The art of losing isn't hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.
From "One Art" by Elizabeth Bishop
So, I had this toothache. It was in a tooth that I knew had a cavity. I knew there was a cavity because the last time I went to a dentist, which was about eight years ago, I had noticed a dark spot on my lower right molar. I noticed it because I am the type of person who compulsively looks in mirrors and inspects everything. Everything. I opened my mouth wide to check out the fillings in the back teeth, and I noticed a spot on one tooth, and I mentioned it to the dentist and he goes, “What, this?”* And at the time, it wasn’t even enough of a spot to call it a cavity, so he just said be sure you brush good, and it’ll be fine, and he suggested that perhaps I should tone down the self-inspections.
Which would’ve been fine, right? Except that this was my last dental checkup before going off to college, and though I’m ashamed to admit it, there were many nights when I drunkenly went to bed without brushing, and many mornings when I stumbled out of bed just barely in time to make it to class, and several other times when I mostly just failed to care because I was 18 or 19 and figured my teeth weren’t going anywhere. And for a while, they weren’t, until I was long past my college partying days, making a sincere effort to brush at least once a day, and getting regular medical checkups. The little spot on that back tooth had grown. I was still in the habit of checking out those back teeth. It had developed into the habit of looking mournfully in the mirror, knowing that eventually I’d have to make a dental appointment to get that filled, and wondering how complicated the insurance was going to be. Foolishly, I waited. It didn’t hurt. No need to go to a doctor for something that doesn’t hurt, right?
But then, one day it did hurt. Something was stuck in it. I gave it a good brushing, rinsed with salt water, and it stopped hurting for a couple days, but it started again. I went through this cycle for a few days until it became clear that I would need to see a dentist.
After calling my insurance company to verify that I did indeed have dental coverage with a $5 copay for office visits, I had the company fax my insurance information over to the only dental office in town that (a) had openings and (b) accepted the particular insurance plan I had. Obviously, when everyone else in town is telling you they can’t get you an appointment until the end of next month and this office says, “Well, I have several openings this week,” you should consider whether you could stand to wait a month. But when there’s a crater in your molar and you find yourself compulsively picking things out of it with the aid of various improvised tools (tooth pick, paper clip, safety pin, earring hook), waiting a solid month just doesn’t feel like an option.
But when I arrived for my appointment, it wasn’t to get a filling or even have a tooth pulled. Since the tooth was not actively hurting at that moment (I had successfully rinsed all the food bits out of it for several days in a row), they gave me a cleaning. A good, 45 minute scrubbing, a painful scrubbing, too. And when I told the hygienist I hadn’t seen a dentist in eight years, she said she’d have to split my cleaning into two visits because there was “so much tartar build up that we won’t be able to get it all in one visit.” Oh, but your insurance will only pay for this type of visit once every six months, and we really can’t wait six months for this, so lets try and get you back in a couple weeks. That’ll be $75 today (you get the discounted rate), and you just pay your $5 copay next time. Oh, yes, I know it’s an unexpected expense and everyone is under pressure in this economy, but this is an investment in your health. You really need this, and you’ll be glad once you’re done. Granted, it’s completely your call. We could just do everything we can for now and then see you back for another regular cleaning in six months, but you will look sortof pathetic if you admit to being bothered by this unexpected yet entirely manageable expense. No pressure, of course.
All this was explained to me as I sat in the dentist’s chair, feet in the air, with what amounted to a small, sharp-edged, dual-action, vibrator-sprinkler jammed into the crevices between my teeth. This went on for 30 minutes before I found myself very briefly the object of attention of one Dr. B, who looked and sounded frighteningly like Ben Stein but with whiter hair and an eerily younger face. He glanced at me, then at my x-ray, made scraping noises with metal objects in my mouth, and told me I would need a root canal. Oh, and those wisdom teeth? They’ll probably need to come out (even though your dentist back home said to leave them alone as long as they’re not bothering you, and they aren’t). But we can talk about that later. After the root canal. For now, give her a treatment plan and schedule a root canal, and I’m out of here because I am a busy man, and it’s not my fault you didn’t brush your teeth enough in college, ya floozy.
