The Tooth

I went to the most terrifying place in the world today: the dental clinic. I’d woken up this morning with a sharp pain under my right lower jaw and, soon enough, I realised it was time to get rid of the wisdom tooth – a divorce I’d been putting off for a few months for fear of the pain. I’d had five teeth extracted as a kid about 15 years ago, and the last of these teeth had been plucked out shortly after the local anaesthetic had stopped working. The trauma of that incident has stayed with me, and resurfaced in full glory this morning.

I made an appointment via Practo at a clinic nearby – the reviews seemed nice – and got there at 12 pm. I met with Dr B, who seemed really nice and didn’t offer any gratuitous advice when I told her I smoke. I liked her immediately. We took a quick X-ray and I was told that my wisdom tooth on the right had to go, and right away because an infection had developed around it. I told Dr B about my traumatic experience having teeth pulled. She promised me she’d keep it completely painless. And she did.

But where she failed – and where most doctors I think would fail – is in making her patient feel less dehumanised. As soon as the X-ray was taken, she began to correspond with another doctor in the room in hushed tones about what was going on with my tooth. Their dialogue was speckled with strange terms, and I couldn’t tell the difference between when they were talking about my teeth and when they were talking about the shape of my jaw. But I surmised it wasn’t looking good.

I had to interject repeatedly to ask what the X-ray was showing. If I didn’t ask, they wouldn’t bother. Even when the extraction procedure was about to begin, I was asked to recline, various implements were thrust into my mouth and a nurse stood on standby. “If you want me to stop for any reason, just raise your hand,” Dr B said. Just as she was about to poke a pointy thing into my mouth, I raised my hand. She was surprised. I asked what it is that they were going to do. She answered, and then it began.

I learnt later that my tooth’s roots were strong, so the damned thing had to be broken up first and then removed piece by piece. The procedure 15 years ago had involved just one implement – a tool I’ve always called the Motherfucker. Dr U had plunged with it into my mouth, used it to wrangle with the misbehaving tooth and, after a few seconds, pull it out. This time, with Dr B, the motherfucker only showed up 45 minutes after we’d started, and in two avatars. Motherfucker I was the cow horns #23 forceps and Motherfucker II was somewhat like a lower anterior forceps.

We had started off at 12.10 pm with two syringes of a local anaesthetic, topping it off an hour later with a third. I was told the one side of my mouth would go numb. “You won’t feel any pain, you will just feel the pressure of my hands as I’m working,” Dr B said. But somewhere after the third syringe, I lost any ability to tell apart pain and pressure. I was lost in my head, flipping through scenes from old Tamil movies looking for anything with a dentist in it. Nothing. Annoyingly enough, the scene that showed up most vividly, and repeatedly, in my mind was Andy Serkis singing ‘Don’t hurt me’ to Martin Freeman, a scene from Black Panther.

Around 1.15 pm, Dr B stepped away from my face, shaking her head in exasperation. Her colleague stepped closer, asking what had happened, while the nurse – who was also the cleaning lady at the clinic – stepped closer to peer into my mouth, a big smile on her face. Dr B said then, “This is a bone-cutting case.”

What.

The fuck.

Did you just say?

As it is, I have very little idea about whatever is going on. The grotesque zircon-tipped tools passing in and out of my mouth aren’t helping me calm down. (One of them, called a Couplands elevator, is what I’m going to call the Little Motherfucker.) The doctor in general doesn’t feel compelled to tell her patient what it is that she’s doing, leaving me to guess for myself. And the one thing that’s said out loud, sans any prompt, is that I’m a “bone-cutting case”. Wonderful. Obviously, right then, I couldn’t stop thinking about The Bone Collector.

After a new set of tools had been assembled and Dr B bent down to inspect the tooth, I raised my hand. She looked at me, I smiled, she smiled back, and explained: “There’s a hard layer of bone around the tooth that I’ll have to cut before I can extract the tooth.” I nodded in satisfaction. The nurse swiftly introduced a suction pipe and began to drip saline solution from a needle onto the tooth, Dr B planted wads of cotton in my cheek and placed a bite my teeth on the left, and we got started again – this time, with a drill called Bone Cutter (by everyone). As it raged against my tooth with noises like R2D2 was being tortured, it felt like the industrial revolution was happening inside my skull, replete with the Kafkaesque style of oppression.

At the end of two hours, my tooth had been chipped into four pieces, each then scraped-and-plucked out in a bloody mess. I don’t know if I was billed for the gloves but I knew they had been changed thrice. Dr B’s hands were trembling as she sutured the wound. Once she was done, her colleague patted her on the back with a triumphant smile. “Well done,” she said, “you handled the case very well.” The case wasn’t pleased to hear this but was glad that it was over all the same.

Doctor-to-patient communication plays an important role in reminding physicians that their wards are people just like themselves. When it isn’t there, it signals that the doctor doesn’t think the patient needs to know. This in turn makes it harder for people to make decisions, and more generally retain their sense of agency because they don’t have the information necessary to act rationally (from the doctor’s POV). Another way this problem reared its head today was in the form of pain. Most of the time, Dr B would heed my raised hand and pause for a minute or so, but every now and then, when she was nearing the end of a step of action, my raised hand would only draw a “Just hang in there”. So the trauma from 15 years ago hangs in there, too.

The silver lining is that I will likely not have to undergo this hell again.

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