A Second Opinion by Nicholas Spitzman
A man goes to great lengths to avoid a dental procedure, and his dentist is unwillingly complicit.
My dentist retired and Dr. Sorensen took over his practice. I went in for my cleaning and she told me unapologetically that my lower left second molar was cracked and that it needed a crown.
"Can we just keep monitoring, and if it gets worse, we do the crown?" I asked.
"We could, but it may crack completely and then you lose the whole tooth. Then we have to do an extraction, and put in a new tooth, which is much more drastic."
"Oh," I said. "I don't do drastic."
"OK. Then the crown is your safest bet."
"What do you think caused the crack? I mean, I floss twice a day."
"Typically it's caused by clenching. Maybe you clench or grind in your sleep, or when you work out, or just throughout the day. Type A people have underlying stress and clench, and after a while it wears down their teeth."
"How do you know I'm Type A?"
"You said you floss twice a day."
"And how would you prevent this from worsening, or happening again?"
"My recommendation would be to get braces, probably just for a couple of years. It'll realign your jaw and your bite, so there's less wear and tear. Then after that, we'd fit you with a custom mouthguard, which you'd have to wear every night. We'd also want to make sure that you sleep facing up."
"I don't know. This all sounds very drastic."
"Well, typically this happens because of both the structure of your bite, and stress. The bite, I can do something about. The stress, you'd need to see a psychologist." She smiled at her own joke.
I sat silently thinking about this.
"Are you stressed, Marcus?"
"I guess I am, yes."
"What are you stressed about?"
"What is there to not be stressed about? Getting my kids into St. Stephen's. My weight gain. My hairline. My job. My wife's job. There's a lot."
"Oh."
"And I guess also AI. And climate change. The war in the Middle East. Rising extremism. Unaffordability. The midterms. Civilizational collapse."
"Well, have you tried therapy?" she asked tenderly. "It can really help you cope with stress."
"I haven't. That's not a bad idea. Thank you."
"OK. So, should I have our admin book your appointment for the crown?"
"No. I'm going to try your prescription first."
"To be clear, it's not a prescription. I can't really prescribe that."
"I understand. But it sounds less drastic than drilling half my tooth off."
I went back in six months for my cleaning. After the tech finished, Dr. Sorensen came in. After some small talk she did her exam.
"Marcus, that crack is still there. Are we doing the crown?"
"Well, is it worse?"
"A little bit. Barely. Have you been clenching?"
"A lot less! I've been going to therapy, like you prescribed. It's really helped!"
"That's great. Remember, though, I didn't prescribe it, I can't do that. But I'm glad it helped."
"Thank you again," I said. I meant it, deeply.
"But look, the crack is still progressing. We need to take care of it."
"Do you have any other ideas besides therapy?"
"I don't know... meditation?" she said with a grin.
"That's a great idea."
"Marcus, I was not being serious."
Six months later, back for another cleaning, we x-rayed it again. The crack had progressed, but only a tiny, barely measurable amount. Dr. Sorensen admitted she was impressed; she had never seen a crack progress so slowly. Typically if you don't address these cases, the tooth cracks all the way through in just a few months, she said. But it had now been a year and the crack was, for all intents and purposes, the same size.
"It's your prescriptions for stress," I said.
"They are not prescriptions," she repeated, amiable but a little annoyed. "But look, no amount of therapy or meditation is going to un-crack a tooth. It can only go one direction."
"Like time and inevitable death," I said.
"Morbid, but yes. Like that."
"Nothing is permanent. Like the Buddha said. Not even your teeth."
"I never recommended Buddhism," she said.
"No, that one I picked up on my own. I think it's really helped too."
"Mmm," she said, nodding.
"Yes. It's about balance. Like with the famous story of the sitar player. If you pluck a string too hard, it breaks. If you pluck it too softly, you can't hear its sound. You have to pluck it in balance, 'the middle way.' Nothing drastic."
"Nothing drastic," she said, in agreement. "Well, I will note in my records again that the crack continues to deepen, but you are choosing not to do the crown. Right?" She said this while getting up to leave.
"Yes. But hold on. What do you recommend this time?"
"Well, I'm afraid to recommend anything now, because you're actually going to do it. So how about just chamomile tea in the evening?"
"Done!" I said.
This went on for years. The crack grew micrometrically, such tiny advances that they were only noticeable with her x-ray imagery equipment. Each time, Dr. Sorensen would still say I needed the crown, and I would turn it down, and she would jokingly recommend something. Supplements. Journaling. Ketamine. Yoga. Veganism. Massage. Prayer. Anti-anxiety medication. Vipassana retreats.
I did all of them. This took on a religious, mystical element for me. Whatever she recommended, no matter how far-fetched, I did. It was keeping me from getting a tooth cut in half (drastic) or even removed (more drastic), or the alternatives of braces and mouthguards and sleep repositioning (arguably altogether the most drastic).
