Seated above a cow

I HAVE WALKED PAST IT OFTEN, noticed it, but had never examined it carefully until a few days ago. I am referring to the statue of Edward Jenner (1749-1823) that surveys the formally arranged pools and fountains in the Italian Gardens at the north end of the Serpentine Lake. This body of water was created in 1730 at the request of Queen Caroline (1683-1737), wife of King George II.  Originally it was fed by water from the now largely hidden River Westbourne and Tyburn Brook. Now its water is pumped from three bore-wells within the confines of Hyde Park.

 

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Jenner is depicted seated in what looks like an uncomfortable chair, resting his chin on his left hand, his left arm being supported on an armrest.  The bronze statue was created by the Scottish sculptor William Calder Marshall (1813-1894). He also created the sculptural group representing ‘Agriculture’ on the nearby Albert Memorial. The Jenner sculpture was originally located in Trafalgar Square, where it was inaugurated in 1858 by Prince Albert, the Queen’s Consort three years before his demise. In 1862, the sculpture was moved to its present location in the Italian Gardens. Incidentally, the design of the gardens was based on those at Osborne House on the Isle of Wight and were created in 1860 to the design of the architect and planner James Pennethorne (1801-1871).

Jenner, a qualified medical doctor, is best known for his pioneering work in developing protection against smallpox. This derived from his experimentation based on his (and other people’s) observation that the pus from blisters that milkmaids received from cowpox protected them against the far more serious disease smallpox. Justifiably, Jenner has been dubbed the ‘father of immunology’. So great was his achievement that Napoleon, who was at war with Britain at the time, awarded Jenner a medal in 1803, the year Napoleon was planning to invade Britain with his recently formed Armée d’Angleterre. The French leader said:

“The Sciences are never at war… Jenner! Ah, we can refuse nothing to this man.” (see: https://www.nature.com/articles/144278a0).

Maybe, these words of the great Napoleon can still teach us something about international cooperation generosity of spirit.

His fame in the field of vaccination overshadows Jenner’s other achievements in science and medicine. He was a first-rate zoologist. For example, his observations, dissections, and experiment established for the first time that the baby cuckoo is born with a depression in its back that allows it to displace the eggs of the  bird whose nest the cuckoo has colonised. The baby cuckoo ejects his or her host’s eggs without the help of the adult cuckoo, which has deposited her eggs in the nest of another species. Jenner published his findings in 1788. This was a few years before he established the effectiveness of vaccination in the late 1890s. He self-published his results in 1898 after his most important paper was turned down by The Royal Society.

Getting back to his statue in the Italian Gardens, there are two features that I had not noticed before examining it carefully recently. One of these is a depiction of the Rod of Asclepius on the backrest of Jenner’s seat.  The serpent entwined helically about a rod is traditionally associated with medicine and healing. Beneath the seat, there is a depiction of a cow’s head. This is appropriate symbolism given the importance of cows in the discovery of smallpox vaccination. The word vaccine is derived from the Latin word ‘vaccinus’, which in turn is derived from ‘vacca’, the Latin for ‘cow’. There is an object depicted below the cow’s head, which I fancy, using a little imagination, might be a stylised depiction milk maid’s cloth hat.

Jenner was not the only person experimenting with inoculation against smallpox, but he is the person best remembered for it because his results and reasoning convinced the world of the concept’s validity and applicability.

Although I do not find the monument to Jenner to be particularly attractive, it is one of London’s statues least likely to arouse anger as its subject had nothing to do with slavery. In contrast to many other well-known figures of his era, Jenner should be remembered for his important involvement in a development that has benefitted mankind for well over two centuries. I hope that his scientific descendants currently working around the world in laboratories will be able to create a vaccine to counter the Covid-19 virus as soon as possible.

What? No gloves!

DENTISTS ARE FRONT-LINE workers, risking their lives for you. We put our fingers in people’s mouths and risk inhaling their expired breath and droplets of saliva and infected material. This has been the case ever since the start of human endeavours to resolve problems related to dental and oral pathology. I began hands-on dentistry in 1977 during the second year of my course in dental surgery undertaken at University College Hospital Dental School (‘UCHDS’). I qualified in early 1982 and worked in general practice until September 2017.

