Turn it off!

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When I first qualified as a dentist and went into practice in 1982, nobody possessed mobile telephones (cell-phones). By the time I retired in 2017, practically all of my patients, even some of the children, carried and used these ‘phones. Believe it or not, my patients often tried using their ‘phones during my appointments.

phon

It was very annoying and ruinous for concentration when a patient stopped me in the midst of performing a delicate operation in his or her mouth in order to answer the ‘phone. Some patients even attempted speaking on their mobiles when their mouths were full of impression materials.

 

One day, I met my next patient at the reception desk. He had arrived punctually, but had his ‘phone up to his ear. He smiled at me, and then said:

“Give me a minute, I am in the middle of a telephone interview for a job.”

“Ok,” I replied, “come into my surgery when you are finished.”

Ten minutes of his half an hour appointment passed, then fifteen, and then twenty…

At the end of half an hour, I returned to the reception desk. My patient laid down his ‘phone, smiled, and said:

“I’m ready now. My interview is over.”

I replied:

“So is your dental appointment. You had better book another one another day.”

Even more annoying were those who insisted on asking me a question and then, instead of listening to my reply, began sending SMS messages. I recall one lady, who had very complex dental problems, which required much explanation of treatment options before I could proceed any further with helping her. Did she listen to me? Oh, no she did not. For half an hour, she sent a series of SMS messages whilst I spoke. At the end of her appointment, she asked me to repeat what I had been telling her because she had had to send a series of “very important” messages. After that experience, I put up a notice in my surgery, forbidding the use of mobile ‘phones. It was a successful move. Patients would reach for their ‘phones, and then my assistant or I would point at the notice. The patient would then apologise, and turn off the ‘phone.

Dentistry and dictatorship

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Between 1944 and 1991, Albania was ruled by a Stalinist dictatorship under the leadership of Enver Hoxha until his death in 1985, and then under Ramiz Alia. The country was even more isolated from the rest of the world than North Korea is today. It was impossible for individuals to visit the country unless they were members of a tour group. In May 1984, I joined one of these groups and spent a most interesting fortnight in the country. Our hosts, the state-run Albturist company, made sure that we had little or no contact with Albanians other than our tour guides and driver, who was a trusted Communist party member. Our hosts hoped that we would only see what the authorities wanted us to see. Their aim was to make us come away from Albania feeling that its repressive regime was one to be admired. I was the only dentist in our group. I managed to gain a tiny insight into the state of dentistry in Albania. The following extracts from my book “Albania on my Mind” reveal something of what I learned. ‘Aferdita’ and ‘Eduard’, mentioned below, were our Albanian tour guides. Although their job included keeping us ‘under control’ and away from other Albanians, they were curious about the world beyond Albania’a watertight borders.

ALBDENT 0

Our tour began in the northern city of Shkodër.

“Our coach headed out of Shkodër along the main road leading southwards. Once we were out of town, Aferdita delivered the first of her brief daily lectures. Every day, she treated us to a discourse on one of a variety of different aspects of life in Albania. The one that I can recall best was on the subject of medicine. She informed us, whilst we were travelling towards Sarandë some days well into our tour, that since the advent of the communists not only had malaria been eradicated, but also tuberculosis and syphilis. After extolling the virtues of her country’s medical facilities, she offered to answer any questions that had arisen in our minds as a result of her lecture. No one said anything. Then, Julian, our British chaperone, knowing already that the young lady doctor travelling with us was a reticent person, asked me, the dentist on board, to pose a question. I asked whether antibiotics were readily available in Albania. My reason for asking this was that I believed that the country, which was clearly trying to be totally self-reliant, would have been reluctant to import costly pharmaceuticals. Aferdita replied indignantly: “Why, of course they are.”

And then, spreading her hands wide apart, she exclaimed:

“When we reach the next town, I will get you a packet of antibiotics this large.”

Sadly, she never fulfilled this unusually generous offer.”

ALBDENT 1

Flash flood in Shkodër, 1984

“After an unexceptional lunch, I roamed around the streets of Shkodër. I came across a small public garden, which was dominated by a chunky statue of Joseph Stalin. Even 30 years after his death, Albania continued to honour him. It was the only country in Europe still revering that illustrious Georgian. There was even a town, Qyteti Stalin (now known by its pre-Communist name as ‘Kuçovë’), named in his memory, but we did not visit it. I am pleased that I saw this statue, because although I did see many other statues on our trip, they were mostly depictions of Enver Hoxha.