At the end of the fourth year, Dr. Sorensen asked my permission to write an article about my case for the Journal of the American Dentistry Association. I agreed. She won a prize for the article, which made her happy, but she still recommended the crown.
After seven years of Dr. Sorensen, I had left my job and my wife, both of which had been two big sources of stress.
One led to the other. "I can accept that you'd want to leave your job because you hate it," my wife had said. "I can accept that you'd find something else to do because you want to be happier. But I can't accept that you want to be unemployed forever just to avoid a basic dental procedure." She left.
Then my kids stopped talking to me after the divorce, which was to be expected. But they were teenagers by then, so this also removed significant stress from my life. I lost weight. I grew a long beard. I wore tiger eye beaded necklaces. I volunteered three times a week at the Austin Zen Center, sweeping the temple and gardening. I spent most of my time in meditation, reading, or writing. I could no longer afford to live downtown, so I rented a studio apartment in Leander, and took the bus down to Seaholm twice a year for my cleaning and consultation.
Keeping up with Dr. Sorensen's prescriptions was a full-time job, which required all of my mental and emotional energy. There was nothing else.
In the eighth year, I went in for my semesterly pilgrimage.
"Doctor, Tibet was incredible. You outdid yourself with that one. I think I may have actually gotten the crack to seal back up," I said, smiling.
She did not acknowledge my comment. She finished the exam, then looked at me seriously. Then for the first time in eight years, she pulled down her mask. This made me realize, I had never seen her mouth or her uncovered face in person, only on her picture on the website. I had been taking existential directions from a veiled oracle, all surgical masks and glasses and dental loupes and headlamps.
"I have some news."
"Uh-oh."
"My husband got a job in Las Vegas. I am moving there in a couple of months."
I was crestfallen.
"I'm selling the practice to another dentist. His name is Dr. Jones. He knows all about your case because of the article in JADA."
"So this is our last appointment?"
"Yes, it is."
"Well..." I held back tears. "What do you prescribe this one last time?"
"The crown, Marcus. Do the crown. That's been my only prescription."
"OK," I said. "I guess I have to now."
Six months later, I rode the bus down to Seaholm for my first appointment with Dr. Jones. I stared out of the window, wondering for the first time whether it had all been worth it.
In the office, Dr. Jones greeted me warmly, saying I was the patient he was most looking forward to meeting. He completed his exam and then lowered his mask to address me.
"Well, it looks like the crown healed up nicely," Dr. Jones said. "But you're not going to believe this. There is a crack on your back right molar now, a very small one."
"Thank God," I said, and cried.
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"Can we just keep monitoring, and if it gets worse, we do the crown?" I asked.
"We could, but it may crack completely and then you lose the whole tooth. Then we have to do an extraction, and put in a new tooth, which is much more drastic."
"Oh," I said. "I don't do drastic."
"OK. Then the crown is your safest bet."
"What do you think caused the crack? I mean, I floss twice a day."
"Typically it's caused by clenching. Maybe you clench or grind in your sleep, or when you work out, or just throughout the day. Type A people have underlying stress and clench, and after a while it wears down their teeth."
"How do you know I'm Type A?"
"You said you floss twice a day."
"And how would you prevent this from worsening, or happening again?"
"My recommendation would be to get braces, probably just for a couple of years. It'll realign your jaw and your bite, so there's less wear and tear. Then after that, we'd fit you with a custom mouthguard, which you'd have to wear every night. We'd also want to make sure that you sleep facing up."
"I don't know. This all sounds very drastic."
"Well, typically this happens because of both the structure of your bite, and stress. The bite, I can do something about. The stress, you'd need to see a psychologist." She smiled at her own joke.
I sat silently thinking about this.
"Are you stressed, Marcus?"
"I guess I am, yes."
"What are you stressed about?"
"What is there to not be stressed about? Getting my kids into St. Stephen's. My weight gain. My hairline. My job. My wife's job. There's a lot."
"Oh."
"And I guess also AI. And climate change. The war in the Middle East. Rising extremism. Unaffordability. The midterms. Civilizational collapse."
"Well, have you tried therapy?" she asked tenderly. "It can really help you cope with stress."
"I haven't. That's not a bad idea. Thank you."
"OK. So, should I have our admin book your appointment for the crown?"
"No. I'm going to try your prescription first."
"To be clear, it's not a prescription. I can't really prescribe that."
"I understand. But it sounds less drastic than drilling half my tooth off."
I went back in six months for my cleaning. After the tech finished, Dr. Sorensen came in. After some small talk she did her exam.
"Marcus, that crack is still there. Are we doing the crown?"
"Well, is it worse?"
"A little bit. Barely. Have you been clenching?"
"A lot less! I've been going to therapy, like you prescribed. It's really helped!"
"That's great. Remember, though, I didn't prescribe it, I can't do that. But I'm glad it helped."
"Thank you again," I said. I meant it, deeply.