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At UCHDS we never wore gloves or masks while treating patients. The exception was for extractions that required minor oral surgery (cutting the gum etc.) when we were required to wear disposable latex gloves. For extraction that only needed forceps (‘dental pliers’) and elevators (wedge-like instruments), gloves were not required, but we did wash our hands between patients. When using the dental drill, we were required to wear safety googles over our eyes. What I have just described was what was considered correct practice at one of Britain’s leading dental schools. In those days, as in the future, any patient we treated was capable of harbouring nasty pathogens that could cause diseases such as tuberculosis, herpes, hepatitis B (and other forms of this virus), mycobacteria, fungi, and rarer diseases, all of which could have proved very detrimental to the clinician or his or her assistant.

The first practice I worked in was rightly considered to be one of the most ethical in the area. Once again, gloves and masks were not worn. Patients rinsed from a proper glass that was washed between appointments before being re-used. Instruments that had been used on a patient were placed in a bath of Savlon disinfectant for a while until they were needed again. All needles and local anaesthetic cartridges were single use only. At lunchtime and at the end of the day, all our metal instruments were sterilised in a hot air steriliser. It was not every practice that bothered to do this.  Horrified? Well, you might well be if you are old enough to have had dental treatment in the UK before the second half of the 1980s.

After I qualified, I subscribed to the New England Journal of Medicine with a vague idea of keeping up to date with medical science. Most of the articles were beyond my comprehension. However, in the mid-1980s, I began noticing many articles were being published about t-cells (a kind of white blood cell). What I only realised later was that these were being published because of the arrival and proliferation of a new threat to health: HIV (‘AIDS’). This epidemic prompted a dramatic change in how dentists operated. Almost overnight, we were required to wear gloves; advised to wear masks; commanded to sterilise instruments before re-using them; giving disposable single-use paper or plastic mugs for patients to use for rinsing.

What amazes me is that during the 35 years that I worked as a dentist, I never heard of or read about more than a handful of patients who were infected following dental procedures. There have been some newspaper reports of patients contracting HIV after seeing a dentist, but in some of these cases the mode of transmission was other than from clinical procedure. Over the years, I attended several lectures on the latest developments in cross-infection control. After each of these, I always asked the lecturer whether there was any scientific evidence that showed whether cross-infection controls in dentistry significantly affected patient mortality. Not one of these academic clinicians could provide an answer. One of them said to me:

“That would make a very good topic for a PhD.”

Whether they make a difference or not, modern cross-infection protocols make both the patient and the clinical team feel safer. I hope that everyone will feel sufficiently safe to be treated now that the atmosphere is infiltrated with particles of the Covid-19 virus. The nature of this highly contagious airborne pathogen justifies the many advances in cross-infection control that the profession has made since HIV appeared on the scene and will require further refinements especially in the field of air purification.

When I think back to my days of providing dental treatment with my bare hands and uncovered face, I am amazed that I and most of my colleagues never succumbed to anything much worse than fatigue and frustration caused by awkward patients.

 

 

Of doctors and Denmark

ONE OF MY TWELVE FIRST cousins, having just read my recent piece about Finchley Road in north London, reminded me about a hospital close to that road,  where she and her parents had received medical care. This reminded me that I had also been treated at that hospital many years ago. So, here is what you have all been waiting for: undergoing surgery in St Johns Wood.

One night early in 1962, I decided to see what it would be like sleeping on the floor with only the carpet between me and the floorboards in my bedroom. I have no idea what made me want to try that. I woke up the next morning, feeling a mildly uncomfortable sensation in my abdomen. It was not a feeling that I had ever experienced before. At first, I imagined that it had something to do with spending a night on the floor, but something made me decide to tell my mother about it. She was concerned about it and made an appointment to see our GP, Dr Clough, who had his consulting room in the ground floor of his home on Finchley Road, close to Golders Green Underground Station.

Dr Clough was a kindly man, a family friend. His waiting room had a large fish tank as well as the usual collection of well-thumbed magazines. His home was directly beneath an outdoor section of the Northern Line. Trains rumbled overhead every few minutes.

