Kurt R.A. Giambastiani

Regular readers (and I have a few) may have noticed I did not post last week. Also (possibly) that I’m late with this week’s post.

There is a reason for that: oral surgery.

TL;DR: I had a wisdom tooth that had to come out. It did, but it did not go quietly. I’m healing and I’m getting better.

Long version:

Prologue

I had one wisdom tooth left in my head. The top ones went when I was in my teens, easy-peasy. The lower left one came out, reluctantly, when I was in my early 30s. The last one, on the lower right, tooth #32,—let’s call him Balthazar—was left alone for several reasons: he had only partially erupted (was still mostly covered by a flap of flesh), he was very low in the jaw, his roots were tucked under the next molar (#31), and those roots were uncomfortably close to the inferior alveolar nerve which runs along the jaw, under the teeth, up to the chin and lower lip. Taking him out would be problematic, painful, and could cause irreparable nerve damage.

I’ve been babying Balthazar along for 30 years, keeping him as clean as possible, handling the minor surface inflammations when they arise, etc. He would bother me once every year or so, but only for a week at most. I thought I had him under control.

Inception

The day after St Patrick’s Day, my jaw began to hurt. Figuring this was one of Balthazar’s standard bouts of petulance, I did what I always did: extra (gentle) brushing, salt water rinses, and so forth. By that Friday, though, the pain had changed. Rather than the usual ache-and-annoyance pain, this was sharp, hot, stabbing, and lanced forward under my jaw all the way to my lip and chin. It was so different, in fact, I thought that I’d cracked Balthazar’s neighbor, the molar #31. I used compresses (hot & cold). I loaded up on anti-inflammatories. But I had no fever, and nothing was sore to the touch, so I chose to ride out the weekend.

The situation did not improve. The opposite, in fact.

Conflict

That Monday, I called the dental clinic for an emergency look-see. Doc #1 took a look, took some bitewings and a panoramic scan, tapped the teeth, and tested them for cold sensitivity. Molar #31 was not the culprit, she informed me. It was Balthazar. He was not happy.

Neither was I.

She referred me to an oral surgeon.

First Action

I had to wait four days before I could see Doc #2, the oral surgeon. By this time, I’d begun to swell under the jawline. Pain had increased threefold, radiating up into the ear and across the brow. I couldn’t open my jaw very wide.

Doc #2 was an affable guy, grey-haired, a glint in his eye, hobbling about in a walking cast like Walter Brennan (go look him up, youngsters). He took another pano, and a CT scan to boot. After some poking and nosing about, he had concerns.

I obviously now had an infection, and it was so bad that I had developed a case of lockjaw (trismus). I could only create a 20mm (3/4 inch) gap between upper and lower teeth, which was totally insufficient for access and extraction. We had to deal with that first. He pumped two bags of antibiotics into me, then prescribed more antibiotics, heavy anti-inflammatories, and a medicinal mouthwash. His major concern was that, as the swelling was on the inside of my jaw, my airway was in jeopardy. Even if he had room between my teeth to maneuver, his clinic wasn’t prepared should things turn pear-shaped. (I overheard him explaining it to his support staff: “We don’t want to end up with . . . ” “A dead patient?” someone finished for him. “Yes. That would make a bad weekend for everyone involved.” No shit. Me especially.)

We opted to wait a day or two and see if the antibiotics started to tamp down the fire in my jaw.

Rising Action

By Sunday afternoon, I was in a very dark place. I had quickly developed a case of thrush and my throat was inflamed along with everything else. The swelling in my jaw, rather than diminishing, had increased, and the pain was constant. While I’m not a fan of the “What’s your pain on a scale of 1 to 10?” question, as my analytical mind always leaves room for torture, childbirth, and a compound fracture of the femur, I had to admit that, for a tooth, I was at a 9.

On Monday (we’re now ten days into this), I called Doc #2. He said it could be lymph or glandular, something more Ear/Nose/Throat (ENT) than Oral Surgeon, so sent me to my regular physician. They’d probably want to do a more in-depth CT scan to be sure.

I ran up to my clinic’s urgent care, where Doc #3 looked at me. Infected: yes. Swollen: very yes. Lymph or salivary gland: unknown. So Doc #3 conferred with Doc #4, their ENT surgeon, and decided to send me up the road to get a CT scan from Doc #5.

