Emergency Medicine Then & Now

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The author and sister Mimi, circa 1940

We were, I think, about six and eight. My sister Mimi and I came home from somewhere, hot and tired and thirsty. We leaned our bikes against the side porch and ran up to the French door – which was stuck tight, as often happened on muggy days. I gave the door a mighty wham. But I missed the wood frame I was aiming for and my hand crashed through the glass pane. I stood there saying “Oh my! Oh my!” until Mimi, who was wise beyond her years, reached through the hole, turned the knob and shoved the door open. I think I was still “Oh my!-ing” while Mimi lead me through the living room, hallway and dining room to the kitchen, splattering blood along the way. We grabbed dish towels, tied them around my arm, returned to our bikes and headed for the offices of our friend Dr. Enos Ray.

Like most small-town doctors’ offices in the 1940s, Dr. Ray’s office consisted of several rooms adjacent to his home – about 8 or 10 blocks from our house. He stitched up my wound, after listening to the story and rather cleverly asking if we had left a note of explanation for our mother. Oops, hadn’t thought of that. Mrs. Ray obligingly started calling around to see if she could find our mother before she encountered an unexplained bloody scene on coming home from somewhere Mimi and I didn’t remember. Dr. Ray probably sent our parents a bill for $5.

Scar

The scar survives

My memory of the entire  incident ends with the bike ride home, all beautifully bandaged and hoping we would see a lot of friends on the way. But the scar (now getting pretty dim amidst the blotches and mottles of seven+ decades) is a constant reminder of my days with the World’s Best Big Sister and a current reminder of the changes in healthcare over those decades.

 I was re-reminded recently. I am fond of remarking at the slightest opportunity that I still, in my golden octogenarian years, have all my original parts – give or take a few teeth. Two of those unoriginal teeth are in the form of very expensive crowns attached for the last 15 years to a far more expensive (not to mention painfully acquired) implant. Not long ago, they decided to swing slightly outward, without so much as a by-your-leave. After a moment of horror (and gratitude that this happened at breakfast with no one but a sympathetic husband at the table) I realized I could nudge them back to where they belonged. I took to chewing on the other side. I called my good friend, longtime neighbor and fine dentist Richard Leeds. He said I should make an appointment with his implant friend Dr. Chin. “You’ll really like Dr. Chin,” he said. “It’s kind of like going to see the mad scientist. But he’s the best.” So I waited until Dr.Chin returned from vacation. And indeed, despite the very proper and competent staff who welcomed me, there was something of a mad scientist to the good doctor. “Let me just peeeeeer around here,” he would say, reaching for strange radar-beam lights and x-ray machines, studying my jaw from every conceivable angle.

 Eventually, he said, “There’s good news and bad news. The bad news is that you’ll Grinprobably need an expensive new crown. The good news is that the implant is just fine so you don’t need surgery, so you don’t need me.” Whereupon he shook my hand, said it had been a pleasure, and no, there was no charge.

 Later, summoned back to Dr. Leeds’ office – and anticipating future appointments for expensive new crowns – I thanked him for sending me to the charming mad scientist. He said he had a few not-so-mad-scientist ideas of his own. Whereupon he gave me a crash course in types of crowns and types of implants now in use, and explained that he thought he could screw my errant teeth back to where they belonged. The explanation was accompanied by several rather vehement maneuvers, and followed by extensive fiddlings around, bite-checking, tooth-filing and what have you. And lo, I am back to where I started with the non-original teeth and their original compatriots. Dr. Leeds will send a bill for considerably more than $5, but probably thousands less than a new crown would have cost. I could not help remembering the days of the de riguer family doctor and family dentist.

Sadly, it should be noted here that Dr. Ray has long since gone to his rewards, and Dr. Leeds is no longer accepting new patients. But given the precarious state of healthcare in the U.S., I can only be grateful for the extraordinary emergency care (Kaiser Permanente included) this middle-class American has been blessed to receive.

Would that healthcare were such for everyone.

Facing Up to Dental Terrors

The only thing worse than toothache/jaw pain, to be cruelly specific, is toothache/jaw pain without insurance. Most of us are without such insurance. It has not even been on the radar of health reform advocates, which is just as well — if you add dental terrorism to abortion and public options we won’t see reform for another few decades.

Nevertheless, tooth reform, euphemistically referred to as full mouth restoration in some circles, is ahead for increasing numbers of Americans sooner or later. It comes down roughly to a choice between fixing the mouth or buying a yacht, but if your jaw aches, you forgo the yacht.

New York Times health writer Jane Brody traced the new path of dental repair journeys in a thoughtful article yesterday, explaining her own costly route from tooth decay to bridges to implants, and throwing out an estimate of approximately $3,500 to $4,000 per tooth for the now-preferred latter. Multiply this by at least three or four times if you have other issues, which most of us do once things start going south in the mouth, needing attention. That would be gum problems, repair to surrounding teeth or necessary attention to bone.

I write with authority. Some years ago, facing all of the above, I visited an assortment of dentists with an assortment of solutions that frequently had me in tears when contemplating the time, details (one would have had screws in my jawbone which I would tighten every few days for months as it rebuilt itself) and costs. Like Brody, I grew up before the days of fluoridated water and have had more repair work since childhood than the Bay Bridge. It was a mess in there.

Finally my husband, whose best wives have been born in 1933 but with bad teeth, said, “Just do it all. Don’t be going patch-patch-patch; do it all.” I proceeded to choose the most sympathetic and understandable (most of them were, except for the screws-in-the-jaw guy) dental professionals, assembled a team and went to work. Or rather, I scrinched my eyes shut while they went to work. Some 18 months and $40,000 later we were free at last.

(Out of this experience, during which I was doing a great deal of entertaining just to keep us happy and sane, came one of my finer unpublished books, Cooking for the Dentally Impaired: Recipes and Menu Suggestions for the Impaired and Unimpaired in Difficult Times. I think it’s a book whose time has come; my agent disagrees.)

Brody’s article is a must-read for anyone stewing over this issue. The following are abbreviated tips for anyone with teeth and plans to keep them:

1 – Consider early-decision. The sooner things like gum surgery, crowns, implants-v-bridges or bone issues are dealt with, the likelier all can be made well and kept that way.

2 – Get second opinions. You may even choose the screw-in-the-jaw route, but there are many different procedures and it is good to find one suited to your temperament and bank account.

3 – Ask questions. I asked so many that I was fired by one team; a polite letter said they did not believe they should take my case. It’s just as well. Those I wound up with answered my questions and seemed happy to do so.

4 – Ask for references. Brody suggests this, and I agree. Because I already knew several people who had been patients of the dentists with whom I eventually invested all that time and money, talking with them about their experiences helped keep me from any surprises.

5 – Talk finances. Several friends of mine have had major dental expenses that were far outside their budget, but worked out payment schedules with their dentists so that necessary work could be done sooner rather than later.

Meanwhile: floss.