The doctor examined me and rapidly concluded that I had a ‘grumbling’ appendix. He told us that it should be removed, but there was no hurry to have the surgery carried out. He recommended a surgeon, who operated at the private St John and Elizabeth Hospital (a Roman Catholic institution) in St Johns Wood, not far from its Underground Station.

BLOG A Hospital_of_St_John_and_St_Elizabeth_(geograph_3306120) wikipedia

This station, which had, and still has, scraggy palm trees growing near its entrance, was close to the ground floor surgery of our ageing Jewish dentist, Dr Samuels, who was a refugee from Nazi Germany. His waiting room did not have a fish tank, but its floor was covered with luxurious oriental carpets, and the magazines in it were issues of the glossy paged Country Life. Dr Samuels’ surgery was in a block of flats, Wellington Court on the corner of Wellington Road (part of Finchley Road) and Grove End Road, on which the St John and Elizabeth Hospital is located.

I was installed in a private room with, to my great delight, a television for my exclusive use. My delight stemmed from the fact that we did not have a television at home. There were also chairs for visitors. The seat of one of these, which was nicely upholstered, could be removed to reveal a commode.

On the day before my operation, I was taken to a bathroom and told that after I had bathed, I was to call for a nurse by tugging on a cord attached to a bell-pull. There were several cords dangling near the bath. I pulled one at random. Then, I peered out of the slightly open bathroom door and saw a frenzied scene. Nurses were running hither and thither, some of them carrying oxygen cylinders. My nurse returned to the bathroom and told me that by mistake I must have pulled a cord attached to the fire alarm.

The operation went without hitch. I do not recall feeling much pain after it. I was kept in my private room for almost a week. Everyday, I watched as much television as I could. As I had been instructed not to get out of bed unless nature called and the television was far too old to be equipped with a remote control, I had to ring for a nurse each time I wanted to watch a different TV channel. When I pressed the bell button, a nun with a white apron (many of the nurses were nuns) would arrive and switched the channel. (The first time I ever saw a television with a remote control was in December 1963 in a hotel in Baltimore (USA). The controller was attached to the television by a long cable).

Many people including my parents and close family, visited me in hospital. Although this was very kind of them, I always hoped they would not stay long because while they were in my room I had to have the television – the best thing about being in hospital – switched off. It always amused me when a visitor sat on the seat that concealed my commode. I wondered what he or she would think or do had they known what was beneath them.

During the Easter holiday, which occurred a few weeks after I had left the hospital and gone back to school, we set out on a driving holiday to Denmark. We drove to Harwich, where I watched our car being loaded into the hold of the ferry in a rope basket lifted by a crane on the quayside.  We drove through Germany, a country in which my parents preferred not to linger longer than needed. We spent one night in a German hotel. It was there that we experienced sleeping under quilts (duvets) for the first time in our lives. We all thought they were a marvellous alternative to sheets and blankets.

In Denmark, we spent several days on a farm near Toftlund, which is about 23 miles north of (formerly ‘West’) Germany. The farm was owned by one of our former au-pair girls and her husband. My sister and I spent several glorious days mingling with the animals on the farm, mostly cows and pigs. This experience made this holiday one that I remember with great fondness. My mother, who saw danger everywhere, was most concerned that I should not be injured by any of the cows’ horns. She was worried that should a horn impact me, it might cause my recently healed surgical scar to split open. She had no need to be anxious. The weather was so cold that we were wrapped in several layers of clothing including thick duffel coats held closed with wooden toggles.

Our hostess’s father was an interesting fellow. He showed me houses in Toftlund that bore two kinds of house numbers, one blue with white figures, and the other red with white numerals. Between 1864 and 1920, Toftlund had been in what was then German ruled territory. One kind of house number had been affixed by the German authorities, the other by the Danish.  This made a great impression on my young mind. Since then, I have always looked out for small details, souvenirs of historic eras, like these.

My mother was so impressed by the duvets (‘dune’ in Danish) under which we had slept both in Germany and Denmark that she bought four down filled duvets in Denmark along with covers for them. These were transported on the back seat of our Fiat 1100. My sister and I sat on them for the rest of our holiday, which took us to Odense and Copenhagen before we returned to London.

