Dental Visit at the Center
The waiting room of the Center for Interventive Health is quiet as you finish filling out the consent-forms. The building was big, but the waiting room was small, just a few chairs, some tables with magazines, you, and a receptionist at a desk behind glass. It smelled like all dental offices smelled, and you can feel the knot in your chest getting bigger as you become more and more nervous. It's just am exam, a little cleaning, you tell yourself. It's been years since you've had the courage to see a dentist, and you've not had great habits; you can't put it off any longer. Plus you'll be getting laughing gas, so it'll be fine, right?Have you eaten or drank anything in the last 12 hours? No. Do you consent to sedation? Yes. The questions get check-marks as you go through them quickly. There always seems to be another page, and the last few you don't even read.Finishing the forms, you gather your courage, stand up, and bring the clipboard back to the receptionist."Have a seat, and Jessica will be right out for you, " she tells you. You find a seat, and wait a few minutes. You pretend to read a magazine, but your anxiety is growing and growing. It seems like hours, but after only 4 minutes, the wait is over.A frosted-glass door by the receptionist opens, and a woman in loose light blue scrubs comes out with a clipboard. She has long blond hair tied back, and smiles as she calls your name to the otherwise-empty waiting room. Dreading what's coming, you stand and say hello. "Come on back with me; we're ready for you, " she says, and you follow her through the door to a wide hallway, brightly lit and with while linoleum floors. It seems like a small hospital. A sign on the wall says "General Medicine" and "Operating Rooms" to the left, while "Oral Surgery" and "General Dentistry" to the right. She leads you to the right. "I'm Jessica, one of the nurses," she tells you.You walk past several small, open rooms with dental chairs in them, a preparation area, and a couple rooms marked with "Exam". Your anxiety grows with every step, as Jessica makes small-talk. She confirms you've had nothing to eat, and that it's been years since your last dentist appointment. “I can see you're pretty nervous?” she tries to reassure you. "Don't worry, Dr. Rey is very gentle, and we're very used to anxious patients. Once you breath the gas, you'll stop worrying, I promise.""You'll be right in here, since you're getting sedation," she says as she opens a door marked "Surgery A". She holds the door for you as you hesitate, then swallow and step inside. The room seems pretty large, with bright walls, a shiny polished tile floor, and frosted windows which let a great deal of the morning light in.You hardly notice this, though, because the room is dominated by a dark blue dental chair, larger and boxier than you're used to. One of the arm-rests has a matching blue strap open on it, almost a cuff, really; large and leather. The other armrest, the right one, has been replaced with a sort of concave board, with two larger black velco strips across it. The headrest is substantial, and is totally covered in disposable clear plastic. This chair is clearly made for oral surgery, not regular dental work."Um..." you say. A room like this isn't helping your anxiety."We do more serious surgery in here," Jessica explains "We want you in this room since you're getting the laughing gas, and this is where the equipment is. Take a seat; I promise you have nothing to worry about.” As if to remind you that you're committed, she closes the door behind you.You consider making a run for it, but it's been years since your last exam. Surely you can control yourself enough to let them poke around and do a cleaning. Instead, you walk over to the chair, and sit down. You're thankful it's in a upright position, and Jessica makes no move to recline it; the lurch when a dentist's chair goes back is universally frightening. You're careful not to put your arms on the armrests, with their straps. The feeling of helplessness is almost unbearable already.Jessica goes to a linoleum counter to your left, washes her hands, and pulls on a pair of pink gloves. Near her is a roller-stand supporting a screen, which she rolls closer to you. She turns it on, and you can see it's some sort of heart-monitor. From a basket attached to the stand, she gets a sensor which she attaches to your left pointer. The machine starts beeping along with your heart, until Jessica silences it. Next, she gets a blood-pressure cuff, lifts your left hand, and pushes up sleeve (you were told to wear short-sleeved, loose clothing). She wraps it around your upper arm, and you rest your arm in your lap, careful to avoid the armrest.