For five days last November I had been living on milkshakes, soup, apple sauce, and jello. I could not imagine chewing something serious in the foreseeable future. Five days earlier, Ethel, in her final year of dental school at UNC-CH, dressed in wrinkled lavender hospital pajamas, worn gray sneakers, and hair clasped unfashionably out of the way; sliced through my gum, sawed off a piece of my upper jaw bone, filed it flat, then sewed back together what was left. It took her three hours. From all anecdotal evidence, it was her first such procedure.
Over a year earlier, I had filled out an application to help North Carolina educate its future dentists. I was going to allow them to learn on my teeth while they charged me about half the going rate that the struggling professional dentists had to charge. I had a chipped tooth and went to one such professional for an estimate. After sitting in a plush waiting room with artistic sculptures and a cascading waterfall, I was attended by three extremely courteous, caring, and solicitous individuals, who informed me that the crown would be about $1500.00.
That’s when I applied at the dental school. After a six months wait for a first appointment, I was told that the crown would cost me about $700.00. Seemed like the way to go. Another four or five months passed and I got a phone call from Ethel to come in and start the work. There would be an initial appointment with a student X-ray technician to get some pics. The student tech, was nervous, humorless, and rough. I knew how x-rays were supposed to feel, but, she seemed oblivious to my entreaties to be gentle.
Then there were a couple of visits with Ethel before the oral surgery. One was for impressions, that gooey play dough thrust into your mouth that quickly turns solid. I’m familiar with two part mixes that harden fast; timing is everything. The window from slimy to stiff can be only seconds. Ethel, making sure not to lose that window of opportunity, was looming the upper mold before my nose when I saw a big glob slide out the back of it and drip pendulously on my tongue. She said, “It feels like it’s going to slide down your throat, but it won’t.” Again, I have had many molds taken over the years, and that’s the first bubble gum lava flow that I’ve been concerned would lodge in my epiglottis.
In these initial visits I was beginning to get it. This wasn’t like going to a regular dentist, just cheaper. This was a romper room with dental students chatting at each other over the cubicles, offhand remarks (“this thing doesn’t work, does yours?”) and a scarcity of teaching professionals; well, there could never be too many for me. The gentle consoling, I had been so used to at twice the price was utterly missing. And, I realized that I no longer felt like the most important person in the room, as I had felt at the “real dentist.” In fact, there were many moments when I felt like the least important person there…. did anybody know my name?
First of all, somewhat disconcerting was the size of the operation. I don’t know why I thought Ethel and I would have our own cozy private room. Silly me! This layout was the size of a basketball court with what looked like a hundred teaching cubicles separated by chest high partitions. When the bell rang, so to speak, there was a rush of students and patients to take their places. The buzz of the place was energizing. “Let’s go get ‘em!”
One more visit was required before this last one which had me on the milkshake diet. It was to do a “core build up” or make a solid foundation for the crown. It involved drilling out the old filling and packing the tooth with solid material which would hold the crown. Ethel knows her stuff with injecting the local anesthesia. She’s good with the drugs. Pain is not an issue here. I would say uncertainty, creeping doubts, discomfort, and lack of a running commentary, like “everything is going just fine, Bill” are more the issue. Then there’s just the anxiety, nervous tension, and exhaustion from sitting confined in the chair for three hours.
For some reason, Ethel drilled at least an hour. I had come to understand that the work in the dental school is slower, maybe due to the lack of experience or such. But, drilling for an hour was not something I had anticipated. Even Ethel was wondering out loud why it was taking so long. Her attending teacher dropped by for a moment and explained, “Yeah, it takes a while, no problem.”
Well, I was forming my own theory about this. I know a little about drills; I work with tools. Drills bits get dull with use. The state of North Carolina is short of funds and college departments are all seeing cutbacks. I think they are out of sharp drill bits and won’t buy new ones. Just one man’s opinion. I could be wrong. On the other hand, sharp drill bits cut really fast. Are they worried that an over eager student might cut too far too quick? Whatever, I couldn’t get Professor Henry Higgins’ lyrics out of my head: “I’d be equally as willing for a dentist to be drilling than to ever let a woman in my life.” I thought, “Henry, you don’t know Ethel.”
