I sent the following text on Wednesday, July 10, 2019, in an email to my wife, siblings, and other close family. To put this anecdote in the context of my overall life, in the 1980s when I was in my 40s and running the family used book shop with my mother in Winthrop Harbor, Illinois, I had an excellent woman dentist in Gurnee who, with large fillings, saved many of my too long neglected, decaying, teeth. My later dentists would remark admiringly about her craftsmanship. She moved. My dentist(s) in the 1990s, when I was in my 50s and caretaking my mother after a 1988 stroke left her hemiplegic and aphasic, maintained my teeth, adding fillings to teeth that already had been drilled and filled and reconstructing teeth from which fillings broke. In the late 1990s and into the 2000s, when I was in my 60s, changes in my circumstances dropped me from a lower-middle-class, barely scraping by, level of wealth to in the hole, from which my wife and I slowly got out and back to scraping by. I continued routine dentist visits for cleanings and for fillings as needed, but as old fillings came out and remaining thin shells of teeth broke down to stubs, I lived with them. That process has continued in my 70s. Then around a year or so ago, when I was still living with my wife in Kalamazoo, Michigan, one of my broken teeth got infected at the root. Time brings change, bodies deteriorate with age, and levels of maintenance and repair of body parts correlate with income, which correlates with family background, aptitudes, abilities, interests, life choices, and the conditions of a society and its economy.
Dear …
Yesterday a dentist at the Peninsula Community Health Services (PCHS) Poulsbo Dental Clinic In Poulsbo, Washington, extracted (pulled out root and all) 5 of my teeth—3 up (#s 12, 13, and 15) and 2 down (the right front tooth—the loose one—and one about midway between the front and the back on the right side.
The call from PCHS came Monday morning informing me of an opening in the dentist's schedule Tuesday from 1:30 to 2:30 PM.
From when I agreed to the appointment on Monday to when it was all over on Tuesday, I kept my thoughts about getting teeth pulled stoic. My alternative was worse—continue procrastinating and living with broken to stubs and infected teeth, and I hoped and expected that the procedure would be almost or entirely pain-free and without complications. My mind kept wanting to fret and worry and imagine awful possibilities, but I kept "54321" returning my attention to the present moment, advising myself to take it as it comes, reminding myself that my present moments beforehand will soon be my present moments during and then would be my present moments after. The time had come to get it done, and all I had to do, step-by-step, was get myself to the dental clinic on time and follow instructions.
Yesterday I walked to the nearest bus stop early enough that, riding two local buses, I got to Fishline more than three hours early to make sure I wasn't late.
(Fishline is a nonprofit organization on the Kitsap Peninsula with a building in Poulsbo the size of a warehouse. The main floor is a food bank set up like a supermarket. On the second floor are social services providing guidance and assistance in the areas of housing, utilities, transportation, budgeting health, education, employment, and childcare. Fishline is similar to Bainbridge Island's Helpline—where I go in Winslow to get advice and assistance from a social worker regarding health insurance plans and government welfare programs—but on a much bigger scale. Also upstairs at Fishline is the PCHS Poulsbo Dental Clinic.)
I hung out in a nearby restaurant, nursing a coffee (with free warm-ups) and around 11:30 slowly eating a Cobb salad.
I walked over to the dental clinic an hour early for my 1:30 appointment, filled out a consent form, jotted some questions on the back, and waited my turn.
Just past 1:30, the dentist's assistant came into the waiting room from the back rooms, called my name, led me halfway down the hall to one of the little rooms with a dentist's patient's chair, and had me sit in it. She took my blood pressure. I don't remember the numbers. She said they were good. My pulse was 90. It's normally in the 60s or 70s, so I knew I was a little nervous.
I took a toilet break and returned to the dentist's patient's chair.
The dentist came in and answered my questions that I had jotted on the back of the understand the risks form. Regarding the risk of excessive bleeding, I'd asked if I might make a bloody mess on the bus seat on my way home, and he said that was extremely unlikely. Regarding the risk of drowsiness and if I could have a nap in the waiting room before leaving to catch a bus, he said that I could do so if I wished up till closing time at 6 PM but that, since he would be using only local anesthesia, he did not expect me to get drowsy at all. In reply to my question what about tooth #14, he said that, while it does have a cavity and need a filling—a task for another visit, it is neither broken nor infected and doesn't need to come out. Regarding my question why the cost estimate form listed only three extractions (numbers 12, 13, and 15) whereas at my initial examination we'd discussed and agreed upon four extractions, we again discussed my teeth, including the one that is very loose because of my receding bone, and agreed that I'd best get five extracted—the three upper ones plus my bottom right front tooth (the one which was loose and was also infected) and one about halfway between front and back on the lower right. He would do at least the three upper ones and thought he would have time to do all five in that hour. I did not have any questions about some of the risks, such as that he might break my jaw or might poke a hole into my nasal cavity.
