At least that’s what an oral surgeon told me six or seven years ago as he stood above me, twisting, turning, and LEANING into the process of yanking my wisdom from bone. I was under a general sedation of Novocain and he was really going at it when he paused and said that to me. I remember laughing, sort of, as he and the cold steel of large instruments pressed against my lower lip; pinched the corner of my mouth. This was only the first chapter in my lesson in true pain. When one goes to the ER and they ask you, “so on a level of one to ten, where would you say your pain is?” I now had a great scale to go on. The tooth pulling was fine really, triple numbed for my pleasure, and plenty of pain pills, it would be the resulting dry socket that would educate me. I have had hernia surgery, and the day after that was nothing like the pain of exposed bone and nerve to air and the former, fading comforts of eating, drinking, smoking and spitting.
A dry socket, you see, is what happens in the hole from whence a tooth has been extracted. If it does not heal properly because you smoke from a bong, a cigarette, drink from a straw or spit, or if the clot that is supposed to form, sparking the all important healing process, either does not form due to thinning blood from alcohol consumption or falls out due to gravity or sucking, well, one hell of a mind numbing pain will result. To render it painless they pack it every twenty four hours with gauze that has been soaked in Benzocaine and clove oil. The result is a numb and pain free hole, but the taste in your mouth which results reminded me of being at a post punk show circa 1985 in the back of what was really a full time beauty salon turned punk rock dive once a month or so. Anyhow, that is what I took away from my first encounter with adult oral surgery; pain medicine is good, dry socket, bad.
About two weeks ago I was blessed with the opportunity to get my mouth looked at again. A recent discovery of spinal injuries had rendered me worthless and unemployable. After a couple of rounds with Vicodin and after what I would call thirty x-rays my principal care provider thought it necessary that I ditch the pill plan and seek physical therapy, and so I did. Nonetheless, this left me with an itch for more euphoria, and coincidentally about the same time that an old filled tooth snapped in half, leaving me in pain again, and with the taste of what I’ll call Mercury in my mouth. My wife suggested that while I did have coverage in the short term I should go and get it looked at. After the three day process of locating a dentist that accepted Medicaid for grown-ups and one who took emergency cases as well, I settled into a nice dentist’s chair where they quickly did another barrage of x-rays and scraped years of stuff off of my teeth and from beneath my gums. They gave me fifteen Tylenol number threes. “Well that sucks,” I thought, and “where is my Vicodin?” I was under the impression that if you go to the dentist you get “prizes.” As it turned out, I had picked the wrong dentist. He found several teeth that needed extraction and set me up for an appointment straight away. It was to be about four days after the initial visit, and two days into that wait I made the call one makes in my state; the call saying the pain medication isn’t strong enough and asking for a higher test variety. I realized then as I always have that this automatically predisposes you to one of two judgments; either you will be given some better meds or will be put on a list as a pill freak. In this case the latter was the result. Anyway, a couple of days later I found myself back in his chair and awaiting extraction number one. It was a Monday, and I had a bad feeling. That feeling would be proven valid after he finished drilling, sawing and yanking at my number thirteen upper, broken off below the gum. As he finished he said it all. “Well, since that was really just a little bit of root left, and had some sharp pieces, you may have a slight discomfort tonight, but just use ice and take whatever you would for a headache should you develop any discomfort.”“Damn it!” I thought quietly, “he isn’t giving me anything; he DOES think I am a dirty pill freak.” I wouldn’t say anything straight away, I just stared blindly into his sadistic blue eyes and thought of all of the other tortured souls that gladly bit his bullet, and meanwhile I made my plan. I would, and did call his office the next morning and complain of the very real pain that I was enduring. I told them of my trip to the ER the night before and how they gave me four Percocet to get through the night, and of each of them, from the triage nurse to the doctor that gave me the samples shaking their heads in disbelief. I even recounted my discussion with three family members who are dentists as well who shuddered at the thought of nothing but Advil or Aleve. Within an hour’s time I was contacted by his nurse, reassuring me that his directions were rock solid. In sheer bewilderment and horror I made it perfectly clear that while I did not intend to question the fair barber’s ethics, I was cancelling further appointments and seeking treatment elsewhere. There was a shock from the receptionist, to which I responded with a shock of mine own, sort of blowing up, telling her that I was a grown man, and had been made to feel like a child, a seeker of narcotics, and other meaningless passive aggressive speech. It was to no avail, but it made me feel slightly better. Soon thereafter I was on the phone with other offices.
