Posted by: M. J. Arcangelini | March 10, 2011

NITROUS-OXIDE TO THE RESCUE: ADVENTURES IN ORAL SURGERY – UCSF, DECEMBER 13, 2007

Once it was established that I was not simply requesting nitrous oxide but had already paid for it myself, since my insurance didn’t cover it (the experience of pain not being one of their overriding concerns), the oral surgeon instructed his assistant to set it up.

The chair, with me in it, was tilted back at a sharp angle with my head aimed toward a far corner the floor. This would allow the doctor access to the offending wisdom tooth, which was growing crooked out of the back of my left upper row and reaching roots into my nasal cavity.  A strap containing the nitrous inhaler was attached, holding my head firmly in place.  I was told that for the first five minutes or so I would be receiving straight oxygen – this, said the assistant, would open up my lungs and make the nitrous more effective; I was all for that.

I had one of R. H. Blyth’s haiku books held in front of my eyes. I had this notion that reading haiku at a time like this would keep me calm and centered – yeah, sure. I made the motions of reading but don’t believe I actually absorbed any of the words my eyes were racing across.  I was waiting to feel something which might indicate that the nitrous oxide was beginning to take effect. For what seemed like a long time there was nothing.  After a while someone wandered in and ask me if I was feeling anything yet. “Very little.” I offered. She wandered back out.

Then the doctor came in, having decided that I must be ready whether I thought so or not.  If you’re going to have someone leaning very close into you with his hands in your mouth for an extended period of time, it helps if he’s good looking.  The doctor or intern or resident or whatever he was (this being a teaching hospital) appeared to be of Mediterranean descent, handsome, dark complected, black hair with a neatly-trimmed beard; I approved.

A panorama x-ray taken on November 1, 2007 by the oral surgeon in Petaluma who determined that the offending wisdom tooth was more than he could handle "in a clinic setting" and that I needed to go to UCSF to have my jaw dislocated under general anesthetic - sure glad he sent me elsewhere.

He opened my mouth as wide as it would go, and then some.  I could feel him poking about with his fingers then I could feel the needles going in, one after another.  There were quite a few of them but the only ones which hurt were the ones entering the roof of my mouth, the hard palate.  Even those hurt very little, just enough to spark memories of such injections without nitrous oxide. Nonetheless I automatically adopted a white knuckle grip on the book I was now holding tight against my chest, as thought haiku could shield me from harm, like a pocket bible to catch a bullet in an old war movie.

Then there was another wait for the lidocaine to take effect before the doctor and his assistants returned.  I was fully under the sway of the nitrous by now and cared little what they were doing. He did not provide for me the kind of running narration of what he was doing that some dentists have done – and which I appreciate.  His speaking was mostly aimed at his assistants.  From time to time, there would be an instruction to me to turn my head one way or another.  Somehow I always managed to pick those instructions out of the flow of words and never mistook them for requests to one of the assistants, at least I think I did.  It was as though he was able to pitch these instructions directly to me through the nitrous haze.

The doctor had warned me in advance that they might damage or even knock off the large crown on the tooth nearest the one they were pulling, so from time to time I did wonder if the bone-crunching crack I heard was the wisdom tooth breaking up or the sound of more dental bills accumulating to redo the neighboring crown.  Such wonderings though did not linger long in nitrousland.

I don’t recall any specific dreams or hallucinations while I was under.  Nor do I recall what I was thinking about much of the time.  It seemed like they were working for an awfully long period; it had to have been over half an hour, maybe 45 minutes.  Periodically I could hear the high pitched  whirring of drills and my skull would seem to amplify the vibrations they made.  Then there was the hammer and chisel – at least it felt and sounded like a hammer and chisel, sharp, shiny, metallic whacks.  With each blow my skull would abruptly jerk from the impact. The sound was a combination of a clang and a crack.  I imagined a surgical steel chisel wedged between the roots of the tooth and the bone of my skull.  Each slam of the hammer budging the roots ever so slightly and slowly out of their grip on the bone.