We spent the Easter weekend in Copenhagen. Almost everything was closed and the temperature outside was very low. We wandered around trying to keep warm. The only warm place that was open were the tropical houses in a botanical garden.

Our return trip was not without incident. We broke down in the German border town of Flensburg just after leaving Denmark. Some electrical component needed replacing. We had to wait about four hours for a replacement part from a company I had never heard of before: Bosch. Well, I was about to become ten years old. So, perhaps it was not surprising that I was unfamiliar with the names of German companies. Whenever I hear the name Bosch or the French word for the German invaders during WW2, Boches, I always remember our four hour wait, parked next to an inlet of the sea in an industrial landscape.

We returned to London. My scar had not burst open. Our four blue cloth covered duvets filled with duck down were intact. After our return to London,  we never again used blankets and the hitherto tiresome job of laying beds was replaced by the relatively simple task of spreading the duvets over the beds. I believe that we were amongst the first households in the UK to use duvets.

Of the four duvets we brought to London from Denmark, I kept and used one of them for about 48 years. Reluctantly,  we disposed of it because over the years it had lost most of its feathers. I have got so used to sleeping under duvets that when I stay somewhere which had tightly tucked sheets and blankets, I have to untuck them fully.

Since my youthful experiment of sleeping on the floor, I have only repeated it when camping. And, when in a tent, I like to separate myself from the ground with a fully inflated air mattress. On the one occasion when I had no air mattress, I barely slept and barely escaped contracting pneumonia, but that is another story.

An appendix usually follows a story or text but in this case, it is at the start of my story. I have lost a short and, apparently, useless evolutionary intestinal vestige, my appendix.  Thinking about its loss and the good time I had at the St John and Elizabeth Hospital, has triggered a chain of memories of an era long past. I hope that I will not be deprived of any more parts of my anatomy, especially whatever keeps alive my recollections of the past, many of which I enjoy sharing with anyone who is interested.

 

Picture of Hospital of St John and Elizabeth (from Wikipedia)

 

Annoying and rude

During the last few years that I practised dentistry, most of my patients brought mobile telephones into my surgery.

You would be surprised how many patients tried to answer their ‘phones when my fingers were in their mouths or their mouths were filled with impression (mold taking) material.

Worse still, were patients who were ‘texting’ constantly when I was trying to explain their treatment options to them.

Once, a patient arrived late, speaking on his mobile phone. He muttered to me that he was in the middle of a telephone job interview. I had no choice, but to let him continue. After half an hour, he told me he was ready for me. I told him that he had wasted my time and his appointment and had to book another one.

In the end, I put up a large sign in my surgery forbidding the use of mobile phones, which was rude and inconsiderate. This solved the problem because, to my surprise, most people obeyed it.

Going viral

Two bees or not two bees_240

I hope that I am not tempting fate by writing this!

I am puzzled by the excessive anxiety over the coronavirus outbreak, which is encouraged by politicians and the press.

On the one hand, the public is informed that the virus outbreak will lead to dire consequences on a global and local scale.

On the other hand, we learn that apart from a couple of susceptible groups at the two extremes of the age range, being infected by the virus is highly unlikely to cause the infected person to suffer much if anything at all.

What are we to believe? Should we be panicking as our politicians seem to be suggesting, or should we not let the coronavirus affect our mental harmony?

Whatever the answer, it is best to be careful!

 

Finally, here is a thought provoking article to read:

https://www.psychologytoday.com/gb/blog/culture-mind-and-brain/202002/the-coronavirus-is-much-worse-you-think 

 

Fears of the dentist

Faces

Most people are very apprehensive about making a visit to the dentist. But, how many dentists are filled with apprehension at the prospect of seeing patients? Almost every day during my 35 years of practising dentistry, I walked into my surgery with a feeling of worry, concern about what might happen during the day.

