Peter Kohlsaat is returning to dentistry after about a 15-year hiatus. This is the fourth in a series chronicling his Journey Back.

                                

The Central Regional Boards

he good thing was that my composite board patient and perio board patient were the same guy, Jimmy, who delivered pizza for one of Minneapolis' more upscale pizza joints. The bad thing was that, three days before boards, he admitted himself to the hospital to pass a kidney stone. This was on Thursday. The Vikes were playing the Lions to a national television audience. This was a $200-plus night for local pizza deliverers, so I knew it was serious.

I had returned to dental school for one purpose: to prepare myself for the Central Regional Board Exams, which constituted the last foreseen hurdle to re-obtain my license to practice dentistry. During my two-month tenure in the University of Minnesota's Family Dentistry program I had been on the lookout for possible board patients. Perio board patients, purportedly the most difficult to locate, were so plentiful that I was setting them up with other board participants like so many blind dates. The other two procedures, however, were proving tough to come by. As the Central Regionals neared, the time had come for me to begin making personal house calls to suspected dentally wayward friends and even friends of friends.

My first effort unearthed Jimmy. I stopped by his apartment and was informed by his roommate, Mike, that he had just left for work. But Mike surmised that my dental instincts were probably well founded and in the kitchen offered me a grape soda. And as my good fortune would have it, Jimmy burst through the kitchen door a few minutes later, returning for something forgotten. After a cursory peek at his dental condition, I scheduled him for an impromptu noon exam for the next day. He turned out to be a treasure trove of dental waywardness—radiographically evident subgingival calculus, multiple four-to-five-millimeter pockets, virgin teeth with interproximal caries, including the much sought after compromised upper anterior. But I still lacked an amalgam patient, so the search continued. Then I remembered Billy, an attorney and long-time friend who had recently resurfaced, remarried, and was practicing law in Mankato. And I knew he had not seen a dentist since the last time I had brought his teeth back to respectability, almost 15 years ago.

When I contacted him, Billy told me he had heard of my impending return to dentistry, that he had, in fact, been waiting for it, convinced that it was simply inevitable. Still looking for the elusive amalgam board patient, I invited him to come see me at the dental school's ninth floor clinics. I surmised that after a decade and a half of neglect, Billy had the potential of offering up a blue ribbon mouth; a cafeteria-style selection of various dental maladies. Profusely pre-apologizing for the condition of his oral cavity, he never the less heartily agreed to come for a visit. Bingo bango, he had a perfect virgin DO lesion on tooth #21.

Curt was Curtiss A, long-time local rock and roll icon. Tall, impeccably dressed, a salt and pepper mop top, his swagger and wit were now well known to the DAU assistants who worked with me during our operative sessions. Like Billy, Curt had previously been a patient of mine, and also like Billy he had not been to the dentist since I had last practiced. Over the last two months we had gotten Curt's teeth back to ground zero. The condition of his periodontium, however, I was preserving for the boards. Tentatively, behind Jimmy, he was my back up perio patient.

Once my patient line-up was secure, all that was left was to prepare. To get a feel for what was to be expected on the perio portion of the exam, Dr. Jeff Carlson from the Perio Department graciously agreed to oversee a mock perio board exam on Curt. It was hugely instructional, going a long way in boosting my confidence. Since I knew exactly which teeth I would be preparing for the board exams, I repeatedly cut distal-occlusal amalgam preps on #21 typodont teeth and distal composite preps on #10. The venerable Dr. Ed Ziegler from the operative clinic next door agreed to critique both my preps, and offered tips to fine-tune them.