Well, eventually the procedure was completed (about three hours), and that’s when Ethel announced to me that I was going to have to have oral surgery. There was not enough room for the crown, and I needed a piece of gum and a piece of bone removed for a good crown fit.
Oral surgery meant having a special dentist/professor in attendance. Actually, I thought from what Ethel said, he was going to pretty much do it himself while she learned. When I arrived for the surgery a couple of weeks later, I discovered this was not the case. Ethel did 95% of it while he periodically gave her instructions. At the same time he was coaching at least one other similar procedure nearby.
The first thing I remember him saying was how to cut the gum. He repeatedly talked about some sort of “push and roll” motion. Ethel started. She wasn’t quite seeing what she needed and said, “I need to use a mirror.” The teacher answered, “I wouldn’t use a mirror with a scalpel in your hand.” So, Ethel continued slicing away at gum on both the inside and the outside.
Then the teacher began coaching on how to handle the “flap.” “Keep the flap out of the way as you clean off the area.” By “flap” I took to mean some precious part of my body hanging in harm’s way. At times, I heard Ethel say, “I don’t know what you mean.” Then the teacher would rephrase his instructions with a variety of obscure technical terminology. Other times, he would revert to the plainer language of knife and flesh. Actually, I preferred the technical instructions.
Having opened my gum, apparently my upper jaw bone was now visible. The Prof was now directing Ethel in sawing or grinding a small piece of this bone away. It’s not like the anesthetic keeps one from feeling what’s happening, there’s a feel and a sound that vibrates to the heart. Believe me, jawbone work has a different sound and feel from drilling on a tooth. Enough said about that.
“Watch the flap,” Prof reminded her. Ethel sawed in what felt like quick and accurate competence, but whoa it was loud. I’m trying to visualize this as it’s happening, not a good idea I know, but I can’t help it. So, being a woodworker, I was not surprised to hear that the cut bone would need to be filed smooth. These must be very nice files, better than anything I have ever seen, but the mechanics and the motion are the same whether you got the file from Home Depot, or the dental supply boutique. Ethel started a back and forth motion with the file, but it kept getting stuck on the return pull. I knew what was happening; it was a combination of her angle and agility. I have no doubt I’ve held a file in my hand already far longer than Ethel will in her lifetime, and that I could have filed my bone with a much smoother motion.
“Watch the flap,” Prof repeated. This flap was beginning to take on phantasmagoric images in my mind. I saw it flopping around like a small sardine, or wiggling like a worm to escape the rapacious file. As far as I know, the flap survived, I never heard much more about it. Possibly part of it was cut away. I think at one point I thought I heard the delicate snipping of a fine pair of small scissors.
Then somehow a chisel got involved. They were going through my whole tool box. Prof started talking about which way the bevel of the chisel should face. As best I could tell it was to remove bone chips. Ethel started chiseling away, but seemed unhappy with her efforts. “It doesn’t feel like I’m doing anything.” “They are microscopic chips,” Prof counseled.
Now, I’m sure I could show Ethel a thing or two about chisels. At this point in my life I could chisel walnut in my sleep, and I’m beginning to wonder, “How many hours has Ethel held a chisel in her hand?” And, I’m asking myself how one qualifies to be a dentist or even gets into dental school. I’m sure there are multiple choice entrance exams, undergraduate grades in natural sciences, interviews, etc. But, are there hand dexterity tests. Does anyone observe a dental applicant with a Dremel tool on a piece of hard maple, or with a chisel on mahogany, or a file on a piece of oak. Would not such exercises give one an idea of whether or not a dental school applicant has agile fingers and the delicate touch of an artist or sculptor. I would think this matters in choosing a profession where the touch of the fingertips is so crucial, but I do wonder if there is any test of the applicant to see if he or she has this talent.
Well, I’ll put it to you like this. Here’s a photo of a piece of walnut that I cut, chiseled, and filed some thirty five years ago. At this point, I had been using such tools for fifteen years. Could Ethel do this with her chisel that I was hearing rasp over my exposed jawbone? Or could Prof even do that?
And this. Could Prof or Ethel cut mother of pearl or inlay silver wire as I did here? Or carve such overlapping woven spruce sound holes?
