A new skill

A progressive disease is one that keeps getting worse.

Waiters in restaurants used to confine themselves to serving food and drinks to customers.

With the advent of digital cameras and mobile telephones with built-in cameras, things have changed. Waiters need to become competent photographers, able to use any kind of image capturing device handed to them by customers seated around a table. Not only do these carriers of food need to be able to operate whatever camera is handed to them, but also they need to be good at composing photos, and many of them are.

When I first began practising dentistry back in 1982, dentists confined their activities in the surgery to dental matters. When I retired 35 years later, not only did we dentists still deal with dental matters but also with general lifestyle behavioural assessment and advice.

Like the waiters, our additional workload is rarely appreciated or adequately rewarded.

Is this progress?

The whole tooth

I often wonder why dentists all over the world advertise their practices with a whole tooth, crown and roots.

Most people, apart from some with knowledge of anatomy, are aware of teeth being more than what can be seen in the mouth: the crowns of the teeth, which are covered with off-white enamel. Unless they have a tooth extracted, the majority of people never see the roots which help to keep the teeth on the mouth.

A more appropriate symbol for alerting people’s attention to a dental practice is a row of tooth crowns arranged as a smile.

Although the whole tooth might be the truth, a row of teeth as seen in the mouth should make more sense to someone seeking a dentist.

Photos taken in Hyderabad, India

Two professions

We made several visits to Central Europe in our car during the mid-1990s.

CZECH

Twice during those years, we drove to the Czech Republic, entering it from the eastern edge of what had formerly been prosperous West Germany. The Western part of the Czech Republic, which had been the largely German-populated Sudetenland before 1945 is thickly forested with tall dark pine trees. We were dismayed to discover that for the first ten or so kilometres beyond the border, the roads through the Czech forests were lined with ‘gentleman’s’ clubs and prostitutes.

When we were in the middle of one forest, the rain began pouring down. At the corner of a road junction in the middle of the wood, we saw a young lady dressed in a shiny red jacket with matching short hot pants. Our three-year old child saw the woman, took pity on her, and said:

“Shouldn’t we offer her a lift.”

The innocence of our child was touching.

Hungary is south of the Czech Republic. In the late 1990s, we drove into it from Austria. For the first few kilometres of Hungarian territory, we saw no prostitutes, but numerous dental surgeries with signs both in Hungarian and German. Often the dental surgery was in a little compound that included a restaurant and a food shop. The presence of so many dentists offering their services so close to the border with Austria suggested that dentistry in Hungary was good value compared with that in Austria. And, while a member of an Austrian family is having his or her teeth repaired, the rest of the family could enjoy a good Hungarian meal and buy some tasty souvenirs to take back home.

Dental tourism is still popular in Hungary. English newspapers frequently contain adverts encouraging people to obtain supposedly cheaper dental treatment in Budapest.

The proximity of Bohemian prostitutes to the Czech border and Magyar dentists equally close the Hungarian border made me consider a possible uncomfortable comparison. I wondered whether people ever see some similarity between the two professions. I hoped not!

Never judge a book by its cover: a dental tale

During my last few years in dental practice, I entered my seventh decade of life; I passed the age of sixty. In a way it was creepy: I had become older than my mother was when she passed away, having suffered painfully during the last few months of her life.

DENTURE

[from Wikipedia]

As a dentist, I knew the age of all my patients. Their dates of birth were recorded on their record cards. I used to look at people of my age, and either think that I was looking good compared to them, or that they were doing better than me. Generally, everyone looked young in my eyes, even those who were my senior. Those, who were younger than me usually, but not always, looked young. Interestingly, those, whom I knew to be much older than me did not look as old to me as I might have thought when I was younger. For example, patients in their seventies and eighties would have seemed ‘ancient’ to me when I was in my thirties and forties, but having reached my sixties, they no longer looked so old from my vantage point.

When I was in a dental practice in Kent during my thirties, I worked with a young girl, ‘T’, a first-class dental surgery assistant. She must have been in her late teens or very early twenties at the time. In that practice, we received the record cards of new patients before they entered the surgery. One day, T handed me the record card for a new patient, ‘Mrs M’. As she did so, she said:

“Look, she’s eighty-nine. What can she possibly want at her age? Surely not new teeth – she won’t be wearing them for long.”

