Tag Archives: dental

A long holiday

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To tell the truth
there is nowt as bad as
a pain in a rotten tooth
hallway with window

 

When I worked in a dental practice near Portobello Road in west London, I met a lot of ‘colourful’ characters, many of whom I might have avoided had I saw them approaching me by chance in the street. One fellow, Ted, a large patient whose nose had been broken at least once and been badly fixed, said to me once: “If anyone ever causes you trouble in the street, just say you’re a friend of Ted. That’ll warn them.”

One day while I was standing in a queue at a takeaway counter waiting to order lunch, someone standing near me, a patient of mine, said: “Need a motor, doc?” I answered that I did not need a car at that point of time. “No problem, Doc,” he replied, “when you need one, just tell me what you want, whatever colour and make, and I’ll get it for you.” Not willing to sound ungrateful, I thought that when he said “get”, he really meant “steal.”

I had many patients who had been in and out of trouble with the law. Often, I would be told: “Look what the prison dentist did to this tooth, doc. Bleeding butcher, he was. Ought to be put behind bars.” I never asked why my patients had spent time ‘inside’. I felt it would be better not to know.

The last patient before one lunchtime was an aggressive young man. He was accompanied by his friend, a slightly older man. Before I had time to ask the young fellow what was wrong, he told me. Pointing to a lower left premolar tooth, he said: “Get it out. It’s f…..g killing me.” I looked at the chap. His mouth did not seem to close properly. “Don’t just stand there. Get it out, man”. I looked at the tooth. It looked alright. It was neither decayed, nor wobbly, nor tender. That strange mandibular posture bothered me.  

 

“You’ve broken your jaw,” I said. “Don’t give me that crap. Just take it out.” I said: “If I take it out, you will still be in pain. You need to go to a hospital to fix your jaw.” This only angered the patient more, and I began to fear for the integrity of my jaw. “I’m not leaving until you take it out.” “Then,” I replied, “I’ll ring for an ambulance.” The patient’s friend said: “Come on, mate, let’s go.” Reluctantly, the patient allowed his friend to drag him out into the street. I locked the practice for the lunch break, relieved to see them leave.

Some days later, I met the patient’s friend in the street. I asked him whether the young man had been to hospital. He did not answer my question. Instead he said: “He’s gone away.” “On holiday?” I queried innocently. “Yes, on holiday.” “Long holiday?” I asked, beginning to understand what he meant by ‘holiday’. “Yes, very long holiday”.

 

Photo by Jimmy Chan on Pexels.com

 

Don’t ever use aftershave!

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CASIO

 

When I was a child living in north-west London in the early 1960s, I used to accompany my mother on shopping expeditions in the West End. I loved going into the centre of London because I considered that Hampstead Garden Suburb, where we lived, was pretty, but pretty dull – a cemetery for the living! We used to take the Underground to Oxford Circus. Our first port of call after leaving the ‘tube’ station was Dickins and Jones, a now no longer existing department store on Regent Street. It closed in 2007, long after my mother died.

Like many other department stores, Dickins and Jones devoted its ground floor to displays of cosmetics and perfumes. On one visit, when we were walking through the over-fragrant ground floor of the store, a sales-lady working behind one of the many stalls, each representing a different cosmetics company, beckoned to me. I pointed towards myself, and she nodded, meaning she really did mean me. I walked over to her, and then without my saying anything, she said: “Sonny, never ever use after-shave lotion on your skin. Now, get along.”  I have never forgotten her advice, nor disobeyed it. I was about twelve years old then.

As I moved into my teens, and I began needing to shave, I was inundated with gifts of after-shave. Well-meaning friends of my parents and adult relatives gave me numerous gifts of cuff-links, which I have never used, and copious bottles of after-shave, which I dared not use. The unopened bottles piled up in my wardrobe and gathered dust.

Many years later, I became a dental student. From the second year onwards, we treated real live patients. They had either referred themselves for free treatment at the dental hospital or they had been referred by general practitioners who could not handle their problems. Many of them made multiple visits. Treatment at the hands of students was often slow. Some grateful patients gave me gifts either during their course of treatment or at the last visit.

