Sunday, 19 August 2012

A Tribute to my Late Father, Professor Issy Pilowsky 04.06.1935 – 17.08.2012

My dad loved me and was proud of me. I know this because he said so, when he was first diagnosed with brain cancer twenty-five years ago. He didn’t have to say it, because I knew it anyway, but I’m very glad he did.

Dad was never Professor Issy Pilowsky to me, he was just Dad. I knew about the long letters after his name and the important work he did as a psychiatrist, of course. I had a world stamp collection built up from international correspondence regarding his esteemed work. ‘Prof Pilowsky’ was one of my university lecturers. When Dad spoke to hundreds of unruly first year medical and dental students about the magic of Behavioural Science, an unnatural quiet prevailed. He delivered knowledge in a way that was clear, simple and captivating.

But that was not how I thought of Dad. He was just my dad.

Unusually for the times, almost certainly because of his medical training, Dad was present at my birth, in 1961. My twin sister was born first.

"Ooh, I think there’s another one in there", the midwife said.

"Issy", my mother said, appealing to a higher authority, "Tell them I’m always fat".

And then I was born, the unexpected twin. I still imagine Dad keeping calm and carrying on, as was his manner.

As Dad climbed the career ladder, our family, my mother, Marl, older brother, Paul, twin sister, Lyn, and younger sister, Marion, moved with him; from Cape Town, South Africa, to Sheffield, England, to Sydney, and then finally to Adelaide, South Australia.

As well as English, Dad spoke Afrikaans, Hebrew, Yiddish and a bit of German and Dutch. Wherever we were in the world, we would have instant family, from Jewish and medical tribes, and sometimes both. Dad enjoyed talking to people and working out how he related to them - often literally, through links of location, migration and surnames. My Dad talked to strangers whilst travelling, as many people do, but he would really talk to them. By the end of a train, plane or automobile journey, he would have learnt things about them that they didn’t know they knew themselves.

Whenever Dad talked to me, I felt special, life felt more manageable, and I too, would know myself a bit better. Whether he was explaining the water cycle with pictures drawn in the sand, or describing points of view using different sides of a toy pen, he made learning fun. He taught me how to do cryptic crosswords, and how to go to sleep easily; "Lie on your side, close your eyes, and think about what you’re going to do tomorrow". His bedtime stories were inventive and inspiring – Griselda, the young heroine of his tales, trained as a pilot with the help of her magic pink cloud.

Dad wanted all his children to be doctors. When I got into dental school, I felt I had disappointed him. When he reported regaling colleagues with news of his daughter, the dentist, I knew his pride in me was unconditional. Throughout my career, he supported me in clinical work, teaching, research, writing, publishing and public speaking. When he proudly attended one of my lectures, as I had once attended his, I felt moved and loved.

Dad ran, swam, climbed stairs at work, and tried to eat well. He was a great model and supporter for my own fitness and health endeavours. On the annual 12km Adelaide City Bay Run, Dad decided to wave me off at the starting line. He then joined me in running the whole race, keeping me company to the finish.

When I left Adelaide to live and work in London, I knew I was in Dad’s thoughts. In the early days, suffering from homesickness, I opened a care package from him to find an unsolicited fifty pound note. It wasn’t my birthday.

"What’s this for?" I asked.

"Actions speak louder than words", Dad replied.

Dad loved reading. We joked that Dad could no more avoid a book store than an alcoholic could stay away from a pub. Despite his cerebral bias, however, Dad did learn to play the violin in retirement, well enough to perform a solo rendition of ‘Happy Birthday’ on my big day one year.

On his regular visits to London, Dad always found time to listen, and share his tales of life in Sydney. He met my partner, Stuart, and approved. He was especially proud and loving of his grandchildren, including Amy, asking for regular updates and photos.

I miss Dad already, but I carry him in my heart. It goes without saying, but I will say it anyway. I loved my dad and I am proud of him.

