Drilling by Fire (part 3)
In my third year of dental school, we were assigned a few actual patients. One of them had a diseased front tooth and, once it was extracted, she would need a bridge. I brought her in for a cleaning, but Dr. Flask took one look at her dangly front tooth and said, “Let’s get to it.”
Dr. Flask must’ve been no more than five years older than me. The full-time faculty who supervised our clinical exploits was supplemented by a roster of part-timers and I pegged Dr. Flask as a hotshot student the school had invited back to teach. Some wanted to give back and impart knowledge. Others realized being a “professor” catapulted their credibility to potential patients who thought, “Well, if he teaches, he must be really good.” Still others wanted the free parking pass in popular Westwood.
“Huh?” I said. “Get to what?”
“Her front tooth, let’s take it out.”
“But Dr. Flask, shouldn’t I do the cleaning first? And aren’t extractions supposed to happen downstairs in the oral surgery clinic?”
“Don’t be such a Pollyanna.” He laughed and offered to go down to the basement and grab the forceps.
“This’ll be a piece of cake. You’re doing your patient a favor. Why make her wait?” I couldn’t comment about the ease of the extraction, never having done one, but I couldn’t disagree with the rest of his logic.
“Is she going to leave with a hole in the front of her mouth?” Up popped an image of my brother who had had his primary front teeth extracted prematurely at the age of four.
When the patient turned away, he rolled his eyes. “What do you think? Would you do that in your own office?” As he headed downstairs, he added, “Just get her numb.”
First I explained the plan to my patient. Even though their participation was critical, most of the patients were so accustomed to student and professor talking over them. Many assumed the treatment was in their best interest – and they simply went along.
Dr. Flask returned and handed me the straight forceps. “Just twist,” he said.
I could hardly breathe. “Do you feel that?” I asked my patient. “Are you OK?” All I had to do was notice her arms by her side, hands relaxed.
Dr. Flask glanced at his watch. Then he covered my gloved hand with his and flicked my wrist like I was turning a doorknob. Just like that, the tooth was out. I stared at the fleshy red bits around the root and felt like I was fifteen and driving on the freeway for the first time.
After two years of dental school, I finally found something I liked: pulling teeth.
With some gauze, I wiped my patient’s lips. Dr. Flask made her some presentable temporary front teeth, which I cemented. As I handed her a mirror and two packets of gauze, I looked up and saw the clinic was empty. It was way past lunchtime.
Dr. Flask was already walking away. “OK, gotta run. Have my own patients to see this afternoon.” And with that he was gone.
I had broken the school rules: extracting before cleaning, in the wrong clinic, without a prepared temporary. Yet Dr. Flask had helped me and together we had helped the patient. Was that so wrong? It was like turning wire into paper clip, bending but not breaking. But if I could disregard one rule, then would it become easier to ignore others? Or to rationalize that breaking a rule was acceptable if it resulted in the greater good?
As I gobbled my lunch, I didn’t know what to think about hotshot Dr. Flask. Or my role in what just happened.
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In many ways, dentistry is like cooking. A mishmash of ingredients, forgetting to boil the water, not knowing when the meat is medium well. Taking a good impression is like hosting Thanksgiving for the first time. Rarely does it go smoothly.
I was working on my biggest case yet, Mr. Fossa with the four crowns and the bushy mustache. Usually impression material required mixing, arm muscles, and choreography. I chose the one product that was “ready to use.” But in lieu of mixing, it involved moving the impression tray through several water chambers in a convoluted fish tank setup with connecting tubes.
After removing his temporaries, I cleaned and dried Mr. Fossa’s four prepared teeth. To prevent saliva contamination, I packed cotton rolls and gauze around each one like I was shipping fragile glass. It was only then that I realized his overflowing mustache would be in the way.
“Um…Mr. Fossa, do you think I can trim your mustache a little, so it’s out of the way?” Then, just as quickly I shouted, “Wait, don’t answer that. Don’t talk, please.”
I wrote yes on one Post It, adding a happy face, and no on the other, with a sad face. He glared at me, then at the signs, and with one stocky finger, pushed a hole through the sad face.
“OK, OK, I’ll be right back.” I ran to the receptionist, past a couple students patiently waiting in line, and said, “Sorry, emergency. Do you have any of those little clips, you know, those little black things that bind paper together? Or any masking tape?”
Clutching the pale yellow tape, I hurried back to my cubicle and proceeded to fold over his facial hair and cover Mr. Fossa’s upper lip with tape. By then, my “ready to use” material was no longer ready and had to re-submerged into the boiling water compartment. I re-dried Mr. Fossa’s teeth. Because it was critical for cold water to run through the tray and harden the material, I rechecked the hose connections.
Finally I inserted the hot impression tray. Water began squirting everywhere. Mr. Fossa scowled in pain, but I couldn’t remove the tray without tearing off a piece of his gum. The tube delivering cold water must have disconnected.
“Help!” I shouted to anyone who would listen.
Water was shooting into Mr. Fossa’s eye. With one eye closed, he batted the hose away.
As I was praying for another set of hands, who should appear but Dr. Flask? Quickly he reconnected the errant tubing and cold water began flowing through the hot tray.
“Do I have to bail you out every time?” he said.
Later Mr. Fossa said, “Thanks God you save my mustache.”
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As graduation neared, I heard a rumor that the “hand god” had been invited to teach on Monday afternoons. I considered myself barely competent, yet someone with the same level of education would be teaching. In my mail slot later that day, I found a note from Dr. Flask’s boss wanting to “discuss an opportunity.” I scanned the envelope again to make sure it was addressed to me.
In his office later, Dr. Flask’s boss invited me to teach waxing in the morphology course. I said, “You mean so I can show other students what not to do?”
“Yeah, that’s the general idea, kiddo, since you just learned it.”
Had I though? I wasn’t certain I had learned enough to treat patients successfully, unsupervised and with sound judgement. And with Dr. Flask as my role model, would I become overconfident and cavalier? Even as I was heading to my first dentist job, there was still so much to learn.