One of my patients was a young lady from the Far East. She was always accompanied by her little son, aged not more than four years. Whenever I gave his mother a local anaesthetic, he would pipe up: “Look Mama, dentist man coming with needle. Look Mama, dentist man… etc.” When her course of treatment ended, she presented me with what I regarded as a wonderful gift, a treasure. It was a Casio digital watch with a tiny calculator keyboard attached to it. This was given to me in the late 1970s, and these watches had only been available for a very short time.

Someone, who came to dinner with my parents in the 1970s, brought us a gift of a box of chocolates made by Floris Chocolates, a company that no longer exists. I remember that the chocolates were far, far better than any I had ever tasted. So, it was with some excitement that I unwrapped a gift which a happy patient had given me after I had made him a set of dentures at the dental school. It was a box labelled ‘Floris’. At the end of the day, I took my gift home, and opened it with great anticipation and high expectations. My heart sunk when I found that the box contained not chocolates, but small bottles of fragrant perfumes. I gifted these to a friend.

J, an attractive young lady, became one of my patients at the dental school. I asked her what she did for a living. She told me that she sold men’s fragrances at a leading London department store (not Dickins and Jones). She asked me: “Have you heard of Brut?” I said that I had heard of the company. “Well, I represent Brut at the store,” she told me. “Do you use fragrances?” she inquired politely. “No,” I answered. “Oh, that doesn’t surprise me. Hardly any doctors or dentists seem to use them.” I was sure how to interpret this and hoped that I was not smelling unpleasant. “I’ll bring you some next appointment,” she told me cheerfully.

On the next visit, the Brut seller, true to her word, presented me with a large box, saying: “See how you get on with these.” I took the box home at the end of the day and examined its contents. It was filled with little bottles labelled with names that I found mysterious: ‘pre-shower splash’, ‘shower splash’, after-shower splash’, pre-shave rinse’, ‘shaving splash’, and (the to be avoided) ‘after-shave lotion’. No instructions were provided, so this well-meant gift was consigned to the wardrobe. After what the lady in Dickins and Jones had advised me, I was not going to risk the after-shave lotion nor any of the other even more curiously named products.

With the exception of the cosmetic products, I have received many other gifts over the years, most of which have given me great pleasure. These gifts, useful or not, have been given by grateful patients who have either also paid me or have been treated free of charge courtesy of the NHS. More than my earnings, which were, of course, very important, even a simple heartfelt ‘thank you’ made  me feel that doing dentistry was worthwhile.

Examining a recurring dream

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The sleeping brain

powerhouse of fantasy

fertile playground of   dreams

 

Dreams

 

Many of us experience dreams that recur periodically, not necessarily every night, but from time to time. Here is mine.

I dream that I am about to take a mathematics exam. I know that I have had a year to study for it, but have done nothing about it. Maybe, I can ‘wing it’ without study, but I am sure that I cannot. There are only a few days left to study, but something tells me that neither will there  be enough time, nor will I ever get started. I will tell you how the dream ends later on.

Ever since I was about 8 years old, I have been writing examinations. First, there were simple tests to enter preparatory school. At the end of each school year, we sat a series of written tests. Then, there were more (and much more difficult) papers for admission to secondary school to be attempted when I was 12.  At age 16, I had to write state examinations in eight subjects, the Ordinary Level (‘O Levels’, now ‘GCSE’).  A year later, a few more state examinations, and then when I was 18, I had to take the difficult Advanced Level exams that could make or broke a candidate’s chances of entering a University.

At the end of each year of my BSc course in physiology, there were examination papers, the results of each of them counting towards the quality (grade) of the degree I would be awarded. 

Following that, I had a three year break from exams while I researched and then wrote up my PhD thesis.

I entered dental school, where for five years I had to pass endless numbers of examinations of all sorts: practical, written, and viva-voce.

Eventually, I graduated as a dentist. However, there was one more examination to be taken: the driving test!

