Saturday, February 25, 2006

Ah, Southern Ohio....

First off: No lurking! If you are reading and enjoying (or even reading and hating) please leave replies! Otherwise I'm forced to assume no one cares and will be forced to sit around wondering why everyone insists dentists have such a high suicide rate. (not actually true; in recent years we've been surpassed by lawyers...)

This post is almost verbatim copied from a recent email exchange with a dental school colleague who now finds herself working in Southern Ohio. (This is, I'm sure, less stressful to her than finding herself, due to vagaries of surnames, sitting next to ME for four years...heh heh...)

Anyway, thanks to Dr. Janice for her inspiration - I wish her the best of luck in joining the small but significant demographic of "NASCAR-watching Orthodontists!"

As you may recall, I spent 3-4 mos working for
[non profit healthcare agency] in [Appalacian Ohio town]; had some good assistants
from [slightly larger town]... I always remember things from that
practice like:

"Bubby don't much take ta sleepin' without his
Mountain Dew, ya see..."

On back of a truck: sticker featuring Osama bin Laden
saying "F--- you A------." That way, when al Qaida's
leader is tooling around Appalachian Ohio, he will see
that, realize he's an a------ and that he can get

On blackboard inside Waverly restaurant/tavern:
"How's a Pike County divorce like a tornado? answer:
Either way, someone's losing a trailer."

Also noted on backs of trucks (it was eerie thinking that my Toyota was the only one for miles around...)

-Keep honking; I'm re-loading.

-(in the style/font of popular milk industry slogan:) gut deer?

- "Terrorism" - just that, w/ an 'anti' ring around it, like the "no smoking" sign or the Ghost Busters logo.

I saw the latter in a parking lot one day and mused, "Ya know, that really makes me stop and think. Cuz ya know, before I got into dentistry, I was totally going to BE a terrorist! But now...I'm just not so sure..."

Needless to say, I was hardly surprised to find John Ashcroft trailing me around for a few days...

Fond memories - I always referred to the area as a place "with more
guns than teeth."

THAT said, I was always impressed that a lot of young
parents with kids were pretty determined to keep their
offspring from losing all the teeth that THEY had; they kept
their appointments, listened carefully to your
instructions and were profoundly grateful for the
services. If Bubby or Sissy weren't brushing enough,
you can belive mom and dad would be letting 'em have
it on the way out the door....

so there you go.

Sunday, February 19, 2006

Serious as Cancer

Friday I spent the afternoon "riding shotgun" with a local oral surgeon. Usually it's fun (for me anyway) to watch someone w/ the skills to shuck out four wisdom teeth in the time it takes me to do one. Today was a little different. He was kind enough to see a patient from the non-profit who we were pretty sure had oral cancer.

The slim, middle aged woman is "between homes," as we say, but had recently started a new job and was pleased to be getting health insurance. Unfortunately, even though she'd noticed the sore in her mouth a year ago, and even though there were resources to assist her in seeing someone, she "put it off because I didn't WANT to know for sure...I was scared."

Increasingly, the difficulty swallowing increased, the pain under her tongue and in her jaw became more severe and frequent, and she finally sought help. The ulcerated, bulging lump ventral to her tongue and the nodular involvement appreciable in the submandibular and cervical areas were hardly subtle. Even the greenest dental student would raise an eyebrow with the symptoms and presentation.

While waiting on the oral surgeon, I made small talk with the patient. We both had family in Ohio. Our places of employment are nearby one another. Yep, it sure is windy today.

The oral surgeon confirmed our suspicions without needing biopsy. "T3 or T4," he said, soberly shaking his head out in the hallway. "I'm sending her to Dr. ---- in Boston. She needs a head and neck surgeon - probably radiation, maybe chemo...."

We returned to his exam room to try to gently tell the patient that we would do what we could to facilitate her treatment. "Can I wait 'til my insurance kicks in?" she asked hopefully. "Two months?" my colleague said incredulously. "Ma'am, I don't want you to wait two weeks. We need you down in Boston next week." He wrote out a script for a strong narcotic so she could sleep at night.

Dr. ---- was in surgery, so the oral surgeon dismissed the patient, promising that his office would call her as soon as they reached the Boston doctor. I shook her hand as compassionately as I good, encouraging her to not hesitate if my agency could do anything to facilitate her transportation or other needs. She left smiling unconvincingly, with a hint of tear in her eye.

It's easy to scoff at people for smoking too much or not seeking care. Harder when the person has a face and a family. I wish she'd come in sooner.