Day 103: Comfort Zone

As a Family Physician, encountering clinical cases that are out of my comfort zone is not uncommon. The nature of my specialty allows me to provide initial evaluation and management of most patient care complaints from patients of all walks of life. At the same time, we as "gatekeepers" to the subspecialty world trust our specialist colleagues to provide a higher level of care when we have surpassed the boundaries of our clinical "comfort zones".

As a family physician practicing on the island of Guam, I have already encountered numerous patients that have forced me to practice out my comfort zone. Cases have included patients with ST-elevation MIs (bad heart attacks) without access to coronary care facilities or cath labs, post-coronary bypass grafts placed in my 15-minute clinic slot, bipolar disorder, and chronic pain from metastatic nasopharyngeal cancer.

As a military-trained family physician in Afghanistan, I have now crossed way out of my comfort zone as a significant portion of my clinical responsibilities includes prehospital and tactical field trauma evaluation and management. It's one thing to go through the trauma training courses, but it's another thing to encounter it for the first time....without my specialty safety net!


Several days ago I was called to our little ER on base to evaluate an ANA soldier who was injured by an IED blast. He had significant head trauma and had a Glasgow Coma Scale of 9 (not good). I must admit I was very nervous, not only because I was your average family physician, but because I was the ONLY physician. Also, by Afghan standards, American doctors know all and can heal all.

I proceeded to the clinic with a medic and we did as we were trained. The Afghan medics did the best they knew how with the limited supplies they had. As a mentor, I tried to use the case as a teaching tool for the Afghan medical staff rather than simply taking over the scene. Starting with the primary survey, going through the ABCDEs, reassessing ventilatory techniques, and conducting a secondary survey, we methodically treated the patient. Once again, I have never led out in a code let alone a real-life trauma scenario...several episodes of ER came to mind, and as much as it would have been cool to ask for a "trauma panel, C-spine, abdomen, and pelvis", that was just not going to happen in my podunk Afghan clinic.

To make a long story short, we did what we could for the patient and successfully packaged him up for transfer to the nearest trauma center. Reflecting back on the whole thing, it was only by the grace of God that I was able to maneuver my way through that clinical scenario. I'm sure He will guide me through many more.

"Hear my cry, O God; attend to my prayer. From the end of the earth I will cry to You, when my heart is overwhelmed; lead me to the rock that is higher than I." Psalms 61:1,2