Friday, November 21, 2014

Personal Loss

Committed concentration is required to excel in dentistry. Some practitioners—or some people in general—are able to concentrate fully in a chaotic atmosphere, while others need total, or near-total, quiet in order to focus. I’m one of the latter. I’ll joke and laugh with my patients until the actual treatment begins, when I need everything to be calm in my immediate space, with no extraneous distractions. My fun-loving and gregarious staff knows this and appreciates it.

The howling laughter from my hygiene room seems nonstop throughout the day. My hygienist is able to do her work while engaging in unrelated conversations. I might comment to a patient undergoing extensive rehabilitation, “Don’t you wish you were in Tami’s room right now?”

Whenever I walk into an operatory, I find my assistant chatting it up and distracting the patient from the upcoming treatment. However, she knows to cut it off when I begin my work. But as soon as that injection needle comes out, she and the patient pick up right where they left off. It creates a nice atmosphere.

But how does one focus when personal tragedy strikes and it becomes an internal distraction? Do we cancel our appointments, appointments that loyal patients may have waited months for? Will those patients understand? Where does our duty to our patients end and that to family and friends begin? Is there a clear demarcation? Probably not.

I recently came face-to-face with this dilemma. Last spring, my best friend, Ralph, was vacationing when he broke his No. 5 and No. 11 beneath the gingival crest. As soon as he got home that Sunday, I met him in the office, took impressions for a flipper, and suggested implants. Later, after extractions and healing, he had the implants placed.

When late summer came, Ralph and his wife were preparing for a European trip they’d previously planned; it coincided with the time when the implants were to be exposed. I discussed his case with the oral surgeon, who suggested the teeth could possibly be restored before the trip if I could get a lab to fabricate the abutments and crowns quickly. However, the surgeon also suggested that this might be rushing it. Ralph decided to wait, which seemed like the best move; he’d put up with the flipper until he returned from Europe.

By late September, the healing collars were in place. By early October, I took impressions of the analogs, keeping the flipper in service for “just a couple more weeks.” That’s when his wife, also a good friend and one of my wife’s best buddies, became seriously ill.

Ralph called me in desperation one night, needing a ride to the ER after his wife had been transported from their home via ambulance. My wife and I kept vigil in the ER with them until well after midnight. It was late, I was exhausted, and I began to consider the 20 patients I had to treat tomorrow—each one requiring my undivided attention. Thankfully, a mutual friend arrived to transport Ralph downtown after his wife was medevaced to George Washington University Hospital in Washington, D.C., for an emergency craniotomy.

Coffee helps, but there’s a limit. Do I cancel? No. I was not so tired that I couldn’t function and, despite my own emotional distractions, I had patients who might also have their own issues.

Ralph’s wife slowly began to recover, but unfortunately, she then lapsed into a coma. My best friend found out that his soul mate might soon die. That weekend, I restored his teeth, but it was incredibly difficult for me to concentrate while placing the abutments and crowns. When he stood up from the chair, his moist-eyed smile radiated beyond anything I had done for him. Is there anything more important than that? His wife passed away the following week and he was able to attend her memorial service without the distraction of an obnoxious flipper in the forefront. On her remembrance board is a stunning picture of her as a young woman, smiling broadly. I will always remember how Ralph looked lovingly at that photo.

As a member of the healing arts, I feel an obligation to people who may also be going through a “rough patch.” Honoring my obligations to them is paramount. They depend on me. And I’m sure you have patients with needs beyond anything you will ever know. They deserve our best.

Jim Rhea, DMD

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