Tuesday, June 29, 2010

Dental Treatment

Dental treatment. Dental treatment is not always expressed in terms of minimally invasive restorative options or delivering the patient from physical pain. Today I witnessed dental treatment of a different kind. I suppose you could argue that it wasn't dental treatment at all, it just happened to be treatment and we just happened to be at a dental clinic.

Today my partner Mike and I were scheduled for an initial exam on a new patient to the clinic. This is common as we are a brand new school. All of our patients are new. This was an afternoon appointment, right after lunch. I was doing the finishing touches of putting the protective barriers on the dental equipment in the operatory when I spotted Mike assisting our patient down the long aisle of dental chairs. The man was elderly, his shirt was carefully tucked into his neatly pressed slacks which were held in place by a tightly cinched fanny pack. Mike stood by his side as he slowly and carefully walked past the gloved and masked students attending their patient's needs. The first thing I noticed about this man was the black ball cap with the US Marines emblem on it he was so proudly wearing. The man was frail, probably not much more than a hundred pounds, he wore a pair of worn out glasses which he had carefully crafted bends in both arms which allowed the glasses to slide past the hearing aids which he wore in both ears. His long sleeves hid the age spots which certainly were there, but his arthritic fingers didn't lie.

This man was friendly, right off the bat. He proudly boasted of his almost sixty year marriage. His odd yet bright humor shone through the wrinkles that certainly told of harder times. He had little money, and came to see what we could do to fit him with a more stable set of dentures. While listening to tales of The Great Depression and Eastman Kodak's Dental Dispensary (where he had his tonsils removed) Mike continued to discuss treatment options. I began to work up a crude estimate on the computer so he could analyze his options for the treatment he was seeking.

Not more than a couple minutes passed, and I heard the last bit of an experience he was telling Mike which he had encountered while fighting in the Pacific. His military experience took him through Guadalcanal and Peleliu, which if you know anything about WWII, you know the significance of those islands and the battles that were fought there. Before I go on, you have to understand that Mike and I couldn't have been a more perfect audience for this man. We had just finished watching a miniseries, "The Pacific", which actually documented the experiences of the Marines 1st Division through the Pacific. We have both read several books on the conflict in the Pacific and have spent hours on the History Channel learning about what the Marines, including this man, had gone through. Maybe it was that his words fell on attentive ears which eased him into unlocking the doors which held back his suppressed emotions and feelings. I am glad he trusted us enough to share his experiences.

We had a good amount of time blocked out for this appointment and it was the last one of the day and Mike and I took advantage of this relic which was sitting in our dental chair. We listened and listened as he shared and shared. Our patient was deeply appreciative of our willingness to listen to him try to articulate the emotions that came as his mind flipped back to the pages of his life's story; clinging to coral boulders while being shelled by the Japanese and combat at it's ugliest. I felt it a privilege to listen. Several times I could see tears well up in his eyes as he resurrected images, scenes, and emotions that he was feeling 70 years ago. I could only imagine what that was like. He shared some experiences, and his expressions led me to believe there were some that were still too hard to share. "If you don't talk about it, you'll start to get crazy" he said. Sharing his experiences with us was a way he would cope. "I bought a book years ago on the Marines 1st Division and its history. I open it up and read a little when I feel brave enough to." he said.

It just so happened that one of my classmates, who served as a marine, was not too far off. I waved him over to come and meet our patient. There is a bond, or a brotherhood perhaps, that exists amongst those who have served in the military. When my friend approached, we told our patient that our fellow classmate had served in the marines 1st division as well. This elderly patient, stood to his feet from the dental chair and gave our classmate a handshake which quickly turned into a hug. It wasn't a normal hug, but the kind of hug that brothers share. They weren't strangers. It was interesting to see the frail and elderly patient juxtaposed with the young and tall student. Separated by generations, yet still closely connected. I admire that.

The time came for our patient to leave. Although no dental treatment was given, I believe our patient had received considerable treatment. He got out of his chair, and said with all sincerity, "I'll never forget this for as long as I live". Mike assisted him out of the chair. The Marine straped on his large fanny pack and made a funny relation to strapping on his gunbelt and .45. I watched Mike escort him back down the hallway where they'd ride the elevator up to the main floor and then out the main doors to the parking lot.

Like the patient, I don't think I'll ever forget that appointment. I have always admired those who fought in WWII, and the bravery and courage they had. Tom Brokaw termed this generation "The Greatest Generation". I am always pleased to run into those from the greatest generation. It was truly a different era. In the past two years of my dental schooling experience we were frequently reminded that "there is a patient connected to those teeth, don't forget!". It's an obvious concept but it doesn't really hit you until you get to clinic and really listen to the patients' concerns and stories.

I hope this patient continues to get the treatment he needs, wherever he can get it. On a smaller scale, I hope we can provide him with a more stable denture. He deserves it. After all, those of the greatest generation are getting harder and harder to find.

Wednesday, June 9, 2010

MWU Dental Institute

Here is our very legitimate sign in front of our building. It does the job for now.

A shot taken of the south end of the 3 story, 100k square foot clinic from the top of the parking structure.

Here is a shot of the reception area where we will greet our patients.

Here is the student break room.

Yesterday marked the day that we have all been waiting for. We, the inaugural class of 2012 have made the transition from classroom to clinic, mostly. The Summer quarter has just begun which means we have flown the nest and landed in a slightly larger nest right across the street. Here we have a little more room to stretch our wings.... ok, enough with the bird analogies.

Because we are in the inaugural class, we have not had the opportunity to have a gradual transition into the clinic as most underclassmen have at other dental schools. Also, because our clinic has just been finished, we have not had the chance to sit behind real-live patients in the dental chair. We can drill and fill with the best of them on our "dexters", or simulators, but we had a good time working on eachother.

We started the day at 7am in the large classroom where we had a briefing for the days activities with the clinic director and college dean. We received our bay assignments for the day and were broken down into groups of three students per operatory. We got suited up in all of our riot gear (just our Personal Protective Equipment) of gloves, gowns, masks, loupes, lights and went to work. Some students implemented the paper-rock-scissor ritual to decide on who would fill the "dentist", "assistant", and "patient" positions. We would all get a turn as an assistant, patient, and dentist throughout the day.

First things first.... We role played and entered each other's medical history, consent forms, and dental findings into Axium, our practice management software. We then jumped into perio charting and did a little scaling with all of the hygiene instruments as well as the ultrasonic scaler.

I played the role of assistant first followed by patient, and then dentist. It was a good experience getting into the clinic and practicing interacting with patients and getting the feel of the clinic and the operatories.

We have about two more weeks of clinic experience/surgery and medical lectures to go before we go full time in the clinic.

Another cool thing we did was we learned how to place sutures in our oral surgery course. Rather than draw straws and practice on each other, we were given pig feet to practice on.

Because we are starting to work in the clinic, we have to make sure we are up to date on all of our immunizations etc. I have been getting nasty "non-compliance" emails from the principal's office for about a year now. I figured my chance of contracting TB was pretty low while sitting in the lecture hall for all of second year so didn't pay too much attention to it. Our dean sent out an email saying we couldn't start in the clinic unless we were all up-to-date on our stuff, so I went to the CVS drugstore across the street where they have a little mini-clinic and found I wasn't the only non-compliant dental student at MWU. There were several of us getting our last minute boosters and TB tests done.