I discovered a bookshop near to Stalin’s monument, and being addicted to such establishments, I entered. I was surprised to find an Albanian textbook of dentistry prominently displayed there. Though crudely illustrated with line-drawings, I could make out that it was quite up-to-date. To the evident surprise of the shop’s staff, I purchased it and another dental book. I still treasure these two unusual souvenirs from Shkodër.”

ALBDENT 2

Backstreet in Gjirokastër

Later during our tour, we visited the historic city of Gjirokastër. Its hotel, like others in Albania, was equipped with a night club, where we, the foreign guests, were entertained by musical ensembles in splendid isolation: no Albanians apart from our guides and a waiter were permitted to enter the club. Incidentally, wherever our group ate in Albania, we were isolated by screens or curtains from other (i.e. Albanian) diners. I later learnt that this was because in 1984 there were great food shortages in the country. We were well-fed, but it was important that Albanians were not able to see that.

“That evening after dinner, a number of us sat with Aferdita and Eduart in the hotel’s night club. Each of the hotels in which we stayed had one of these. With the exception of our two guides and the musicians who performed in them, these clubs were out of bounds for Albanians. This evening we were entertained by a small band that played western pop music, mainly tunes originally performed by the Beatles. The noisy background of these clubs provided our two young guides with opportunities to ask us about life beyond their country’s tightly sealed borders. However, it was clear that Aferdita was trying to eavesdrop on Eduart and vice-versa. As the musicians strummed away in the semi-gloom of the club in Gjirokastër, Aferdita turned to me, rolled her lower lip away from her teeth, and asked my opinion of her gums. She wanted to know if they had been treated properly. I told her that I was unable to give her an opinion in such poor light.

The following morning, I spotted some tubes of Albanian toothpaste on display in a locked glass display case near the hotel’s main entrance. I tried to communicate to the receptionist (who did not understand English) that I wished to purchase a tube. I used to collect toothpastes from wherever I travelled and was curious to taste its contents. Whilst I was doing this, Aferdita appeared, and asked me what I wanted. I told her. She explained my desire to the receptionist, and moments later I had become the proud owner of a tube of Albanian dentifrice.”

ALBDENT 3

Many years later…

“In 2001, long after my trip to Albania, I began working in a dental practice in west London. Many of my patients were, and still are, refugees from the places in the world, which are stricken by military and political conflicts. Algerians, Iraqis, Afghans, Kurds, Palestinians, Eritreans, and many other others who have fled their far-off disturbed homes sit in my surgery and reveal the ravages that life has inflicted on their teeth. During the terrible conflicts in the former Yugoslavia, many of my patients hailed from Kosovo, and usually spoke poor English in addition to their native Albanian. Many were the smiles that I elicited from them when I quoted the old party slogans, undoubtedly poorly pronounced, and wished them ‘Mir u pafshim’ instead of ‘Goodbye’ at the end of their appointments.”

 

“ALBANIA ON MY MIND” by Adam YAMEY may be purchased from Amazon, lulu.com, bookdepository.com, your bookshop. It is also available as a Kindle

Not really…

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American and English

similar lingos

sometimes different  

USA

Some years ago, I practised dentistry in a surgery near Ladbroke Grove in West London. One day while I was waiting for the next patient to arrive, I found myself alone at the reception desk, the receptionists having gone off somewhere briefly. The telephone rang. Being a helpful sort of person, I picked it up.

“Hello, this is the dental surgery,” I said.

A man with an American accent said to me:

“I want to speak with June Courtney.”

June was a dentist, who used to work in the practice.

“I am afraid she does not work here anymore,” I replied.

“Well, maybe you’re her husband?”

“No, I am not.”

“Well, maybe I can interest you in buying some bonds,” continued the trans-Atlantic caller.

“I’m not really interested,” I replied.

“Well, that means you might be a little bit interested,” the caller replied.

“let me explain something to you,” I began, “if someone English says that they are not really interested, it does not mean that they are ‘slightly interested. It is a polite way of saying that they are not at all interested; they are totally uninterested.”

“Well, thank you for explaining that, sir,” the caller said before ending the call.

I guess that sometimes it pays to speak bluntly.

Monkey business

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MONKEY

 

I was reminded of what follows, a true story,  after seeing an excellent photograph (reproduced above). The photographer Ajay Ghatage (from Bangalore) has kindly allowed me to use this photo.

Until I first visited India in 1994, I had never seen a monkey except in a zoo. Even in the hearts of big cities in India, these creatures are as successful as other city fauna such as pigeons, wild dogs, and birds of prey. I never cease to be fascinated by the monkeys’ antics, but I do recognise their nuisance value.

Kitchen windows need to be protected to stop monkeys from entering. At least once I walked into the family kitchen and startled a monkey, which was about to leap out of the window clasping a bunch of bananas.