My tooth started to hurt again, even when I brushed, and using my improvised cleaning tools didn’t help, either. I was rinsing with Listerine several times a day. When the small bottle I carried in my purse ran out, I stopped by Walgreens on the way home from work one day and couldn’t stop myself from taking a swig in the parking lot. Immediately I was confronted with the problem: Where to spit? I couldn’t just lean out the window in rush hour traffic and spit on a neighboring vehicle. I couldn’t open the door and spit on the ground and risk looking like a drunk or a tobacco chewer or both. So, I wedged the full Listerine bottle between my thighs, removed the cup/cap, and spit into it. I drove very carefully the rest of the way home, breaking gently, slowing to a crawl to go over the speed bumps, and merging ever-so-politely in order to avoid upsetting the shot glass of spit and mouthwash that was threatening to ruin my pride and the upholstery of my car.
I called the dentist the next day.
“I have an appointment for a root canal, but I want to know if I can come in sooner. My tooth is really hurting.”
“You don’t have an appointment for a root canal. Your appointment is for a cleaning. You have to go to the other side of the office to make an appointment with the doctor.”
“No one told me that. I thought I was making an appointment for my root canal.”
“Nope. But I can get you in for a root canal … next week?”
“Well, no one told me that was an option. I really need to think about this, but let me make the appointment now, and I’ll at least get to talk to the doctor when I go in.”
I made a lunch time appointment because I don’t like to take time off work when I can avoid it, and they didn’t have any evening appointments available soon enough. In the interim, I sought advice from people I knew who’d had root canals. Everyone seemed to think it’s best to save the tooth if you can, I chose to proceed with the root canal rather than extract the tooth. I arrived early for my 11 a.m. appointment but sat in the waiting room until 11:15 anyway. By the time I reached the dentist’s chair, I had made up my mind that I was there to have a root canal. I told Dr. B as much, he administered anesthesia, and began drilling away. The procedure was painless, Dr. B put a temporary filling in my tooth and told me to schedule the second half of the root canal at the front desk.
At the front desk, the receptionist told me I didn’t owe anything since the procedure wasn’t finished yet, however the total cost would be $580 at the end of the next appointment. What happened to the $5 copay? my inner voice screamed, but all I could say was, “They didn’t tell me that.” Then the tears began to flow. An old man who had been sitting the waiting room across from me earlier appeared to smirk at my tears as the receptionist said something about a treatment plan — the treatment plan, yes, that was supposed to explain what was involved in this root canal business. That was supposed to explain all the costs. What happened to the treatment plan? I never got a copy.
I put down $50 that day, left the office sobbing, and left my husband a voice mail in which I could only choke out the words, “Hey, it’s me. I need you to call me, okay?” He called me 30 minutes later, afraid I’d been too drugged to drive back to the office. I did drive, though. I stopped off at Smoothie King to get a liquid lunch, and as I sat in my car, in the rain, in the parking lot, I struggled to get it together enough to go inside and order a medium Angel Food. I stopped crying and heaving hysterical sighs long enough to get inside, but before I could order, I realized my wallet was missing. I ran out to the car, got the wallet, and came back. The other customers applauded, but one woman looked at me and saw how distressed I was.
“You have too much going on,” she said. “You just need to slow down.” I took a deep breath, nodded, and tried not to cry.
“Are you ok?” She said.
“Do you want a hug?”
I nodded again.
She walked right up and hugged me.
“Ah jeeze,” I said. “I’m really going crazy. I’m hugging a complete stranger … but that’s OK.”
“I’m not a stranger. My name is Tanya.”
Tanya was amazing. She gave me hope. She told me to take care of myself. Don’t make myself sick. She had been a victim of sickness, she said. She was diagnosed with breast cancer just a few months before losing her job. She was living off savings, and she would have her last radiation treatment in a few more days.