I have never found writing examinations stressful.

My recurring dream ends as follows. After pondering the hopelessness of my prospects via-a-vis the forthcoming mathematics exam in my sleeping brain, it occurs to me that it does not matter after all, because already I had a BSc, a PhD, and a dental degree. Then, I wake up.

This dream ending might have a basis in reality. When I was ready after completing the dental course, I took the set of dental qualifying examinations arranged by the Royal College of Surgeons. I passed them.

Three month’s later, after I had been working with patients in practice for most of that time, I returned to the dental school to take the university dental examinations. I was already qualified, and did not really need the extra qualification, but I went along nevertheless.  The university exams required me sitting a number of written papers along with a clinical test. While sitting on an uncomfortable chair, scribbling exam essays at high speed, I paused for a moment. As in my dream, I asked myself why was I bothering  to waste time on attempting to attain this superfluous  qualification when I had so many already.

Garlic and parsley

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PSX_20180917_175556.jpg

 

My late mother was a good cook. I know that you will think that often children praise their mother’s cooking however awful it is. In the case of my mother, her cooking was praised by many people, who still remember her skills in the kitchen many years after her demise at an early age. My mother was a keen disciple of the pioneering food writer Elizabeth David, who helped introduce Mediterranean cuisine to the British. Many recipes from the Mediterranean involve the use of garlic and parsley.

Although my mother did not permit my sister and me to cook in her kitchen, we were ordered to be in the kitchen with her either to keep her company and/or to do the washing-up. Our presence in the kitchen and proximity to a skilled cook engendered a life-long love of cooking in both my sister and me. When my mother died, I took over her kitchen and learned, by trial and error, how to cook. My sister did the same and ran a restaurant successfully for quite a few years.

Many of the dishes I cooked, and still make, contained copious amounts of garlic. This was not a problem until I qualified as a dentist, and moved to a practice in Kent, about 80 kilometres from London in distance, although it felt much further culturally and in many other ways.

Friends have often asked me whether the mouths that I treated emitted bad smells. The short answer is that although they might be malodorous occasionally, the dentist rarely smells them while treating the patient. However, the converse is true for the patient. In modern practice, the patient is often almost horizontal on the treatment chair. He or she can easily smell the dentist’s breath.

Soon after I began practising in Kent, I lived in local rented accommodation. I cooked for myself in the evenings, often preparing dishes with large amounts of delicious garlic.

One morning, Mrs G, a late middle-aged woman, attended my surgery. Soon after I had lowered the chair to a semi-reclined position, I commenced working on her teeth. In those days, the early 1980s, dentists did not routinely wear surgical gloves, nor did they wear facemasks. A paper facemask such as became ‘de rigueur’ after the beginning of the AIDs (HIV) epidemic, would not have prevented what was to occur after I began treating Mrs G.

After I had been at work for about a minute, Mrs G swept her hand in front of her mouth, and exclaimed: “Ooooh, Mr Yamey, you’ve been eating garlic.” I apologised, and from that day onwards I never ate garlic on a day before I was due to work.  

After I had been in practice for about twelve years, I began working in inner London instead of ‘extra-terrestrial’ Kent. My patients in London came from all over the world, and most of them ate at least as much garlic as I do. The garlic restriction that I exercised in Kent became unnecessary.

Parsley was another problem I faced when I first arrived in Kent. I used to buy my lunch at the local Tesco supermarket. Many of its employees were patients in the practice where I worked. In addition to sandwiches and potato crisps, I enjoyed eating something containing chocolate with my midday meal. Many was the time when the lady at the check-out till would hold my Mars bar or Crunchie up in the air, and then shout at the top of her voice: “Look what the dentist is eating.” I digress.

One summer’s day, I needed some parsley for something I wanted to cook. I entered the local Tesco and asked an assistant where this herb was kept in the shop. Surprised by my request, she answered: “Sorry, love, we only get that in at Christmas.” I was shocked. Only an hour and a half’s drive away in London, parsley was available throughout the year. The Medway Towns, where I worked, were trapped in a 1950’s time-warp when I first arrived there. By the early 1990s, when I shifted to London, the area was emerging gradually into the present.