Friday, 14 October 2011

Hard to Impress

“Can you guarantee to fix my tooth in one appointment?” the woman on the telephone asked.

“I never guarantee anything without seeing the tooth first, but I do help most people get out of trouble in one appointment,” I said.

“I don’t ever want to have to come back again,” the woman said.

“Okay,” I said.

“Which type of x-rays do you use?” the woman asked.

“We get the big ones that go right around your head and show all your teeth and jaws, the orthopantomographs,” I said.

“What about bitewings?” the woman asked.

“We like to have the big OPT’s first because we get much more information with less radiation exposure that way. But if we need small x-rays for detail, we can always get them too,” I said.

“How will you tell if the tooth would be better off with a filling or an extraction?” the woman asked.

I spent another five minutes discussing the criteria for restorative versus extraction treatment planning. Every answer seemed to lead to another question.

“You know a lot about dentistry, and you ask intelligent questions,” I commented.

“I am a dentist myself,” the woman said.

“Wow. That’s great. Where do you work?” I asked.

“I don’t work as a dentist. I’m a medical secretary, I work in the London teaching hospitals,” the woman replied.

“Oh,” I said.

“I gave up dentistry five years ago, soon after I graduated. I didn’t like working on patients unless they were unconscious,” the woman said.

“Oh,” I said.

The woman, Anna, had heard about me from another of my clients, who recommended me. She booked an appointment for the following Monday.

“Welcome,” I said, when Anna arrived for her visit with her husband, Keith.

She shook my hand. My nurse offered various forms for Anna to complete. I checked her health history and other details.

“Would you like Keith to come with you into the treatment room?” I suggested.

“Oh, no. He can stay out here,” Anna said, indicating the lounge room.

“Okay,” I said, glancing at Keith. He seemed used to being referred to in the third person by Anna.

Anna settled into the dental chair, and we examined her mouth and teeth together as she looked in the hand mirror.

“It’s the lower right wisdom tooth; it probably needs to come out. I realized after I spoke with you last week,” she said.

I checked my charting and her large OPT x-ray, obtained that morning.

“I think you’re right,” I said. “Would you like to have it done today, after we’ve cleaned your teeth?”

“Yes, please. I don’t ever want to come back again.”

I numbed Anna’s lower jaw and gave her teeth a spring clean. I sat her up in the dental chair for a rinse.

I felt my nurse’s hand gently on my shoulder. I looked up. Ada pointed to a large brown spider in the corner of the treatment room.

I decided not to draw attention to the minibeast, and to deal with it after Anna had left the room.

Anna’s attention had been caught by Ada’s hand signals, and she turned her head.

“Oh, my God, you have a huge spider in your surgery!” she exclaimed.

The moment for silent monitoring had passed. I got up, calmly apprehended the spider in my gloved hands, crushed it, and wrapped it in the gloves and a plastic bag. I disposed of it in the outside bin. I asked God for karmic forgiveness.

I scrubbed up, gloved back up, and took Anna’s wisdom tooth out. It was painless, and took seconds.

Anna joined Keith in the lounge.

“It was amazing,” she said.

At last, I thought. She’s ready to acknowledge my superior skill, extensive training, and comforting chair side manner.

“She chased and caught the biggest spider I’ve ever seen. She was so brave. I could never have done that!” Anna said.

Keith smiled. I smiled. Anna apologized for any earlier abruptness. I suggested a routine annual recall to keep her smile in top condition.

Anna got out her diary and we confirmed a time.

Friday, 2 September 2011

Strangers on a Train

As the train lurched forward, the elderly woman moved backwards at the same speed, then forwards, and then to the ground. She was a tourist, or at least someone unfamiliar with the London Underground tube system. I could tell by how slowly she moved; she was still standing when the train took off. I was too far away to reach out to her.

