ralph robert moore
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Copyright © 2001 by Ralph Robert Moore.
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Return to lately 2001.
the surgeon's scalpel is a slow bullet
october 6, 2001
I moved out of my family's house when I was twenty-one. It was strange having those people, father, mother, younger brothers, faces familiar as movie stars, help me load my furniture.
My first of many apartments over the years was in Fairfield, Connecticut, on the third, top, floor of an old wooden house owned by a white-haired German woman, Mrs. Schneider, who has probably passed away long since. I paid ninety dollars a month for rent, and I think that included most of the utilities. She only climbed the three flights of stairs to my apartment once, to request that after I wash my dinner dishes I throw a handful of salt down the sink's drain, to help break up the bubbles.
At the end of the block where I lived, past rows on either side of other three-family homes, most of them blue or gray, and trees spiraling their leaves, and little girls on the mossy sidewalks skipping rope to rhyme, was a dentist's office. I remember thinking at the time, how convenient.
Convenient because since my early teens, I've always had trouble with my teeth. It wasn't that I didn't take care of them, or ate too many sugary snacks, it was just that when I was younger I came down with Scarlet Fever ("Probably one of the last cases of Scarlet Fever in America," the family physician told my parents at the time). As luck would have it, and luck always does have it, I contracted the fever just as the hard surfaces of my permanent teeth were forming. The fever prevented the outside dentin layer from being as thick as it should, making them much more susceptible to cavities and infection, which led to decades of dental work since. Today, I still have all my teeth, thanks to years of painful procedures and expense, but nearly all of them are crowned.
The first crown I ever got, my only gold one, was at that dentist's office at the end of my block.
I don't remember his name now, and his face is just a blur-- he was young, he wore glasses, he played tennis-- but I do remember sitting in his reception area the day I was due for the gold crown. If we see me sitting there, I'm on, I believe, a cloth sofa. There's something in my hands. I can't see it clearly anymore, a rectangular shape, possibly a magazine, but more likely a book. My hair is down to my shoulders, black and curly, my face is bony, and although I don't have a beard yet, I do have a moustache.
As I happen to glance up from whatever it is I'm reading, I see this tall, immensely overweight man slowly trundling down the interior hallway where the dentist's workrooms are, towards the reception area. That sight in itself is mildly unusual, but what makes it memorable is that as he slowly tips left, right forward, he's blowing up long, skinny, pink, blue, yellow balloons, bending his face forward to fill each one, expertly knotting off the pinched open end of each as it takes shape.
There are people of all ages in the reception area, including three or four kids. They, of course, immediately pop out of the oversized chairs in which they had been fidgeting, gathering around in front of the big man, begging him as he twists each long balloon into air-plump, curling shapes that look like dogs, cats, rabbits to the degree clouds look like mountains, faces, armies.
After he happily passes them down to the children, part of his happiness no doubt derived from being himself through with the dentist for the day, he glances around at the seated rest of us and mumbles, but loud enough to carry, "I hate dentists."
I've got nothing against dentists myself, and really have had few bad experiences with them, considering the white-jacketed battalion of them I've gone to over the years. This past Thursday, October 4, I went back to the specialist I had consulted earlier this year about that same gold crown in my mouth, which after almost thirty years was now acting up.
You can read the background on my problems with that tooth here and here. Briefly, there's been bone loss with that tooth over the years, to where now it's getting infected on a regular basis. Each time I have to take 2,000 milligrams of antibiotic a day, for a week, in order to get rid of the infection.
My regular dentist referred me to the specialist because the specialist performs what's known as "minimally-invasive bone graft surgery", a phrase, like so many, that starts off sounding okay, but has, in its tail, the rattle of dread.
Back in July of this year, the specialist did a deep root planing in the lower right quadrant of my mouth, where the tooth is located (you get several shots of novocaine in the gums around the quadrant, then they slip a thin dental scalpel between the tooth and the gum, down to the jawline, to scrape out any plaque that's formed under the gumline. It's not as painful as it sounds).
This past Thursday, I had a follow-up appointment with him to see if this procedure may have been enough to get rid of the infection around the gold crown, or if it was necessary to move on to the bone graft surgery.
Mary came with me this time, to keep me company, which I very much appreciated.