I put my eyeglasses in my shirt pocket. The dentist's assistant gave me special sunglasses to cut the glare of the examination lamp. The dentist gave me numerous hypodermic needle shots of a numbing medicine into my gums. My eyes closed so I wouldn't have to see the needle, my body tensed as I felt each sting, but I was able to follow his instructions to take deep breaths through my nose. Then the dentist and his assistant went out of the room for a few minutes, and when they returned and he started prying at an upper left tooth, I felt no pain or discomfort. He pried then pulled with his special tools till that tooth came out. Then he scraped out and showed me the little red blob of infection, the abscess, that had been under the root. There was the tooth that, more than 10 months ago, my Kalamazoo dentist said needed to come out. I had finally detoured around my phone phobia and stopped procrastinating taking the steps to get it out.
One by one, the second, third, and fourth tooth that the dentist and I had condemned to extraction got pried and pulled out without my feeling any pain or discomfort. He scraped out infection that had been under the fourth tooth. When he started prying at the fifth tooth, the right bottom front tooth, I felt a sharp pang of pain and so signaled. The dentist gave me some more needle shots, and I felt no pain or discomfort as he pried and pulled out the fifth tooth and scraped out infection.
During the whole procedure, the assistant had sprayed in water and sucked out water and saliva and the dentist had squirted water to rinse each toothless gap.
All five out! All done!
The dentist raised the seatback till I was sitting upright. I gave the sunglasses to the assistant and put on my eyeglasses. I shook hands with the dentist, both of us pleased that the extractions had been routine, pain free and with no complications.
The dentist's assistant told me the most urgent of my post-procedure instructions and then gave me a flyer of all of the instructions. I have attached to this email a photo of them.
I was about to ask when the dentist volunteered that he did not think he needed to give me an antibiotics prescription, given that he thought he had scraped out all the infection and that I have a strong immune system.
The assistant took my blood pressure again. She again said the numbers were good. My pulse was 93. Then she put a couple of gauze pieces in my mouth to soak up blood and said to keep them in for about 20 minutes.
I got out of the chair, found my footing, and realized that I felt okay.
At the check-in check-out counter, a receptionist told me that as soon as the dentist was again taking new appointments, I'd get a call about getting that one cavity drilled and filled. I already have a September 30 appointment for getting my teeth cleaned.
With my sweater, my leftovers from lunch, and my little blue knapsack holding my take-away paperwork, I walked out of the clinic, down the stairs, and across Viking Street to a bus stop. Google Maps on my smart phone showed that it would be better than half an hour till the next bus. A bit surprised that I felt good enough to do so, I decided to walk the 1.3 miles to the North Viking Transit Center, where I'd catch bus #390 to Bainbridge Island. Before I boarded that bus, I took out the bloodied gauze.
At supper that evening, because considerately Lura[, my niece in whose outbuilding bedroom I sleep and write,] had chosen to fix mashed potatoes to suit my temporary need for a soft food diet and because we were belatedly celebrating [her grown-up son] Andrew's birthday, I broke my near keto diet by eating, along with some plain yogurt, a serving of mashed potatoes mixed with an egg, the frosting off of a piece of carrot cake, a nibble or two of cake, and a little bit of ice cream.
I took a couple of acetaminophen tablets before supper as a precaution but did not need them. I slept good, and all through the night and all day today, I have been pain-free, without having to take any over-the-counter or prescription anti-pain medicine.
My life on Bainbridge Island goes on.
The dental clinic will bill me. The cost estimate that they gave me says that the usual charge for an "extraction erupted tooth" (a tooth broken off near the gumline) is $250 per tooth and for me on the sliding scale is $63 per tooth. I don't anticipate any difficulty paying the bill.