“You’re amazing,” I sobbed. “I want you to get better.”
“I am better,” she said. “I have claimed my healing.”
I couldn’t believe I was crying over a root canal. I didn’t tell her. I thanked her profusely and went back to work with a sinus headache (the inevitable result of crying). I tried to tough it out through the day but ended up going home at 4 p.m., at which point I slept, whined, and apologized to my husband for being a burden. The only food I managed to stomach that evening was about four spoonfulls of some kind of mediocre soup and a slice of a baguette.
Appointments Three and Four:
At appointment three, I received the second half of my cleaning, which was far less painful than the first. It was unremarkable.
By appointment four, I had figured out that my extreme emotional reaction was more likely due to the anesthesia than being told the cost of the root canal. I knew I could afford the procedure, even though it was an unexpected an inconvenient expense, so it had to be the drugs. Not to mention that loss of appetite is not at all how I normally cope with bad news. I asked to be treated with a different type of anesthesia if possible. The doctor’s assistant explained that the usual anesthesia actually contains adrenaline, which causes some people to have nervous reactions. Only then did I realize exactly how bad for me that particular anesthesia had been — we’re talking about someone with an anxiety problem, panic attacks, and trouble spending extended periods in groups of people — even if those people are close friends and family. Giving me an extra dose of adrenaline before telling me I owe nearly $600 just doesn’t go over well.
As I sat in the chair pondering all this, the doctor and his assistant prepared and administered a different kind of anesthesia, one which they said was slightly less potent and might wear off more quickly (not a problem, I figured, since the last one had left me numb for much of the day). I few needles to the jaw later, I was numb and just waiting to get the drilling done. Perhaps they didn’t realize how quickly the drugs took effect because Dr. B walked away for a good ten minutes, and in the mean time, my face got droopy, and his assistant remembered something.
“Oh, has anyone given you one of these yet? She said, handing me a form.”
“No, what’s this?”
“This is just a release form giving us permission to do the root canal.”
Should I have stopped her at this point? Should I have protested? Should I have said, “What the hell? You already started the root canal last time I was here. You didn’t give me a treatment plan, didn’t tell me what was involved, didn’t tell me how much it would cost, gave me drugs I wasn’t prepared to cope with, drilled the center out of my tooth and suckered me into a long, drawn-out, multi-visit process, and NOW you’re giving me a release form?” Yeah. I probably should’ve said that. But I didn’t. I signed the form and let them drill into my tooth again because realistically, what dentist would take a patient who was half way through a root canal someone else started? Then they strapped a humiliating device on my mouth. It involved a rubber sheet and something like an old-fashioned head-gear, and I couldn’t stop the mental images of disturbing pseudo-medical porn from flooding my brain. I stared into the blindingly bright light overhead, and decided I would need to see a different dentist as soon as humanly possible.
As the anesthesia wore off, I began to twitch and squirm, and eventually even to moan and jerk away from Dr. B, who administered more anesthesia and soldiered on. Still, he was unable to finish the root canal. I learned later that it was at least in part due to the fact that the root of my tooth formed a 90 degree angle at the bottom, which made it particularly hard to drill. Had I known this earlier, I might have chosen to save myself the pain and extract the tooth right off the bat. But there I was: tooth drilled, root canal nearly finished, thinking if I could just finish this mess, I would reward myself at the end by finding a better dentist. Knowing that at least another $700 in dental fees lay ahead, I paid what was left of my nearly $600 root canal bill although the procedure wasn’t finished. This would allow me to space out the payments and make the $700 seem slightly less painful when it came due.
