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For the first time in my long career, two patients came in to the office this week to have their 30+ year 4 unit bridges replaced. Most significantly, I placed those old bridges.
Why?
Because before I replace an old bridge, I send my patients to Root Canal Experts for a scan to make sure that the supporting teeth are healthy and without infection. And what do Dr. Byrne and Dr. Banchs tell me to do? Take off the bridge and see how MUCH decay is under the bridge.
Every very old filling, crown or bridge (20+ years) has tooth decay under the old restoration and the only question is 'How much?"
35% of the time, the one of the teeth is hopeless and requires extraction and replacement with an implant. The other 65% of the time, we can place a new filling, crown or bridge.
Why would anyone wait longer than A QUARTER OF A DECADE to have old work replaced?
Because the dentist doesn't tell them to replace the work.
I am telling you: REPLACE ALL of your old dentistry...even if you have to take 12-24 months to redo it.
It is ALWAYS less costly to be proactive rather than re-active when it comes to your health, your car or your house.
Omaha — I’VE been watching the monitor for hours. Natalie’s asleep now and I’m worried about her pulse. It’s edging above 140 beats per minute again and her blood oxygen saturation is becoming dangerously low. I’m convinced that she’s slipping into shock. She needs more fluids. I ring for the nurse.
I know about stuff like septic shock because for more than 20 years I was a transplant surgeon, and some of our patients got incredibly sick after surgery. So when I’m sitting in an I.C.U. in Omaha terrified that Natalie, my 17-year-old daughter, might die, I know what I’m talking about. I tell the nurse that Natalie needs to get another slug of intravenous fluids, and fast.
The nurse says she’ll call the doctor. Fifteen minutes later I find her in the lounge at a computer, and over her shoulder I see a screen full of makeup products. When I ask if we can get that fluid going, I startle her. She says she called the resident and told him the vital signs, but that he thought things were stable.
“He said to hold off for now,” she says.
“Get me two bags of saline. Now,” I tell her.
She says, “I’m calling my supervisor,” and she runs out of the lounge.
Natalie is awake and looking around when I return. Her face is that dark red that sends waves of panic through my gut.
“What’s wrong?” she says.
I’m a lousy actor.
I know I shouldn’t be my daughter’s doctor. They taught us the problems with that during my first week in medical school. It’s a really bad idea, especially in high-risk situations. There are a few exceptions; like, it’s probably O.K. to sew up your child’s cut on vacation or to hand out antibiotics for uncomplicated infections.
We doctors are also very superstitious that when dealing with family members of physicians, or of V.I.P.s, something is always going to go wrong. The more the Special Person hovers over the care of his or her loved one, the worse the complication will be. I’ve had conversations in which doctors feel they change their routine with V.I.P. patients, and it’s that disruption in routine that allows error to creep into their care.
But right now, I don’t care about any of that. I’m the one with experience taking care of really sick patients, and if I know she needs more fluids, she’s going to get them.
I break into the crash cart, a box on wheels full of stuff they use to resuscitate patients. I pull out two liters of saline solution and run both into Natalie’s IV in less than 20 minutes. Natalie’s pulse slows and her blood pressure rises. An hour later, after the nursing supervisor and on-call resident finally arrive, I’ve finished infusing a third liter. Natalie finally looks better.
This wasn’t the first time during Natalie’s illness eight years ago that I broke my promise to just be her dad. It started a week earlier when she came into the den and showed me the blood she’d coughed up. I suspect a father without my experience might have chalked it up to flu. Maybe because I was a transplant surgeon, and always considered the worst possible cause whenever a patient had a hiccup, I took her to the hospital. I was worried the blood meant she had a bacterial pneumonia, a bad one. And it did.
On the way to the hospital, Natalie took a deep breath and looked at me. “Am I going to die?” she asked. I’m convinced that she would have been dead before morning had I not been a doctor, and one who could recognize septic shock when it affected a normal teenager.
I am haunted by that moment, and others like it involving people I love. My younger son, Joe, almost died 15 years earlier from septic shock, the same kind that killed Jim Henson. He became ill while I was out of town. I flew home and by the time I arrived at the hospital, he looked deathly ill to me. I told the nurse I thought he should be transferred to the intensive care unit, but she said the doctors thought he was improving. Joe stopped breathing during the night and I have blamed myself ever since for not insisting they move him.
Over and over again during my dad’s last few years of life, I felt as if I should have just moved in with him so that I could prevent all the well-meaning doctors and nurses from killing him. Sometimes it was just because his doctors weren’t talking to one another and their conflicting prescriptions sent Dad to the hospital.
In the end, he died about 10 minutes after receiving an injection I didn’t want him to receive. From my home in Omaha, 800 miles away, I asked his caregivers not to give him a medication that I worried could be lethal but that they insisted was routine for old people like him. I thought we’d reached an agreement but while on the road to visit him the next day, I got word that his heart had stopped.
Last year my wife’s mother had colon surgery and when we went to visit her in a rehabilitation center two days after her release, I discovered that she had an abscess the size of a lemon in the wound. It was red and swollen and she said it hurt like the devil but the attendants had assured her it would get better because she was on antibiotics. We took her to the E.R. where the nice doctor used an ultrasound to look it over and told me he didn’t see any pus there. But I could see a large pocket of pus, so I asked him to call the surgeon. The surgeon probably told the E.R. doctor to humor me, but as he took a knife to the wound, no one in the room except the E.R. doctor was surprised when creamy yellow, foul-smelling pus shot out of the wound and soiled the young man’s spotless shoes.
I have more stories like this. What are the odds of that? I don’t think it’s me.
After three days in the hospital, Natalie got better. A new chest X-ray showed that there was much less fluid in her chest. Her fever resolved. They changed one of the antibiotics and the nausea she had had all but disappeared. They told her she could go home. They prescribed antibiotics for her to take at home, and removed her IV catheter.
Natalie went back to school, and the next day was interviewed by a TV reporter because she was one of the few who survived her kind of pneumonia in Nebraska. She talked about her disappointment over missing swim meets.
Natalie recovered from that illness eight years ago, but I didn’t. I stopped operating and taking care of really sick people two years later. I told myself I had become too distracted by my increasing administrative duties to be a safe doctor. I was glad to leave all that behind. Now I just want to sit on the sidelines and marvel as a new generation of doctors performs the miracles. I never again want to step in to rescue someone I love. But I will, if I have to.
Without reflection and re-evaluation we would never move forward. Constant learning is the true sign of a professional.
There are very few cases that I would not change if given the opportunity.