I started my first complications course while I was at Northwestern in 2009. We called it Meltdown: Lesson Learned in IR. The first iteration took place at the American Club in Kohler, Wisconsin. How we managed to get corporate sponsorship for such a lush setting is beyond me. But somehow we secured funding from several vendors and put on a really great meeting. We dined like royalty, luxuriated in the finest accommodations, and played golf on a course that would later host the Ryder Cup. All while presenting the cases that had gone horribly wrong and, occasionally, resulted in the unintentional demise of a patient.
James Joyce purportedly said, “Mistakes are the portals to discovery.” So dissecting a case or procedure that resulted in an unexpected complication is a sacred learning opportunity for any physician. I do not use the word “sacred” lightly; sometimes we forget, when we are obsessing over the circumstances that led to a complication, that a person was seriously injured- and that person was someone’s mom, or sister, or grandmother, aunt, or beloved spouse. There is the morbid fascination that happens when terrible complications are shared (which is a natural human reaction). Again, we must remind ourselves of the real consequences to the real people that we have inadvertently hurt.
Meltdown only last a few years- I think the business model was unsustainable, but the educational value was clearly evident. Everybody I knew loved the meeting- there was so much to learn. I genuinely believe we helped change practices which ultimately benefits patients. We revived Meltdown several years later, after I got to the University of Colorado. There the meeting became known as Mile High Meltdown. Again, a terrific meeting with a lot of high value learning.
Nick Hopkins was a neurosurgeon at the University of Buffalo. Well, let me edit that sentence: “Nick Hopkins was THE neurosurgeon at the University of Buffalo.” He really was a generational talent, a visionary who truly led his specialty forward. I only knew Nick during the last years of his life, before he died in 2024. Nick changed the way neurosurgery and endovascular neurosurgery were practiced. And along the way, he knew that complications in such high stakes specialties would be invaluable to positively evolving patient care. He started the Failure Analysis Advisory Council (FAAC) meeting about 30 years ago. He invited neurosurgeons, interventional cardiologists, interventional radiologists, and vascular surgeons to attend, along with engineers, CMOs, and executives from many device companies. The FAAC was a heady mix of folks, all of whom wanted nothing more than to improve patient care by sharing what went wrong and brainstorming about how to do it better. The FAAC is an “invite only” event and the price of admission was presenting at least one of your procedures that resulted in severe morbidity or mortality.
Today the meeting continues on, thanks to the Jacobs Institute at the University of Buffalo. It has been renamed “the Nick meeting” or NHCC (Nick Hopkins Complications Course) in honor of its founder. It continues to value the importance of objectively assessing our complications, in an environment of peers. Pretense is not tolerated; someone will call you out if you try to present a case that went badly but you did something “heroic” to save the day.
For some reason, I occasionally think about what my legacy will be when I’m done. These ponderings might be worthy of its own blog posting someday. That said, I think The Nick is an amazing legacy for a amazing physician, terrific person, and deeply dedicated family man like Nick. I think Nick would be very proud of The Nick.