The Good Doctor

Note: Please do not get a wrong impression of my practice and clinical skills after reading this piece. It is not ALWAYS THAT bad.

The nature of my work involves giving relief from pain and restoring wrecked teeth to their original. As far as the first objective is concerned, I manage to achieve that (almost always) without inflicting additional pain. When it comes to restoring teeth to their original, well, if it is somewhat close to original, I should be very happy. Usually I reach, if not very close, with in visible distance of original. Since the expectations of my patients is not very high, most of them are satisfied with what they get. As a result, I am used to receiving bouquets than brickbats. If not a bouquet, a flower or at least a petal.

When a succession of cases turn out right, I tend to take it as routine and start thinking of myself as something exceptional in the field. I start reveling in the imaginary glory and will need a well aimed brick to bring me back to my senses. I get it once in a way but usually the throwers do not intend hitting me hard. Very rarely I get someone who can express their feelings clearly and forcefully, in no uncertain terms. They tear out the crown that I will have built on my head and put me back in my place.

This gentleman was a native of UP, amply expressive in his hindi and spoke the words as they formed in his mind. No polishing. Most of its flavor is lost when translated to English but I have no other way of communicating his words to my friends. We have to make do with my translation. Still, I think it provides a fairly good idea. For the benefit of those who can understand hindi, I have tried to put his words as I heard them, though I have a feeling that I only make matters worse by writing ‘HIS’ hindi as ‘I’ remember. If you can gloss over grammatical blunders and concentrate on the gist, you will be fine.

He rang the bell at nine one night.
“Aap doctor saab hai?” (Are you the doctor?)
“Haan, kya taklif hai?” (Yes, what is the trouble?)
“Yeh dat bahut dard kar raha hai, isko nikal ke fek do” (This tooth is paining very much. Remove it and throw it away)
I looked in his mouth. It was an impacted wisdom tooth, very badly decayed and in a very crooked position. I told him that it would be a very difficult extraction and that it will have to be extracted by an oral surgeon.
“Woh kahan milega”? (Where can I get him?)
I told him that we cannot get him as and when we want but he will come over if we consult him and request him to do the needful.
“Toh, bulao na unko” (Then, call him.)
I explained to him the process of surgical extraction, need for X Rays, surgeon’s appointments etc etc. and told him that I can arrange to have his tooth removed in about three to four days.
“Teen char din! Yeh dard leke mai kaisa rahoon? Abhi kuch karo. Mera dost ne bola aap phataaphat dat nikaal dete. Aap kuch nahi kar rahe hai.”
(Three four days! How will I live with this pain? Do something now. My friend told me that you will remove the tooth immediately. You are not doing anything.)
He settled on the sofa in my waiting room holding his head in his hands.

There was little that I could do. When the tooth decides to trouble you, and gets stubborn about it, it is not easy to make it change its mind. None of our analgesics and antibiotics exercise influence over it. We either need to kill it by drilling through it and removing its blood and nerve supply (we call it RCT) or pull it out of its base (we call it an extraction). With this fellow’s tooth there was no chance of me attempting any of these. I took a chance and injected a dose of local anaesthetic which we use for numbing the tooth and jaws before removing teeth. Half of his jaw lost its sensation and the pain vanished immediately. He literally fell at my feet.
“Aap daktar nahi hai saab aap bhagavan hai” (You are not a doctor sir, you are god)

I took an X Ray, consulted our surgeon and scheduled surgery. The tooth was anaesthetized and the surgeon began working. He made a cut in the gums, exposed the jaw bone and started to drill around the tooth to release it from the bone. In between we chiselled out fragments of jaw bone from places where the drill could not reach. (Note: These are standard procedures and not our attempts to pull out the tooth by hook or crook) As the surgeon reached deeper the patient started feeling pain.
“Are saab, aap log kya kar raha hai? Mera poora haddi tukda tukda karke nikal rahe hai kya? Bahut dukh raha hai. Woh dant kaa dard is se achcha tha. Aap jo kar raha hai sambhaal ke karo.”
(Oh sir, what are you doing? Are you breaking my jaw into pieces and taking out the tooth? It is paining badly. That toothache was better than this. Whatever you are doing, do it carefully)

I had to inject some more anaesthetic around the area where the surgeon was working and he went in deeper.