When I opened the door to the building, I turned around and said to her, "Tell me. Doesn't this smell like a museum from the fifties? Hallways and dust?"
I told the receptionist I wanted to use the restroom before I saw the doctor. She buzzed me through the brown door to the short hallway within the sanctum. As I've related before, unlike almost every other restroom on earth, this one has a sliding door. I slid it shut, turning my back on the door in case someone slid it open while I was urinating. Zippered back up, I realized for the first time, on this, my third visit, that in fact there was a way to lock the sliding door, by lifting up a brass latch inlaid into the door, and at the same time realized I had in fact, this time, inadvertently lifted the latch, so that I was now locked inside the closet-sized restroom, with its small silver mirror and galloping horses wallpaper.
By agitating the inlaid brass latch I managed to force the restroom door open, with more dramatic force than I had intended, almost barging into the squat dental assistant who had apparently been sent to locate me.
After I was seated in the dental chair, lowered backwards so that my shoes were higher than my face, like an unhappy astronaut, the specialist showed up. White hair and glasses. He looked in my mouth to refamiliarize himself with my problems, then took an x-ray.
Disappeared while the x-ray was developed.
Reappeared, holding the wet gray, black and white film in his right thumb and forefinger.
We looked at it together.
"I see a definite improvement here." He swiveled his head around to look me in the eyes. Pointed, with his pinky, at the clipped-up illuminated film I could see by raising myself off the backwards-tipping padded chair and looking over his white shoulder.
"You had nine millimeter pockets before, but they're down to seven millimeters now. That's a big improvement."
I let out a 'sigh of relief.'
He kept looking at the illuminated film, like an auto mechanic studying something greasy. "Big improvement."
So no surgery?
I soon realized, but maybe not soon enough, that the specialist could be very optimistic about little details to the point where he imparted false hope. He was sincerely pleased at my improvement in pocket depth with that tooth, and I appreciate his enthusiasm, but I would have even more appreciated him telling me up-front that his enthusiasm was limited to pride in his technical achievement at reducing pocket size in a tooth that still required surgery.
"You have two choices. We can go the way we have been, where we treat the infection in the tooth each time it flares up, with antibiotics, and I guarantee it will flare up again. Maybe next time it'll happen just as you're about to sit down for a Thanksgiving meal, or getting ready to open Christmas presents." (Spare me the cinema). "But each time it does flare up, by the time we treat it, there's going to be further bone loss. Or, we could try to resolve the problem once and for all, by proceeding with bone graft surgery."
I opted for the surgery. I had, before I sat down. The fact is, something needs to be done for the tooth. I could keep putting it off, but that would just prolong my period of dread. I want to get it over with.
I made an appointment for the surgery in three weeks, Friday, October 26.
He explained the specifics to me.
That Friday, I needed to arrive half an hour early. I'd be given a couple of pills to swallow, which might knock me out or not, but in any event would relax me. I'd be taken into the specialist's workstation, and novocaine injected around the gold crown.
The first thing he'd do is "open up the gum around the tooth." In other words, using a scalpel, peel my gum down on either side away from the gold crown, down to the jawbone. This was necessary to determine if I had a fracture in the tooth. Assuming I didn't, he'd then use a dental scalpel to cut away any scar tissue around the tooth, reshape the heretofore buried bone of the tooth, and apply sterilized bone graft tissue where it was needed. Once that was done, the gum would be stitched up around the tooth again, and the same water-repellant material used in British raincoats stitched on top, to keep the transplanted bone tissue in place. In nine months, it should stimulate additional bone growth which would reduce my periodontal pocket.
The operation itself would take about an hour and a half. Mary would need to be there, to drive me home afterwards. Someone (Mary) should stay with me for at least an hour after the surgery, to watch over me. He would prescribe pain killers for the first day, after which I could probably get by on aspirin.
(Let me say here that I don't mind at all pain after a surgical procedure. Because the procedure is over. I'm in my own white-sheeted bed, tamping a red-blotted Kleenex against my mouth, in recovery. What I don't like is feeling pain during a procedure, because pain during a procedure signals damage is being done. It may be damage for a beneficial purpose, but it's still damage. The surgeon's scalpel is a slow bullet).
For the first few days following surgery, I should only eat soup and soft foods. It may be a week before I'm ready for steak and tortilla chips.