The dentist referred me to a company on Bainbridge Island that provides false teeth. The Referral Order gives the diagnosis as "ICD-10 K08.9: Disorder of teeth and supporting structures, unspecified". I suppose that that is Medicare code. The reason given for the referral is, "Please eval and fabricate upper and lower partials. Thank you!" The dentist said that they would charge me full price and that he didn't know if my insurance would help pay for partials. I don't either and will find out. At this point, I am considering getting false teeth "partials", as chewing will be difficult with the big gaps between my teeth. I am to wait a few days before contacting the company on Bainbridge Island, to give the referral order time to reach them. My gums won't be healed enough for a false teeth fitting for 6 to 8 weeks.
Next for me to get done—get an eyes exam and update my eyeglasses prescription.
Love,
Brian
Dear …
Yesterday a dentist at the Peninsula Community Health Services (PCHS) Poulsbo Dental Clinic In Poulsbo, Washington, extracted (pulled out root and all) 5 of my teeth—3 up (#s 12, 13, and 15) and 2 down (the right front tooth—the loose one—and one about midway between the front and the back on the right side.
The call from PCHS came Monday morning informing me of an opening in the dentist's schedule Tuesday from 1:30 to 2:30 PM.
From when I agreed to the appointment on Monday to when it was all over on Tuesday, I kept my thoughts about getting teeth pulled stoic. My alternative was worse—continue procrastinating and living with broken to stubs and infected teeth, and I hoped and expected that the procedure would be almost or entirely pain-free and without complications. My mind kept wanting to fret and worry and imagine awful possibilities, but I kept "54321" returning my attention to the present moment, advising myself to take it as it comes, reminding myself that my present moments beforehand will soon be my present moments during and then would be my present moments after. The time had come to get it done, and all I had to do, step-by-step, was get myself to the dental clinic on time and follow instructions.
Yesterday I walked to the nearest bus stop early enough that, riding two local buses, I got to Fishline more than three hours early to make sure I wasn't late.
(Fishline is a nonprofit organization on the Kitsap Peninsula with a building in Poulsbo the size of a warehouse. The main floor is a food bank set up like a supermarket. On the second floor are social services providing guidance and assistance in the areas of housing, utilities, transportation, budgeting health, education, employment, and childcare. Fishline is similar to Bainbridge Island's Helpline—where I go in Winslow to get advice and assistance from a social worker regarding health insurance plans and government welfare programs—but on a much bigger scale. Also upstairs at Fishline is the PCHS Poulsbo Dental Clinic.)
I hung out in a nearby restaurant, nursing a coffee (with free warm-ups) and around 11:30 slowly eating a Cobb salad.
I walked over to the dental clinic an hour early for my 1:30 appointment, filled out a consent form, jotted some questions on the back, and waited my turn.
Just past 1:30, the dentist's assistant came into the waiting room from the back rooms, called my name, led me halfway down the hall to one of the little rooms with a dentist's patient's chair, and had me sit in it. She took my blood pressure. I don't remember the numbers. She said they were good. My pulse was 90. It's normally in the 60s or 70s, so I knew I was a little nervous.
I took a toilet break and returned to the dentist's patient's chair.
The dentist came in and answered my questions that I had jotted on the back of the understand the risks form. Regarding the risk of excessive bleeding, I'd asked if I might make a bloody mess on the bus seat on my way home, and he said that was extremely unlikely. Regarding the risk of drowsiness and if I could have a nap in the waiting room before leaving to catch a bus, he said that I could do so if I wished up till closing time at 6 PM but that, since he would be using only local anesthesia, he did not expect me to get drowsy at all. In reply to my question what about tooth #14, he said that, while it does have a cavity and need a filling—a task for another visit, it is neither broken nor infected and doesn't need to come out. Regarding my question why the cost estimate form listed only three extractions (numbers 12, 13, and 15) whereas at my initial examination we'd discussed and agreed upon four extractions, we again discussed my teeth, including the one that is very loose because of my receding bone, and agreed that I'd best get five extracted—the three upper ones plus my bottom right front tooth (the one which was loose and was also infected) and one about halfway between front and back on the lower right. He would do at least the three upper ones and thought he would have time to do all five in that hour. I did not have any questions about some of the risks, such as that he might break my jaw or might poke a hole into my nasal cavity.
