Specimens

Like most dentists, I see a wide variant of the human race in my clinic. Some of my clientele is normal. At times I’d say most of it is normal. And there are the days when I scrape and search for a shred of normality among the lot and come up blank.

Sometimes I’ve thought that what I need is a psychiatrist to set up his practice in my waiting room and screen my patients…

…or impatients, as some would be better called, like the ones who bang at the treatment room door despite the notice inviting them to sit and wait, and who ignore the ten or fifteen waiting patients before them. Most of these characters are not in pain; far from it. One told me he had to go back to his shop, and since he was paying for his treatment anyway, how dare I make him wait?

Often I thought of putting up an Uncle Sam Wants You style poster with my photo: "Sit Down. THIS MEANS YOU." But would it even penetrate minds as these?

Another species of impatient is the one who wants his or her treatment done fast.The commonest such treatment is the root canal, which is something that absolutely cannot be hurried, and which I always begin by explaining cannot be hurried. Yet I daily find myself in conversations like this one:

Impatient (Imp): "Doctor, how many more sessions?"

I: "I can’t tell you that, your canals are still exuding pus."

Imp: "But can you give me a rough idea?"

I: "Sorry, I can’t. As I explained at the outset, your tooth is badly infected and we can’t fill it until we sterilise the canals."

Imp: "But I have to come so far…"

I: "Well, I’m sorry, but the bacteria in your canal don’t know that."

Imp: "Will it be finished by the nineteenth? I have to go out of town on the nineteenth."

I: "Again, I’m sorry, but the tooth doesn’t know that you’re going out…"

(Let me emphasise here that all this had already been explained before starting treatment.)

Imp: "My friend had a root canal done in only two sessions."

I: "So would you, if you hadn’t had an infection in this tooth."

Imp: (Signifies assent and understanding)

I: (finish treatment) "Please come on Friday for the next session."

Imp: "You’ll fill it on Friday, right?"

This is also the sort of person to be careful of, after treatment is over. The typical impatient will push for a time saving compromise and then begin moaning loud and long about how the results of treatment don’t match up to expectations, and try to wiggle out of paying.

Another such conversation:

Imp: "I’m not satisfied with this crown."

I: "Why?" (Sinking feeling. I know what’s coming.)

Imp: "It shows metallic when I smile."

I: "I told you it would, that’s why I recommended a porcelain crown."

Imp: "Can’t anything be done to cover it up?"

I: "No."

Imp: "But I’m not happy, everyone makes fun of me when I smile."

I: "I did warn you of this, but you preferred the metal crown anyway."

Imp: "But porcelain is so expensive. Can’t you do something?"

I: "We can always take out the metal crown and do the porcelain, but of course you’ll have to pay for it."

Imp (with bad grace): "All right. I’ll think about it." (Makes a hurried exit, casting dirty looks at me over his/her shoulder. And later the spouse will call to ask all these questions again.)

The impatient, however, yields pride of place as a species to the specimen. Specimens conform to no set pattern; they can be of all shapes and sizes, of all shades of bizarre behaviour. It’s impossible to set standards for a specimen. Whatever one might write would be only true of one at any particular time.

What should I say if asked about a typical specimen? Should I mention the one who said he rinses his mouth daily with (I fervently hope) his own urine? With the girl who sat down in the dental chair with her fly open, displaying flowery panties and wisps of pubic hair? With the guy who told me proudly, when I asked about his general health, "Oh, I’m fine. I have no diabetes, no asthma or allergies, no acidity, no blood pressure, no temperature, no pulse…"? How about the one who was supposed to take three tablets of an antibiotic a day, beginning one hour after prescription, and instead began taking three tablets every hour?

I have instituted an award of Specimen Of The Day in honour of these people, and send it around by text message. I have probably forgotten the less egregious ones, so if anyone reminds me of them I’ll include them.

