Medical Doctors versus Rumba Dancers

Being a patient instantly levels the playing field and provides the insight into why we as doctors, dentists and health care practioners do what we do.  I came back from a vacation with a throbbing in my jaw. I called my general dentist who came in early in the day to squeeze me into a crowded schedule. He quickly determined that an old root canal filling had failed and an abscess had formed above it. The choices were to remove the tooth or drain the abscess and try to re-do the root canal work.  He picked up the phone and called the endodontist who asked me to come right over because I was in pain. This kind gentleman suggested I start on an antibiotic to quiet down the inflammation and infection, take some pain medication and decide if I wanted to pull the tooth or repair it. He was concise and professional in saying the procedure to save the tooth only had about a 55% chance of success.  He suggested I think about it but call him back if the pain progressed.  I questioned the choice of the antibiotic because it had a significant chance of causing antibiotic related colitis. I believe he changed antibiotics from his choice which was more efficacious for this type of infection because he deferred to my concern.  Before I left his office he phoned the general dentist, discussed his findings and suggestions and made sure we were all on the same page. I was sent to the pharmacy and then back to the general dentist.

The general dentist wanted to save the tooth. He said that even if the tooth needed an extraction, he wanted an oral surgeon to do it because of the post in the tooth and other complications. I was given my x-rays and referred to an oral surgeon.

The oral surgeon could not see me for two days. During that period of time, the pain had become significantly worse. I was taking ibuprofen frequently and applying topical anesthetic benzocaine often. I didn’t sleep the night before the oral surgery visit due to the pain.  When I arrived at the surgeon’s office I had expectations of the pain being relieved by tooth extraction or a tooth sparing procedure.  To my amazement, the oral surgeon said he didn’t have time for the procedure today. He wanted me on a different antibiotic and felt that on this antibiotic the pain would subside in 48 hours. He scheduled me for surgery in a week. I told him I didn’t think I could hold out a week. He offered no pain medications despite me saying the pain was close to a 15 on a pain scale of 1-10.

I filled the new antibiotic prescription and called my general dentist to tell him how disappointed I was in the oral surgeon. I could feel an abscess on my upper gum. It was the source of pain, was fluctuant and needed to be drained. I told my general dentist that obviously my expectations and the oral surgeons were not aligned but I didn’t think I could last a week.  That night the new antibiotic nauseated me. I threw my guts up all night and spent most of it awake hugging the toilet bowl with first productive and then dry heaves.

I called the oral surgeon who suggested I stop the antibiotic and stop the ibuprofen substituting milder acetaminophen (Tylenol). I told him Tylenol didn’t relieve this pain.   That night I was in agony. Despite an ice pack on a chipmunk like jaw the pain was overwhelming and the nausea and vomiting continued.  At 8 a.m. on Saturday I decided it was late enough to call the oral surgeon. I had made up my mind that something definitive needed to be done. I called his emergency number and he called right back.  He told me it wasn’t too early to call; in fact he was on the first tee at the golf course. After listening to my story he promised that after his round of golf he would check his schedule and move my procedure up from Wednesday to Monday (48 hours away.)  He promised to call me when he finished his round of golf.

I called my hospital ER, dizzy, dehydrated and feeling that in an effort to save the tooth we might kill the patient. The ER doc suggested I come in, get hydrated IV, get a shot for nausea and call the oral surgeons listed on the emergency call list. On the list was one who had worked on my children years before. I gave him a call by chance. When he called back in a few minutes he asked me to meet him at his office in twenty minutes. He opened the office himself, took a history, examined the tooth, figured out how to shoot an x-ray, anesthetized me using my wife and me as his assistants and drained the abscess.  He put me on a narcotic pain medication and continued the antibiotic.  He gave me detailed post procedure instructions and promised to call me later to check on my progress. He told me he couldn’t understand the actions of the other oral surgeon. “If you are a surgeon aren’t you supposed to use your training to ease pain and suffering?” I went home anesthetized and fell asleep for the first time in days.

The phone woke me up and it was this angel of mercy calling to check on me. He asked me to call him first thing Sunday morning and if I was not much better he would call in his team to his office and extract the tooth. If it was better, he promised to call the endodontist on Monday and discuss the tooth sparing procedure.  I thanked him and went back to bed.  Shortly after 9 p.m. the phone rang again. It was the original oral surgeon. He called (after completing his round of golf) to say he had checked his schedule for Monday and he couldn’t see me before the end of the day. I thanked him for the courtesy of the call and told him I had changed surgeons.

In my second year of medical school training, the Chief of the Department of Medicine at the very fine Brooklyn Jewish Hospital said there are different types of individuals with physician degrees. “There are Doctors and then there are rumba dancers.”  Doctors are compassionate and work to prevent and heal suffering. Rumba dancers have degrees in medicine, possess all the social skills, tear up the dance floors at the local country clubs and do little to go out of their way to help those in need.  It was very clear in my mind who the doctor was and who the rumba dancer was in my treatment plan.