ADEX/PIE II continued

As I was waiting for my patient to come back to start the next prep, I started to hear unusual things about my patient. One of the runners asked, "Is your patient ok? He literally stopped in front of an assistant, yelled 'You're beautiful' while staring at her, and then walked away". My assistant, who walked my patient to the line to get checked, said that the patient started dancing while in line while everyone looked at him.

To be honest, I thought his behavior was weird, but normal for him, and didn't think that I should stop working. His behavior was strange, no doubt, but had been for the past couple of appointments and ever since I met him. So I continued.

I start my class III prep. Patient again fell asleep. I thought that the cavity extended beyond ideal, so I asked for a modification. It was denied, meaning what I asked for was too small, or too big, or I didn't need to do anything at all. I frantically started analyzing, but looking clinically, I concluded that I didn't have to do anything and that the prep was fine.

Meanwhile, the patient could tell I was anxious, and started mumbling under his breath as I worked, telling me he was praying for me. Which was sweet, but again, weird.

I sent my assistant and patient off, and after getting the patient back, I was ok to restore and all was well. I succeeded in 2 out of 3 procedures, and was ready to bring it home. However, this is when it all went downhill (uphill?).

I hadn't eaten properly all day, and felt like I had a small window of time to take a break, grab some food, and regroup for the last part of the exam. I also wanted to give my patient a break. I gave him some food, and told him to come back in ten minutes so that we could get started.

Ten minutes pass, and he comes back, saying he needs to use the restroom. Ok. I tell my assistant to show him where the bathrooms are, and to bring him back after he's done... except that he takes thirty minutes. I still have sufficient time for perio, so I'm ok with this for the moment. The patient comes out of the bathroom and basically starts talking about his bowel movements as we walk him back to the chair.

I send him off to get approved, but he comes back with an officiant trailing behind him; have I done something wrong? Did he not get accepted? No, but I forgot to check and record his blood pressure for the final time that day. This makes me lose 15 minutes, and I will have to resubmit my patient after getting his pressure, potentially losing another 15 minutes. I check his blood pressure: 165/100mmHg. Not good. Far from good. I keep my cool, and tell my patient to walk around, go outside for a minute and come back, hoping the BP will drop. The patient starts losing confidence in the situation, and it looks like he wants to back out.

I lose it. I think of the fact that if I don't have a patient, I will fail, and due to the stress I was already feeling, I start tearing up. This makes the patient feel bad, and he says he will go for a smoke and come back. Meanwhile, I go to the front desk and ask about a back up perio patient. There are none, but some classmates start making calls in case I need one.

I start talking to the patient outside, as he's smoking, and a classmate comes out to try to help me. He says he will come back to the operatory. It's almost 4:00pm at this point, and I need to have started by 4:15pm. My wonderful patient care coordinator at school tells me they might have a back up for me, and to let me know if I need him.

Checking his blood pressure again, I get 150/94mmHg, which is acceptable for treatment. However, since the patient had a high reading initially, the floor monitors want to check the pressure again. For them, it is high. One gets 150/100mmHg, one gets another reading. Neither are acceptable, meaning I need to find another patient ASAP.

This is when everything falls to pieces. My patient begins accusing me of lying about the blood pressure, and putting him in danger. I tell him no, I wouldn't do that, and blood pressure readings change minute to minute. However, he is distraught and cannot be consoled. Meanwhile, I am frantically trying to think of plan B. I have ten minutes to find another patient. I tell my assistant to run to the front desk to tell them I NEED A NEW PATIENT.

I try to rationalize with the patient, but he is not hearing anything I am saying. Finally, I have a runner escort him out, even though he is mad. I am losing time.

Getting sleepy again. Part 3 later!

ADEX/PIE II

I took the second and last part of licensure boards on Saturday, and thankfully passed! However, it was the craziest, most dramatic day. Just wanted to write it down because I have the worst long term memory, but this will be hard to forget!

I wake up at 5:30am, and arrive at school around 6:00am. My patient and second year dental student (D2) assistant said they'd be there around 6:30am, so I got busy setting up my cubicle and grabbing items from dispensing for the day. I expect to use the same patient for all three procedures for the day, and feel thankful that I could set up once, and I wouldn't have to worry about coordinating multiple patients and resetting the cubicle at all.

The three procedures: Class II (posterior tooth restoration), Class III (anterior tooth restoration) and periodontics (deep cleaning).

6:30am rolls around, but I don't start worrying yet. I continue setting up and making sure I am good to go at 8:00am for a shot gun start. My assistant arrives at 7:00am. Slightly late, but understandable due to traffic from the Monument 10K going on that morning-tons of streets blocked off. He goes to get accepted as an assistant for the day. I call my patient, who says he's still waiting for the bus, but that he's going to make it, do not start looking for another patient to take his place. I see my Class II backup patient in the waiting area, and am relieved that at least I can use him if my original patient is late or doesn't make it.

