Extracting the truth

EXTRACTING TEETH IS still a significant part of the job of a dentist.

When I qualified as a dentist in 1982, I joined the practice in Rainham (Kent) run by Julian U. He was a generally competent dentist and very skilful when it came to extracting teeth. If, as it happened from time to time, I was having difficulty removing a tooth, he would come into my surgery to apply his skill and experience to the problem at hand. Whenever he did this, he would work on the offending tooth, but would stop when he knew I would be able to complete the operation.

Julian could have easily finished the job himself, but he left it to me to do this for a good reason. He knew that if I removed the tooth, the patient would believe that it was my skill that contributed to the successful conclusion of the operation and therefore would not lose confidence in me.

Later in the day, after the patient had left, Julian would explain to me why I  had had difficulties and how to avoid repeating the problem. He was a great mentor as I began my career in dentistry.

The NHS used to pay a standard fee for an extraction. If an extraction proved to be particularly difficult, involving bone removal for example, the practitioner could write to the NHS explaining why the operation was not simple and enclosing a radiograph (xray image) of the tooth in question. In these cases, the NHS used to pay a larger fee than the standard one.

On one occasion when I had not taken a radiograph prior to an extraction because I  had assumed it would be simple, the operation proved to be very difficult. After completing it, I  applied for the supplementary fee but did not receive it because I  had not submitted a preoperative radiograph.  I was furious not only because I had not been adequately remunerated for my effort but also because my word had been doubted.

Some months later,  a distressed couple brought their infant to my surgery. The child had chewed on a keyring and it had got stuck between two teeth. Carefully, I cut through the ring and thereby removed it from the kid’s teeth.

Still smarting from my failure to convince the NHS that my extraction of a few months earlier was truly difficult, I  wrote up my keyring removal and applied for a fee for this unusual procedure.  I explained that neither had I taken a radiograph (because it was unnecessary) nor was I  able to send them any evidence, such as the remains of the keyring because the parents had wanted to keep them. I waited patiently for the NHS to reply, which they did. To my great surprise,  they believed my story without me sending any evidence and paid me a decent fee. Nowadays, it would be unwise to perform any extraction without having taken a preoperative radiograph. This is not for the purposes of seeking enhanced remuneration but to protect the practitioner should the patient decide to make a complaint against the dentist. Sad to say, but by the time I retired, preventive dentistry acquired a new meaning. In addition to preventing dental disease in patients, it has also come to mean preventing the dentist from litigation and defending him or her when malpractice is alleged.

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.

BLOG GLOVE Silvi_1024

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)

 

Eye wash in Sarajevo

In the late 1970s and throughout the 1980s, I used to visit the former Yugoslavia, where I had and still have many friends. Often, I stayed in Sarajevo (now in the Republic of Bosnia and Hercegovina), with Marija and her family. Here is something that happened on one of my visits. The account comes from my book about Yugoslavia, “SCRABBLE WITH SLIVOVITZ”.

Cross eyed_500

Marija, my host in Sarajevo, lived alone in her flat. Her husband, although an ardent communist, had fallen foul of Tito’s regime. Since the late 1940s, he had spent most of his life in prison. Many years after my last visit to Sarajevo, Liljana told me that her father used to be released from jail occasionally for short periods only to be re-arrested and re-incarcerated soon after. I was not clear about what he had done to deserve this. He must have been the ‘wrong kind’ of communist. Maybe, he had been a Stalinist and/or a supporter of Cominform. This organisation’s headquarters were in Belgrade from 1947 until 1948, the year when Yugoslavia’s relationship with Stalin’s Soviet Union began to go sour and the country was expelled from Cominform. It is possible that it was Stalin’s militant antagonism to Yugoslavia in the late 1940s that helped Tito to unify his ethnically diverse population.

During one of my visits Sarajevo, I noticed that the white part of one of my eyes had become completely red. It was a little uncomfortable as well. I hoped that no one would notice it; I wanted to avoid any fuss. So, I set off one morning to find a pharmacy, hoping to buy an eyewash, something like the British product ‘Optrex’.

As there was no way that I could possibly have explained what I wanted using my rudimentary knowledge of Serbo-Croatian, I decided that I would have to try to act out what I wanted. I wandered along the chilly snow covered streets, puzzling over how to do this. In the end, I felt too shy to try to attempt the necessary charade. I hoped that with the passage of time my eye would heal.