Moments later I was reassured by another receptionist that I had been hoodwinked. I told her of other teeth needing extraction and she said that while they could not give me anything for the pain in the first hole, if I was to come in immediately, they could pull another and treat the pain after that. I was in the old Ford and running. When I got there, they were very receptive. They had semi-loud rock music playing in my room, it felt good. The hygienist or assistant was a nice fellow, covered in beautiful tattoos and spiked, jelled hair. His and the dentist’s name were the same, Mike. They were great. They already had all of my x-rays on electronic mail from the former office and were preparing to go in. They noticed that I needed several teeth pulled and it was just up to which one. I had been discussing my former twenty four hour ordeal with another nurse who was asking all the regular questions regarding allergies, pain scale, etc. when the dentist entered, smiling. “What’s all this I hear?” he called out as I was telling my life story to his nurse. “He wants pain pills.” She answered quickly, almost in a silly way. He re-stated that while they could not give me anything for the previous days pulling, if I wanted them to pull another they would be happy to pull another for me and “give me whatever I wanted.” I had found it, the Holy Grail of oral surgery. I recalled the conversation to him that I had had only hours before with the former driller’s receptionist, of how she said “he said to keep it packed tight with gauze, sit in a comfortable chair, like a recliner, with my head above my heart, and don’t talk.” My newfound buddy leaned in, eyes all a gleam and said “that’s because he didn’t want to give you pain pills, we give Percocet.” After a few moments I was shot and numbed. Before he went in I told him of the only other extraction I had done, years ago, and how that doctor had quipped to me, as he was deep in my mouth that “you know, in my line of work I have come to find that teeth just aren’t meant to be pulled.” Moments later, as the tattooed assistant began the suction and the dentist readied to do his best, he looked at the lesser Mike and said “hey Mikey, I have realized that teeth just aren’t meant to be pulled.” Mikey didn’t really respond the way Doctor Mike would have liked I guess, for as he told me to “bite down” and said “you’re all done my man”, he walked out, mumbling something about how maybe the lack of response was due to his inherent Canadian sensibility. I noticed then that he did have a bit of a Martin Short quality about him, and I liked it. We exchanged a firm handshake, discussed playing golf, and I was on my way with the paper rights to twenty five more Percocet. My mission was complete. I made an appointment for the following Wednesday to have the rest yanked, it was a Tuesday.
Now in the first hours of that day I probably ingested five or six of those lovely treats, in pounded powder form, chased with Coke. I was feeling no pain, and back in the warm and fuzzy world of the doped up. My wife seemed nicer, I danced with my children, and I cooked, cleaned and drove the road along my beach slowly, all with a smile on my face. With the weekend approaching, and a few teeth yet to barter with, I felt my pain med stash was getting light, and I didn’t want that, so I called back, complaining of a dry socket in the tooth they had just pulled. After a short exchange with his receptionist about the issue, she assured me that I could not just come in once a week to have a tooth pulled as my “insurance” would not cover that. She was speaking in code, and I knew what she meant. I decided to have the rest pulled on the following day, Friday. All went as planned. Mike the Canadian dentist looked me over, and regarding the broken tooth that started the whole saga, said “I knew that tooth would give you trouble my man.” He was smiling, so I smiled back and said, “Yep, you are correct sir, so let’s take that and the rest out.” I questioned further about meds, joking with him that “doesn’t having multiples pulled get you double Percocet?” to which he replied smiling, “only if I get half.” So the dance began. He shot me a few more times, and within moments I had another three holes in my head. He gave me the script and off to the pharmacy I went. He also gave me a prescription for an anti-microbial mouthwash, and instructions for usage. Moments after dropping the notes off to the pharmacist, she approached me saying, “We’ll have the other ready for you in a moment but this one you have to wait two days for.” It was the Percocet! “Oh no, how could this be...” I wondered, as I sat there, my greatest fear realized. I reluctantly approached her at the window again and asked what the problem was. She explained the new rules about oxycodone and how based on Medicaid’s rules for dosage, and the pharmacy’s, that I had to have at least two days worth of medicine left. I assured them that I didn’t and opened my mouth, all full of gauze and blood and mumbled “I have this.” She nodded that she understood but I would need to either get my doctor to change the dosage info, or prescribe something else. I tried desperately calling the office several times from the parking lot before my phone died. I rushed to the office and explained my situation to the receptionist, the numbness was wearing off as she said, “I know, it hasn’t been long enough.” I tried explaining it to her but she just told me that the doctor was already gone for the weekend and out of town to boot! “Sorry,” She said smugly, “going to be a couple of days.” It was only then that I realized the very real consequences of the hole I had dug. Here I sat, on a Friday afternoon with a crisp new prescription for happiness and nobody to fill it. After another conversation with Medicaid I was told that if I wished to pay out of pocket they would have no problem with it, so I called the pharmacy. The pharmacist told me that while Medicaid may have no problem with that, it was against pharmacy policy. I was stuck; in pain now, full blossom, and without any narcotic recourse. “Shit!” I thought to myself. After one more call to the receptionist at the office that left me sounding and feeling desperate, she asked if she called in some Vicodin instead, would that help. I told her that I thought it would. While on the phone to the pharmacy to check the status of that, and now well after all numbness had subsided, the receptionist left a nasty message on my phone: “ I called in the Vicodin, now I don’t want to hear from you again today, this weekend, next week, or NEVER!” She hung up.
I would like to tell you I handled the Vicodin more cautiously, but I would be lying. I choked it down, and that would be the end of it. I developed another dry socket and thanks to my own abuses, I endured it mostly pain med free. I guess I should have heeded the warning in that joke years ago, that teeth most definitely are not meant to be pulled.
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