One I remember back when I used to work in a hospital. The two other dentists had both treated this particular patient; they sent him to me with the warning: "Watch out! This guy’s crazy!" So I was rather circumspect in treating him, since I never could find out in what manner he was crazy. But during the entire treatment, which took an hour, he acted normal; I had about decided he was fine. And then, after getting out of the chair, he pulled up his trouser legs and told me proudly, "Look, I’m wearing mismatched socks…"

There was a woman called Helen whom I remember, who used to dig in her own gum for a nonexistent fragment of tooth which she was convinced was embedded in her bone, till she gave herself muscle spasm. Nothing I showed her on X rays convinced her otherwise. Other dentists had tried as well; at last she disappeared. I guess she found someone to cut a hole in her gum to take the "tooth" out. Anything’s possible.

There was this American preacher in 2003 who tried to hand me tracts for his fringe church and made a real, determined bid to convert me all through the treatment. In retaliation, I handed him some of my anti-Bush plays. He shut up after that.

Specimens are a special breed. I’ll keep including them as memory or treatment bring them to me.

And there are the third species: the other creatures. These are a few sets of patients who can be broadly fitted in stereotyped groups. We can fit them as under

1. The uncooperative kid: Will kick, scream, resolutely refuse to open its mouth, do anything to avoid treatment. The last one vomited on the floor, quite deliberately. The parents are usually to blame. They would either threaten the kid with a visit to the dentist as a punishment or else act in such a way that the child’s scared out of its wits. I remember a woman who told me loudly, right in front of the kid: "Doctor, please treat her, I can’t bear to watch." What is the child supposed to feel like after that?
2. The Bengali boy: An absolute and utter wimp, as I discussed some time back in another post. This one will have to be accompanied to treatment by one or both parents even when in his early twenties. In the recent past, one also qualified as a specimen, when he proved that he had no conception of the difference between left and right. His mother will be incredibly garrulous and overweight, as are virtually all Bengali matrons, and both parents will try and stand over the dentist’s shoulder to watch the treatment in progress.
3. The Bihari Woman: In fact, North Indian women in general. They will of necessity be brought in by their husbands. Of necessity because they can’t even summon the gumption to tell the dentist their name. All questions would have to be directed at the husband who will answer for his wife. I used to look and speak specifically at the wife in the early days, ignore the husband totally, and tell the wife to answer the questions. But then I’d ask "How long have you had the pain? Do you have the pain now?" and the woman would promptly begin rolling agonised eyes at her lord and master. More recently I gave up. I tried my best. No way I can change the world on my own.

A subset is the Muslim North Indian (not Muslim East Indian, who are normal) woman. This subspecies wears burqas and cannot be made to bare the face even for purposes of treatment for more than a few seconds. Where I lie there are no burqas, but I remember as a student in Lucknow turning to pick up filling materials on my instrument from my tray and already finding the veil back on the patient’s face.

4. The Khasi villager: This breed is actually pretty sensible by most parameters except for a peculiar fixation. If I ever extract a tooth from one of them, I have to make sure the tooth has a hole in it. Bam khniang, as they say: the tooth has been "eaten by insects". I've learnt that even if an impacted tooth has to be removed, or one that is destroyed by gum disease, I still have to create a hole in the otherwise undamaged tooth to satisfy these people, because they will check to see if a hole is there. Or else they will never be happy. Even the absence of pain or trouble will not make them happy.

5. The Meitei  and Mizo patient: These two ethnic groups are very different in culture, religion, language, in just about every way, but are united in one thing: it's almost impossible to get any idea into their heads. You might repeat something 1000 times, but in the end you'll find nothing has gone in. Oddest because they are both educated peoples. Typical conversation:

I:"We can save this tooth by root canal treatment."

M/M: "It has to be taken out?"

I:"No, I can save it." (Show flip charts etc to explain how I'd do it.)

So they agree. And I do the root canal. One day:

I; "Tomorrow I'll do your root filling"

M/M (brightening immediately): "Oh, tomorrow you'll take the tooth out?"

If ever I write my memoirs, they are going to be called Down At The Mouth...