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Everyone who works in health care encounters serious complications.

Everyone who works in surgery, encounters serious surgical complications.

Everyone who works in complexed surgery, encounters complexed serious complications.

We can convince ourselves as we become older and more experienced that the complications become less and that the impact reduces.

I am 25 years into dentistry now and I am beginning to think that, that is not the case.

Some of the best clinicians I have ever met are the ones who will discuss openly, the things that have gone wrong and how it has impacted on them.

This was never more so, then when one of my best friends, Craig Wales, presented a complication case at a failure conference, which stopped the show.

Craig spoke about compartmentalisation and the need to be able to “box things off” and get on with your job.

Craig also discussed how difficult it is to actually do that.

Stephen Westaby, in his book on being a Paediatric Cardiac Surgeon, would discuss the fact that you had to be prepared for a patient dying on the operating table on a Monday afternoon and turning up to the operating table again on a Tuesday.

Not quite the same in my line of work, I guess.

That said, there is a definite spiral when a complication occurs, a definite anatomical framework.

Of late, I have been dealing with a complication for a patient, which is now well in to their third week. I’ve seen the patient most on many days in that time and spoken with them over the telephone regularly.

This is a complication in like of which I have not seen before and one that perhaps (if I had the strength) I would present at the failure conference in November.

There are several components to the anatomy of a complication, as far as I can see, it these might be as follows;

1. The immediate empathy for the person sat in front of you, who is in distress or pain or otherwise.
2. The guilt that you might have done something to cause or exacerbate the complication.
3. The fear that this complication will result in some significant sanction to your work; worst of all and to its greatest extremity, the loss of your ability to practice
4. Shame, that you’re not as good as everyone else who is providing this type of work, because you are the only one who seems to see things like this happen.

I have provided tens of thousands of surgical procedures on the inside of patients mouths and have seen, many, many, complications that have resulted from my handy work.

Each time I try to reflect and re-learn and improve, but suspect each time the complication takes a little bit more from me and my resilience and my ability to continue.

I do believe that your ability to deal with serious complications comes from an experience of dealing with serious complications and there are strategies and techniques in dealing with patients in the midst of such trauma, that reduce potential impact on the patient and their family and also reduce the patients urge to lash out for revenge or to harm someone else due to the harm that has been caused to them.

The complication that I have been dealing with for the past 3 weeks is not as a result of anything that has been missed or anything that has been done below an excellent standard, it sadly is just “one of those things” one of the ways that I have learned to deal with, breaking bad news to patients is being on the receiving end, bad news being broken to me by people who know how to do it.

Some years ago, a close member of my family suffered a horrendous anaesthetic complication, which almost lead to their death. This would have been a massive and serious, critical incident in a large teaching hospital, had it not been for good fortune and great care, which lead to the complete recovery of the individual in question.

In the midst of that though, the urge to blame and to ask questions and to find out what happens is great as a family member.

Bizarrely a few weeks after the event itself, the head of anaesthetic institution in question ended up in front of me as a patient. I knew the person and I had spoken to them many times before.

I explained to them that I was a family member of that “patient” that they had the good grace to talk to me about it and the case itself as they knew exactly what had happened. In the end, the clinician said, “I know it sounds twee, but I’m afraid it is just one of those things.” The fact of the matter is, that life is full of just “one of those things”, that does not make it any easier to deal with, when we are the ones trying to pick up the pieces of the complication.

Blog Post Number - 2075