Another few minutes and the fellow was squirming again. I injected some more. We had to finish what we started.

“Aapne chaar injection diya, lekin jyaada farak nahi hai. Aadha ghante se aap log mera haddi tod rahe hai. Aap se nahi hoga to chod do. Mai jaa rahaa hoon.”
(You have given four injections but I do not feel much difference. Since half an hour you people are breaking my bone. If you can’t remove the tooth, leave it. I will go.)

I convinced him that we cannot just stop at that stage and leave things as they were. By then the tooth was almost free. It only needed the final push. The root was bent and had stuck in one corner of the jaw bone. That was not unusual. What was baffling me was the pain. Once a nerve is blocked we never have any trouble. Here, I could make out that the nerve was blocked because there was no sensation in half of his tongue, lips or jaws. All other teeth were numb. Yet he was complaining of pain when this tooth was being sectioned and moved. I forced a little more of the drug directly into the tooth and it seemed to work. The surgeon gave the final push, the patient jumped and the tooth was out. The wound was sutured, I offered a prayer to the gods, prescribed strong painkillers and sent him away, instructing him to come over after a week to have the stitches removed.

He rang the bell at eleven the next night.

“Ye saab. Aapne kya kiya muje pata nahin. Daat to nikal gaya. Lekin pehle se ab jyaada dard hai. Mera dost ne bola aap achchaa daktar hai. Isiliye mai aap ke paas aaya tha. Ab dheko mooh bhi khulta nahin. Kal se barah goli khaayi mai. Dard kam nahin hota. Lagta hai aap ke paas aake maine galti kiya.”
(Sir, I do not know what you did. The tooth is out. But the pain is more than what it was before. My friend said that you are a good doctor. That is why I came to you. See, I can’t even open my mouth properly. Since yesterday I have swallowed twelve tablets. Pain is not coming down. I think I made a mistake coming to you.)

I explained to him that sometimes there is a little more pain after the extraction because the wound gets infected. And that happens if the blood does not clot inside the socket from where the tooth was removed and the wound remains open. I advised him to take antibiotics, prescribed some antiseptic rinses and told him that I would give him an injection to reduce the pain. At the mention of the injection he flared up.
“Aap mujhe maar ne ke liye itnaa saaraa injection kyun de rahe hai. Aap ke pass bandook nahi hai ? Ek baar goli maardo aur bas, sab kuch khatam”
(Why do you need to prick me so many times to kill me. Don’t you have a gun? Put a bullet in and everything will be over.)

I managed to calm him down and convince him to take the injection and fortunately it acted. Within minutes he was better. I sent him off telling him to repeat the injections for two or three days till the pain was less.

I was worried. I wanted to call him the next day and enquire about his condition. But if he said that he still had pain I had nothing more left to do. So, I kept quite. After another day the suspense was unbearable. More over I was worried that he may again wake me up late at night and ask me to do something for his pain. I called one of his friends who had accompanied him and enquired about him. The fellow was ok. I was told that he was able to eat ‘roti bhaji’ and was sleeping. I was relieved.

He did not come to my clinic again. I do not know what happened to the sutures. He might have decided to pull them out himself rather than pay me for more pain. I met him in the market nearly after two months.
“Ab sab kuch theek hai saab. Kuch bhi dard nahi hai. Aur woh dhaaga apne aap nikal gaya. Lekin jeeb ab bhi thoda sundh hai. Kya karoon?”
(Now everything is OK sir. No pain at all. And that thread came out on its own. But one thing, my tongue is still numb. What shall I do?)

I gave a vague reply and escaped before he came out with more complaints. It was possible that some part of the nerve was traumatized while removing the tooth and his tongue was still numb. Again there was nothing I could do to rectify it and it would take its own time to get back to normal.

I could not make the tooth numb when we badly wanted it. The tongue was still numb after two months when it should have been back to normal after two hours. I was responsible for both. “The good doctor.”