“It's just getting to know you.” she laughs as the cuff pulls tight. You can see on the monitor that your heartrate is high, and your blood-pressure elevated. She makes a note on a clipboard, and then moves towards the door. “I'll go get Dr. Rey, and tell her you're ready. She'll be here in just a minute.”Left alone, you collect yourself and finally look around properly. You're in the middle of the room. Above you are a collection of large, circular ceiling-mounted lights, with shiny reflectors. Beside you, there are two matching blue stools, one for the dentist and presumably one for her assistant Jessica.To your left, there's the counter with the sink, countless cabinets and draws. There's the heart monitor, connected to your left arm. You momentarily watch as it counts your heartbeats and measures the oxygen in your blood. Your anxiety is making your heart run fast, and as the blood-pressure cuff periodically inflates, you see your blood-pressure is running high.To your right are a couple of stainless steel roller tray full of dental tools. They're far enough away that you can't see onto them, but even if you could, they're covered with green sterile drapes. You can at least see the loops of tubing indicating one of the trays holds the drills, polishers, and other handsets that usually overhang a dental chair. You can imagine the picks and their sharp points and you shudder.A stethoscope hangs from an IV stand in the corner, the stand an artifact of the more serious surgeries they usually do here, you assume. A computer keyboard and screen is attached to an articulated arm, something for taking notes. You can't read it from where you are, but there's a dental chart open; a computerized picture showing a row of teeth.Finally, pushing yourself partially around the chair to look behind you, there's the reason you're in this room: a large, square machine on a big cart. With cylinders hanging off the side, screens all over the center, and a deflated blue bag. You know it's an anesthesia machine. With your eyes, you trace one of the many plastic and rubber tubes to find a grey rubber nasal mask already attached. The top of the machine is covered by drapes, just like the carts. You're simultaneous afraid and relived; the idea of being put under General Anesthesia is scary; you don't want to be that helpless.But that's not why you're here; some nitrous oxide to take the edge off is a totally different thing. An extra stool sits by the machine, just behind the chair you're in. This one, you note oddly, is bright red, and doesn't quite fit the blue decor of the rest of the room.Before you can contemplate this much more, there's a knock on the door. Without waiting for any response, it opens. “Hi, I'm Dr. Victoria Rey,” the dentist introduces herself as she enters. “You can call me Victoria.” She speaks without a noticeable accent, but has light Asian features, maybe Korean? She's pretty short (although it's hard to tell exactly how short from your seat) and has her black hair pulled back severely. Like Jessica, she wears loose blue scrubs, and already has a white surgical mask around her neck.Behind her comes Jessica, and then another woman, tall, in pink scrubs. You notice her bright green eyes. “This is Dr. Anna. She'll be assisting me today,” Dr. Victoria explains as the two doctors wash their hands one after the other.“Assisting? For cleaning?” You ask.Dr. Anna speaks up, as she pulls a set of gloves on. “You'll be getting nitrous oxide, so we want to make sure we keep an eye on you. Don't want you getting into any shenanigans while you're intoxicated, do we?” She laughs as she claims the red stool by the anesthesia machine, behind the chair.“Have you ever had laughing gas before?” Dr. Victoria asks, claiming the stool to your left, as Jessica sits to your right.“No.” You say.“That's alright. You have nothing to worry about,” she says. “We'll put a mask over your nose, and let you breath for a few minutes. You'll feel tingly and dizzy, and your anxiety will just melt away. Just keep breathing through your nose, and we'll be done before you know it. Alright?”You nod your head. While she's talking, Dr. Anna powers up the machine behind you. She's an anesthesiologist, and has heard Dr. Rey's patter a thousand times. Dr. Rey reassures the patient, but Dr. Anna's gasses do the real work. She checks the tubes are all connected correctly, checks the gasses flow properly, and checks the oxygen and nitrous supplies are sufficient. Unbeknownst to you, she also checks that she has a supply of Sevoflorane hooked up and ready in the vaporizer.Satisfied, she turns the controls to start the flow of oxygen and of nitrous oxide. “Alright now,” Dr. Anna is seated mostly outside of your view, but she leans forward and loops the gray mask over the headrest, over your head, and over your nose. It's really happening now. You take a deep breath, as if delaying the inevitable.