I made my appointment to finish the root canal and to start to post-core and crown process, and in the mean time, I sought out recommendations of dentists. I explored every possible option, and I even considered flying home to Louisiana to see a dentist I trust so I could end this charade with the local dental office once and for all. But within a week, the tooth broke. I swear to God, I was following all the rules, but there you go. The side chipped right off while I was eating French fries, and I must’ve swallowed it by accident. It left the temporary filling exposed. I called the dental office, which was closed. The answering service woman explained that the dentist on call doesn’t respond to anything after 11 p.m., and as it was 11:15, I could choose to either go to the emergency room or just wait until the following morning. I wasn’t bleeding out, so I chose to wait. As I lay in bed that night, I coached myself on what to say the next day. I would tell them to pull the tooth. I would never go back. I would find a new dentist. And if anyone tried to make me feel bad about removing the tooth, I would tell them, “I’ve lost more important things than this tooth.” Silently, I enumerated the many things I’ve lost.
It was the Wednesday morning before Thanksgiving, and I got a 9:15 appointment with a Dr. M. I was expecting another Ben Stein look alike but was surprised to meet a young female dentist not much older than myself. She had a brunette bob with near-blond highlights. It was apparent that she put some effort into her make up that morning. She looked like someone my age who I wouldn’t be likely to be friends with because we had nothing in common even though she was, by all accounts, a really nice person. She didn’t look like a dentist. She didn’t look like Ben Stein. I had a brief feminist experience in which I came face-to-face with my own ingrained sexism as I realized I wasn’t 100% confident in this young, attractive, friendly and well made-up female dentist. I made a conscious decision to trust her because (a) at least she was nicer than Dr. B, (b) she was my only hope to get rid of this damned tooth, and (c) I needed to get over that sexist bullshit because I wouldn’t have let anyone else get away with saying the same things I was thinking. Be the change you want to see and all that.
Dr. M took a look at my tooth and noted that the break looked rather superficial and she could probably still cap it, and I’d be able to go ahead with the post-core and crown. She took an x ray to make sure the break wasn’t worse than it appeared. She offered to cap the tooth for me, but — and this was my moment of triumph, strange as it may seem — I looked her in the eye, willing my tears back into their ducts, and said, “I really just want to pull the tooth. I want to be done with this. I’ve been round and round with this tooth. I can’t keep taking time off work for this, and I honestly can’t afford it, and I just want you to pull it.” She patted my cheek and said she would do it. She conferred with another doctor about that 90 degree root. She numbed me up with my preferred anesthesia. She worked quickly with her assistant, who happened to be the same person who dealt with me sobbing embarrassingly at the receptionists’ desk a few weeks before. She warned me before doing things that might hurt, “You’re going to feel a lot of pressure here.” And she stopped when I raised my hand to ask for a break. he was everything I wished my first boyfriend would be. It crossed my mind to stay at that dental office as long as I could only make appointments with her. I was in love with Dr. M.
After much pushing, prodding and pulling, I heard and felt a crack somewhere beneath my gum line, and Dr. M produced a tooth.
“Cah ah heee?”
“Huh? Oh, sure, just let me get this cleaned up quick. Once we get the root tips out, you can get a look at this.”
There was more digging around in my mouth, then the application of a suction tube to remove the blood, then Dr. M and her assistant left my side briefly. They wanted to take an x ray to be sure all the bits of root had been removed. While they were gone, I lifted my head just enough to see the paper napkin on my chest. It was stained with blood. I felt a little sick and a little proud. Dr. M came back with good news. The x ray showed no pieces of the tooth remained. Dr. M put stitches in my gum; told me how well I’d done; gave me instructions for caring for the wound, 800 mg of Ibuprofen and a prescription for Percoset, which I ended up never taking. She sent me off with a firm warning to eat something before taking any medications. I didn’t get to look at the tooth. I really wanted to see that 90 degree root.