I put my eyeglasses in my shirt pocket. The dentist's assistant gave me special sunglasses to cut the glare of the examination lamp. The dentist gave me numerous hypodermic needle shots of a numbing medicine into my gums. My eyes closed so I wouldn't have to see the needle, my body tensed as I felt each sting, but I was able to follow his instructions to take deep breaths through my nose. Then the dentist and his assistant went out of the room for a few minutes, and when they returned and he started prying at an upper left tooth, I felt no pain or discomfort. He pried then pulled with his special tools till that tooth came out. Then he scraped out and showed me the little red blob of infection, the abscess, that had been under the root. There was the tooth that, more than 10 months ago, my Kalamazoo dentist said needed to come out. I had finally detoured around my phone phobia and stopped procrastinating taking the steps to get it out.
One by one, the second, third, and fourth tooth that the dentist and I had condemned to extraction got pried and pulled out without my feeling any pain or discomfort. He scraped out infection that had been under the fourth tooth. When he started prying at the fifth tooth, the right bottom front tooth, I felt a sharp pang of pain and so signaled. The dentist gave me some more needle shots, and I felt no pain or discomfort as he pried and pulled out the fifth tooth and scraped out infection.
During the whole procedure, the assistant had sprayed in water and sucked out water and saliva and the dentist had squirted water to rinse each toothless gap.
All five out! All done!
The dentist raised the seatback till I was sitting upright. I gave the sunglasses to the assistant and put on my eyeglasses. I shook hands with the dentist, both of us pleased that the extractions had been routine, pain free and with no complications.
The dentist's assistant told me the most urgent of my post-procedure instructions and then gave me a flyer of all of the instructions. I have attached to this email a photo of them.
I was about to ask when the dentist volunteered that he did not think he needed to give me an antibiotics prescription, given that he thought he had scraped out all the infection and that I have a strong immune system.
The assistant took my blood pressure again. She again said the numbers were good. My pulse was 93. Then she put a couple of gauze pieces in my mouth to soak up blood and said to keep them in for about 20 minutes.
I got out of the chair, found my footing, and realized that I felt okay.
At the check-in check-out counter, a receptionist told me that as soon as the dentist was again taking new appointments, I'd get a call about getting that one cavity drilled and filled. I already have a September 30 appointment for getting my teeth cleaned.
With my sweater, my leftovers from lunch, and my little blue knapsack holding my take-away paperwork, I walked out of the clinic, down the stairs, and across Viking Street to a bus stop. Google Maps on my smart phone showed that it would be better than half an hour till the next bus. A bit surprised that I felt good enough to do so, I decided to walk the 1.3 miles to the North Viking Transit Center, where I'd catch bus #390 to Bainbridge Island. Before I boarded that bus, I took out the bloodied gauze.
At supper that evening, because considerately Lura[, my niece in whose outbuilding bedroom I sleep and write,] had chosen to fix mashed potatoes to suit my temporary need for a soft food diet and because we were belatedly celebrating [her grown-up son] Andrew's birthday, I broke my near keto diet by eating, along with some plain yogurt, a serving of mashed potatoes mixed with an egg, the frosting off of a piece of carrot cake, a nibble or two of cake, and a little bit of ice cream.
I took a couple of acetaminophen tablets before supper as a precaution but did not need them. I slept good, and all through the night and all day today, I have been pain-free, without having to take any over-the-counter or prescription anti-pain medicine.
My life on Bainbridge Island goes on.
The dental clinic will bill me. The cost estimate that they gave me says that the usual charge for an "extraction erupted tooth" (a tooth broken off near the gumline) is $250 per tooth and for me on the sliding scale is $63 per tooth. I don't anticipate any difficulty paying the bill.
The dentist referred me to a company on Bainbridge Island that provides false teeth. The Referral Order gives the diagnosis as "ICD-10 K08.9: Disorder of teeth and supporting structures, unspecified". I suppose that that is Medicare code. The reason given for the referral is, "Please eval and fabricate upper and lower partials. Thank you!" The dentist said that they would charge me full price and that he didn't know if my insurance would help pay for partials. I don't either and will find out. At this point, I am considering getting false teeth "partials", as chewing will be difficult with the big gaps between my teeth. I am to wait a few days before contacting the company on Bainbridge Island, to give the referral order time to reach them. My gums won't be healed enough for a false teeth fitting for 6 to 8 weeks.
Next for me to get done—get an eyes exam and update my eyeglasses prescription.
Love,
Brian