The remaining two portions of the boards involved ivorine teeth in the typodont—a root canal on tooth #8 and full gold crown prep on tooth #19. Preparing for these was a no-brainer. The endo portion of the exam required the candidate to create an access opening and fill and seal it. Practice teeth were available for $10.50 each. Dr. John Kurtz, an endo grad, assessed the first one. He informed me my access opening was too small and not nearly triangular enough. The canal was also not sealed far enough apically. Who would have known? The second one I attempted had a much-improved access opening, but with a canal that was still not sealed sufficiently apically. This kind of information was invaluable. Dr. Zeigler again eyeballed my practice full crown prep, simply reinforcing the basic design. What more could I do? Continue to praise Jah.

Just as I thought all my ducks were all in a row, I heard about Jimmy's trip to the emergency room. Over the next couple days I called him daily. He had been released from the hospital to pass his kidney stone in the palliative confines of his own apartment, armed with vials of pain medication and drugs to ease the stone's passage. He gallantly assured me over and over that he would be ready. Billy was raring to go, and being a lawyer and having grappled with his own bar exam--actually more than once--he was eager to play any part in foiling any perceived hostile action by any regulatory board in any way possible. The day before the boards I decided to promote Curt to Number One Perio Patient, sparing Jimmy, despite his assurances that he would be there for me, from a possible four-and-a-half-hour marathon session. Instead he would sit simply as my composite patient.

I had taken the Central Regional Boards 23 years ago. I felt ready then and I again felt ready. The trick was to simply remain calm and unflappable, and confident of your preparedness. I was in Group E. My schedule was thus: Sunday—full crown prep; Monday—amalgam, perio, and composite; Tuesday—endo and crown seating.

After a brief orientation, promptly at 1:30 p.m. Sunday we all began en masse, preparing typodont tooth #19 for a full crown. Floor examiners, like looming specters, roamed the aisles. A certain soberness had rolled into the clinic like a heavy fog, which was not alleviated by the insidious lite rock piped into the testing area through the intercom speakers. Putting aside these distractions, I hunkered down to business.

Using the same technique I had utilized while in private practice on hundreds of full crown preparations, I finished the prep and the impression a solid hour before the next candidate. It was a tad unnerving, but I had been encouraged not to piddle around with any of the procedures; just do what you gotta do and finish. So I left everything in a box for the lab to pick up and went home.

The next day was jam-packed, from eight in the morning to five that night. Unlike the full-crown prep of the previous day, there was little time to dilly dally, although allowing an hour-and-half to fill and carve and amalgam seemed a bit excessive. Billy made the drive from Mankato without incidence, correctly anticipating the Monday morning rush hour traffic, and was there in the lobby bright and early, eager to thwart the menacing intentions of another licensing board. Everything went fine.

At noon I ambled out to the lobby to retrieve Curt for the perio portion of the exam. He was sitting comfortably with that day's newspaper. As I greeted him he showed me the story he was reading. It was a full-page piece about him, including a big photo. Every year for 20 years Curt has performed a John Lennon tribute on December 8th, the date of Lennon's death. It is always a well attended affair and has usually garnered a certain amount of media attention. This year, Jim Walsh of the St. Paul Pioneer Press Dispatch, had set up a conference call with Curt, himself, and Yoko Ono, the resulting conversation providing the fodder for the story. What better way for Curt to bask in such widespread limelight than as a patient for an arduous perio board exam?

Curt was the perfect patient. He sat stoically, without so much as an audible moan, through the entire three hours, as I poked, scraped, curretted, and scoured his upper right quadrant. The only indication of duress came at the screeching of ultra-sonic scaler, which elicited from him little manic chuckles. During this time I did, however, notice an increase in pedestrian traffic by my corner cubicle. It seems that word had circulated that Dr. Kohlsaat's patient was a rock star and people had to take a peek. I even caught one of the floor examiners, against a wall with a newspaper, looking our way. Again, the exam went without incident.

While finishing up Curt, over the loudspeaker came the notice, "Dr. Kohlsaat, you have a patient in the lobby." I was hoping this was Jimmy and not one of my regular patients with a dental emergency or scheduling mix-up. It was Jimmy and as he straggled into the clinic, he looked wan and drained. He told me had not yet passed his kidney stone and had spent the previous few days in bouts of agony, but was gallant and willing.