“Just take another deep breath, and remember to breath through your nose.” Anna admonishes. Cold gas begins to hiss lightly from the grey mask, pushing itself gently up your nose. Your fear pounds in your chest, as you take a tentative breath. The gas smells slightly sweet, but not unpleasant. You breath out, trying to calm yourself, and take another breath. You know that the more gas you breath, the better you'll feel, but the idea of losing control is frightening.“Deep breaths. All the way in, through your nose” Anna says again. You take a much bigger breath, filling your lungs this time. Dr. Anna adjusts the mask a little, and increased pressure around your nose pulls you tight against the large headrest. You take another breath, feeling a little confidence. You repeat to yourself that it's best to breath as much gas as you can, and make the the fear melt away. Besides, it's starting to feel warmer, in the pleasant sort of way.Anna turns up the nitrous a notch or two, although you can't smell the difference. You take five or six more breaths, slowly, breathing as deeply as you can. While Dr. Victoria hasn't moved to turn on the overhead lights, you think it's brighter in the room now.Dr. Anna, behind you, is turning up the nitrous every couple of breaths. The first few times, you notice her moving when she does, but then you lose track.It's at this point that you realize that the gas is truly having an effect. When you look over at Nurse Jessica, the room spins a little. You blink a few times and it's clear you're getting pleasantly dizzy. You take another deep breath through your nose, then another. The gas doesn't smell so sweet anymore. You take another breath, and your fingers start to tingle, then so do your toes.You take another deep breath in, and then out.“You're doing great,” Jessica smiles. Her voice echos a little bit. The room seems brighter, and you're tingling all over now.Another breath. Dr. Anna turns the gas up. You realize you're not feeling anxious at all anymore, and are rather relaxed. You smile.“Feeling good, I see?” Dr. Victoria “I think we're almost ready now.” She reaches out with her pink-gloved hands, and holds yours reassuringly. It's a nice feeling. You can feel her grip is soft and her hands warm. You grip her hands back, in acknowledgment of her reassurance.She's not actually trying to reassure you, though. Dr. Anna, seeing that you're well intoxicated, knows it's time for the next step. Reaching over to the anesthesia machine, she turns on the dial that controls the Sevoflorane. The vapor rushes into the airstream, through the breathing circuit, and into the nasal mask. If you notice the change in the gas, Victoria will intercept your hands, gently pushing them into your lap while you breath the anesthetic.Feeling happy now, you gulp down another breath through your nose. Maybe you're already too far gone to sense the change in taste of the gas, or maybe you just don't realize what it means, but you don't react. Instead, you breath out and take another breath. You concentrate on your breathing; pulling in an intentional breath of the oxygen, nitrous, and its illicit anesthetic payload. Your eyelids start to droop. While Victoria is still holding your hands, you're no longer holding hers.You look up at Dr. Rey, at Jessica, both are watching you. Their faces are blurry now, but they've both tied on their surgical masks now. You're not sure when they did that. You breath in again. Your eyelids are heavy now. The room, which seemed so bright and warm before, now seems dark, and fading. Fading.