Sunday, August 7, 2011

Of dental and mental surgery

“Alright then”, the nurse said in her business-like manner. “We’ll use sevoflurane and no propofol. The anesthesiologist will be here shortly to answer your questions and explain in greater detail”.

“Ok, thanks. Oh, and I hope you won’t use halothane, because apparently it’s no good for kids with issues like his”, I added, motioning to Rithvik who was patiently waiting in a corner.

“No, we don’t use halothane any more”. There was a long, hesitant pause. “You know, I learn so much from parents of autistic kids. They are so informed, they do their research, they bring up stuff that sometimes we haven’t even seen. It’s great”. She left, shaking her head.

And tears welled up in my eyes.

Hmm, that’s strange, I thought, as I watched the nurse disappear behind large double doors. Why would a simple comment like that get me emotional?

Then it came to me. Somebody gets me. What a change, when you’re used to facing only skepticism, condescension or outright resistance. The connection we made there was a very simple one – no big impact, no angels playing harps in the background – yet it stood out due to its rarity.

We were standing in the outpatient surgery waiting area at Texas Children’s Hospital in downtown Houston. There were families occupying each of the enclaves and more outside in the reception area awaiting their turn. It was finally here, the day we’d been dreading for months: surgery under general anesthesia to remove Rithvik’s bad tooth and do other related dental clean-up work.

There was to be a repeat experience soon. A trio of ladies in green surgical scrubs walked up to us. The middle one introduced herself as the anesthesiologist. She was friendly and pleasant, and we quickly jumped into the details of fat-soluble anesthetics and mitochondrial dysfunction. About fifteen minutes later, we found ourselves saying gratefully, “Thank you so much for taking the time; I’m afraid we’re really holding you up”.

“No, not at all!”, Dr Torres protested, holding up a hand. “Your son is the most important patient for us right now, and I want to make sure you’re comfortable with everything before we proceed”.

That really does it for me. Here’s a perfect stranger (especially one wearing this forbidding uniform) prioritizing my son. My eyes filled up with tears again. This time it must have been really obvious, because Dr. Torres continued, looking earnestly into our eyes, “You’re nervous about the surgery, you’re nervous about your son and his challenges, and ...”. I don’t hear the rest, because I’m thinking, “Me, Mr. Got-it-all-together, nervous? Really?“ In the weeks leading up to D-day, at each of the umpteen times Rithvik had asked me “Will Dr. Elsa be gentle with my teeth, Appa?”, I had summoned my most confident demeanor and assured him she would. We had rehearsed the whole routine ahead of time - him inhaling deeply through a mask and then pretending to fall asleep, followed by my best impressions of drilling and filling, and him awaking with healthier, cleaner and fewer teeth in his mouth. On the whole, I was fairly confident in his ability to handle the experience, and optimistic for a positive outcome of the procedure overall. And I had taken it upon myself to pick up Sowmya and Roshan when their confidence faltered.

But I also remembered there was a moment the previous morning. I was making myself a cup of tea, when all unbidden, a vision fluttered into my mind’s eye. I saw a grim-faced doctor emerging from the operating room to announce solemnly that Rithvik didn’t make it - due to a reaction to an anesthetic agent we hadn’t authorized. I saw Sowmya collapse to the floor, and me grabbing the doctor by the collar. But then, just as suddenly as it came, the specter melted away, replaced by a clear and grounded sense of perspective. I guess we all have fears (or to be more precise, outcomes we really don’t want). But we train our brains to operate on those fears in our own unique ways. Some of us dwell on them, some run from them, some handle them objectively, and some like to see, in Teflon’s words, how they can run circles around them. On reflection, I’m seeing that one of the things I like to do is to run a preview of the worst case. My sense of comfort with that scenario is a key parameter that informs the decisions I make. But that’s another post.

I thought it was interesting how easily the sensitive doctor’s remark opened a window to my own mind's workings. And as I now muse on the whole topic of connecting with another human being, I recall a discussion of communication in a book I read many years ago, with a graphic I’m reproducing below.

I forget what the bull’s eye was labeled, but I suspect it would be the name we give to the source of our emotions – heart, soul, spirit, or even deeper, what we call the core of our selves. And I suspect the richness of our relationships with the people in our lives would be in direct proportion to how deeply we connect with them.

Here's to deep connections, rich relationships and fuller awareness of ourselves,



  1. Sree,
    Thank you.

    Sometimes I believe there's no deeper sense of connection than the one we derive from feeling 'got'.


  2. Sree. Thank you so much for sharing this experience. I'm going to grab back to this one a couple of times!

    P.S. Can you tell me how Rithvik handled this experience further? Did he have pain afterwards from the removed teeth, and if so, how did he handle that. Would he agree to do it again?

  3. Iris: overall, Rithvik handled it fairly well. As I mentioned, rehearsing it beforehand really helped, and he was very cooperative going into the operating room. The procedure lasted about an hour, and the anesthesia wore off at the end, right on schedule. He was very disoriented upon awakening*, and therefore a bit agitated, and needed us to calm him down. We had instructed the dentist to minimize the number of teeth pulled, and the final tally was just one tooth pulled, and 3-4 fillings. He didn't seem to have much discomfort for the rest of the day, and by the next day he seemed to be back to normal. No other ill effects from the anesthesia as we had feared.

    P.S. I know because one of his first questions in the recovery room was "What year is this?", followed by "What month is this?", "What day is today?" and "What date is today?" :-) He is normally well-anchored in the calendar, and needed that info to get his bearings back.


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