Once my wife’s family decided that it would be fun to go on an outing to the Big Banyan, a few miles outside Bangalore. The Big Banyan is at least 400 years old and lives up to its name – it is a vast rambling tree that spreads its branches and aerial roots over a huge area. It is a popular picnic place, but, having visited it, I fail to see why. We found a clearing within the area covered by the tree, and then laid out a blanket for a picnic. Before we could sit down, many monkeys appeared. One of them began tugging at the blanket, and others looked greedily at our picnic baskets. The situation became so menacing that we abandoned the idea of a picnic and retired to eat in the car.

Many years later, my wife, our daughter, and I visited Badami in northern Karnataka. This place is famed for its fabulous Hindu, Jain, and Buddhist temples, some of which were carved in the living rock by the Chalukya dynasty in the 5th to 8th centuries AD. The area was infested with monkeys on the look-out for almost anything they could get hold of.

Some of the ancient temples are located next to a ‘tank’ or lake. While we were looking at these, our daughter wanted to take a photo. So, my wife held her bag.  Suddenly, I heard my wife making loud growling sounds. She was tugging our daughter’s bag while a monkey was trying to pull it away from her. The monkey was strong, but my wife’s growls scared it into releasing the bag.

A short while later, we sat down to have soft drinks under some trees. Our daughter ordered a virulently coloured orange carbonated drink. It was not one we would have recommended, but it appealed to our daughter. After the bag incident, we had warned her not to let go of anything, but she forgot momentarily. She put the opened bottle of drink beside her on the bench. Before she could say “monkey”, the bottle had disappeared. We looked up into one of the trees, and saw a monkey putting the bottle to its lips.

A few seconds later the monkey turned the bottle upside down, and then poured its contents down through the branches. Clearly, it was a creature with a discerning palate.  

A bit too far

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Drill a bit,  not too far.

In the tooth is a nerve:

do not disturb it

 

DRILL 1

 

It would not have been fair to my patients if I had written what follows before I had retired from practising dentistry. If I had been one of my patients, I might have lost confidence in my dentist after reading this.

Before dental students are allowed to drill teeth on living patients, much training is required. A great deal of this is done using plastic teeth mounted in the jaws of the heads of a mannequin, known as a ‘phantom head’. The plastic teeth are held in the artificial jaws with metal screws. The screws fit into holes on the undersides of the teeth so that the crowns of the teeth appear intact. As a dental student, I spent many hours each week practicing cutting standardised cavities. The cavities had to be cut to very precise dimensions, which were neither to be exceeded nor the opposite. I recall that certain parts of the plastic teeth had to be cut to exactly two millimetres deep and much the same width. At first, I found this extremely difficult. Not only was I not yet used to using dental drills, but also the plastic cuts in an awkward way.

Eventually, the time arrived for a practical test. Unsupervised, we were required to cut one of the several cavities that we had been learning to prepare. Disaster struck. Within a few seconds of starting my tooth, I had cut too deep. The metal of the screw retaining the plastic tooth in the phantom head was staring me in the face. I called over the examiners. They studied the tooth carefully, and then one of them said to me:

“I think you have exposed the nerve, Mr Yamey.”

“We might be looking at a root treatment, here, don’t you think?” asked the other examiner.

I could not believe what I was hearing.

“I think we’re looking at a failure here,” I replied.

They agreed.

I spent another few weeks in the phantom head room, and retook the exam, which I passed with flying colours, you will be relieved to learn. Now, I was deemed ready to treat dental cavities on real teeth in real patients – under supervision, of course.

The first tooth that I had to work on had only a little decay. Nevertheless, after the intense training, which emphasised cutting teeth should be done as conservatively as possible, cutting only as little of healthy tooth tissue as was strictly necessary to retain the restoration (‘filling’), I approached my first ‘real’ tooth with much trepidation. After boring down to the two-millimetre depth that was ingrained in my mind, I could see nothing but healthy tooth – no sign of decay. I summoned the clinical teacher (the ‘demonstrator’). He looked at the tiny hole I had created with great care and laughed.

“You have not yet cut through the enamel. Keep going,” he said.

The enamel, for those who are uncertain about dental anatomy, is the outer covering of the part of the tooth that is visible in the mouth. Beneath it, is the dentine, and below that the dental pulp chamber, which contains nerves and blood vessels. Decay spreads much more rapidly through dentine than through enamel.

I looked at the demonstrator, and said:

“But in the phantom head room we were told never to go deeper than two millimetres.”

“Those were just plastic teeth,” the demonstrator replied, “forget all that.”

 

[Picture from “Der Zahnarzt in der Karikatur” by E Henrich]