The man with her, presumably her husband, helped her to her feet. He spoke an Asian language. I could not tell what he was saying, but the look of concern on his face spoke volumes. The woman, shaken, sat down in the seat next to his. His enquiries grew more agitated.

As the woman spoke, I noticed for the first time she had lost a front tooth. She certainly had all her teeth when she got on the train. I tend to notice these things. Now there was a gap where her upper right central incisor used to be. I looked at the passengers on either side of me and across the aisle. Every one was focused on the unfolding drama. No one was moving.

"I’m a dentist," I found myself saying. "Can anyone see this lady’s missing tooth?"

I put a reassuring hand on the woman’s arm, the universal language of comfort. Several passengers rallied.

"Found it!" one of them cried, pointing to an intact, long rooted tooth on the floor of the carriage.

"Has anyone got a clean plastic bag or tissue?" I asked.

"I have a bag," a man offered, handing over his Sainsbury’s shopping carrier.

In the ultimate form of recycling, I inserted my hand into the bag and used it as a glove. I picked up the tooth by its crown, being careful not to disturb its chances of replantation by handling it by the root. I mimed mouth opening to the woman passenger. I wiped the root with the saliva in her mouth, and replaced it, the right way round, in its socket.

"You need to see a dentist," I said, frustrated by my lack of language skills. But her husband nodded, and I hoped they would seek and find aftercare.

"Thank you, every one," I said as I sat back down.

The carriage, almost mystically, lapsed back into silence. I sensed a change in atmosphere, concern for the woman injured, and a feeling of connection with each other in her cause.

When it came to my stop, I waved goodbye to the woman and her husband. They looked up as I got off.

"Take care," I said.

I reported the incident to the station staff before leaving. They took down some details.

"We will follow up," they assured me.

As anonymously as I had entered the transport system, I left. But for those brief minutes in which I had done everything I could to save the unfortunate woman’s tooth, I had experienced a little bit of truth in the phrase, ‘A stranger is just a friend you haven’t met yet.’

Tuesday, 16 August 2011

A Tooth for a Tooth

“He thought I was looking at his girlfriend the wrong way, so he headbutted me,” Alec said.

“Were you?” I asked.

“He was drunk,” Alec said.

“How is he now?” I asked.

“Sober,” Alec said, “And he’s agreed to pay for the damages.”

I took Alec through to the treatment room, and we examined the cracked tooth in the front of his upper jaw. The injury occurred a week ago on a night out at the pub. Now Alec’s central incisor did not respond to cold. It was tender when I tapped it. It had changed to a grey green colour. Over half the crown had disappeared, leaving a diagonal, jagged edge.

“The tooth has died, I’m afraid,” I said.

“I don’t want to lose it,” Alec said.

“If we try to save it, it will need a root filling, a post-core, and a crown,” I said.

Alec and I discussed all the alternatives, from doing nothing (free, but disfiguring, unhealthy and uncomfortable), to taking the tooth out and replacing it with an implant (expensive, intrusive and only as a last resort).

“This will be the most expensive pint of beer my mate ever drank,” Alec said as he scheduled his first appointment to begin restoring his tooth.

“Better than having you press charges for assault,” I commented.

“I think that’s why he’s so happy to pay for the work,” Alec said.

At his next appointment, Alec arrived with his friend.

“Joe’s come with me today to pay for my treatment,” he said.

Joe produced a credit card and settled the account. I sensed tension between Joe and Alec, a mountain of unexpressed feeling between them, perhaps?

“How are you feeling, Joe?” I asked.

“Pretty stupid and sorry,” Joe said.

“Promise me you won’t make a habit of this. It’s harmful, distressing, and costly,” I said.

“I know. I don’t normally,” Joe said. “I’d just had a bit too much to drink, that’s all. When I drink I’m not the same person.”

“He’s a great mate, really,” Alec said.

“Ah. Might be a good time to reconsider the value of a wild night out. But if you find you need help to drink less, there are plenty of lovely folk out there to help you. I’ll get you some numbers,” I said.