I wish I could say that once this surgery is over I'm through, but the truth is, I'll need to have the same procedure repeated in about seven other locations in my mouth.
But I'm going to wait until next year before I even think about that.
As I've mentioned before, we made our backyard into a small park, with three extra-large beds that take up most of the yard, walking paths around them.
In the center of the first bed is a tall, beautiful Japanese pear tree, which we call "Joe's Tree", because we happened to plant it the same week Joe, Mary's dad, broke his hip slipping on the snow near his home in Milwaukee.
In the center of the second bed is a crepe myrtle tree, which this far south grows about twenty to thirty feet tall. It blooms large bracts, somewhat like lilacs, which stay pink throughout the Summer. It's beautiful.
In the center of the third bed, rising out of a stand of tall, dark-green cannas, is our satellite dish, looking like a digital tree.
Earlier this year, it stopped working properly once again (it was ten years old by then), so we decided to go with one of the newer, smaller systems (we use Dish now).
The problem was getting rid of the old dish. It rises on a metal pole out of a concrete-reinforced hole, about fifteen feet high, with a ten foot spread.
Even if I were to take the time to disassemble the entire structure, working with a wrench on a ladder, there's no way the sanitation department would pick it up.
We took an ad out in the local paper, to see if anyone were interested in removing the dish for its parts (a lot of old dish systems from around here are sold south of us, in Mexico).
Our ad read: "10 Ft. satellite dish. Yours if you haul off." (the paper charges for each letter and each space in your ad).
A week later, our ad appeared: "Loft satellite dish. Yours if you haul off."
Although ten foot satellite dishes are still somewhat popular, "loft" satellite dishes aren't, because they don't exist. We didn't get any calls.
Finally, this week, I went through the handyman want ads in the paper, and called one. The guy sounded like an old man on the phone, I pictured him answering the call from bed, with crumpled Kleenex on the carpet all around him, but when he showed up he was actually a young, cheerful Latino weightlifter with a hoarse voice.
We walked around back, and I showed him the dish. After a silent minute of calculations, he turned to me with a squint. "I can do this for you for $185."
That seemed kind of high. I offered him $100. We haggled a bit, and shook hands at $140.
Yesterday morning, the day he was supposed to remove the dish, he called to say he wasn't sure he could do it then after all, because it was raining (I think he was concerned about lightening). I could hear a baby crying in the background. Although we both live in the same town, as it happens it was raining in his part of town just then, but not mine. He decided to give it a try. He showed up with his pick-up, his defense against the rain a white-brimmed hat pushed down around his ears. I had to go out for a while, so I told him when I'd be back, so he'd get paid.
I didn't get far down the street when it started to pour. I mean really pour, to where cars were slowing down to a crawl, and all you can see in your wet windshield is gray.
By the time I did get back, the skies had cleared again. His pick-up was parked at our curb, the disassembled dish and pole filling it.
"I will show you what I did?"
He seemed proud of his work, which he should have been. He somehow got the dish out of the stand of cannas without harming any of them (I had expected, reasonably, that he'd have to destroy some to work around the dish, which I told him was fine), and had filled in the hole where the pole had been with dirt. It looked great.
He looked pretty wet. I wrote the check for his original estimate, $185, rather than the $140 we agreed on.
He backed away a step, smiling. "No, it's okay."
I insisted. "You didn't quote for doing this in the rain."
He goes on our list of Honest, Dependable Repairpersons. It's one of the most valuable lists we have.
Even though we have a satellite dish, we don't often get a chance to watch much TV.
The other night, though, Mary and I were lying in bed, trying to find something to watch to fall asleep to, and came across the movie Next of Kin.
The movie itself is standard stuff. A man (Patrick Swayze) avenges his brother's death. It was made in 1989, at the height of Swayze's stardom (he had already been in Dirty Dancing, and the following year would star in Ghost).
What was amazing about the movie though was the number of bit players in it who, a few years later, would emerge as stars themselves.
We're watching Swayze in a scene, and all of a sudden Liam Neeson walks in. A few scenes later, Helen Hunt shows up in a small part. Then Bill Paxton, then Ben Stiller.
"If they made this movie today, can you imagine how many people they'd have to pay eight-figure salaries, to appear in it?"
Mary laughed. "Yeah, everyone but Patrick Swayze."