How do I handle complex patients with many problems at once?

You have already come far. You manage most of what walks through your door, and that took years. The complex ones feel different because they are, more moving parts, more risk, more to hold in your head at once. Feeling buried by them is not failure. It is the honest weight of hard cases. No one keeps all of it in their head. The doctors who handle these well lean on lists, on colleagues, on a plan written down instead of remembered. Complexity is managed on paper and in teams, not by a better memory. For your next hard case, pick the single most dangerous problem and steady that one first. Write the rest down so nothing is lost, but give yourself permission to take it one thread at a time. That is how anyone carries a heavy load, piece by piece.