Doc #5 shot me full of an iodine contrast agent (“It’ll make you feel like you’re peeing, but you won’t be,” he informed me, and he was oh-so-right on that one). With my blood hot from the injection, the scan went fine, and I went to wait in the parking garage as Docs #3 thru #5 conferenced over the results.

It was not anything to do with the glands, and thus not anything Doc #4 (ENT) could address. It needed to be dealt with by Doc #2 (oral surgeon). I spoke to Doc #2, and he said with the possible airway obstruction, he couldn’t deal with it himself, and recommended me to Harborview ER, where they have an oral surgeon on-call. They’d have the wherewithal to handle any unfortunate turn of events.

Rising Tension

At this point, I was feeling like a ball in a pachinko machine, bouncing from pin to pin, ever descending. Would I end up in the Win pocket? Or would I go down the Lost Ball chute? No one was taking charge. No one was shepherding my care. I was in pain, frustrated beyond reason, and if I’d had an army at my back, I would have taken very little to convince me to invade Gaul or get involved in a land war in Asia.

Not having an army at my back, we opted instead for Harborview ER, in downtown Seattle, well known for its excellence in trauma treatment.

Excellence aside, the ER of Harborview is a pit. Hard to find, hard to navigate, a warren of roped-off aisles, dingy and dim and threadbare, I began to wonder if this was at all a good idea. As with all ERs, it was a combination of inaction and kicked-hive frenzy. And, being an urban ER, it had quite the cast of characters.

There was the drug overdose and the walk-in stabbing victim. There was Dave, the old guy, who was only there because he took a tumble and his neighbor (against his wishes) called 911; he was waiting for his taxi ride home (“It’ll be here in 20 minutes,” he was told). There was the guy in burn swaddling, and the young woman just back from a vacation in Puerto Rico who had been vomiting since 4AM (it was now 5PM), and who, despite her feeling so ill as to come to the ER, still took the time to apply and curl her fake eyelashes. There was the creature who sailed through, swathed in black from crown to toe, looking for all the world like a Bene Gesserit sister.

We waited for three hours (swaddled burn-guy gave up and went home) before my wife, her hackles fully raised by now, went and asked the incredibly uninterested triage nurse if he could tell us where we were on the board.

“Burn is before you…”

“He left.”

“Oh, well, then there’s one other person. You’re up after that.”

Dave’s twenty-minute wait was now in its third hour, but finally, just as we were called, his cab did arrive. Good, because I wasn’t going to go in before he got a ride home. Poor guy.

Back in the bowels of the trauma unit, Doc #5 eventually dropped by and told us we had to wait until Doc #6, the on-call oral surgeon, arrived. (Why he hadn’t been paged sometime during our three-hour wait, when I had told them up front that Doc #2 sent me to them specifically to see their oral surgeon, I can’t tell you.) Thirty minutes later, Doc #6 arrived, and before even taking off his backpack, he proceeded with the standard palpation and evaluation. Then he uttered the magic words.

“Here’s the plan,” he said.

Finally—finally—a plan. Finally, someone other than me, someone with medical experience and education, was willing to take charge, formulate a plan of action, and see it through.

The plan, however, wasn’t going to be easy.

First Attempt

The first part of the plan was, right then and there, to attempt to drain the abscess which was located inside my jawline, way in the back, deep under Balthazar’s firmly impacted feet, all through an aperture currently (at its widest) only 20mm wide. The chances of success were limited, given that the ER isn’t well-suited to this activity, and Doc’s toolkit (in his backpack) didn’t have everything he had in his main office. But Doc #6 was also concerned with the pressure on my airway, as the abscess could turn bad, quickly, forcing me back to the ER in even more trouble.

He tried. He tried with diligence and passion. He rammed a bite-block between my teeth, widening my locked jaw to about 30mm, and as the pain from that subsided, we pressed it even wider. He cut and scraped and tried this angle and that angle. He grabbed my jaw with one hand and pushed an awl into it with the other. It would not give.

Eventually, he retreated. Balthazar had won the battle, but Doc #6 was determined to win the war. Doc #6 went off to confer with a colleague.