When I returned to Marija’s flat that evening, she immediately noticed my eye. In French, and sounding worried, she said that I might have caught something that sounded to me like ‘retinit’, a disorder about which I knew nothing. She succeeded in alarming me greatly by saying that there was an epidemic of whatever this was in Sarajevo, and that many people were being blinded by it. Next morning, she told me, she would take me to see a friend of hers, an ophthalmic specialist, at the university hospital. This also worried me. I remembered the depressing looking hospital that I had seen many years earlier when I was visiting Peć in Kosovo. My enduring image of that place was of its pyjama-clad inmates leaning out of upper-floor windows and hauling baskets of food up on ropes from their relatives, who were waiting outside the building on the ground below. The hospital in Sarajevo was nothinglike that.

I was introduced to the lady ophthalmologist, who then seated me in a special high-backed chair. A white-coated nurse approached me, carrying a syringe fitted with a long, broad-gauge needle. I must have winced in anticipation because Marija said,
Ne t’inquiétes pas. C’est seulement une piqûre.” (Don’t worry. It’s only an injection)
An injection … in my eye: I did not like the thought of that. She
laughed again, and said,
Regardez, le dentiste a peur d’avoir une piqûre!” (See, the dentist is afraid of having an injection)

Eventually, the nurse managed to squirt some liquid onto the surface of my eye, rather than into its interior, as I had feared was going to happen. The ophthalmologist examined it with her special equipment. It turned out, to my great relief, that I had an attack of conjunctivitis, which could be easily cured with the eye-drops that she gave me. After the clinical examination, we retired into her office. She rang for an assistant, who returned with cups of Turkish coffee and a dish filled with little cubes of lokum (Turkish delight).

 

I have lost touch with Marija and her family. All I know is that her daughter and son-in-law along with their child emigrated to the Seychelles shortly before Yugoslavia erupted into a self-destructing civil war.

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.

Stung on the tongue: a careless diagnosis

Big bee_640

I cannot remember the name of the person who taught us dental pathology back in 1981 at University College Hospital Dental School, but one thing he told us made a deep impression on me.  He said that it was unlikely that we would see oral cancers frequently in general dental practice, but when we did see one we would feel a certain ‘jizz’ (our teacher’s word), a feeling that we were looking at something unusual and worrying.

One day when I was in practice, a delightful late middle-aged woman visited my surgery as a new patient. She said there was something on her tongue that had been bothering her for several weeks and was making eating and speech difficult. She had been to her doctor (medical), who told her that she had had a bee sting on her tongue. She told me that she had been taking antibiotics prescribed for it for  quite a time and the condition was only getting worse.

I had never encountered anyone with a bee sting on their tongue. The lady’s story and her doctor’s diagnosis sounded strange. She showed me her tongue. As soon as I saw the huge ulcer on the side of it and its peculiar border, I felt that ‘jizz’, which our pathology teacher had mentioned. I knew that the poor lady had, almost without a doubt, a carcinoma on her tongue. I told her my suspicions, and she looked relieved, and was grateful. Clearly, she had not believed her doctor’s story. I phoned the local oral surgery department, and they admitted her promptly.

About a year later, the lady reappeared. During the surgical treatment of her cancer, she had lost several teeth and wanted a denture to replace them. Sadly, her mouth was by now so distorted that making a prosthesis was beyond my competence. I referred her to a prosthetic specialist. Unfortunately, she did not live long enough for his work to be completed.

Whether earlier intervention would have saved her life, or at least prolonged it, is a question than cannot be answered. 

In my 35 years in dental practice, I only ever saw two patients with obvious oral cancers. However, I did refer many patients to have unusual looking lesions seen by oral surgical specialists. None of these gave me that ‘jizz’ nor turned out to be cancerous.

No need to worry

 

 

adult ambulance care clinic

 

While I was studying to become a dentist, I took advantage of an optional fortnight shadowing anaesthetists. It was not a hands-on experience, but it was totally fascinating watching anaesthetists keeping patients healthy whilst they were deeply anaesthetised.

One day during a morning coffee break, I was sitting having refreshments with a senior anaesthetist and his team. Suddenly, I heard a shrill prolonged sound coming from a nearby room. I asked a technician what it was. He told me not to worry about it.

A few moments later, the senior anaesthetist asked me:

“What is that high pitched noise?”

“Oh, it’s nothing to worry about, ” I answered confidently.

“Really?” I was asked.

“Oh, yes. there’s absolutely no need to be concerned,” I advised the senior anaesthetist.

If it had been fashionable at that time, I might have told him to ‘chill’, but in those days chilling was reserved for cold weather and refrigeration.

“Hmmmm,” he replied.

After a few moments, he said to me:

“Well, actually that signal is the warning sound made by an oxygen cyinder that is about to become empty. I would really worry about it, young man.”

At that moment, I felt like a complete idiot and hoped that the ground would open up and swallow me.

 

Photo by Pixabay on Pexels.com

 

 

 

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.

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)