Through the next few days, I poured over the instructions for caring for the extraction site. I meticulously avoided acidic foods and beverages. I did not eat turkey or cranberry sauce at Thanksgiving but stuck to stuffing and other foods soft enough to be mashed with my tongue or chewed on one side. I texted a friend in a tizzy when I found a piece of noodle slouched in the hole where my tooth once was. The noodle did not respond to the “gentle rinsing” described by the dental assistant. My friend texted her mother, who was also a dental assistant. Word came back: I could rinse, but no spitting, sucking, or sneezing was allowed. The noodle was defeated. On Friday, I sneezed. By Saturday night, I allowed myself beer, the effects of which were heightened by several days of a mostly liquid diet. We had a party, and at 1 a.m., we went to the Double T Diner, where I had baklava.
Nearly a week after the extraction, I sat dully tonguing the stitches in my gums, trying not to interfere with the healing yet unable to resist my compulsion to fidget. I suckled my beer gently. The stitches were coming loose, and the thread dangled in the back of my mouth like the lose yarn on an of an old sweater. I ached to pull on that thread, to unravel it just to see what would happen. In two days, I would have an appointment to get the stitches removed, but I worried about the loose thread. I simply couldn’t cope with the prospect of complications — infection, abscess, dry socket, which I nearly had panic attacks avoiding — I had been cautious for a week, and I didn’t need a reason to spend even more time and money on my floozy teeth. But that night, I pictured all the beer I’d had over the weekend, how I’d heard the effervescence from soda could dissolve or dislodge the blood clot and cause dry socket — how much worse could beer be? I lay in bed imagining my stitches coming undone and my precious blood clot washing away in rivers of beer until I fell asleep. In the morning, I worried that the final checkup would result in the doctor conjuring up some other issue for which I would require some other expensive treatment. I considered cutting the last remaining stitch with nail scissors and skipping bail.
On the day my stitches were to be removed, the husband and I had to carpool because his car was in the shop. Despite a frantic day at the office, I spent much of the day imagining finally being free of my unraveling stitches. I tried not to fidget, and while standing in line at the Indian buffet where I went to lunch with my coworkers, I had just enough self-control not to say, “Today, I’m getting the stitches out of my gums from that tooth extraction I had last week.” After work, my husband dropped me off at the dentist’s office and went across the street to get himself a cup of coffee. I warned him: They always run at least 15 minutes late, so even if we get there on time, they won’t see me till 5:30. He planned to be back by six. I walked up stairs, signed in at the front desk, and by the time I finished hanging my jacket, a dental assistant was there to call me back. She sat me down, snipped the one remaining stitch from my gum, and rinsed the wound with salt water. It didn’t hurt at all. It felt instantly better, in fact, as the temptation to fidget was removed. When she went to get the dentist, she left the little wad of thread on the tray beside me. It looked like a small dead bug with a bit of mush (probably rice pudding) caked on the wings. Or like something you might find in the bathtub drain.
Then my Dr. M returned.
“How are you?” She said cheerfully.
“A thousand times better than I was last time!”
“How about the day of the extraction? That was one hell of an extraction, huh? Did you have a lot of pain?”
“Not really. I turned in the prescription you gave me but I never ended up taking it. I just took Ibuprofen for a couple days.”
She was enthusiastic about this news. I gazed into her green eyes (enhanced by colored contacts, but beautiful nonetheless) and noticed how much she resembled one of my heroes, Carlin Ross.
Dr. M leaned me back in the chair one last time. She swiped her finger along my gum line, looking for swelling and irritation, commenting that the healing seemed to be coming along fine. She said it would heal even faster now that the sutures were out of the way. Sutures, I thought. Yes. I had forgotten that word. She reviewed my chart, saw that I had no need to come in for any appointments any time soon, and encouraged me to take a break, rest up, and enjoy the holidays. And that was that. On the way out the door, I checked in with the receptionist about my refund for the root canal. In the car on the drive home, I took a photo for posterity. I wondered if I would ever see Dr. M again. Then we went out for hamburgers.
*Please note that all dialogue in this piece is paraphrased. I wasn’t taking notes in the dentists’ chair as I was hoping all along that this would not be the type of medical experience that merited an essay, especially one of this length. If I had known it was going to be so dramatic, I would’ve brought a tape recorder.