Alec looked approving. Joe looked contrite. I handed Joe the telephone numbers of agencies more experienced in these matters than myself.

After several visits, Alec’s tooth was beautifully restored. With the help of my dental laboratory, who examined Alec in person to confirm the shade selection and improve the detailing on his crown, Alec now had a tooth that matched the rest of his smile perfectly.

“Invisible mending,” he said, smiling at himself in the mirror for the first time since his injury had occurred.

I rang Alec some time later to see how he was getting on.

“I don’t see Joe that often these days, to tell the truth,” he said.

“Oh,” I said, “And what about you? How are you and your tooth doing?”

“My new tooth is about to become a celebrity. My band is headlining this summer at that music festival I told you about,” Alec said.

“Well done,” I said, laughing. “I shall look out for you and your tooth in the line-up.”

Wednesday, 18 May 2011

A Fairy Tale

“You’ll be wearing a Tooth Fairy costume and handing out leaflets at Sainsbury’s,” Stuart, my Practice Manager and marketing maestro announced. He looked a little anxious about pimping his girlfriend - sending me out on the streets, scantily clad, to promote Gentle Dental Harrow.

The kind, cuddly Tooth Fairy, known for exchanging money for baby teeth, was my professional alter ego. Stuart, at six foot two inches in height and over fifteen stone in weight, had been known to scare small children visiting Gentle Dental on nursery school excursions. I think of him as a gentle giant, but he did not qualify to dress up in Tooth Fairy tutu and tights.

“When?” I asked.

“Today,” Stuart said.

I looked over at my work experience student. In university interview practice I emphasized the importance of physical projection in selling oneself. “Teeth, tits, tush,” I signaled as shorthand for smiling and standing tall and proud. Now it was my turn.

I wriggled into my turquoise lycra and netting costume, adjusted my padded breasts (artificial), my padded behind (natural) and my Tooth Fairy wings (totally natural, of course).

“You look gorgeous,” Stuart encouraged, despite his misgivings.

He took photos. He handed me our remaining ‘Two for One’ Smile Care Visit promotional leaflets. He helped me adjust my wings.

Outside Sainsbury’s, my work experience student and I distributed leaflets to willing shoppers, extolling the virtues of Gentle Dental Harrow to anyone who would listen. It was the morning shift, with elders arriving by taxi to do their weekly shop and mothers with preschool children in pushchairs.

However striking or inappropriate my costume, in fact, because of my striking and inappropriate costume, I was a hit with children in pushchairs. Kids found me clever, likeable, funny and charming. I chatted with their parents and shared tiny teeth tooth brushing tips. I smiled and flirted. Time flew.

Half an hour into our marketing initiative, a store employee came up to us.

“I’m going to have to ask you to leave,” she said.

“Why?” I asked.

“This is Sainsbury’s. You’re not allowed to do this here,” she said.

“Are you the manager?” I asked.

“No” she said.

“I’d like to speak to the manager,” I said.

“He’s in a meeting,” she said.

“I’ll wait,” I said.

We continued to hand out leaflets.

“We’re probably not on store property or land out here. I’d like clarity before I move on,” I said.

My work experience student looked nervous.

An elderly woman approached us.

“You’re asking to get raped in an outfit like that,” she said.

I didn’t hand her a leaflet. I glanced at my young colleague who was handing leaflets to more courteous and curious bystanders.

“We’re almost out of leaflets,” I said.

My work experience student looked relieved.

Three fit builders invited me into the back of their white van. I declined their thoughtful offer. I had work to do.

I carried on handing out leaflets.

Two uniformed male police officers approached. My heart sank. Had the elderly woman made a complaint? Had the store employee called in the big boys?

“What’s going on here?” the shaven headed officer asked.

“We’re promoting our dental practice, Gentle Dental,” I said.