Why I practised dentistry

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UCL 1 University College London Portico

University College London Portico

I retired from dentistry exactly one year ago. This is how I got started 36 years ago…

I began studying dentistry after I had completed my PhD in physiology in 1976. My original intention was to obtain a clinical degree so that I would be able to widen the choice of post-doctoral opportunities beyond the field of specialisation relating to my doctoral thesis.

I entered the dental school at University College London (‘UCH’) ‘armed’ with a doctorate. There were two kinds of teaching staff at the school. The academic staff were attached to the University and the clinical ‘demonstrators’ were dentists who came into the hospital on a part-time basis to assist with teaching in the clinics where the students learned to treat patients. All the demonstrators used to address me as ‘Doctor Yamey’, but the academic staff, many of whom did not have PhDs, used to address me as ‘Mister Yamey’.

At the end of each course we studied, we would have to pass an examination. This consisted of a written paper along with a practical examination. All of the examinations included a face-to-face spoken test, a ‘viva-voce’ (or ‘viva’).

During my pharmacology viva, I was asked several questions by a pair of examiners. One of the examiners told me that I had answered one question incorrectly. I was sure that I had answered correctly, so I said: “I am certain that what I have said is right.” The two examiners looked at each other, and I began to worry. Then, the examiner who had not contradicted me said: “You know, he’s right.”

During another viva, the task was to look at a microscope slide, and then to comment on it to the examiners. When I had looked at the slide, I turned to examiners, and thought I heard one of them saying: “Where is it from?” Absentmindedly, I said: “It’s an unusual surname. It originates from Lithuania.” I had thought that I was being asked about my name, rather than the slide. Fortunately, I was able to give a satisfactory account of what I had seen under the microscope.

At the end of the first year, we were examined in general human anatomy. I entered the room where my viva was being held and sat down with the two examiners. One of them, an external examiner, said to me: Do you remember me?” I looked at him blankly before he said: “I used to meet you walking on Hampstead Heath with your parents. Please give them my regards.” At that moment, I knew that I had passed the examination.

The final year examinations, which determined whether you would or would not be awarded a degree in dental surgery were quite harrowing. Most people considered that the viva conducted by the dean of our dental school and a dean visiting from another dental school was the most frightening part of the finals. And, when I took the finals, we learnt that the visiting dean, the external examiner, had a fearsome reputation. So, I was somewhat nervous when I entered the room to face the deans. After answering a couple of questions evidently satisfactorily, the dean of our dental school said: “Well, of course we’re looking forward to you joining our staff when you qualify…” At that moment, I realised that I must have qualified.  I said that during the five-year dental course, I had discovered that I enjoyed treating patients, and that I would enter practice rather than academia.

One of the many things that appealed to me about practising dentistry is the constant contact with a huge variety of people. This is not the case in academic research. It can be a lonely business. The other appeal of practising dentistry is that often, but not always, a problem can be identified and solved. Someone loses a filling. The dentist replaces it: problem solved. In academic research, as each question begins to be solved, many others present themselves: it is never-ending.

A narrow escape

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Ladbroke monument

 

My first job as a dentist was in a lovely practice in the Medway Towns. After having worked there for eleven years, I married and then lived in London. As it became tiring commuting by car between Kensington and north-east Kent, I changed practices. I worked for about nine months in north-west London in a practice where I was not happy. Then, I moved to another practice near Portobello Road. After about four years, the owner of that practice decided to open another branch in Maidenhead, Berkshire. I thought it would be interesting to work in a brand-new practice, and as Maidenhead was served by a good rail connection from Paddington, which is near my home, I decided to move to the new practice, where I treated its very first patient.

Usually, I boarded a local train that left Paddington a few minutes past eight in the morning. Just over half an hour later, I used to disembark at Maidenhead station, which was a couple of minutes’ stroll from the practice. Of the patients whom I treated there, the less said the better. My best memory of the place was that it was near a wonderful sandwich shop. The people who worked there had no idea about portion size control. So when I ordered my favourite sandwich, filled with prawn mayonnaise, it contained so much filling that I could hardly get my mouth around it.