“That's it. Just a few more deep breaths, and you'll be off to sleep,” Jessica says to you, quietly.You think, for a moment, that this isn't right. Off to sleep? That doesn't seem to fit right. Maybe you've gone too far. Best to take in some fresh air? You open your mouth to breath some air that isn't gas. You try to take another, but then Nurse Jessica leans over and reaches up, and lightly covers your mouth with her pink glove.For a moment, this panics you. Your eyes go wide as you realize how helpless you are. You might be going too far under. Now Jessica is forcing you to breath more gas, and Victoria is holding your hands so you can't resist! But you have to breath again, unwilling, and the anesthesia gas pushes your concern away. Jessica's sleep comment slips away in your memory as you stare into her eyes. You won't remember anything after this moment.You take another breath, without thinking. Automatically. The room seems far away now. You think Jessica was smiling at you, but you can't focus on her anymore. Your eyes flutter closed.Another breath, and all that remains is the vague sounds of air in your head, flowing in and out. Time seems to rush past quickly now.It's impossible to know how many more breaths you take, how much more anesthetic you inhale, but any thoughts you had about your dental cleaning, the doctors and nurse, the room, all are long, long gone. Any meaningful awareness falls away.“They're well-sedated now,” where you are, you can't hear Dr. Anna's voice. “Smooth uptake. I'll keep them breathing spontaneously for now.”If you'd turned around earlier, you would have seen the anesthesiologist unpacking a set of loaded syringes, monitoring electrodes, and airway equipment on her machine, but you can't even open your eyes now. You don't feel anything at all as she begins to place the electrodes on your chest, under your shirt.Jessica removes her hand from covering your mouth. and moves to roll the trays closer to the chair, and then the IV stand you'd noted in the corner. “The nervous ones are so easy to trick; gulping down as much gas as they can,” she comments as she removes the green covers from the carts, revealing plastic packs and of tubing and rows of gleaming surgical tools. She pockets the stethoscope hanging from the IV stand and replaces it with pair of IV bags.Dr. Rey lifts your left arm onto the armrest; the armrest you'd so carefully avoided before you were insensate. She places it gently in the leather cuff, then closes it over your wrist, buckling it only loosely. Jessica does the same with your right; velcroing your right arm to the concave armboard, palm up. Given your level of sedation, the only movements they're preventing are involuntary, so pulling the restraints tight around you isn't necessary.Retrieving items from one of the uncovered tray, Jessica deftly ties an elastic around your upper arm, then, after an alcohol swab, slides a needle into the inside of your elbow. You aren't even close to awake, but Dr. Anna hasn't put you completely out, either. You might feel painful stimuli, like the stab of the needle seeking your vein. But any thoughts about what the pinch means, even a basic acknowledgment of the discomfort, are far beyond you now.Jessica connects the IV canula to the lines, the lines together to the bags, saline and a cocktail of precautionary drugs; mostly antibiotics. Once she's started a slow drip, she moves the articulated arm that holds the computer to chair-side.Dr. Rey uses a foot-pedal to raise the surgical chair, and pitches it backwards. Once you're lying flat, she ignites the surgical lamps. In other circumstances, you might feel a rush of terror from the movement, and flinch from the light in your eyes as she positions to towards your face, but of course, you don't. Picking up a brightly colored bite block from a tray, Dr. Rey levers your jaw open, and props it between your molars. “Let's see what we're doing today...” she comments, and with a probe begins to examine your teeth.The probe's tip stabs into your gums, picks at their sides, scrapes across their top. She begins to dictate, calling out every time the probe sticks. “Extract number 1; it's impacted. Fill number 2, occlusal. Fill number 3, occlusal. We'll need films on 6, but root canal or extract...” Methodically, Dr. Rey works her way through the problems your years of avoidance have caused, while Jessica notes down the treatments they're about to apply. Your chart fills up with slashes and red symbols. Eventually, Dr. Rey puts down the probe.“It's about what we expected. Shall we continue as planned?”Dr. Anna hands a small tray of her prepared syringes to Jessica, who first selects a large syringe, full of a milky white liquid. Jessica twists the propofol syringe into a port on your IV line, and without pausing, smoothly pushes a large bolus into your arm.Maybe the painful poking in your mouth has woken you somewhat, or maybe you've been mouth-breathing for a few minutes now, but the burning sensation in your vein produces a low moan. You twitch against the velco and leather cuffs. But as Jessica injects another syringe, maybe a paralytic, the propofol catches you. Without ever opening your eyes, it drags you down into nothingness. You're sure to be confused and in pain when you awake, but for now, oblivion.