“Nice name,” the officer with the cropped red hair said.

“We have a special interest in people who are terrified of the dentist,” I said.

“I’m sure we’d all come and see you if you’re dressed like that,” the first officer said.

“I can’t dress like this at work for health and safety reasons. My Tooth Fairy wings get in the way,” I said.

“That’s a shame,” the first officer said.

“Our sergeant could do with you,” the second officer said.

“He’s complaining of toothache and he hates the dentist,” the first officer agreed.

“I’d love to see him,” I said, handing them a leaflet.

We returned to work, triumphant and exhausted.

“That was great,” my student said.

“I’m never doing that again,” I said.

“You both did brilliantly,” Stuart said.

The next day we heard from the suffering sergeant at our local police station. We saw him the same morning and safely and lovingly restored him to health and serenity.

Our work experience student, unscathed by her adventures with the Gentle Dental Tooth Fairy, went on to study dentistry at Guy’s Hospital.

Stuart posted photos of me in my Tooth Fairy costume, teeth, tits, tush and all, on the Internet. My initial embarrassment has long since given way to gratitude, affection and pride. 

Tuesday, 26 April 2011

Needle Phobia

Rita had a badly broken down tooth that was giving her pain. She knew she needed it out. She had come to her first appointment prepared for an extraction, with James, her boyfriend, for support. We agreed the tooth was too decayed to save and that an extraction would be wise, the sooner the better, before the pain and infection worsened.

Rita was relieved and grateful to find a dentist (me) willing to offer an emergency appointment and fix the problem. There was just one even bigger problem.

“I hate needles”, Rita said.

Rita was absolutely phobic about dental injections. At the age of 8 years, she had had an unexpectedly painful dental injection that had gone on for an excruciatingly long time. The dentist had continued despite her obvious shock and pain, and her mother had told her to “Get on with it”.

As an adult, Rita had all her previous dentistry carried out with general anaesthetic, where she could be ‘put to sleep’. We discussed all the options for treatment this time, weighing up the risks and benefits of each, including referral for similar support with sedation or general anaesthetic.

But Rita wanted her tooth out today. She had seen my website, and she wanted to improve her ability to receive dental care while conscious, an experience she trusted me to provide.

“Sure”, I said.

Rita, James, my nurse and myself, all trooped into the treatment room. Rita sat herself in the dental chair. She was literally shaking with fear. I deployed ‘Lambie’, one of the soft toys I use for just such occasions. With Rita holding Lambie tightly, my nurse patting Rita’s arm and James stroking her hair, I applied ‘magic jelly’, a topical anaesthetic gel to numb the gum before injection.

Building trust is a delicate and crucial process. Fear of prolonged or unexpected pain was a significant factor in Rita’s phobia. I asked Rita to indicate to me with a raised hand if she wanted me to stop, and promised to do so immediately, even if she just wanted to “rest, cough, swallow, or comment on the weather”.

I used the ‘tell, show, do’ technique to avoid surprises, informing and demonstrating to Rita at every stage what I was about to do. Some people prefer not to know or see what is being done for them, and that is respected. Other people like the reassurance of explanation and advance notice, and Rita clearly benefited from this.

Rita was encouraged to breathe, focus on wriggling her toes, and to feel a deepening relaxation spreading from her toes, up her legs, and throughout her body as she relaxed and breathed ever more deeply during her care.

Rita stopped shaking, and relaxed her rigid hold on Lambie. With the support of my team, I gently and slowly numbed Rita’s jaw with a local anaesthetic injection in her mouth. I spoke soothingly and hypnotically to Rita. The offending tooth was carefully delivered in two sections while James and my nurse held their posts supportively.

Once finished, I congratulated Rita and assured her that she would not miss the tooth at all, which we then examined carefully. Rita noticed how much bigger and more rotten it was than she had imagined. Rita also took the opportunity to look at and touch the anaesthetic needle, which she declared was much smaller and finer than she had thought. She was delighted to have coped so well with treatment, and said she now felt confident to have future treatment with local anaesthetic only, a great step forward in practical and emotional terms.