One Monday evening, I returned to Paddington a little earlier than usual. Not being in a great hurry, I bought a ticket for the following Monday’s journey to Maidenhead.

On the following day, Tuesday the 5th of October 1999, I arrived at Paddington early as usual. Having already bought my ticket the evening before, I was able to take the train that left a few minutes earlier than the one I usually boarded. It left just before 8 am. The train I normally travelled on left a few minutes after 8 am.

I arrived at Maidenhead and began working. In those days, I used to have a radio running in my surgery. I heard a news bulletin that mentioned that there had been a terrible rail crash. I thought nothing of it until I returned to Maidenhead station that afternoon. I discovered, to my annoyance, that no trains were running as far as Paddington. They were all terminating west of Paddington at Ealing Broadway, where, fortunately, there is an Underground line which allowed me to continue my homeward bound journey.

It was only when I reached London that I learned more details about the crash. The train that I normally boarded every morning, the one which left a few minutes past 8 am, had collided head-on with a high-speed express train coming in the opposite direction on the same set of rails. Later, it was reported that 31 people had died and over 500 were injured. Most of the victims, killed and injured, were on board the train that I missed taking because I had bought my tickets on the night before.

There is a monument to those who died in the crash. It is near the large Sainsbury supermarket on Ladbroke Grove. Whenever I see this simple stone monument or think about the incident, I shudder. One of the names on that memorial could have easily been mine.

Whisky for my teacher

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teachers_scotch_whisky_70cl

During the last two years at dental school, we were assigned dental laboratory technicians to supervise us as we struggled to learn how to make acrylic dentures and gold crowns. Mr K was my crown technician. A friendly man, he used to listen to the problems that we encountered when trying to treat patients and, simultaneously, to deal with the often fussy and (necessarily) pedantic clinical tutors. Before any conversation could begin with with Mr K, the student would have to visit the canteen (two floors down) to fetch a cup of coffee for him and another for the student. Goodness knows how many litres of milky coffee entered Mr K during his working day.

When the number of days before qualifying began shortening rapidly, my fellow students and I began to look for practices where we could commence practising dentistry at last. One morning Mr K said to me that there was a dentist, Mr L, in the Medway Towns, who was looking for a newly-qualified associate. I had never visited the Medway Towns, which are about 80 kilometres south-east of London. A trip to the ‘country’ sounded attractive, and, who knows, I might have been offered a job. Actually, although surrounded by lovely countryside, the Medway Towns are far from rustic.

On the day before my interview, my father told me that Mr L had cancelled the appointment. I was saddened briefly, until my father told me that Mr L had said that Mr M, whose practice was in another part of the Medway Towns, was also looking for an associate. I rang Mr M, who asked me to visit him the next day.

Mr M turned out to be delightful. I knew that if he wanted me, I would enjoy working in his practice. He offered me the job instantly. I worked happily in his practice for eleven years until for practical reasons it became necessary for me to work in London.

Just after qualifying, one of my patients at Mr M’s practice asked me how long I had been a dentist. Not wanting to risk alarming the patient by revealing that it was less than a month since I had qualified, I answered: “I have been working in London for the last five years”. In dentistry, you need to think on your feet.

As I was leaving the practice to return to London after my interview, Mr M handed me a bottle of Scotch whisky. He said: “Give this to Mr K when you next see him.”

I did as I was instructed. When I spoke to a fellow student who had been directed to a practice by Mr K, I learned that a bottle of Scotch was Mr K’s fee or commission for finding associates for dentists who knew him.

I doubt that there are many employment agents or ‘head hunters’ that charge employers as little as the cost of a bottle of Scotch.

Keep your hair on

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Mr T was a regular attender at my dental surgery. Bald, he had a high pitched voice. For some years he made appointments on Saturday mornings because he commuted during the weekdays. He retired and then began coming to see me on weekdays.

