Gory Crowning & Crowning Glory

“Tsk, tsk, tsk,” Penny kept muttering under her breath. She was wearing a mask well before facial masks became a mandatory item for everyone in the world. Petite and gentle with a matching sweet smile, she was offered as his replacement dentist. Looking at her delicate hands, the old man was happy to change to her when her father retired as head dentist of their family practice. Her father had massive hands, much like an old cobber’s callused hands in the Aussie outback, if the truth be told, quite unsuitable for a dentist – massive hands meant that he was prone to knock the old man’s teeth unknowingly with his tools. It was a sun-dried cobber with more cavities than teeth in his mouth who taught the old man when he first arrived as a teenager in the great southern land of the aborigines that “If it ain’t broke, don’t fix it.” Missing teeth are just that, missing, not broken. So, there was nothing to fix. The sun-dried cobber probably learned that from a descendant of the natives who once roamed the land freely before the arrival of Willem Janszoon, a Dutch navigator, and some 165 years later when James Cook claimed their land for King George III, the bloke who wore the crown in Great Britain at the time.

The population of the natives were decimated by the white settlers, through disease and violent wars. Stones, spears and boomerangs didn’t save them. Deep knowledge and understanding of the topography of the island didn’t save them either, not when those they welcomed with open arms came with double-barrelled shotguns, rifles and cannons. Victors write the history, of course; very few gory details were recorded by those who represented the crown. It is important to therefore recognise that the great southern land was not conquered. Neither was it invaded. Words are important to convey the right narratives with the right nuances. Australia was a colony of settlement, not of conquest. Land sold to the settlers were registered with ‘freehold title’ whilst ‘remaining’ land that hasn’t yet been sold today is known as ‘Crown land’.

“If it ain’t broke, don’t fix it,” the old man said to Penny when she recommended crowning his lower right molar. He would not be able to recognise her if he came across her outside her building. Most of the time masked, the only time he could have a short glimpse of her face was after she had finished roaming inside his mouth with her finger. But, his vision was poor without his glasses, as he was required to leave them on the bench by the nurse, to prevent water and blood splashing on them, I suppose. He was one of those annoying patients who asked a lot of questions, but she had a clever way of dealing with that. “Open wider, please,” she would simply say, as she pressed down his tongue or moved it to the left or right. Time is money, you want to know more about dentistry, Google please. The old man understood that logic but he could not help himself. Maybe he just wanted to delay the inevitable discomfort that marred every visit to his dentist. Penny first suggested he crowned his tooth some four years ago, well before the pandemic. This was the third dental check-up since then. Check-ups used to be half-yearly but Covid was a good reason to ignore the reminders to visit Penny. She showed him the x-ray. “See, there and there?” she pointed to the dark blotches on the grey image of the x-ray. Amalgam dominated that corner of his mouth and made it look like a cave with lots of minerals to mine. “It’s barely holding the teeth here and here,” she lectured. “We can’t say when it will break.” So, the old man finally acquiesced to the crowning but still gave Penny a dirty look. That’s how they generate more income. He had trained his own staff the same way. Find reasons why a customer will want to buy more than the one item they came to the store for. I only came for a regular check-up, he reminded himself.

“I mean, how can you like a person who rushes out of the room and leaves you alone, all vulnerable and feeling abandoned, whenever she takes an x-ray of your mouth?” the old man asked. Penny rushes back to the room after the machine had zapped him with some radiation. “It’s pretty harmless, no need to fret,” she said. “Pilots are exposed to much more from cosmic radiation,” she explained.

“She’s alright,” I argued. “I find her gentle, professional and caring,” I said. “She does not over-service and she surely does not over-charge,” I continued defending her.

A fortnight later, the old man was back for his crowning. There was no ceremony although the nurse applauded and congratulated him for making the right decision. “Thanks, Charity,” Penny said to her nurse. Looking at the colour of her skin, the old man decided she must be African, in all likelihood, Sudanese. The Sudanese were the latest wave of refugees coming to Australia from a war-torn region. Charity’s main task was to shove a suction hose into his mouth, and skilfully manoeuver it so that he did not swallow any of the wastes. Throughout the procedure, the old man sounded like Darth Vader, “haawwthh, caaawwthh, haawwthh…” as the suction hose worked overtime. Penny was all the while busy with her electric drill. The sound of drill chipping away amalgam had to be one of the most terrifying sounds she could make. Menacing at his wide-opened mouth, she destroyed the amalgam that had protected his gums from rotting ever since he was a teenager. Why can’t they design a drill that produces the soothing sound of a clarinet?

The old man clasped his hands together tightly as the metallic shrill of the drill reached a crescendo. Telling himself to breathe deeply and relax did not work. Penny noticed his body was stiff like a body in a coffin. She knew she had not waited long enough for the drug to work. She was already twenty minutes behind schedule, and if she could make up lost time, this was it. Waiting for the procaine to numb his mouth was like watching the hands of a clock move. Boring and time-consuming. “Do you want me to top up the drug?” she asked. “No, no. I’m alright,” the old man replied. The night before, he had read about Nietszke’s ‘love of fate’ amor fati – everything that happens to us in life is necessary. It is not just accepting our fate, it is loving it, whatever happens, good or bad, pleasure or pain. The old man had a long time ago adopted the method to cope with pain – by loving it. Amor doloris helped him to anticipate pain at a dentist’s chair in Sydney. “When you anticipate pain, you actually welcome it,” the old man said. “That dentist was rough and uncaring, oblivious to my discomfort and fear of the incredibly gelid pain that shot through the facial nerves up my head every time he loaded the drug too quickly into my gums.”

Penny interrupted his thoughts. “Can you add another cotton swab please?” she said to Charity. The old man did not taste the blood oozing out of his gums – Charity had done a great job with the suction hose – he only knew he was bleeding because Penny told him so. “Sorry, I couldn’t avoid it,” she voluntarily admitted. After the procedure, the old man looked for the swabs to check how much blood he had lost but they had been swiftly discarded into the bin to hide the evidence. “No gory details to report here,” he said to me.

It must have been awful to live in the era before painkillers were discovered. Apparently, the Sumerian clay tablet, (approx 2500 BC) listed opium as an analgesia. “How long ago did dentists use analgesics?” the old man asked Penny. Not knowing what the aborigines used, Penny said it was known that the early British settlers used some form of painkillers to extract their teeth in the late 18th century in Australia. “Maybe opium?” she suggested. It wasn’t until September 1847 that ether was used in New Zealand to perform a dental extraction on a prisoner at a Wellington jail. This practice later spread to Australia.

Penny agreed it was terrible luck to be living in past centuries. A patient of hers had shared a story of a great-aunt’s experience on a dentist’s chair. In those days, lucky brides-to-be were given complete dentures as a wedding present. Dental decay meant most brides did not have a full set of teeth to show in their wedding photos. The great-aunt wanted to look beautiful on her wedding day, so what better present than a chance to remove all her remaining teeth in exchange for a full set of dentures? Unfortunately for her, the husband-to-be had a big row with the dentist who naturally refused to offer his services after that. No matter, the husband-to-be knocked out all her teeth without any numbing drugs.

Last week, the old man attended his niece’s graduation ceremony. It had been delayed for three years due to Covid. The 2022 graduation ceremony of the Royal Australian and New Zealand College of Radiologists was held in Adelaide. Three quarters of the new Fellows were in Clinical Radiology. Fellows in Radiation Oncology occupied only two rows of seats – a small exclusive batch of highly intelligent individuals. Numbering only thirty seven, these were the crème de la crème of the College. His niece and her hubby were amongst them – of course, that was why he kept talking about them to me. In 1977, the old man was just one of a handful of Asians in his school at Unley High. He attended classes for less than six weeks there before moving to Norwood High. In Norwood, they called him Bruce after the great kung-fu master. Adelaide then was like a mini Athens. Graced by mainly beautiful Greek girls who were somewhat enchanted by the odd-looking Chinese boy, they showed keenness in his fighting skills. “Show us how to do a flying kick,” the prettiest girl in the group asked. “Are you ‘black belt’?” another lass asked. The bespectacled boy was of course too scrawny to convince the girls he was a ‘black belt’, so his standard reply was “Master taught us never to show off our skills in vain and never to fight when we don’t have to.” With a slight bow, he would leave them agog, but more impressed with his mysterious skills.

“How the world has changed,” the old man said to me. At the ceremony, it was the Asians that dominated the occasion. The graduates were predominantly Indian (or Sri Lankan?) ethnicity closely followed by those with Chinese surnames. He was immensely proud to be there. Now when an Asian boy is approached by other students, he won’t be asked the colour of his belt. Kung-fu is no longer the only domain of an Asian. “In just about any field of excellence, you’d expect to see Asians stand tall,” he said. “Perhaps not in football,” I replied acidly. The old man was surprised the Hippocratic Oath no longer applied to modern-day doctors. The new Fellows were all required to swear to the Declaration of Geneva. “The sentence about not permitting the patient’s age, disease, social standing or other factors to affect their duty to the patient astounded me, ” the old man confided to me after the event. “Why? I can’t see how that is at odds with medical ethics,” I said. “Well… remember during the height of Covid when hospitals around the world could not cope with the heavy influx of patients to the hospitals? Did they not have to behave like God in choosing who lived and who died? Did they not sacrifice the aged and the infirmed to save the young and fitter patients? And would they not save their family members first if push comes to shove?” I looked at him silently and simply walked away. At that moment, I perfectly understood why most of his friends found him annoying. The Declaration is a set of ethics that prohibits discrimination. Why question it?

His niece’s hubby swept off not one but three special Research Prizes and Grants. “He is perhaps the only one promoted to Associate Professor,” he continued to brag. “I am so proud of them,” he carried on enthusiastically. I did not want to dampen his spirit, so I tried my best to look interested and engaged in the solo conversation with a body language that suggested respect and awe. I learned that they are now working with the best of the best in Toronto. The legends in the business of oncology. The ones whose books are now text books for university students around the world in their field of medicine. They are just a doorstep away from their idols, the authorities in their field. The gods of oncology. Experts like Arjun Sahgal whose work in spinal and brain cancers and central nervous system tumours have won him multiple awards, or Laura Lawson whose work on breast cancer needs no introduction. The recognition they have received and the respect they have earned in the field of oncology is a crowning glory of their complete dedication to serve humanity in medicine.

At their daughter’s graduation ceremony 28th Oct 2022.