Sunday, December 31, 2023

Not Even Not Zen 334: Biomythography - Note 78, On Novocaine (I)

On Novocaine

In the 1970s, everyone in the United States seemed to be suspicious of pain. Stating that you were in discomfort made your doctor's eyes narrow. He would put you on his naughty list right then. Pain was a precursor to demanding opiates, which led next, obviously, to heroin, which meant you were some kind of junkie. You couldn't admit to feeling pain without being a junkie any more than you could admit to being an atheist without being a commie. Culturally, your best bet was to let your arm fall off and hope a nurse would leap to the right conclusion from it.

Dentists were the one sort of medical professional who could admit their patients were in pain. In fact, they discussed it openly. One of them introduced me to novocaine. 

What a Pain, Generally 

I grew up with a lot of martial arts sparring sessions. They give you a nice approach to your body. Sharp twinges become less alarming. You learn the difference between a kick that stings and one that injures. Even in real fights with people hitting their hardest, a blow taken is usually not an injury (not a serious one, anyway) and it's good to know. You learn to see or feel the difference in other people, which is helpful.

Endurance sports like swimming lend you a familiarity with aches, cramps, and soreness. You sense the difference between a muscle spasm and a tear. You learn to persevere when your arms and legs won't move. If you're persistent enough, you feel the differences between muscles, ligaments, and tendons. Humans have a wide array of internal chemoreceptors, cutaneous receptors, and stretch receptors. You can learn to pay attention to them.

Being tormented by adults or bigger kids, the kind of sessions where a bigger person pins you and you can't escape, doesn't seem to give most people the same kind of physical insights. Yet the insights are there to be had. You can lean into the torture.

My experiences with leaning-in led me in the wrong direction about novocaine.

First Novocaine 

"My wisdom teeth came in two years ago," I complained to my mother one day. I was seventeen. She had herded me into her car to drive me to the dentist. I slumped in the seat and leaned into the corner by the window, away from the future. "They're fine. It's dumb to take them out."

"The dentist says they're pressing against your other teeth." She always took the side of the medical professionals, no matter what they said. We'd had similar conversations before. I suspected the dentist was drilling and filling cavities that didn't exist. This extraction seemed like more of the same.

(A year later, when the dentist announced I had twenty-two cavities, I refused to go back. The things he claimed were cavities looked about the size of dust motes, even when enlarged on my x-rays. Fifteen years later, I visited a dentist again. The next x-rays showed I had three cavities. So I think I was right.)

I remember way too much about the extraction, so I'm going to skip a lot of details. You know the weird, half-clean, half bacterial smell of a dentist office. You've heard the banter between the assistants and the dentist. My dentist talked a lot that day because he knew I was suspicious of the extraction. He allowed how, yes, my enamels were fine except for my wisdom teeth. Then he warned me that my mouth wouldn't stay healthy if he didn't remove those last molars.

"I've got great novocaine," he said. This was his selling point.

"No laughing gas?" I asked. My previous dentist had used nitrous oxide on me for every procedure.

"That's old stuff," he sneered. "It distracts you but it doesn't deaden the pain. Novocaine eliminates your nerve sensations. I'm going to have to break your teeth off from your jaw, remember. So no, no laughing gas."

"But you're going to give me a shot in my cheek."

"Yeah." He nodded.

"Ugh." As a child and teen, I had gotten eight years of allergy shots. I took them twice per week at first, then once per week. The needles had entered the flesh of my upper arms, which is not a bad place. Nevertheless, they hurt every time.

Eventually, I sat down and let him give me the shot. It burned, of course. I tried to lean into it but the sensation was so sharp, it surprised me even when I expected it. A couple minutes later, the dentist returned to give me another in the same cheek. It didn't hurt as much because my jaw was numb from the first time. He inserted a bunch of clamps in the back of my mouth and screwed them down to my wisdom teeth. The clamps, as they went in, looked like medieval torture devices, thumbscrews for those pesky bits of wisdom.

After the dentist got all the contraptions in place, he dipped into his supplies for another syringe. He sank a needle into my gums. It hurt like a needle. After the third shot, though, I finally grew numb enough for him to start his cuts. It wasn't too hard to move my spirit toward the remaining pain, to take it in and enjoy the living experience of it.

The procedure seemed to involve a lot of blood. The assistant tried to keep me from seeing too much of it but there was enough to make her scramble for more equipment. Within ten minutes, the throbbing pains were back, too. Each time I got cut, it felt like a stab wound. I leaned into the sensation. 

The sensations grew. I leaned in more. 

I had read lots of old adventure stories, comic books, and war novels that featured torture. (Tintin had gotten thrown into a torture chamber, probably more than once. War heros suffered in them, too.) In all of the stories, the main characters remained fearless despite the torment. Mentally, emotionally, and physically I leaned in as if I were accepting my disfigurement and death at the hands of torturers. 

At some point, even though I had accepted the sensations and the dentist was chiseling out pieces of tooth without too many problems, he could tell I was feeling it. He administered another shot. He resumed the extraction of bone fragments from the upper right. By the time he got to my lower jaw, he could tell something was wrong with the novocaine.

"It shouldn't wear off this quickly," he murmured to his assistant. "Isn't this the same stuff as yesterday?"

"Yes. It was a nearly full tube."

The dentist administered another shot. Out loud, he started to worry about how many novocaine dozes were advisable. He kept talking and blaming the assistant. He gave me another dose. He did it again. He administered the last of the tube. The remaining painkiller wore off quickly, too. By the time he broke off my bottom wisdom tooth, I understood pretty well why tooth pulling was used as a form of torture in so many countries. I felt everything clearly. Even the clamps on my teeth, although they sat unmoving, flared with their additions of misery. When the dentist started his stitching procedure in my gums, I felt every jab of the needle. I felt every flap of loose flesh. I leaned into every spasm. My legs and fingers twitched involuntarily.

At some point, I became delirious with agony. My sensations got confused. Stabs of pain created swirling lights in my vision. The dentist, to his credit, ignored his circumstances and carefully finished his sewing of my gums, top and bottom.

On my way out, he gave me more painkillers, which I dumbly refused, so he gave the pills and a prescription to my mother.

Although the extractions may have been unnecessary (although certainly not unusual), in retrospect the pain was not his fault. It took me twenty-three more years to understand my body's reactions to novocaine and other painkillers.

Back in 1978, though, the reaction most on my mind was my dentist and his assistant. I had to return a week later for more extractions. The team said they would remove my two remaining wisdom teeth. 

This time, although the novocaine would wear off quickly after every shot, I would expect it. 

The dentist would only half expect it. During the second procedure he would grow convinced that, somehow, it was my fault. He was right.

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