Five minutes, ten minutes, twenty minutes pass and no sign of my patient. Finally, at 7:50am I call my patient, gearing up to call my backup patient into the clinic for lesion acceptance. 

"I'm in the bathroom." The four most stress releasing words I hear. I run to meet him outside the bathroom and usher him into my cubicle. I check his blood pressure: 150/94mmHg. Just barely meeting criteria for acceptance. I send him away to get his lesions checked and approved. Since he is my class II and class III patient, I am allowed to get both approved at the same time.

My patient is gone for twenty minutes and the whole time I am thinking, "Please do not get rejected." A few classmates were getting their lesions rejected, causing them to scramble to get another patient submitted and accepted. I was already getting a late start, and did not want any delays.

Finally, he comes back to the cubicle: both lesions accepted! I send my assistant with a thank you note for my backup patient, with the message that my backup patient is good to leave for the day, I do not need him. By this time, it's 8:20am and I am ready to get started. Check in was supposed to be from 7:00am-8:00am, and so most of my classmates have already been working for a good twenty minutes. I anesthetize, rubber dam, and start the prep. 

The patient says that he hadn't slept all night, and proceeded to fall asleep, turning his head to the side and closing his mouth. Every five seconds I had to stop, readjust his head, and placed a bite block to prop his mouth open. 

I continue until all caries are gone, go up to the measurements of an ideal prep, and submit with all paperwork. Again, sending the patient away creates a fear that they will tell me to temporize the tooth, aka you failed and have to put a temporary filling in until a proper filling can be done at a later date.

He comes back in, but not without grabbing a ton of snacks meant for dental students. I think this is where he started shoving granola bars into his mouth while I was trying to work. But, I get an official stamp: "OK for restoration" Yay!

I restore, again readjusting his head every few seconds. I submit, and again get another validating stamp.

I'm getting tired... part 2 tomorrow!

Rotations

As I sit in my operatory, waiting for my last patient in Martinsville, VA, I get a rush of adrenaline. I notice that this happens at the end of every rotation I have-a sense of finality, that this is one less hurdle I have to accomplish until I graduate. The list of rotations and requirements seemed endless at the beginning of the school year, but now it's down to the wire.

I'll probably never come back here again, to this clinic. Nor to Saltville, Lynchburg, Northern Neck, or anywhere else I've rotated through. I say that not in a "good riddance" type of way, but it's the reality. I've never been good at closure, even for the most fleeting experiences. 

Goodbye, Martinsville! Onto the next.

Senior Selectives

My school has started a cool little extracurricular called Senior Selectives, in which senior dental students can do extra work in an area of interest. It's basically an individualized class. I applied and participated in Oral Pathology/Medicine last semester, which I found to be worthwhile. Definitely learned a lot in terms of treating TMD pain and seeing pathology. One of the patients I saw had oral cancer that did not get picked up by her ENT physician. Also diagnosed trigeminal neuralgia, BMMP, TONS of lichen planus, among other conditions.

I applied again this semester for Pediatrics and got in. I've only done two sessions, but I'm actually enjoying it. Pedo at my school doesn't have a great reputation with the dental students, as we basically waste away for a week or two doing cleanings on 17-year-olds who have all their adult teeth and are treated the same as our adult patients. It's boring.

I saw a little 6-year-old kid this afternoon, which is actually a first for me to see someone so young, apart from my dental missions trips. Thankfully she was very compliant and had minimal fear of the dentist. But beyond that, I think I thrive on one-on-one tutoring and guidance which I get through this program. I suppose everyone does, but the student-to-teacher ratio is often quite skewed in any institution. But I like that I can ask questions right away, and see my own patients knowing that I have immediate backup, and am pulled aside regularly to be shown interesting cases. So far, all the faculty have been very engaged and invested in my education in their specialties.

One of my regular group practice faculty happens to practice up in Pedo once in a while. I randomly started chatting and talked a bit about my grievances as a student and what the future kind of holds for me. I'm honestly a bit discouraged by the education I've gotten at my school and was wondering out loud if I would be okay "in the real world". Unexpectedly got a lot of helpful advice and encouragement, which I am super thankful for.

In conclusion: a fan of Senior Selectives!

Inspiration in procrastination

My life as a student is coming to a close. I have to say, after 23 consecutive years in school, I CAN'T WAIT! Honestly can't see myself missing school at this point.

However, in contrast to the "country club semester" last fall (as one of my faculty called it) now is the final hurdle of tests, and licensure boards. Including one tomorrow that I am procrastinating in studying. As per custom, right? :) It just feels so familiar and.. right. Won't have too many of these specific moments left.

It's officially 2015. So far it has consisted of:
Jan 1-4 New Orleans
5-6 First days of spring semester, mostly consisting of housekeeping, admin work
7-9 Off-campus external rotation to Northern Neck Free Clinic

After a whirlwind of traveling, both for fun and for school, this weekend and tomorrow seems like the start of the year. Finally feel settled into the year.

I have no idea where I'll be after this summer, but I will say I'm ready for new beginnings.