The average non-dental person might not realise that treating patients is like walking on thin ice. With many patients in the UK just itching to sue the dentists, whom they fear, even the slightest thing might lead to a legal confrontation between the patient and the dentist. Clearly when a patient suspects that the dentist has made a clinical error, pulled the wrong tooth for example or made a filling that keeps failing, recourse to compensation is sometimes reasonable. However, something far less ‘life-threatening’ like a verbal misunderstanding can lead a litigious person to attempt to obtain remedial compensation. So, to avoid trouble and also to ensure that a patient leaves satisfied, the prudent dentist must treat each patient with tact, delicately, and clinical excellence. All that seems quite reasonable.

However, there are patients, whom the dentist dreads. The very sight of their name on the day’s appointment list can ruin the dentist’s day from the moment he spots it. These people, many of whom I wish I had been courageous enough to dismiss, often exploit the dentist’s desire to provide them with excellence. They ask for the impossible, or for things they know that they cannot possibly afford, and they are never satisfied. Worse still, they keep coming back to the surgery for minor matters, which are often unresolvable because of their sad personalities. I may sound a bit harsh, but many of the persistent complainers that I saw were unemployed, receiving their treatment free of charge (because of state subsidies), and had little else to do apart from sit in dentists’ waiting rooms.

Then, there are the dental obsessives. These patients are often quite charming until they reach the subject of their teeth. Even what you and I might hardly notice becomes a major problem for them, even a life crisis. They will keep asking the dentist to redo some small repair on a tooth because they, and only they, can perceive that there is some minute imperfection. And because of fear of complaints and litigation, I used to plough on with these people and long for retirement. Sometimes, I felt like telling them that in the grand scheme of life, a minor ‘defect’ in the teeth is nothing compared with having a major illness, or starving during a famine, or being injured in a traffic accident, but I ‘bit my tongue’.

Despite my continual anxiety about keeping the patients on my side, there was the odd occasion when a patient was genuinely grateful for something I had done. Those expressions of gratitude were worth more to me than whatever fee my treatment had attracted.

So, next time you have to visit the dentist and are filled with fear, spare a thought for the dentist, who might well be feeling the same as you, but cannot show it because it would wreck your confidence in him or her.

 

It has its uses

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In the UK, unlike some countries in Europe, we have a fairly liberal attitude towards Moslem women covering their heads and faces to a greater or lesser extent. In the last dental practice where I worked until I retired, our patients came from all over the world. A not insignicant number of our female patients were Moslems who wore some kind of head covering. A few of them insisted on being treated by female dentists, but most of them did not mind seeing one of the male dentists.

One of my female Moslem patients came to the UK from a north African country. She always wore a loose-fitting headscarf, but did not cover up her face. One day, she needed to have a front (incisor) tooth removed. I explained to her that the situation was such that she would have be without any replacement for it for 24 hours – I cannot remember why. 

Will you be able to cope without that tooth for a day. The gap will show every time you speak or smile,” I said.

Picking up the end of the scarf she was wearing, she covered her mouth with it, and then said humorously:

This has its uses!

And with that comment, she allowed me to remove the troublesome tooth, and then left the surgery with her face covered. She looked like a typical Moslem woman wearing a face-covering. Nobody would have guessed that she was missing a front tooth.

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)]

Through the tongue

During my three and a half decades working as a dentist, I have been assisted by numerous ladies varying in age from sixteen to over seventy years. ‘Carly’ was one of them. When she joined me in a practice west of London, it was the first time she had worked in a dental practice. She was a quick learner, but far from discreet.

CARLY

When we had a new patient, we recorded the person’s details on the outside of a record card. One day, a smart-looking woman sat down in my dental chair, a new patient, and I asked her for her personal details: name, date of birth, address, and so on. Carly entered the information on the record card. When we had finished, Carly asked the patient:

“Are you M.R.S. or M.I.S.S?”

The lady replied:

“Miss.”

Quick as a flash, Carly said:

“I can’t see why you ain’t married. You ain’t ugly or anythink.”

The lady took this quite well. She could see that Carly meant no harm.

One Monday morning, Carly arrived and said to me:

“Ere, look at this”

She stuck out her tongue, which had a shiny silver-coloured metal stud pierced through it. I was lost for words for a moment, and then asked her if it was uncomfortable.

“No, it ain’t,” she replied, “It makes eating spaghetti difficult, though. It gets caught up on it.”

All morning, whenever a patient sat in my dental chair, she would tap the patient’s shoulder, and then say: “Wht d’ya think?” before sticking her tongue out to display her stud to the person in the chair. Most of the patients were either politely complimentary of just smiled. By now, my regular patients had got used to Carly and her friendly but cheeky manners.

Another day, Carly arrived at work. Very excitedly, she told me:

“You’ll never guess how much I paid for a large pack of prawns at Tesco’s.”

“Four pounds?” I guessed.

“No, just a quid.”

“That’s a good bargain,” I said.

“What me and me boyfriend do,” Carly explained, “is we swap the labels on the packets in the chiller so that we get the special offer prices instead.”

“Be careful,” I advised.

On yet another occasion, Carly arrived at work looking distressed. I asked her what was wrong.

“I crashed me boyfriend’s car.”

“But you haven’t got a license have you, Carly?”

“No, but I was drunk. I got in his car and drove it backwards into a lamppost.”

I am sure that the boyfriend was not pleased because throughout the day Carly was rung up by him on her mobile ‘phone. She would go out into the corridor, but because she was screaming at her chap so loudly, everyone could hear her.

During one appointment, I was beginning to scale (remove the dental tartar or calculus) a lady’s teeth. After a few minutes, while I changed instruments the lady, a well-dressed woman with airs and graces, asked me:

“Excuse me, Mr Yamey, but what exactly are you doing to my teeth?”

Before I could answer, Carly replied quickly:

“E’s cleaning the crap off yer teeth.”

The patient seemed quite happy with this simple summary.

Despite Carly’s occasional rather undignified comments, she was an excellent assistant. Patients appreciated her unpretentious, friendly, open approach and the fact that she was rarely silent. After a few months, when she had gained some experience, Carly left our practice to take up a better paid position in another dental practice. Some weeks after she had been working there, she dropped into our surgery to say ‘hallo’. I asked her how she was getting on in her new job. She replied:

“It’s ok, but they have told me not to open my mouth during the day.”

Picture source: “Der Zahnarzt in der Karikatur” by E Hinrich (1963)

Pull it out…

After qualifying at University College Hospital Dental School in early 1982, I practised dentistry for another thirty-five and a half years. I never owned my own practice but worked in those owned by other people. I worked in a total of five practices. With exception of one practice, where I worked for less than eight months, I enjoyed the conditions of the rest. None of my ‘bosses’ (i.e. the practice owners) appeared to mind how much or how little I earned for them and how much time I took off for travelling. I am grateful to them for their tolerant attitudes towards my laid-back approach to work.

My first boss, ‘J’, provided gave me a smooth introduction to the trials and tribulations of general dental practice. He was always ready to give me advice if I needed it, but gently encouraged me to take control of my decision making so that I became in charge of what I was doing.

During the first few months of being in practice, I often encountered difficulties when extracting teeth. Maybe, at that time I had insufficient experience to know when an extraction was likely to be too difficult for me to perform. Maybe, some teeth are just very hard to extract. This is the case.

If I got stuck midway through an extraction, I would ask my dental nurse to summon J. When J, who was very skilled at extracting teeth, arrived, he would work on the tooth up to a certain point. Then he would say to me that I should finish the job. He could have easily completed the extraction himself, but he wanted me to do it so that my patient would not lose confidence in me. I feel that this was extremely kind of him and will always be grateful for his sensitive approach. Later in the day, when there were no patients about, he used to take me aside and explain what he had done to loosen the tooth. Thus, I learned how to improve my technique.

As the years passed, my ability to perform extractions, even difficult ones, increased. Often, I would extract teeth that my colleagues would have referred to specialists. Although some of my other dental skills improved over the years, It is sad to relate that what I became best at was removing teeth rather than saving them!

PS: dentists never PULL out teeth; they use various techniques to widen the tooth socket and to split the collagen fibres that hold the tooth in the socket.

Picture source: “Der Zahnarzt in der Karikatur” by E Heinrich (1963)