Mrs M strode into the surgery and looked around.

“What lovely linoleum flooring,” she said, “where can I get some of that? It would suit my new kitchen.”

“I’ll find out for you. Please sit down. Make yourself comfy,” I said, “how did you get here?”

“I took a taxi, dear, but now that I know where you are, I’ll drive myself next time.”

I carried out the preliminary dental examination, and agreed a treatment plan with Mrs M.

“It will take four or five visits to make your dentures,” I explained.

“That’s alright, dear, I’ll fit them in around my work.”

“What is that you do?” I enquired.

“I do the accounts for my son’s business, dear. Keeps me occupied,” she said, getting up to leave.

When the patient had left the room, I looked at T and said:

“Never judge a book by its cover, or a patient by her age.”

 

Riding along in my automobile

I was just nineteen when I took my first driving lesson. I was staying in Harlow (Essex) doing my first holiday job (at Beecham’s pharmaceutical research laboratories). I used to have the lessons after work during the early evenings when there was little or no traffic on the roads.

DRIVING

Driving in Bavaria: my car in 1986

I found it very difficult to coordinate hands and feet, so that gear changing presented me with quite a challenge. I drove slowly, especially when approaching traffic signals when they were turning red.  I could not face the palaver of foot brake, handbrake, clutch, and gear synchronisation that was needed when stopping at a red signal. Occasionally I drove so slowly that the car almost stopped moving. After about six lessons, the instructor said to me:

“You are my first pupil whom I have had to ask to drive faster.”

A couple of lessons later, he told me sadly:

“You are going to take much longer to learn to drive than most other young people.”

I knew he was right, and we agreed not to have any more lessons.

Twelve years after my summer job in Harlow, I began practising dentistry in the Medway Towns (in north Kent). I took up the job there in April 1982. I was still unable to drive. I rented ‘digs’ near the practice. In the evenings after work, there was little in the way of public transport in the area apart from the railway that connects the three main centres of the Medway Towns. I decided that life in this part of the world would be very dull if I did not learn to drive.

One of the dental nurses in the practice recommended a driving instructor, Mr B. I decided to take an intensive course of driving lessons, paying for three or four hours a week. Mr B’s method of instruction suited me well. I learnt in a car with dual controls. My instructor, who sat in the passenger seat beside me, had a clutch and brake pedal that he could operate if necessary. Occasionally, he would operate them, and I would say to him:

“I was just about to brake when you operated your controls.”

Mr B would reply:

“If I need to use the dual controls, then I feel that you did not make the right decision in time.”

After about six weeks, Mr B considered that I was ready to take the Driving Test, which I booked. The test was scheduled for ten o’clock one weekday morning. The Test involved driving the examiner along local roads. During the drive, the candidate is asked to perform several prescribed procedures, such as: reversing around a corner; a hill start; an emergency stop; and parking the car. At the time of day when I took the Test in Gillingham, one of the Medway Towns, there was almost no other traffic on the roads. This made things easier for me. Also, I was able to anticipate when the examiner was going to ask me to perform this or that prescribed manoeuvre. I passed the Test, the last important exam I have ever taken. I attribute my success to two factors. One of them was Mr B’s superb tuition. The other was dentistry. Let me explain.

During the five years prior to my Driving Test, I studied dentistry. Many of the clinical procedures I learnt involved using the dental handpiece (drill). The speed at which the bur (drill bit) rotates is controlled by a foot pedal. Where and how the drill cuts is controlled by hand movements. I had learnt to drive a dental drill. Driving a car, with the feet/hand coordination it involves, became simple for me after my dental training.

Soon after getting my Driving Licence, I bought a second-hand car. On the first day, a Thursday, I drove it to and from the Savacentre, the local supermarket, three miles from my flat. On the Friday evening, I drove through the countryside to Faversham, which was twenty miles from where I lived. On the Saturday, after finishing my morning clinic, I set off for north London, sixty miles away. It was the first time I had driven on a motorway. That was not too bad but driving across the metropolis of London felt like a bad dream. I had never driven in heavy traffic before. By the time I had crossed south London and the River Thames, I had developed a severe headache. When I reached a major, congested traffic intersection in Camden Town, I felt like getting out of the car and abandoning it. Things reached rock bottom, when the driver of a car near to mine leant out of his window and yelled at me:

“Bloody Sunday driver.”

Late on the Sunday night, I set off to drive back to Kent. Being late, there was less traffic than there had been in London on the Saturday afternoon. I had planned to cross the river using the Blackwall Tunnel. However, I missed the turning for it and found myself on a dual-carriageway that led inexorably eastwards away from London. Every now and then the road crossed intersections on steeply humped fly-over bridges. I knew that eventually I would reach the Dartford Tunnel that passes beneath the Thames, but I was getting cold and lonely as I drove through a darkened industrial landscape and then through countryside that seemed featureless late at night.

I drove through the long tunnel beneath the Thames. When I reached the toll-booth on the Kent shore, I paid the toll to a man sitting in a lighted booth and thanked him. It was a relief to be able to talk to someone, even for a few seconds, after the lonely journey I had just made.

The next few journeys I made to London always resulted in me getting a headache, but eventually I began to enjoy driving. I enjoyed it so much that later on I drove several times from England to Hungary and farther afield to the former Yugoslavia, often on my own and enjoyed every minute of the journeys.

It’s enough to drive you around the Benz

Of my attempts to learn to drive a car, I will write on this subject at another occasion. Suffice it to say that by the summer of 1982, when I had been practising dentistry for several months, I passed the Driving Test at the age of thirty years. I began to enjoy driving and cars in general. I changed my car often. Over a period of eleven years while I practised in Kent, I possessed (in the following order): an Austin Allegro, a Volkswagen Polo, a Volvo 340, then two Volvo 240s, and then a Volvo 850. The last two cars I owned after those were Saabs.

 

MERC 2

 

Some time during my eleven year stay in Kent, I fancied owning a Mercedes Benz. In my mind, this make of car rated above all others. Apart from the company’s long heritage (it started in the late 1880s), the cars it produced were reputed to be strong, reliable, and very roadworthy. It is of interest to note that Adolf Hitler rode around in Mercedes cars. I suppose he must have known that the Mercedes in the company’s name was chosen because Mercedes was a daughter of Emil Jellinek (1853-1918), a motor manufacturing entrepreneur who created the Mercedes trade mark in 1901. Emil, the son of a rabbi, was married to Mercedes’ mother Rachel Goggmann Cenrobert, who was of French-Sephardi descent. Therefore, the car Hitler enjoyed was named after a Jewish woman. But I digress.

A new Mercedes Benz dealership opened close to the practice, where I worked. One lunchtime, I drove to the dealership to test drive a Mercedes estate car. A salesman drove me about a mile, and then let me take the wheel on the way back. At a certain stage, I needed to operate the handbrake. I looked for it in the usual place on the central console that separates the two front sets, but it was not there.

“Where is the handbrake?” I asked the salesman.

“I have no idea,” he replied, “I have never driven this model before.”

He thought for a minute, and said:

“Try that handle beside your left leg.”

He was right, but my confidence in him diminished.

When I had driven the car back to the dealership, I asked to be shown some pre-owned cars, as the new ones were way beyond my price-range.

Another digression seems appropriate at this point. Many years after visiting the Mercedes dealership, I hired a car at Heathrow Airport. It was an up to the minute luxurious Vauxhall estate car. A charming young Asian lady handed me the keys and told me where to find the vehicle. I sat in the driver’s seat and started the engine. Immediately, I noticed a warning light telling me that the handbrake was engaged. I looked for the handbrake. It was neither on the central console nor was there a handle near the foot pedals. I was flummoxed. I returned to the car hire office feeling rather foolish and described my problem to the young lady. She smiled before explaining that the handbrake was operated by a small button on the central console near the gear change stick. After returning to the car, I found the button, which was no bigger than the surface of a dice such as is used in board games. It was flush with the rest of the console and looked like a decoration.

 

MERC 1

 

I was quite taken with a greenish Mercedes saloon car, which was almost favourably priced, but still some way beyond my reach. The salesman opened the vehicle and invited me to sit in the driver’s seat.

“What do you think?” he asked.

“Very nice,” I replied, “but I’m not so keen on that plastic trim on the central console around the gear stick.”

“Sir,” he exclaimed, affronted, “that’s not plastic. It’s highly polished wood trim. The very best. This is a Mercedes, you know.”

“Sorry,” I replied, not totally convinced, and continuing, “I like the car. Are you prepared to lower the price?”

“Oh no, sir, that is totally against our company policy. The price we offer is the only price. Our company does not haggle.”

Lunchtime was nearly over, so I said that I would think about the car and would let him know my decision soon.

Twenty-four hours later, I was eating my lunch in the practice when the telephone rung. One of my colleagues answered it and then handed me the receiver. It was the salesman, whom I met the day before.

“Mr Yamey,” he said, “I have good news for you. I have spoken with my manager, and he says that we can offer you the car for £1000 less.”

“Thank you,” I replied, “let me think about that.”

Even with the discount, the car was still beyond my means.

 

merc 3

 

Twenty-four hours later, two days after visiting the Mercedes dealership, I received another call from the salesman, again whilst I was eating lunch.

“I have more good news for you, My Yamey,” he began, “my manager has authorised a further thousand-pound reduction in the cost of the car you are interested in. That’s a discount of two thousand pounds. Makes the motor very reasonable, don’t you think?”

I told him that I was not sure about buying at that moment, and that I would get back to him if I changed my mind. I had by then decided that not only was the car too expensive even with the unexpected discounts from a firm that never offered discounts, but, also, I was actually happy with the car I already owned.

Good Friday

Years ago, I knew a dentist, who owned his own practice. His residence was in the same building. His patients could ring him any time of the day or night. If there was an urgent out-of-hours problem, he would usually open the surgery and try to help the unfortunate patient. Most of his patients were considerate and did not ring him at inconvenient times. However, once someone rung him at three in the morning. The caller said that his toothache was so bad that he was unable to sleep. My friend, an intelligent man, said to him:

“You come and see me at eight in the morning. That way only one of us will have a sleepless night.”

 

boy

 

Occasionally, I had to be ‘on call’ for out-of-hours and weekend emergencies. When I worked in Kent before the widespread use of mobile ‘phones had begun, I had to carry a small radio receiver in my pocket during the hours I was ‘on-call’. If the gadget bleeped, I had to ring the telephone number of some remote call-handling centre. The centre would then provide me with the telephone number of the person in trouble. Usually, the ‘emergency’ turned out to be someone wanting to make or cancel a dental appointment in the middle of the night or on a Sunday or bank holiday. There was little I could do about these abuses of the emergency system.

One Easter weekend, I was contacted by a mother, whose son’s front tooth had snapped off and he was in pain. I asked the caller to bring her son to see me in the surgery, which I opened specially for her son. The boy arrived. The situation was not good. The child had managed to snap off a lateral incisor, leaving the root below gum-level. The tooth was un-saveable and needed to be removed. To extract it, I knew that I would have to perform some minor surgery, lifting the gum and then replacing it (using sutures). It was a job that would have been difficult to perform alone without an assistant. Fortunately, I had the ‘phone number of one of the practice nurses, who lived nearby. Luckily, she was able to come to assist. The operation was done without problem.

When I had finished treating the child, the mother neither thanked my assistant nor me.  She was typical of many National Health Service (‘NHS’) patients, who do not appreciate what is done for them because it is done free of charge. Many of the services provided by the NHS are free, and because of this a proportion of patients show no gratefulness. They take the system for granted, feeling that what is done for them is their birth right.

It was Good Friday morning when this emergency treatment was carried out. The boy’s mother said:

“What a shame that this happened today of all days, Good Friday.”

Silently, I agreed with her. I said:

“Well it’s been a bad Good Friday for your child.”

After a few moments, I added:

“It was also not an awfully good day for Jesus Christ.”

The mother gave me a dirty look, and then took her child home.

 

[Picture source: “Der Zahnarzt in der Karikatur” by E Henrich (1963)]

Turn it off!

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

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…

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.