Despite everything, it all went well. The only incident came near the end of the preparation, while, from the lingual, nervously chasing the merest hint of stained enamel, I deviated from ideal form by slightly extending onto the tooth's buccal surface along a line of hypocalcified enamel. I realized that I should have obtained an OK from a floor examiner to modify the preparation, but at that point I could only hope that my reason for the improv was patently obvious and justifiable. I gave Jimmy a tenner for the cost of parking in the ramp across the street, and headed home. That night our Uptown Bar basketball team had a league game, which was the perfect outlet for the day's pent up stress. A few beers wit da boys, and an early bed.

My schedule for Tuesday allowed me eight hours to seat a gold crown and demonstrate my endodontic prowess on a typodont central incisor. I was done by 10 o'clock. That was that. It was over but for the results, which, I was informed, should be in my hands within a couple weeks. It all seemed profoundly anticlimactic. Since last spring I had applied myself diligently to a series of logistical endeavors, each one requiring an undistracted focus. All cartooning inspirations, except my regular obligations, had been rigorously ignored, lest I become completely consumed in something other than the immediate task at hand. Alone in my exam cubicle cleaning up, the Peggy Lee song, "Is That All There Is" came to mind. While I knew some of my board procedures could have been improved upon, I had no doubt I had performed well enough to pass. Up to this point it had all been more or less a personal challenge to see if, after being so completely out of dentistry for so many years, I could pull it off. Now what? How to include dentistry into my life without changing my life.

As I waited for the elevator, alone in the ninth floor lobby of Moos Tower, I gazed out the full-length windows at the Minneapolis skyline. The steel gray clouds hung low in the December sky. It looked like snow. What now, I asked again. After this arduous eight-month ordeal I should have felt victorious, self-satisfied, jubilant. Instead, I felt inexplicably troubled. And then the nagging realization of what I had just done, again made itself clear: I was about to trade four months of winter in Mexico for two days a week of dentistry in Minneapolis, or wherever.

But nothing had yet changed, actually. There were no immediate obligations that prevented me from leaving for Mexico. I had no "job." I could go home, load up the van, point myself south on Interstate 35 and in 14 hours be in Wichita. From there it was just two long days to San Diego. And then 1200 miles down the Baja peninsula to Los Cabos, to my familiar little second-floor cuarto at the Posada Señor Mañana, which for the last six years had become my home away from home.

I pictured myself in my hammock on my own little private veranda, perhaps having just finished a typical meal of grilled marlin. Maybe a small lobster tail or plate of shrimp on the side. Beside me a small tumbler of sipping tequila. Smoking a nice little Cuban cigar. A cheap crime novel on my chest. I could visualize the red chili pepper lights strung from the ceiling shining through the palm trees into the thick tropical night.

I thought of my secret dive spot: only a half-hour from the hotel. I had snorkeled this surprisingly secluded cove hundreds of times, out amongst the jagged rocks and coral, with its often-turbulent water. Every underwater landmark was as intimately familiar to me as was the interior of my van. I knew every hole in the coral where I had ever seen a lobster, where I spearfished for grouper, snapper, and the stupid clown hawkfish, which would keep nervously still in the crevices and under overhangs, convinced of its invisibility. Every dive allowed me to dive subsequently deeper and deeper until after 20 or 30 dives I was able to descend about 40 feet. I could lie on my stomach at the bottom and look under the rocks, my Hawaiian sling stretched tight, waiting for dinner to peek out, curious as to whether it was safe to emerge.

These thoughts were fast-forwarded through my mind until my idyll was interrupted by the bell of an arriving elevator. I stepped in and as the elevator doors closed in front of me I tried to shake my misgivings. Pragmatism, I told myself, is not a good trait for a cartoonist to possess.

                             Part 5