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Surgery at the branch clinic
06/10

While I worked at my first job in Western Australia, I’d have to do time for a day or two each week in the branch clinic. It was in a small town, somewhat inland. An old wooden building, with a flat out the back, in which the nurse lived. It was a funny, ugly little town. There didn’t seem to be a simple hint of architectural grace, and all the buildings looked tired and worn, paint fading, the people even seemed drab.

Branch clinics have some universal characteristics. The equipment is always old, and inadequate. And you have to get the job done, however you can. This day, a dog came in with a broken upper canine tooth. There was no doubt that it had to come out, as the root canal was clearly exposed, a dark little dot in the middle of the white tooth. Left with an open root canal, bacteria would track up the tooth, and the inevitable consequence would be an abscess simmering away at the tip of the root. A nasty toothache, and chronic infection upsetting the body.

“Ok then, lets get this fellow under, and see what we can do to get this tooth out,” I said to my nurse. She was a strange girl, sort of grey and faded around the edges. She always got in a bit of a fluster when we had to do an anaesthetic, and was running around, getting what little, old and worn gear we had ready to go.

“It’s all ready. We haven’t done any dental work here for ages, but I found the tools…” She went back to filling the anesthetic machine with halothane. I caught a whiff, and warned her – “Hey – be careful not to breathe that stuff at all, it does awful things to your liver!”

We got the dog out, eased the induction anaesthetic into his vein, and got him intubated and settled.

I looked at the tray of elevators, scrapers and such – and my heart fell. There were, I noticed, what you might call “limited options”, and what there was was old, and blunt as my thumb. The secret to an effective extraction is sharp elevators, so you slip with ease between the tooth and the bone, gently breaking down the periodontal ligament until the tooth simply falls out. With a broken, but healthy tooth, it’s very hard work even with good tools.

I set to work. Sweat sprang forth from every pore, as I exerted every ounce of power in my body, trying to get these blunt, awful, worn out tools to do the job at hand. I muttered curses at my parsimonious bosses, and millimeter by laborious millimeter I attacked and ground my way towards extracting this tooth. He was a big dog, and the tooth was nearly the size of my little finger where it went into the gums. I tried different angles, I tried everything, and the endless torture for me and the poor dog went on, and on, and on.

“How are you going?” asked the nurse.

I looked up, sweat streaming from my face, all red with frustration. I paused, laid down my tools, and shook out my poor, aching hands.

“This is a bloody nightmare!” I replied. “I’m starting to wonder if I will be able to get this tooth out at all… How long have I been going at this?”

“Jeez – it’s been an hour.”

I took up my tools once more, and kept at it. Despite my best efforts, occasionally the tool would slip, gouging the poor dogs gums. I shuddered to think how sore it’s mouth was going to be after this horrible, horrible job. But little by little, I managed to jam and batter the elevator further along the root of the tooth- more by sheer force and will than by good technique. My hands were wrung tight, aching in every sinew, one hand holding the dogs head steady, the other wrapped so tight around the handle of the elevator I had to nearly peel each finger undone in turn when I took a break. I felt like I’d played 2 or three games of footy in a row. I was battered and stressed about how much harm I was doing, and all because I was left with worn out, blunt tools. I was angry!

Then, at last, the tooth came out. The root was about 2 inches long, so no wonder it was so damned hard to get out. There was a gaping cavern left, which I stitched together as best I could; then I sent the dog home with a large amount of pain killers, and when I saw him the next week, he was right as rain.

I asked for some new dental tools at the branch clinic, and was quite unsurprised when no new ones ever arrived….

 

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