Another Nugget 💡 | Not Urgent Doesn’t Mean Not Complex
In April 2017, during a visit to Cleveland involving my son Alex’s diaphragm-pacing wires, Mary Jo, a member of his specialized pacing team, noticed a mole near one of the wires.
She encouraged me to have it checked.
It wasn’t an emergency.
But it wasn’t something to ignore, either.
Alex’s diaphragm pacer is his primary respiratory life support. Its wires travel beneath his skin and exit through his chest.
Removing a mole near those wires wasn’t necessarily as simple as scheduling an ordinary office procedure.
When we eventually saw a dermatologist, she considered Alex’s medical history, the unfamiliar implanted equipment, and his unusual responses to anesthesia and other interventions.
Rather than removing the mole herself, she referred us to a plastic surgeon.
The surgeon evaluated the situation and felt comfortable performing the procedure at Nationwide Children’s Hospital, where additional precautions and accommodations could be arranged.
In March 2019, almost two years after Mary Jo’s original observation, two moles were removed.
Both were benign.
And that brings me to something important.
A reassuring outcome does not mean the precautions were unnecessary.
The moles were benign, but we didn’t know that from the beginning.
And their eventual pathology results didn’t eliminate the considerations involving Alex’s life-support equipment, neurological injuries, or autonomic instability.
Those considerations existed regardless of whether the moles were cancerous.
This is something I wish more people understood about medically complex care.
Urgency and complexity are not the same thing.
Something can be nonurgent but still require specialized expertise, careful planning, communication, and individualized precautions.
And something that looks simple can have serious consequences when the person performing it doesn’t understand the whole clinical picture.
Good care isn’t always about acting faster.
Sometimes it’s about knowing when to ask questions, involve another specialist, and carefully coordinate the next step.
Now consider how these situations appear in medical records or assessments.
Two benign moles removed.
A relatively simple procedure.
A successful outcome.
But where is the record of everything required to make that outcome possible?
The clinical judgment?
The consultations?
The coordination?
The precautions?
The years of knowledge brought into the decision?
If we measure only the task and its outcome, we may miss the complexity of performing it safely.
And if we mistake a good outcome for evidence that little support was necessary, we risk overlooking the very knowledge and precautions that helped make it possible.
Not every complex need is an emergency.
Not every successful outcome was simple to achieve.
And not every complication that was prevented will ever appear in a medical record.
Sometimes the greatest evidence of good care is what never went wrong.
#MedicallyComplex #PatientSafety #DisabilityAdvocacy #IndividualizedCare #HCBS #CaregiverSupport #NursingCompetency #DiaphragmPacing
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