variety in my practice

After thousands and thousands of extractions, fillings, root canals, dentures, cleanings etc etc, work in the clinic gets monotonous. The queries, fears, expectations and reactions are almost identical in all patients. It is the variety in personalities and idiosyncrasies of individuals that makes my work interesting.

The short, slender and frail looking lady with her palm covering a mildly swollen jaw reluctantly entered the clinic. I am sure that she must have been suffering at least for the past three or four days and that it had taken her that long to make up her mind and build up the courage to visit my clinic. I showed her the chair. She went near the chair and stood there hesitating. I assured her that sitting in the chair is not painful and asked her to sit. She sat down gingerly on the edge. I took the mirror in my hand.
“No, no doctor. please don’t touch the tooth. It hurts”.
It took time to convince her that I just intended to look into her mouth. She did not believe me. I kept the mirror aside and held my hands back. I asked my assistant to focus the light. She opened her mouth half. That was enough. I knew what the trouble was and what was to be done. I told her the bad news. She had to have her tooth or whatever remained of it, out. There was no other way. She almost fainted. She took a few minutes to recover and digest the news. Now it was time for queries.

“Can’t it be cured with medicines?”
“Can the tooth be removed when there is pain and swelling?”
“Will it affect the eyes?”
“Will the swelling increase?”
“How many days does it pain afterwards?”
“My sister is getting married next month. Will I be alright by then?”
“Will it bleed a lot?”
“How long will it bleed?”
“I get scared if I see blood”
“As it is she is weak doctor, will bleeding cause anemia?” (Husband)
“Will it hurt too much?”
Here I had to mention that I will be giving an injection to make the jaws numb.
“Will you be giving an injection?”
“ I am more scared of injection than removing my tooth”
“Can’t it be done with out injection?”
“Where will you give injection?”
“Inside the mouth? Oh, god, can’t you give it on the Hand?”
“Last time when she took an injection she fainted doctor. It took half an hour for the doctor to make her OK” her husband gave her the cue to faint.
Now, I answer all the queries according to the mental condition of the party, mixing elements of sincerity, honesty, compassion, indifference, and humour where possible. I answered the lady with patience and tried to calm her down. But the statement regarding the tendency to faint made me apprehensive. Even after witnessing hundreds of faintings in the chair, and uneventful recoveries, my hands start shaking when a patient faints. Apart from my own nervousness, I need to deal with the patient who has fainted, my assistant who gets agitated, patient’s attendants who are anxiously hovering around, and the people in the waiting room who are trying to peep in and are fearing about their fate. It is something which I can do without.

When I heard the husband mentioning that she fainted on taking an injection, my thoughts were on finding a way of postponing the case, and hoping that they find some other dentist. But I was sure that the removing the tooth at the earliest was the best thing for her and braced myself for the work, with a prayer on my lips. I made sure that the emergency drugs were ready, assured the lady repeatedly that I will manage with minimum of pain and prepared the syringe. She closed her eyes tight, asked her husband to hold her hand, requested my assistant to hold the other hand and hesitatingly opened her mouth. The lips were quivering. I touched the gum with a cotton swab to apply some numbing paste before the injection. She gave out a shout. Two or three heads from the waiting room peeped in. I injected a few drops in the gums. Her body was shaking. I adjusted the chair to a reclining position expecting her to faint any moment. She did not. Slowly I injected the local. Once the tooth was numb, there was no more trouble.
I finished the extraction in minutes and the lady was unable to believe that the tooth had been removed. She thanked me and asked me to give her another appointment for the removal of one more tooth which was troubling her now and then!

The captain (he had retired from the army after his short service) was a contrast to this lady. Boisterous, fearless and confident. He was a regular in my clinic for the past five years. I had done a few simple fillings for him and he insisted on getting his teeth cleaned every year.
He entered the clinic as jauntily as ever. Well built, fit, confident and smart as always in his jeans and shirt. (I wonder how some people get the clothes to fit them perfectly. If the trouser waist fits me, the length is too much. If the sleeves of the shirt are OK, the chest is tight. I try to get the cloths tailored, but results are worse. All in all I end up looking like -to borrow the expression from Wodehouse- like something that the cat has brought in.) I look at the captain with awe.

He sank in the chair with his usual remark.
“ I like this chair doc. It is so comfortable. I think I should buy one.”
He adjusted the head rest to suit him and stretched his legs. I wished all my cases were as easy going as the captain. He said that he had a little pain near the last tooth while chewing. I was surprised to find a wisdom tooth erupting. It is rare to see a wisdom tooth erupting at the age of forty. But sometimes it does. A part of the gum that was covering the erupting tooth was coming between the upper and lower teeth and causing him pain. I told him that all I need to do was to snip off that part of the gum.
“ Why can’t you pull out that bloody tooth and be done with it? I can do with one tooth less.”
I said that there is no need. Just snipping the gum would do. I asked him when does he wants me to do it.
“When? Right now. Finish it. Take your scissors and cut it out”
I told him that I will inject a few drops of local.
“Why bother with all that doctor. I can easily bear a bit of pain”
His words were music to my ears. Still, I said that though he may be able to bear a bit of pain, it is difficult for me and I would be more comfortable with a few drops of local if he had no objection.
“Objection for the injection! Doctor saab we are used to bullets. Do as you please”

He opened the mouth wide. I loaded the syringe and was about to inject when he closed the mouth shut. I told him that I was yet to inject and asked him to open the mouth. No response from the captain. His hands fell off the handle and his head rolled. The captain had fainted.

It took me twenty minutes to revive him. Since he did not recover in the reclining position of the chair, I had to lift him with the help of my assistant- who was not of much use, and put him flat on the ground. He opened his eyes only after slapping him hard and splashing water on his face. His pulse and pressure remained low for more than ten minutes. I was about to call for my physician friend when he opened his eyes and wondered where he was.

He said that it never happened earlier and felt that it was probably because he had skipped dinner the previous night. He told me to go ahead and try again. But I had had enough. I knew he was frightened. I was sweating and had sprained my back while lifting him. I told him that we will do it after a day or two and prescribed him a tranquiliser to take before the procedure. We scheduled it a week later.
It is now two years. The thin bit of gum covering the last tooth is still there and troubles him now and then. He says that it does not bother him much and manages with pain killers, antibiotics and mouth washes. I accept his words with relief.