I could feel him pulling pieces of the tooth out and sometimes would hear him say something to an assistant to the effect that they had gotten a particularly difficult piece.  Eventually it was all out and the doctor sent for his supervising surgeon to come in and take a look at what he had done. This was the doctor whose name would actually appear on all the records and bills.  They both sounded pleased.  Then the repair work began.

Everything that happens on nitrous oxide has an abstractness to it which allows for great distance from what is occurring and truly does not admit fear or anxiety about any of it.  I said that I did not recall dreaming while under, but everything feels like a dream – so how could I tell?  When it would seem that things were taking too long, the catchphrase “this too will pass” actually held meaning and allowed me to drop any concern I had and just kind of cruise along, a dispassionate observer of my own experience – there and not there. This is an ability I wish I could conjure without nitrous whenever I should need it.  The part of me that the doctor needed was there, while the parts with the potential to get in the way of what they needed to do were drifting off in the aether somewhere, looking down on the entire procedure with a lax curiosity.

When they removed the wisdom tooth it opened a passage between my nasal cavity and my mouth which now needed to be closed in order to prevent the unhealthy, not to mention unappetizing, exchange of matter and fluid.  This was apparently the part of the procedure which none of the previous doctors I had seen in Sonoma County felt capable of handling.  Now I was having this attractive surgical intern or resident do it under the supervision of his teacher, of whom I caught only the proverbial fleeting glimpse.  Thanks to the nitrous, I was unconcerned by this.  I heard discussions between those working on me but could not quite make out the words, or perhaps simply didn’t care enough to make out the words.  Then I felt the needles going in for the stitches.  Like the lidocaine shots, I could feel the ones going into my gums and cheek but they did not hurt.  The ones going into the roof of my mouth pierced through the nitrous oxide as though it were simply another layer of tissue through which they were passing.  The pain itself would probably best be described as a tweak or sharp pinch – nothing to get excited over.  It was more the surprise that I was feeling it at all that impressed me than the minor pain itself.  Of course, being able to feel this small pain brought into question the effectiveness of the anesthetic altogether; and off along such anxiety-strewn paths my mind began to wander until the nitrous would scoop me up into its gaseous arms humming an atmospheric lullaby, and it would be as though I had completely forgotten how to worry.

Then I felt them gathering up all the various equipment and tools that had been laid out across my chest and tilting the chair, with me still in it of course, back into an upright position.  The doctor said, “Okay that’s it.  We’re done.”  The nitrous in my nostrils was slowly replaced by oxygen again.  I was becoming aware of the novocaine/lidocaine pins and needles-y numbness, that sense of inflated flesh swelling my face into Elephant Man distortion which disappears when a mirror is presented.

The doctor explained to me what he had done, it seems they cut out a piece of the inside of my cheek and planted it into the hole through to my nasal cavity, then drew gum and tissue over it and sewed the whole mess up.  He and the assistant instructed me in follow-up care, thrusting written instructions into my hand, and that was it – they were done.  I thanked them, adding “I don’t imagine that was easy.”

Before he could escape, I asked if I could take the tooth with me: a souvenir, a talisman, something to add to the gris-gris bag.  But he said that it was in too many pieces to be recognizable besides, he went on to inform me, he could not release it anyway because it had to be disposed of as bio-hazard waste. With the nitrous still lingering in the corners of my consciousness my first thought at hearing that was to wonder if anyone had told the tooth fairy.

 

begun 12/15/07 – 12/23/07
revisions 1/16/2011 – 03/10/2011
Sebastopol, CA

Advertisements

Responses

  1. …….a story I remember well!! Thanks Joe!

  2. Brought me back to my visits to the dentist when I was a kid. Today’s visits, with whatever it is they give me now to make me numb, are just not the same.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: