The latest highly commended Writing Competition winner comes from Dr Jay Bala, a dentist from Sussex. On the theme of 'That one patient', she discusses a harrowing case where her patient's pain was not subsiding
He still stands at my surgery door. Not literally, of course. But in that particular corridor of the mind where certain patients never quite leave, he is there — face swollen, eyes searching, asking the question he asked me more times than I can count: ‘What is happening? Why is this not getting better? What do we do next?’
I have no satisfying answer. I never did. And that, I think, is precisely why he stays.
It started as the most unremarkable of appointments. A routine six-monthly check. The kind that runs like clockwork — probing depths, radiographs, a polish, a smile, see you in six months. He left with a clean bill of health. If dentistry were cars, he’d have sailed through his MOT. One, maybe two weeks later, he was back.
Pain and sensitivity in the upper left, around the wisdom tooth region. We had completed some treatment in that area not long before — a restoration, done and dusted. The radiograph showed what looked like a possible overhang. Straightforward enough. We redid the filling. He accepted the plan without question, the way trusting patients do.
One week on, he returned again. Pain ongoing. A mild soreness now. And swelling — subtle, against the tooth adjacent to the one we had just restored. The presentation looked inflammatory. We were thinking pulpally involved tooth, periapical pathology, a straightforward if unwelcome progression. Root canal treatment was recommended. He sat in the chair, and we began.
Except it didn’t resolve. It worsened. A colleague reviewed him when I was unavailable. By now, three of the upper molars at the back were mobile. Not one — three. The working assumption shifted to infection, and two courses of antibiotics were prescribed. Amoxicillin. Metronidazole. The usual arsenal. The swelling did not budge.
And this is where I want to pause, because this is the moment I return to most often. Not with guilt exactly, though that visits too. But with a kind of forensic curiosity — the clinical equivalent of retracing your steps after you have lost something important.
At eight weeks from first presentation, something shifted in me. The alarm bells that had been ringing quietly grew loud enough to act on. I picked up the phone and called the on-call SHO at our local hospital. I asked — I pressed — for this patient to be seen that same night with the possibility of a non-dental diagnosis in mind.
He was seen. The same night. I had done what I could. He was reassured. Discharged. The working plan from the hospital: dental resolution — redressing, or extraction of the upper molars if needed.
Two weeks passed. He did not improve. He was visibly changing now. Constantly exhausted, pale in a way that worried me. The swelling on the side of his face had continued to grow, quietly and without remorse. He stood at my door and asked me again — why is this not resolving?
I did not have the answer he deserved. But I knew, with the kind of certainty that bypasses logic and lives somewhere older in the clinical brain, that this was not dental.
I called the hospital again. This time I did not suggest. I insisted. I demanded the patient be investigated for a non-dental cause and re-referred urgently.
Twelve weeks had now passed since that first appointment - the one where everything was fine, where he had sailed through his MOT and gone home without a worry.
The full oral and maxillofacial team saw him. Tests were started. Investigations ran.
Within days, the word came back that changes everything it touches. 'Cancer’
Advanced-stage oral cancer. The size and extent of disease had, by now, rendered surgical intervention impossible. The disability that resection would cause was deemed too great. There was no curative pathway left open to him. He was referred to palliative care. He died within six months.
I have thought about this case more than I can quantify. In the darker moments, I have replayed it like a clinician possessed - the timeline, the decision points, the calls I made and the ones I wish I had made sooner.
But I keep returning to a discipline I have found useful in navigating the parts of this profession that cannot be fixed: stoicism. Not the cold, unfeeling caricature - but the real thing. The distinction between what is within our control, and what is not.
What was not in my control: the biology of his cancer, which had almost certainly been growing long before he sat in my chair. The hospital decisions made on the nights he was seen and discharged. The speed at which a system, pressed on all sides, moved.
What was within my control: my clinical instinct, and what I did with it. My willingness to make an uncomfortable phone call. My refusal to accept reassurance when my eyes told me something different. I made those calls. I pushed. I re-referred.
And still — it was not enough. That is the particular grief of cases like this. Not negligence. Not ignorance. But the gap between doing the right things and getting the right outcome. That gap exists. It is real. And no amount of reflective practice makes it easy to sit with.
Our Writing Competition hub page will feature all the winners and highly commended entries. Keep checking the page for updates