“I’m such a coward. I should have come much sooner”, Rita chastised herself.

I reminded Rita that her fear and avoidance was the result of the childhood trauma over which she had been powerless, not because of any weakness on her part, and that a phobia is a logical way to protect oneself until a sense of safety is assured.

Then I reminded Rita that she was not, in fact, afraid of needles. She looked at me, puzzled.

“A picture paints a thousand words”, I said, pointing to several beautifully wrought tattoos on her arms, silent tributes to her courage and determination.


Please note that I have made changes to protect the identity of my client but this is a true story. I thank my client, who kindly consented to her story being shared. 

Thursday, 14 April 2011

It's Complicated

“You need to have your wisdom teeth out. They’re deeply impacted and draining pus. I’ll refer you to the oral surgeons”, I said.

‘What does impacted mean?’ my client asked.

“It means they’re stuck. They haven’t got enough room to come through properly, you can’t clean them because they’re halfway under the gum, and you keep getting infections around them”, I said.

“They’re not bothering me. Why do I need to have them out?” my client asked.

“The infection is causing bone loss. If you leave them you could lose both the wisdom teeth and the teeth in front of them. And it’s causing halitosis,” I said tactfully.

“Halitosis?” my client asked.

“Bad breath”, I rephrased helpfully.

“You’re saying I have bad breath?” my client asked, clearly mortified.

“A little,” I said, “And it will go once the wisdom teeth are out”.

“How soon can I see the oral surgeon?” my client asked.

I grabbed my letterhead and completed the referral before my client could change his mind. He had not wanted to come to the dentist. He had merely asked about his teeth for an opinion. Now he was lying back in the dental chair with a plastic apron around his neck.

It was an unusual end to a first date. I had invited Stuart over for dinner. We had known each other as friends for years and recently decided to get to know each other in a romantic way. Since I live over the shop, popping downstairs for a bit of after dinner dentistry had seemed easy and logical. Stuart had not seemed so sure, but my enthusiasm overrode his objections.

The oral surgeon agreed wholeheartedly that Stuart needed to have his wisdom teeth out.

“She’s taking good care of you", he said, nodding his head towards me at the consultation.

Five months after our first date, Stuart lay back in a hospital gown and asked the nurse to reassure him again that the surgery was needed. The nurse assured him that on the overburdened NHS they only offered procedures that were absolutely necessary and no more.

The next time I saw Stuart, on his return from the general anaesthetic recovery room, he was dribbling, groggy and euphoric from potent painkillers.

“Marry me,” he slurred.

Stuart, separated from his wife, was still legally married. Tempted though I was, I could not take his wonderful offer seriously, nor take advantage of a man under the influence.

“You’re high”, I said.

Stuart’s recovery was complicated by dry sockets (loss of the protective blood clots) and infection. I loaded him up with local anaesthetic, more painkillers, antibiotics, and dressed his sockets with sedative seaweed poultices. I fed him soup and porridge. I bought him six box sets of ‘The Sopranos’, the only method that seemed to provide distraction from his pain.

For two weeks, he hated me, his girlfriend, and, for better or for worse, his dentist. He withdrew his marriage proposal.

Fortunately, Stuart survived his ordeal, and so did our relationship. One year later, I diagnosed and extracted his daughter’s infected wisdom teeth, this time with Stuart at the helm, talking her through the procedure.

The responsibility of treating family members weighed heavily upon me. I maintained professional integrity by asking myself if my care for my clients was what I would want for my loved ones. And whether I offered the same treatment to loved family that I do for my clients. This situation passed the test.

Years later, Stuart and his daughter still appear to love me. When I think of their wisdom teeth, I think of their loss as my gain. In the process, I gained a little more wisdom myself.