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My View: Taking the time to listen

May 05, 2014

By Fred Quarnstrom, D.D.S.

Dr. Quarnstrom
Bill came to the office for his six-month recall appointment. He had recently retired and lost his dental insurance. He has been a patient for about 20 years. We chatted for a few minutes about his retirement and his concern over the cost of his continued care in the future. I mentioned that as a veteran he was eligible to get his dentistry done at the Veteran's Administration hospital three blocks away.

He said, "I will come here until you retire. You don't remember me, do you?"

I said, "I am sorry to say I don't, but what I am forgetting?"

The veteran told me this story. "About 10 years ago, I was at work. I operate cranes and sit about 100 feet above ground in the control cab. It was a windy day and the cab was swaying and bouncing. The loads were close to impossible to control. I had only had about two hours of sleep the night before due to the recurrent nightmares I have reliving my Vietnam combat experiences. These memories had prevented me from getting a good night's sleep for weeks.

"I told my boss I had a dental appointment. I had chipped a tooth a couple of days ago and I needed to get off the tower. Your office got me in that afternoon. I told you that I thought I might be going crazy. I went on to tell you about my ongoing hallucinations reliving my Vietnam experiences. At the time, I really thought I was losing it. The small tooth chip was the least of my problems.

"You just sat there and listened to me. Then you told me you would be concerned if I did not have nightmares considering the amount of close combat I had lived through. You got on the phone and made an appointment for me with the post traumatic stress disorder clinic at the VA hospital. You encouraged me to go see them because of a doctor from the PTSD program at the VA who had spoken to your Rotary Club. You really connected with me that day, partially because you had been in Vietnam too. I will come here until the day you close your doors."

It turned out that the VA was able to help him. He started sleeping better as the combat flashbacks diminished over time. He was a much happier person the next time I saw him. I discussed PTSD issues with four or five other patients who I knew had served in Vietnam. It turned out I had shared similar experiences with three of them and one Korean veteran as well.

Recently a new patient was referred to me to get his teeth cleaned. To say he had heavy calculus was the understatement of the century. It seemed like his tartar was as thick as barnacles on the hull of a Navy ship. To top it off, he was a severe dental phobic and had not seen a dentist in three years.

I asked him why he was avoiding dentists. He said one of the service dentists had made fun of his fear of dentistry and forcibly jammed his head back in the chair. So here was a veteran who had seen plenty of combat and yet he was petrified of dental treatment. He simply could not bring himself to see a VA dentist because of his experience with the military dentist.

I told him, "Well, first, you are in control. If I do anything that bothers you or if anything hurts, stop me. If it is just getting to be too much for you to be here one minute longer, raise your hand and I will stop. Would it be OK if I tried to do some cleaning?" He gave me a hesitant "OK."

I worked above the gingival tissue and showed him some of the bigger pieces of calculus that I had removed and discussed what they were doing to his gums. I absolutely did not want to cause any pain. Every few minutes I checked to see how he was doing. The debridement went well. After I had removed about 60 percent of the deposits off 10 of his teeth it was time to quit. He had done well and I did not want to risk losing his trust by going on for too long. Then we talked about how he was doing personally. He said he, too, was being treated for PTSD at the VA. I talked about the fact that I had made an amphibious landing at Chu Lai, Vietnam with the Marines and a Navy Construction Battalion in 1965. I was just nine months out of dental school. I had a drill powered by a foot treadle, no X-ray, no suction and no compressed air. I ended up doing humanitarian dentistry in local villages and served on a couple of medical evacuations of wounded Marines. I was in way over my head, but soldiers do what they have to do. I thought this might make him more comfortable knowing that I had an appreciation for what he had been through.

He was back a week later. An upper first molar that was decayed off to the roots was bothering him. I used local anesthesia this time and had to be extremely gentle due to his fear. I used one carpule of xylocaine and injected it slowly. I got the tooth out with no pain. After that he gave me his permission to clean that quadrant as long as it was anesthetized. I stopped several times to be sure he was doing OK. When I was done, I complimented him on how well he had cooperated.

He relayed to me that he nearly burst into tears just sitting down for our first appointment. "Had I known you had been in Vietnam, I probably would not have come here. I just knew no one could not understand or accept how I was affected from my combat tours, particularly another vet."

He told me he thought I would view him as a coward because of his fear of dentistry.

I assured him nothing he could say or do would cause me to judge him. What he had done and lived through was more than reason enough for his fears. I was glad he was seeing the doctors at the VA and I told him that if he ever needed an ear to listen, I was available. I have no training in psychology but I certainly could understand and appreciate what he had been through and I was willing to do anything I could to help.

It will take us several appointments to get his teeth cleaned. My fees will probably not cover my overhead expenses because of the extra time it will take to complete his dentistry. That is fine with me. He deserves my understanding and a little extra time.

Sometimes the most important thing we can do as dentists is to listen.

Dr. Quarnstrom is a general dentist in Seattle. He graduated from the University of Washington School of Dentistry in 1964. In 1965, he served with the Marines and Seabees in the first amphibious assault in Vietnam at Chu Lai. His tour of duty was followed by a residency in general anesthesia.