medicine. That's what I did. I got in Graduate School there and Dr. Gilbert Taylor, who is with the Department of Biochemistry, he had just come to Greenville and was setting up his lab so I saw some of his posters and I really didn't know him from Adam but something about the way he looked and his mannerisms and his poster presentations and stuff, I thought this guy was really on the ball and I could get some tips from him. I went to see him and told him I wanted a job and wanted to work on my Masters Program and do a Masters thesis and asked him if he had anything for me. He took me in and I started working on my Masters and I started working in his Lab and basically got his Lab up and running. I was his first student. People got to know me around the School of Medicine and my advisor put in a good word for me and we moved over to the Brody Building and I did the first scientific experiment done in the Brody Building. The Department of Anatomy moved in first and then the Department of Biochemistry moved in second. A week after that none of the Anatomy Labs were operational and nobody had any ongoing research going at the time and we moved in Dr. Taylor was gung ho and always had been and I decided that I was going to be the first person to do any kind of experiment in that Brody Building so just as soon as the door was unlocked I took my project and set everything up and ran a couple of tests and I was the first person to do this in that building. That is a little accomplishment that I claim. Anyway, it was just in that era that I started in the medical school. I was passing those guys in the hall all the time and talking to them and they knew how bad I wanted to go to Medical School. I was doing all A's in all my graduate work. I eventually entered Medical School.

Beth Nelson: Then after Medical School, what about Match Day? Was that your first choice?

Seaborn Blair: Yes, I knew I wanted to live and practice in eastern North Carolina and we had a very good program and I felt it really didn't make sense to go somewhere else with all the pulls and connections if I knew I wanted to practice in eastern North Carolina and really liked living in Greenville. It was a good fit. I looked around and there were some other attractive programs but they just didn't fit what I wanted to see. We went with the program back here. There are different programs now. Of course, with any program you get what you want to put into it, especially with family practice programs, you can learn nothing or you can work hard. You can be as competent as any other resident in the hospital can. I felt like I was really interested in it and I really wanted to work hard. Everything I did-when I went out the back door here I was prepared. I really might not have known everything to do but I felt like I had what I needed There was a lot of reliance on the people in Greenville here.

Beth Nelson: There was a physician here at the time?

Seaborn Blair: Eventually I wanted to move back closer to home.

Beth Nelson: Tell me about the decision to come down here.

Seaborn Blair: It was a tough decision at the time. I wanted to be a little bit closer to Wilmington and I could have had a successful practice there but it was not really like they need a doctor there. It was in the area around southeastern Pender County that is where I was thinking of going. We had bought land there and now that place is swarming with doctors and if I had done that, financially I probably would have been more successful but there is something about going somewhere where somebody needs you versus a place where you can make lots of money.

Beth Nelson: Tell me about coming here for the first time.

Seaborn Blair: Well, I wasn't very impressed with it when I came the first time. I came from a modern medical center and I came to this dusty old place. There was a physician who joined and then there was Bob (or Robert) Jacobs. He was a young fellow and he came out here and joined Don Burkes who had been out here for thirty some years.

Beth Nelson:Was he the first physician?

Seaborn Blair: No, there had been physicians here throughout the years. There was a doctor here for a long time. There was a doctor here who did tonsillectomies and delivered babies who lived in a house near here. Before that they used to have a corpsman. There used to be a Coast Guard or Navy base with a corpsman from the Navy base. There was a doctor in Beaufort who used to fly over if somebody really needed a doctor over here. That was about it. There was a doctor in Currituck who used to come over. Sometimes he would get a nurse and fly over with the nurse to do surgery over here.

Beth Nelson: So initially you were not very impressed.

Seaborn Blair: There were not the modern conveniences and equipment that you need but there was just such a need here. Jacobs left right after I got here.

Beth Nelson: Did you know at the time that he was going to be leaving?

Seaborn Blair: I guess he really didn't tell me he was going to be leaving. So, I got here and started seeing people. People were coming in here in droves. Dr. Burkes had just retired off the North Carolina Board of Medical Examiners and people were coming from Ocracoke, people with the Surgeon General, people with the National Guard. They really didn't have anybody to take care of emergencies and they knew I came and I was accessible. They had a helicopter to come and bring people here and nobody ever charged me anything to use the facility, it was free. I had my own building and the equipment I had. They had something like a Foundation that helped me and somebody came down here and helped offset the cost and get me better facilities, so I was able to live, get situated and settled.

Beth Nelson: What about from Anna's standpoint, how did she like it down here?

Seaborn Blair: She was from a small community. People loved her so much, the people in the church and she grew up in the church. It was a small community. She had a group of friends at Hatteras. A lot of people wanted to get the physicians, a lot of people wanted to take care of her. When you are a doctor on the island, everyone wants to do what they can for you. They want their happiness. It's great having that acceptance. It is easier to do your work. They accept you when they need you. It makes it a lot easier to do your work.

Beth Nelson: I guess you're probably a very visible part of the community.

Seaborn Blair: Well, not really that much. I worked so hard for so long. When I was down here I was on call every other night and every other weekend. Sometimes when I was out here I would be on call for one month at a time. We have a lot of stuff happen down here. A lot of it is at night they come down here at the medical center sometimes two or three times a night. A few times a month you would work all day and all night and all the next day. I made myself too accessible. I think people got used to it and that is what people wanted. You really wanted someone else to come in and help you out. Every once in a while I would have somebody come in from Pennsylvania and help me out. That really doesn't help with the people who want to see you and don't care about others. After awhile, particularly in the last two years, I tried to do things to somehow try to manage my life and make myself a little bit less accessible.

Beth Nelson: Was that gradual or did it come about more recently?

Seaborn Blair: It was a gradual evolution to what was happening. Having three children I decided I was going to be there for my kids. You keep making that sacrifice and after awhile you don't know what happens to you but you know I had to do it for six or seven years as my children were getting bigger and going in and out of school but when you have people 3-1/2 hours away from Greenville that is like taking from Greenville all the way up to Charlotte to the hospital. Actually, I guess it's like taking them to Greensboro. It is just such a long way to get taken care of if I didn't do it. Finally we got a helipad and started being really aggressive in emergency and trauma to get people in and stabilizing them, while at the same time EMS was involved. They were doing some work to help. EMS has grown remarkably in the last few years to have two fulltime paramedics. They may have four or five paramedics. If you call 911 you have paramedics come in your back door in less than ten minutes. You can see a physician in anywhere from fifteen to thirty minutes. There probably isn't anywhere else in North Carolina that can do that. EMS can page me at 3:00 a.m. and it is three to four minutes to drive from my house to the medical center. It is only about fifteen minutes before they see me from a trauma scene.

Beth Nelson: How often are you taking calls?

Seaborn Blair: Two or three times a week and one full weekend per month. Right now I have some other people come in. That was one of the major issues in getting somebody to help me, to try to get me some support and help.

Beth Nelson: How do the people react to that?

Seaborn Blair: We have had some real problems with that. Have had some real bad experiences. We kind of weeded through them and found a base of four or five different physicians we use that are competent, one was from Greensboro. We have recruited another doctor to join us who is going to be pretty good.

Beth Nelson: Were you in medical school about the same time that Chip Brown was?

Seaborn Blair: Yes, maybe not in the same class but we were there at the same time. I remember that name.

Beth Nelson: He was in one of the first classes. Chip grew up in my hometown of Ahoskie. Then he talked about going back to Ahoskie and practice. He also did ED work somewhere but he was in a plane crash and was killed not too long ago. He had grown up in Ahoskie and his mom and dad knew everybody in the world and it was really tragic. He came back to Ahoskie a lot and was well thought of. It was a shocking blow.

Beth Nelson: I had read an article probably when you were working by yourself about how you were doing. Then Al Hodges joined you.

Seaborn Blair: He started after I had been here four years.

Beth Nelson: Wasn't he a resident?

Seaborn Blair: He was working in that capacity. He came down here and covered and helped me out as much as he could.

Beth Nelson: I'm sure that made your call situation a lot more tolerable.

Seaborn Blair: Absolutely, it sure did.

Beth Nelson: Now, have you recruited somebody else?

Seaborn Blair: Yes, from Norfolk for at least by the end of July, right out of school. He is a lab technician. It is one of the first things I did when I was on my own. Just to get somebody to help out and back up with my lab work. I had somebody that lives in Ocracoke but she doesn't work for me any more. She used to come down and help me out and I would back her up too. I would stay up all night and work on things.

Beth Nelson: The growth is crazy down here and the traffic is just crazy.

Seaborn Blair: I do agree with you.

Beth Nelson: Tell me about how the population has changed since you have been here.

Seaborn Blair: We have had slow but steady growth here. Growth here has really been restrained a lot by the fact that we don't have water. We can't really build unless you have a new water system. A couple of places are really restricted by the Park Service. They have just built another plant, which ought to help out a lot with that. Dare County, as a whole, is a hard county.

Beth Nelson: How many people live out here now?

Seaborn Blair: I don't think anybody really knows. When you look at the box holders at the Post Office there are about 3,000 - 4,000 including Hatteras and Avon, but in the summertime the population explodes down here. We have maybe 30,000 here.

Beth Nelson: I have heard that is one of the challenges. The seasonality of it makes it really crazy and I imagine makes scheduling a nightmare.

Seaborn Blair: Yes, it is a nightmare but it is really different when you're independent practicing out here by yourself on the island. It is like shifting sand. If you build a house it is hard to have a good foundation underneath. I feel like that is where the hospital really helps. It gives long term stability and the people are good resources. It was difficult to do when you are by yourself. We really cannot stand to close up for two or three weeks or a month when you have a million-dollar office and employees. Avon has become the economic center on the island and it has the most room to expand as far as housing is concerned. One thing that we couldn't stand was somebody coming up there and getting creamed with the urgent care center and with the tourist population. So, for a long time I tried to get up there. I had an office in Buxton which I tried to operate.

Beth Nelson: How many miles away is Avon?

Seaborn Blair: Avon is 20 miles.

Beth Nelson: Did they recruit him or did you?

Seaborn Blair: It was a joint thing. We spent about a year and a half trying to get somebody. It was really difficult finding people. We have all kinds of people who are interested but they come down with their husband or their wife and who is not happy here. It just takes a unique person. From a physician standpoint, you have to have somebody who is confident in their field who can handle just about anything that comes through the door and, believe it or not, there are not too many physicians who can handle that. It is nice having sophisticated diagnostic services here, those specialties here and across the street. In the ED, it is good to have a buffer there and have somebody to work as a family physician sometimes.

It is good to have somebody who can do trauma and GI stuff, but up here you are far away from everything and anything can happen. It scares you, scares the daylights out of you. It has got to be more of a challenge and as to your practice it just doesn't scare you because you love the people. It is tough to come down here in the middle of the night and have a broken arm and not have a radiology technician or somebody who can read the xray and help you. You basically come in and shoot it yourself and read it yourself and do everything.

Beth Nelson: That TV is not sitting there for the "soaps", I'm sure.

Seaborn Blair: We have telemedicine. We have one in the other room and usually use that one for watching tapes. We use them for training and we try to use every inch of the office.

Beth Nelson: So, are you outgrowing this place?

Seaborn Blair: Yes we are, absolutely.

Beth Nelson: It is not just updating, it is enlarging too that's important?

Seaborn Blair: Well, it was never designed to be a high volume ambulance receiving facility. It was designed to be a small hospital. These rooms are not examining rooms, these are hospital beds and OR beds where the newborn nursery was.

Beth Nelson: How many beds does this hospital have?

Seaborn Blair: 46 beds and a Newborn Nursery, 1 Emergency Room, 1 exam room, 1 OR and 1 newborn nursery. The place is a nightmare to practice in because of the way it was built. We utilize it in the best way we possibly can. The hospital has come up with a plan to renovate it.

Beth Nelson: How soon?

Seaborn Blair: It is in this year's budget. Not to enlarge, just to renovate.

Beth Nelson: Won't it be a shock to go from this building to a new building?

Seaborn Blair: Yes, it will be. It is a big political thing. The Park Service owns the land it sits on. The building is owned by the community and by the county and we operate it. We don't have any claim to the building. There is no written lease, it is only a handshake but I can use it as long as we practice medicine down here.

Beth Nelson: Everything in the hospital has to be so official and documented.

Seaborn Blair: We don't have as much bureaucracy and crap down here.

Beth Nelson: How about the staff and how are they adjusting?

Seaborn Blair: It frustrates the hell out of them. Having to calibrate all the stuff, how cold is the refrigerator where you keep your Pepsi for lunch. I never realized it would be so doggoned complicated.

Beth Nelson: Has it surprised you that it would be like this?

Seaborn Blair: Yes, I didn't realize it would be this complicated. When we hire somebody we have to do a criminal background check. All this time we have done without this stuff and it is more like a private business. With financing you have to go through certain steps to do things to make these things amenable. There are important steps you have to go through every week and every day.

Beth Nelson: I'm sure that Anna was frustrated also.

Seaborn Blair: You have to balance the good with the bad. When it is good there is more of a benefit. I'm happy with it like this much more than like it was.

Beth Nelson: Why did you choose HealthEast?

Seaborn Blair: The number one thing was the complete of trust there. I had worked together with some of these people.

Beth Nelson: You ask as many questions of them as they ask of you and that you have a lot to ask them about?

Seaborn Blair: Well, I have done it for a long time and I wanted to have somebody that would help me and help my medical center. All the other hospital systems were kind of out of my realm.

Beth Nelson: But you're trying to do something down in Avon that might have been years down the road.

Seaborn Blair: I don't know if I could have done it myself.

Beth Nelson: I know you had thought about it any number of times trying to do something like that.

Seaborn Blair: Yes, but I still look at what we got that is ours, our building. I have had a lot of input into what would happen here. I'm sure it would be nice to have it all myself and not worry about this or that, but it is just not reality.