One Thursday just before Mr T was due to enter my surgery, our receptionist rushed in and said : “Don’t be surprised when you see Mr T.”

A few moments later, a woman in fairly dowdy, quite unfashionable clothes walked in and sat in my dental chair. When this person with a good crop of hair greeted me, I recognised Mr T’s voice and his familiar face was framed by his unfamiliar hair. I looked at my dental nurse, and she looked back at me, astonished.

As I always did, I asked the patient whether he/she had any medical problems lately, or had to see the doctor lately. The transformed Mr T said “not at all.”

Puzzled, I performed the dental check up, and discovered that there was a tooth that required extracting. T consented to this and we arranged for him to return a week later. He/she left the room.

In those days, early in my career, whenever I performed a tooth removal I asked the nurse to support the patient’s head gently during the procedure.

As soon as T left the room, my nurse said to me: “Don’t expect me to support his head next week. What if his wig were to come off in my hand?”

A week later, dressed as before in dowdy women’s clothing and with a full head if hair, the previously bald and previously male-attired T turned up for his extraction.

Before commencing, T asked me in his high-pitched voice which was now in complete harmony with his female appearance: “Will this take long?”

I said: “Only a few minutes. Are you in a hurry?”

“Slightly,” T replied, “I am going shopping with my wife in a quarter of an hour.”

I suspect that throughout his working life, T had yearned to appear female, but only in retirement was he able to make his fantasy into reality. His wife must have been a very understanding woman.

Do they speak Welsh?

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MARS

One of the many patients, whom I treated while I was studying dentisty at University College London, was a highly intelligent senior civil servant. There was much work that needed doing in his mouth, so he visited my clinic frequently and we got to know each other reasonably well. At least, that is what I began to think.

 One morning, he arrived for his appointment and sat in my dental chair. After exchanging pleasantries, he said:

“You know those Martians, who have landed in Wales?”

“Mmmm,” I replied.

“Well, I’ve heard that they communicate without exchanging words.”

“Telepathy?” I asked.

“Yes, that’s it”

I turned away from him, ready to wash my hands, when he continued:

“Well, I was wondering whether when they are in Wales they communicate in English or Welsh.”

Feeling a smile coming on, I turned my back to him, and began washing my hands for long enough for my urge to laugh to wear off.

As the saying goes, it takes all sorts…

Ouch! Pull it out!

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dent 1

When I qualified as a dentist back in 1982, there was no vocational training period during which the newly qualified dental surgeon worked under the guidance of an experienced practitioner. Like others who graduated at that time, I was plunged into the ‘deep end’. I was fortunate that the owner of the first practice where I worked was understanding and helpful. He provided me with much valuable advice.

However, nothing can prepare you for the unexpected.

One day, a new patient sat in my dental chair. He spoke English with an eastern European accent. He may have been Ukranian. He said to me: “It is my philosophy that when I am having pain from a tooth, I remove it from my mouth.” Having just spent five and a half years training to save troublesome teeth, I asked him whether he was certain that he did not want an attempt to be made to save the tooth. He was adamant: he wanted the tooth out.

When he pointed at one of his upper incisors, a tooth that was visible when he spoke, I asked him again whether he would not prefer to save such a prominently visible tooth. Once again, he explained his philosophy.

With some reluctance, I administered the local anaesthetic to render the proposed extraction painless. While his jaw was going numb, I asked him once again whether he was sure that he wanted to lose the tooth. He did not change his mind.

It is usual to check for numbness the area around a tooth that is to be removed. This is done by prodding the area with a sharp-pointed probe. As I began to do this, the patient pushed my hand away sharply. Before I could ask him why he did this, he grabbed the offending tooth with his thumb and forefinger, twisted sharply, and cleanly extracted the whole incisor with its root intact. My assistant and I stared at the man, totally surprised.

He said: “All I needed was the injection. The rest I can do myself”. Needless to say, I did not offer him a discount.

 

dent 2

 

Pictures from “Der Zahnarzt in der Karikatur” by E Heinrich, publ. 1963