In the intermission, Doc #7 dropped in. Harborview is a teaching hospital, and word got around about this old guy and his wacky wisdom tooth. Doc #7 had an interest and came by for a peek. I had no energy (or desire, really) to deny him, so with gentle hands and soothing words, he took a look, thanked me, and departed.

Then Doc #6 returned. He had made an appointment for me, the next day, to come in and take Balthazar to the woodshed. I had a fleeting feeling of disloyalty, as this was supposed to be Doc #2’s tooth, but I discarded that quickly, opting in favor of the Doc who’d displayed the greatest concern for my welfare.

My wife drove me home. I felt like I’d lost a barfight. I felt like Rick Deckard, coming home after battling Leon, bleeding into his shot of vodka, knowing he had to go out the next day and deal with Roy and Pris.

I failed to sleep.

Second Attempt

Balthazar was now in full raging maniac mode. He was Dr. Doom, Pazuzu, and effing Sauron all wrapped in one. That 1-to-10 scale? We’d turned it up to 11. (For teeth . . . I am still reserving a spot for that compound fracture of the femur.)

The front side of Harborview Hospital is the total opposite of the ER side. I think it’s safe to say that the ER is on the six-hole side while the front presents a smiling face of medical excellence. We arrived, checked in, and were ushered back into the clean, well-lit corridors that had—believe it or not— a harbor view.

We were met by Doc #8, who would be doing the procedure. Middling height, on the fresh side of thirty, he exuded a casual confidence without seeming cocky. We discussed at length the procedure, the risks, and the possible outcomes. We might get Balthazar out completely. We might not. We might need a follow-up surgery. There would be bone removed. There would be blood. There would be pain, though Novocain and nitrous oxide, respectively, would handle the pain and the attendant anxiety. Doing nothing, he stressed, was not a viable option and I agreed; after ten days, I’d had a sufficiency of doing nothing.

In we went.

Climatic Action

In times of stress, my humor often takes a turn to the dark side. When the assistant asked if it was OK if she revealed the tools, I began to riff on Torquemada (“First, mention the tools; then reveal the tools.”) before assuring her that, without my glasses, they all looked fuzzy and clean and completely unthreatening.

I won’t go into details of the procedure except for this: the drill. Anyone who’s had a cavity filled knows that high-pitched whine that fills your skull as they carefully rout away the decay and prep for a filling.

This was not that drill.

This was a different breed of drill, a drill that could go through anything. It fired up as does a turbine, with a whoosh of air and a rising tone, but this drill’s tone did not, like it’s soprano cousin, immediately try for that high C. No. This drill rose from baritone to alto and stayed there, screaming like a god-forsaken banshee, a guttural, demonic howl of rage and ruin that barely took breath as it ripped through bone and tooth alike. It was, by far, the most unsettling thing about the entire two-hour operation, and I hope never to hear its like again.

Toward the end, we needed another pano X-ray, so I was escorted the length of the clinic to a room where I stood, bleeding from the mouth, looking exactly like an extra from a George Romero movie (go look him up, youngsters). Back in the chair, Doc #6 (from the ER) came in to say “hey” and check on me. The clinic boss, Doc #9, came in to confer, and Doc #10, another resident, popped in to see the guy with the wacky wisdom tooth.

After a bit more banshee-drilling, I got stitched up and came home.

That was Tuesday.

Denouement

Wednesday and Thursday passed in an oxy-haze, but progress was definitely made. I’m starting to go bonkers on a liquid diet. I like soup and yogurt and smoothies and pudding just fine (the Ensure I’m not crazy about), but I’d really like something solid, something with texture, something (pardon me, my plant-based friends) meaty.

But such foods are still only in my future (though I did gum down a crust-less piece of diced bread today). My jaw is still locked at 20mm and, in addition, I have lost all feeling on the right side of my lower lip and chin, and back a bit on the cheek. The Docs are confident that this is temporary, as they didn’t catch sight of the nerve itself down in the socket.

The pain is manageable. Mornings are iffy, but usually low-pain. The tide of pain doesn’t start to rise until about noon, reaching high tide around 8pm, at which point it’s back to oxy-land for a few hours, but even that tidal sway is beginning to abate and level off.

So, that was the past fortnight for me, and why I’m a bit tardy with my weekly post.

I hope your last two weeks were better.

Much better.

k