Ah, I’m losing it. Lying in this chair hearing the buzz and grind around me has driven me insane with futile imagining about my caregivers. I further amuse (or abuse) myself with the awareness that Prof in private practice could make more in an hour than I made in a month carving that walnut and spruce instrument. So, under different circumstances and in a just world, I could show Prof things about chisels that he could only imagine in his wildest dreams. “Give me that damn chisel, Ethel, and I‘ll show you a thing or two!” Oh my! I try to relax and take deep breaths through what limited air space remains mine to claim, and I try to remember that I must accept the universe as it is, not as I wish it were.
And, though the universe is innately unfair, and talent doesn’t always synch with responsibility or authority or equitable remuneration, I don’t have it so bad. With a twist of fate I might have been at Gettysburg like my forebears and have been carted off to some tent behind the lines and have my limbs sawed off with only a swig of whiskey to distract me. No, I don’t have it so bad. Further, as I sit in this comfortable chair and am hearing the file and chisel hone the fine points of the only jaw I’ll ever know, I’m getting better care than 99% of the world’s current inhabitants will ever know.
It has now been a couple of hours, and Ethel finally asks, “How are you doing?” I thought they had forgotten I was there. Why do they always ask that when your mouth is spread open with sharp things in it. Disentangling myself, I managed to mumble, “Not so good.” Ethel sounded sincerely surprised. How could she not know that I was totally exhausted, somewhat traumatized, and my bladder was about to explode, and there was still another hour to go.
“Well, just tell me, is everything going OK?” I said. “Oh yes,” Ethel answered, as if I had not been overhearing the confusion that had been going on for the last couple of hours.
The truth may have been that everything actually was going just fine. The careless chatter, constantly going on as if I couldn’t hear, may have been just normal shop talk. I talk like that when I’m at work, though not if my client is standing there.
We were down to stitching things back together. Nothing I overheard indicated to me that Ethel had ever done this before. Prof went into extremely detailed explanations down to the three loops of tying the knot. So, with what I understood to be a curved needle holding a piece of thread, she starts to sew. “Don’t pull like that,” Prof said, “it will tear the flesh. Use a circular motion.” Here I had to wonder, “Don’t they try this on frogs first?”
I felt the threads pull and slide, presumably through the flap. Each time I sensed her tying a knot, I hoped she was done. Instead the needle would enter again from a different direction. At one point mid-stitch I felt the procedure come to a halt, Ethel’s hands were gone, the thread lay unattended on my tongue. I opened my eyes, and Ethel had disappeared. For what seemed like several minutes, I lay there, not knowing what was going on, diddling the thread with my tongue.
Eventually, I overheard Ethel a booth or two away talking to Prof. She was asking him questions about the stitching. Prof again was explaining the procedure with complex instructions. Eventually, Ethel returned to complete the stitches but still seemed concerned about the process. Prof then came over and was dissatisfied with how the stitching was wrapped up, so he stitched a little more.
Prof at this point was clearly ready for lunch. He stuffed a piece of gauze under my lip, and then I overheard him on his cell phone chatting with someone about lunch on Franklin Street.
It was over. I had never felt this exhausted, brain-dead, and flat out run over by a truck from a dental visit, or almost anything else. All I wanted was to sip a milkshake, lay on my sofa and feel sorry for myself. Feeling dumb and dazed, I stumbled to the cashier’s desk, and wrote a check for $150.00, the brightest moment of my day. Not bad for one spectacular three ring circus, and a lot less than I would be forking out in that office with the waterfall. I made it to my van, texted my son, Alex, a UNC undergrad, to see if he would join me for a milkshake. When I picked him up, he said, “You don’t look so good.”
Now, I like to be a good citizen, and I like to be proud of my state. And, when possible, I’d like to do my part in the promoting the education and health of its people. So, I feel like I’ve done it here… a little give and take, a bit of pain and progress. And, I won’t even begin to discuss the ins and outs of the equitable distribution of health care in our country, but here’s a day a Tarheel laid his jaw on the line for a better future and the health of everyone. Now, Prof and Ethel, be sure you do your part, too!
Postscript: From the perspective of several months later with the crown successfully installed, I’m very satisfied with my experience at the dental school. I finally got the courage to negotiate a bathroom break during the typical three hour session. As in all things, we must speak up and be our own advocate. It was a learning experience for me as well as for them.