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articularly common concern amongst professionals when working with service users with dementia and learning disabilities which public services and policy makers need to be mindful of.This article presents and analyses a set of notes written by the psychoanalyst Melanie Klein following an operation in 1937. The notes, entitled Observations after an Operation, act as a case study of the intersection of psychical, material and social relations as they play out in the immediate aftermath of surgical intervention. Using a c