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Stepping Outside Your Comfort Zone

David Epstein, MD, shares a lesson he's learned from stepping outside of his comfort zone, and involves compressions on an open chest.

I performed cardiac compressions on an adult with an open chest.

The surprising part was not that I was performing the procedure. I had performed chest compressions on open and closed chests in the cardiac intensive care unit (ICU) previously. The surprise was that I was performing compressions on an adult patient. I was a pediatric intensivist! While our mantra in pediatrics is that children are not small adults, we could also say that adults are not big kids. So, this definitely placed me outside of my comfort zone.
How did this happen, you may ask? Well, some years ago, I was working in a hospital that had a cardiac ICU that combined pediatric and adult patients. There were specific adult intensivists and pediatric intensivists in the ICU that cared for their respective aged patients. However, at the time of the incident, I was the only intensivist in the ICU at the time. When the cardiac arrest happened, I felt alone…but, I wasn’t.
As the code started, I heard one of the nurses yell to me, “Hey, peds doc!” As I turned my head in the direction of the call, she threw a pack of sterile gloves at me and said, “we need you in here!” As I hastily walked through the unit to the bedside of the patient, I was struck by how big the patient was and how small the gap of her open chest was. I mostly saw infants with open chests that spanned the length of the sternum which was a much larger open space relative to their chests. This adult patient’s chest opening was as big as my hand, which was relatively small compared to her body. However, in thinking back, the absolute area of the open chest of infants was significantly smaller than this adult because they were obviously smaller. It was just the relative size of the opening that struck me.
Anyway, as I put the sterile gloves on and stood at the bedside, I placed my hand inside the chest of this adult patient and began to directly compress the heart and help it pump blood to the rest of the body. Soon, the adult intensivist arrived and took over. It was a surreal experience and one that I have not had the pleasure of repeating since then, thank goodness. But, I was relieved and looked back on the experience with appreciation because it did place me outside of my comfort zone.

“It was a surreal experience and one that I have not had the pleasure of repeating since then, thank goodness.”

Nevertheless, the lesson that I learned was a bit different than just the concept of needing to step outside of one’s comfort zone. The experience showed me how important the support of others was when stepping into uncharted territory. There was a cadre of nurses, respiratory therapists, and other staff that made the situation much more comfortable for me than if I was alone. I played a part in the resuscitation and had a team to work with. The huge amount of appreciation that I felt was for the professionals whom I shared the experience with and it showed me how important it was to have the support of others when stepping outside of one’s comfort zone. I may have felt alone initially, but I soon realized that I wasn’t!

How have you stepped out of your comfort zone and what has helped you do it?

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