Part III - Back to school
Monday, January 3, 2000
ctober 1st, Monday. I shaved, even though my first patient of the day was just a typodont. In fact, it was my first patient in almost 15 years. Fifteen glorious years of quasi-bumdom, years that never once demanded a clean-shaven face. I'm not saying that the next 15 years cannot be equally as glorious…but without my usual winters in Baja, where I spearfished for groupers, snappers, and the occasional lobster, camped on the beach and lived on fresh cerviche, where my daily kayak ride routinely put me out amongst the migrating gray whales…well, the next 15 years might be glorious, certainly, but there I was, on the ninth floor of Moos Tower at the University of Minnesota, and I wanted to cry.
Even though there was no Dental Rehabilitation program at the School of Dentistry, the Family Dentistry resident program seemed to offer the best fit. In this clinic, instead of being surrounded by the normal swarm of naïve, wide-eyed, harried undergraduate dental students running around looking for signatures, I was able to cloak myself in a bit of sanctuary. In the Family Dental program resided a global mish mash of dentists from Guatemala, Honduras, Mexico, Hungary, Bosnia, French Canada, all here for a variety of reasons. The included students, for the most part, were rotating seniors getting schooled by staff DAU assistants. All in all it allowed me to go about my business with little fanfare.
That first morning I was led to my little cubicle, one that was by all appearances not normally scheduled for operative procedures. There was a large gray steel storage cabinet in one corner and against an adjoining cubicle wall, a smaller steel cabinet, where seemingly forgotten papers, books, and whatnot were haphazardly stacked. I made a cursory inspection of the cubicle's drawers and, instead of the expected dental paraphernalia, I found staplers, tape dispensers, pens, pencils, papers, and a curious array of party favors such as noise makers, ribbon, gaily decorated paper napkins. Occupying the dental chair was my typodont, its dentition safely protected by a thick, steel-plated cranium. One of the DAU assistants brought in an operative kit and I was left alone.
After that first day, I told Jim Gambucci, head of the Family Dentistry program, that I was ready to start seeing patients. He pursed his lips and took on a very serious air. You could always have fun with Jim. But despite my extended hiatus, I felt I was indeed perfectly capable of performing adequate dentistry. Even though my hand had not held a high-speed handpiece for all those years, it had held a pen every day. And while a momentary dalliance with the pen never resulted in a pulpal exposure, for all practical purposes it's the same action. Being the responsible as well as diplomatic soul that he is, Dr. Gambucci gently suggested I take a deep breath and spend the week doing exams, prophies, and simply observing.
A full crown prep was my first operative procedure. Then a root canal on a lower first molar. A couple amalgams. After that second week I was off and running. During all this time I did not hesitate to share with my patients the story of my return to dentistry from a life of cartooning. It gave me the opportunity, while the novocaine was taking effect, to explain the soon-to-be-obvious unfamiliarity with the various materials I was apt to demonstrate. The DAU assistants into whose section I was assigned, into whose section I intruded, came to be my most necessary and effective teaching aids. They watched over me like mother hens. Despite their own busy schedules it seemed one of them would inevitably appear at my chairside just as I needed assistance, patiently guiding me through an impression procedure, or educating me on the newer dental materials. Bonded amalgam! The future is a great thing.
I went back to school for one reason: to prepare myself for the Central Regional Boards, which were to be given at the beginning of December. That gave me two months to get it together. I opined that if I could familiarize myself with the various procedures, my hands would take care of themselves.
During our preliminary discussions Dr. Gambucci expressed the concerned that the dental school perhaps might not be able to provide me with an adequate number of patients, so he recommended that I supply as many of my own as possible. All my dentally-wayward friends were contacted and I was much moved by the confidence they showed in me. SteveO, who hadn't been to a dentist since I sold my practice, told me he had been waiting for my return all these years; a return he always knew was inevitable. He had no idea how close he had come to his own inevitable dental apocalypse. The program sees its share of weirdo patients, but I doubt if they routinely see such a consistent stream of oddballs as I was able to parade through. Between aging rock and roll scenesters and embraced societal misfits, my own patient list was sufficiently lengthy.
As it turned out, the school's concern a about a potential patient shortage was entirely misplaced. Apparently the general public is rife with dental emergencies and the university is far from just another port in the storm. From this pool of dental emergencies I was soon booked solid a week in advance. New names appeared on my daily schedules like wanton hopefuls on the local nymphomaniac's dance card. It all began to feel like my own personal private practice, which the assistants repeatedly reminded me it wasn't. The front desk and I came to an arrangement that involved only the occasional emergency patient from then on.
So, what's changed during the 15 years I've been away?
Materials: impression materials: I love the way a caulking theory has been incorporated into the delivery design. I bet the manufacturers also love the new delivery design. They can't be cheap. And let me guess…every four or five years the industry totally redesigns them, necessitating a complete inventory overhaul? And the colors…very trendy.
Composites: Does anyone else miss Concise? What was once contained in a little box in an operatory drawer has become its own entire tray of shade-categorized syringes, gels, brushes and that oh so groovy UV light gun. Is this stuff really that much improved over the self-setting Concise? I'm sure I'll get the hang of the layering technique on large restorations, but right now it's just clumsy. But all those shade options...impressive.
Amalgams seem pretty much the same as when I left the profession, although I'm sure the dental supply salesmen, regarding current advances, would have much to extol.
Implants were not around when I was practicing, at least not so ubiquitously to the general public. I saw a patient who was missing a lower lateral and canine, between two bridges, and it was suggested that with a bone graft to augment a too-narrow osseous ridge, implants would be feasible. And amazingly affordable, at least cheaper than a new car, unless, of course, it's a car that I might own.
Infection control: If I had been living on some remote beach for the past 15 years and was plopped suddenly back into modern dentistry…a scenario that is only mildly inaccurate…I would be led to surmise that infection was rampant. The lives of dentists, dental personnel, and their patients, I would be forced to conclude, were now at best highly tenuous. "Imagine the insurance premiums, " I would think to myself and cower. The dental operatory at some time must have been discovered to be a toxic time bomb, putting entire strip malls at risk. Pathologic microbes must have now evolved into indefensible little monsters. When did all this happen? Should I feel blessed to have survived even my paltry six years as a practicing dentist?
Granted, this is Serious Business, but I have to assume there are simply way too many people employed by OSHA. This alone might be enough to shock me into voting Republican. Hidden cameras are surely just around the corner. What host of other rules and regulations awaits me upon the emergence from my dental school cocoon? My god, what ABOUT insurance companies?! Even back in my practicing heyday insurance companies were not above eating their young. I cannot fathom to what hand-writhing, low levels of deviousness they have now acclimated themselves.
There will more than just a little humor if, after I've laboriously jumped through all the pre-licensing hoops and the required tests have all been passed, and I recoil. I can see it now: my Journey Back has been completed, I put the gloves on, don the face mask, get ready to roll up my sleeves…on second thought, keep my sleeves rolled down…take a good look around at my new environment and say to myself, "What the hell could I have possibly been I thinking?!" And I run back into the woods to my favorite smallmouth river and never think of such foolishness again.