Critical Incident Essay 1

Written by a University of North Carolina dental student

If I have to pick one incident on my senior rotation that affected me the most to be writing about, it would be my experience with some of the patients in the hospital. The whole atmosphere of the hospital, especially the in-patient clinic where I was working, was depressing. Ninety percent of the patients were in very poor health, over 60 years old, and most were in wheelchairs and missing a body part. It was extremely hard to communicate with most of them. They either couldn’t hear you or could not understand what you were doing for them. I think that having only done dentistry in a closed environment such as dental school, you tend to lose the big picture. You don’t think that you would have patients that are so medically compromised, taking 30 different types of medications, having many systemic diseases, and as the health care provider, having to deal with all that.
It hit me for the first time, that maybe for some patients who are medically compromised, dentistry may be the easiest part of all and knowing how to deal with all the medical issues and taking the risk of rendering treatment to a patient who is taking a hundred different medications is the hardest part.

If I have to pick one patient out of all of them, it would be the gentleman who had lost literally half of his face due to a lymphoma. He had been a chain smoker for a long time who noticed a small nodule around his nose one day. Biopsy confirms lymphoma and, of course, surgery is the way to go from there. Once surgeons start the procedure, there is not much to leave behind, half of the face has to go, including: one eye, one ear, and the whole nose.

The head of the dental clinic is mostly responsible for dealing with patients as such. He amazed me. We had a lecture with him and he was nice enough to share some of his work, “obturation” as he called it, and the prosthetic work that he does for those patients. He makes prosthetic eyes, noses, ears, jaws, and dentures, and his work is spectacular.
One day when I was working on an elderly patient, he called me in and asked me to go visit this patient with him. All he said was that my patient has lost his nose and mouth and that he had made him a prosthetic nose and mouth, including teeth. When I walked into the room, I could not believe my eyes. In a way I felt as if I was in my gross anatomy lab, except this was a live patient and not a cadaver. The patient had literally no nose, lips and hard palate, no teeth either. One could see the entire nasal base and the bone structures inside his nose and the left side of his face. The soft tissue was totally missing. I have never felt like that before encountering a patient, I started to feel nauseated. The scene was just too much for me. Yet, for the patient not to feel bad, I left the room using an excuse, washed my face, and came back and decided to be strong. I was shown the prosthetic nose, half mouth and full denture attached to a fake palate that he had made for the patient. It was amazing. The patient was able to place the nose in and out; the hard palate was implanted to the remaining bone structure. The way the base of the prosthetic nose was set up was similar to the structure of dental implant, and the tissue-stimulating part of it was glued back on the base.

Two things shook me; first, by how broad the scope of dentistry can be, though many people think of it as a limited career. This simple experience proved that wrong. Second, the appreciation that this patient had for what was done was indescribable. It made me think that there is so much we can do as dentists and if there is an interest how much we can improve someone’s life. After talking to the patient, as I got more comfortable looking at him, he told me that he had decided never to leave home again because people were “grossed out” looking at him and they would turn their heads around or he would get the look of pity. He had initially decided to wear a mask and limit his social life and never go out in public if he didn’t have to, but thanks to the miracles of dentistry, and providers, he was a different person. He had gained his confidence back and was once again able to be social and live a normal life. It made me be proud to be a future dentist.