"But look, the crack is still progressing. We need to take care of it."
"Do you have any other ideas besides therapy?"
"I don't know... meditation?" she said with a grin.
"That's a great idea."
"Marcus, I was not being serious."
Six months later, back for another cleaning, we x-rayed it again. The crack had progressed, but only a tiny, barely measurable amount. Dr. Sorensen admitted she was impressed; she had never seen a crack progress so slowly. Typically if you don't address these cases, the tooth cracks all the way through in just a few months, she said. But it had now been a year and the crack was, for all intents and purposes, the same size.
"It's your prescriptions for stress," I said.
"They are not prescriptions," she repeated, amiable but a little annoyed. "But look, no amount of therapy or meditation is going to un-crack a tooth. It can only go one direction."
"Like time and inevitable death," I said.
"Morbid, but yes. Like that."
"Nothing is permanent. Like the Buddha said. Not even your teeth."
"I never recommended Buddhism," she said.
"No, that one I picked up on my own. I think it's really helped too."
"Mmm," she said, nodding.
"Yes. It's about balance. Like with the famous story of the sitar player. If you pluck a string too hard, it breaks. If you pluck it too softly, you can't hear its sound. You have to pluck it in balance, 'the middle way.' Nothing drastic."
"Nothing drastic," she said, in agreement. "Well, I will note in my records again that the crack continues to deepen, but you are choosing not to do the crown. Right?" She said this while getting up to leave.
"Yes. But hold on. What do you recommend this time?"
"Well, I'm afraid to recommend anything now, because you're actually going to do it. So how about just chamomile tea in the evening?"
"Done!" I said.
This went on for years. The crack grew micrometrically, such tiny advances that they were only noticeable with her x-ray imagery equipment. Each time, Dr. Sorensen would still say I needed the crown, and I would turn it down, and she would jokingly recommend something. Supplements. Journaling. Ketamine. Yoga. Veganism. Massage. Prayer. Anti-anxiety medication. Vipassana retreats.
I did all of them. This took on a religious, mystical element for me. Whatever she recommended, no matter how far-fetched, I did. It was keeping me from getting a tooth cut in half (drastic) or even removed (more drastic), or the alternatives of braces and mouthguards and sleep repositioning (arguably altogether the most drastic).
At the end of the fourth year, Dr. Sorensen asked my permission to write an article about my case for the Journal of the American Dentistry Association. I agreed. She won a prize for the article, which made her happy, but she still recommended the crown.
After seven years of Dr. Sorensen, I had left my job and my wife, both of which had been two big sources of stress.
One led to the other. "I can accept that you'd want to leave your job because you hate it," my wife had said. "I can accept that you'd find something else to do because you want to be happier. But I can't accept that you want to be unemployed forever just to avoid a basic dental procedure." She left.
Then my kids stopped talking to me after the divorce, which was to be expected. But they were teenagers by then, so this also removed significant stress from my life. I lost weight. I grew a long beard. I wore tiger eye beaded necklaces. I volunteered three times a week at the Austin Zen Center, sweeping the temple and gardening. I spent most of my time in meditation, reading, or writing. I could no longer afford to live downtown, so I rented a studio apartment in Leander, and took the bus down to Seaholm twice a year for my cleaning and consultation.
Keeping up with Dr. Sorensen's prescriptions was a full-time job, which required all of my mental and emotional energy. There was nothing else.
In the eighth year, I went in for my semesterly pilgrimage.
"Doctor, Tibet was incredible. You outdid yourself with that one. I think I may have actually gotten the crack to seal back up," I said, smiling.
She did not acknowledge my comment. She finished the exam, then looked at me seriously. Then for the first time in eight years, she pulled down her mask. This made me realize, I had never seen her mouth or her uncovered face in person, only on her picture on the website. I had been taking existential directions from a veiled oracle, all surgical masks and glasses and dental loupes and headlamps.
"I have some news."
"Uh-oh."
"My husband got a job in Las Vegas. I am moving there in a couple of months."
I was crestfallen.
"I'm selling the practice to another dentist. His name is Dr. Jones. He knows all about your case because of the article in JADA."
"So this is our last appointment?"
"Yes, it is."
"Well..." I held back tears. "What do you prescribe this one last time?"
"The crown, Marcus. Do the crown. That's been my only prescription."
"OK," I said. "I guess I have to now."
Six months later, I rode the bus down to Seaholm for my first appointment with Dr. Jones. I stared out of the window, wondering for the first time whether it had all been worth it.
In the office, Dr. Jones greeted me warmly, saying I was the patient he was most looking forward to meeting. He completed his exam and then lowered his mask to address me.
"Well, it looks like the crown healed up nicely," Dr. Jones said. "But you're not going to believe this. There is a crack on your back right molar now, a very small one."
"Thank God," I said, and cried.
from FICTION on the WEB short stories https://ift.tt/hRdKXcn
via IFTTT
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