Apart from having them just drop out of your gums, another way to lose your teeth is to have them roughly chiseled and pried out by a group of reckless, poorly-trained, and sniggering nincompoops. That's how I chose to part ways with my wisdom teeth ten days ago.
It must be made quite clear that, while the molars in question were causing me some mild discomfort, and had been for years, there was no emergency, no sudden dire need to have them out. I submitted to the surgery because people ranging from dentists to Aimee to busybody acquaintances have long said that I should. "If you wait a long time, it can really be painful," they would say, as well as, "and, since they've erupted, you could get a nasty infection in there." Also, due to my excellent benefits package as a resident at the University of Iowa Hospitals and Clinics, the operation was free. I would remind myself of this last point often after the surgery. Staring at my disfigured visage I would glumly remind myself, the price was right.
To begin, they offered me sedation. I'd been sedated long ago for a knee surgery, and dimly remembered that it made me nauseated. Also, if I was sedated, I'd probably lie around in recovery for an extra 30 minutes. Since they were also making Aimee parent Henry in the not-very-enriching confines of the Hospital Oral Surgery Waiting room, I asked if I could just go with local. The nurse looked at me skeptically. "Sure, we can start with local, I'm a flexible guy. Tell you what, at any time in the procedure, you let me know, and we'll just put this nice tube in your arm and send you off to dreamland."
That seemed like a great plan, and it was only later that I would think, Since you're going to be gently using my mouth like a pack of starving hyenas uses a dead zebra, shouldn't we have arranged some sort of signal? Like I'll roll my eyes back in my head and quiver. Look out for that, that'll be the "High sign."
My second-year oral surgery trainee bounced into the room and, after furrowing his brow at my request for local ("Sure, we can try that," he said cheerfully.), we got started. After the usual stabbing unpleasantness of having lidocaine injected into my jaws he went to work on the first tooth. I could see the clock out of the corner of my eye; it was 8:30.
I was amazed at how much brute force was required. I couldn't see what instruments he was using, but if I had to re-create them based on the pressure and the movements that I could see out of the corner of my eye, I would take a flathead screw driver and put a 90 degree bend in the shaft. Then I would pick up a pair of pliers and similarly distort them. Of course, the hand held drill I identified easily enough, and it was the employment of that tool that really made me point my toes and scrabble with my fingers. The nurse was kind enough to distract me by leaning on my chest and pressing on my trachea with his hand. "I'm just protecting your airway," he said somewhat reassuringly, as he leaned some large fraction of his body weight against my airway.
And then the first tooth was done. The clock said 8:50. The nurse had asserted that without messing around with sedation we'd be done well before 10. That meant, I mentally calculated, that the first tooth had taken several minutes longer than expected. "Doing alright?" the trainee asked. I grunted. It hadn't been so bad, and I assumed that the other three would go more quickly.
Teeth #2 and #3 went about the same. The trainee did accidentally penetrate up into my maxillary sinuses on both sides, an adverse event that I'd been warned was somewhat more likely because, on x-ray, my sinuses revealed themselves to be huge. That's a medical fact that I was quite glad to have confirmed. "They're really huge," the trainee said smilingly. I nodded, smiling as well, thinking of all the times my loud booming voice had gotten me into trouble from 4th grade to last Thursday. It's because of them, I thought, looking at the two black holes above my mouth on the x-ray. I have congenitally oversized resonating chambers in my head.
They checked with me a few times to see if I wanted sedation, and I grunted in the negative. It was very painful, and I was tempted, but it seemed a waste since we were 75% done. I remembered Macbeth:
I am in blood
Stepped in so far that, should I wade no more,
Returning were as tedious as go o’er.
Finally, it was time for tooth #4. It was 9:30, and I wondered anxiously if Henry was climbing the walls of the waiting room. The trainee strained and grunted. He tried several different bent screwdrivers. He switched out the head of his drill. He kept saying, "Wow, this one's a real bear." He'd grab some part of the tooth with the bent pliers and pull, then the pliers would slip off and bang into some other part of my mouth. This kept happening, and I started to keep myself occupied by imagining that he was a trick pool shooter, and that my mouth was the sides of the pool table. Some of his plier jerkings would ricochet off all four sides and, occasionally, they would somehow hit five. At odd moments, the nurse would lean on my trachea.
He finally straightened up and seemed to sag. I wondered how his hands must feel. It must be tiring, I thought, as the nurse aspirated a seemingly endless supply of blood out of my mouth, to do this much damage without using a hammer. I couldn't see the minute hand, but the hour hand told me that it was well after 10.
"Well," he said glumly. "Let's call in Dr. So-and-so. (not his real name)" I knew that glum tone, I had used it myself when I was in over my head; he was calling in staff. I was pleased and terrified, which is an odd combination of emotions. Pleased because it had seemed like for some time things had not been going smoothly, and I am conceited enough to enjoy having my medical judgments validated regardless of the setting. I was terrified for obvious reasons.
Dr. So-and-so came in and repeated the trainee's maneuvers, only with more gusto. He also kept saying, "It's a real bear," which led me to conclude that this was the approved way of describing tenaciously impacted molars, handed down from master to apprentice for generations. His bent pliers whanged off my other teeth, the top of my throat, and even the outside of my cheek. That's new, I thought, worried for my cheek. Must be a more advanced technique.
And then he got it. "That's about as hard as they come," the staff surgeon said, consolingly to the trainee and complimentarily to me. He patted me on the chest.
After all that, it has been a difficult recovery. My face swelled up hugely. The pain was poorly-managed by ibuprofen, and the hydrocodone didn't help much. I took the day after the operation off and then went back to work to show my face. It was embarassing to be disfigured. People insisted on learning why I was so swollen, and then of course they all had a long and nasty story to tell about their own wisdom teeth. These stories were of amazingly little comfort. I did my job very badly and had a bad interaction with a clinician on the phone. Accordingly, I took a third day off from work. That weekend, the fevers set in.
These were solid fevers, peaking at 101.4 F, and accompanied by dramatic sweats. A thin discharge drained continuously from my nose and mouth that reeked of death. I went back to work on Monday and warned people, "If you smell something like used tampon or a soiled diaper wrapped around a dead raccoon or something, don't worry, it's just my face." The sinuses are infected, of course, and casualties from the battle between my oral flora and my immune system come streaming out my nose and down into my mouth.
And that's where we are today, 13 days post-surgery. The fevers are slowly abating, and the discharge mostly just comes from my nose. I'm down from 4000 mg to 3000 mg of ibuprofen per day. The swelling is almost gone. I've upgraded from a routine to a strong-ish antibiotic, which I'm certain doesn't cover everything that lives in my oral cavity. If I wasn't getting a little better, I'd worry about the ability of the trainee to treat a post-operative infection. As it is, though, I'm trying to be a good patient, and am following the trainee's instructions to the letter.
About once per day for the past few days, I get chilled, the pain in tooth #4 flairs, and the rankness of the discharge swells to a crescendo. At these times I nod grimly and, perhaps, wisely to myself and think, You get what you pay for.