On Novocaine
Part III
When my wife got fully employed, we switched to her insurance. We explored our new healthcare options. I settled on a dentist after years of searching. The reason I settled on one was unrelated to our insurance, unfortunately. (It was unfortunate for our finances, not our health. Our health improved with a better dentist.)
We had moved from practice to practice while we tried to find dental care we could tolerate. Finally, through a recommendation, I located an excellent dentist. Unfortunately, he did not take any insurance. At all. I was shocked by how expensive he was. But despite his higher costs, I brought the family into his offices. I'm cheap, yes, but I wanted all of us to benefit from his care.
Some professionals have a deft touch. They are so much better than others you would think they were in a different, higher calling. He was one. He also took a 'no pain' approach to his practice, which I felt was an impossible but noble goal. He came surprisingly close to achieving it. In retrospect, his personality helped. He talked me through the procedures. He acted as if I were interested in the art of dentistry. He made it interesting. With him, root canals seemed routine. Years ahead of anyone else, he declared that enamel fillings and caps were his standard. He studied the results of each procedure with care and taught me not to accept sub-standard work.
"Speak up if something doesn't feel right," he would say. He knew from his first look into my mouth that I had a tendency to accept bad work.
He also noticed my twinges of pain before I did during each procedure. He renewed my doses of novocaine when he felt it was appropriate. His careful attentions lulled me into feeling I was normal with respect to my body chemistry. Well, I mostly was, I suppose. But everyone responds a little differently to medicines. Everyone fits into the human range of reactions. It's rare to find a person who has the typical response every time to every treatment.
Just as it turns out hardly anyone has a normal body temperature, it's unlikely anyone has a completely typical internal chemistry.
The Final Clue
After the birth of my third child, I talked to my doctor about getting a vasectomy. She gave me a referral to a specialist less than a mile away, a woman who did the procedures on an out-patient basis. (As it turns out, the operation is almost always done in an out-patient way. I had never given it any thought before.)
I reported to my first appointment and found it was mostly an explanation. I had to listen and fill out forms saying I agreed to have the procedure done. I don't remember any other preparation. My second appointment with her was the operation.
As with many previous procedures, all with dentists, this one started with a shot of novocaine. The surgeon did such a skillful job of it, though, I don't remember the injection. My first vague recollection is of her testing the results.
"Do you feel this?" she asked.
"Yeah, a bit." I couldn't see what she was doing but I could tell the location on my body.
"Huh."
She administered another dose, possibly the third in her series. She returned a few minutes later.
"Can you feel this?" she asked. She poked me where she was planning to make her incision.
"A little."
"Does it hurt?"
"No." Now that I had an idea of what I should say, I tried to let her know it was fine to proceed. I wanted her to get on with the operation. "I can always feel pressure, heat, and cold after novocaine. But my dentist goes ahead and drills anyway. It's fine."
She had finished her pre-surgery preparations earlier. She had tidied up around me after the last shot. There really wasn't much more for her to do except start cutting. So she positioned her chair, sat in it, adjusted her position relative to me, and made the first cut. I felt the pull of the incision but there was no pain.
I smelled rather than felt the soldering iron when she burned the ends of the vas deferens shut. It was something I had expected in a rational way. The reality seemed a bit different, not bad but definitively medical. Five or ten minutes passed as she worked. I wasn't paying attention to the clock. After a while, she started on the other side.
This time, I felt the cauterization.
No location on a human body is a good one to feel searing heat. Places where lots of nerves cluster together are even less ideal. But as my awareness grew more acute, I surveyed my situation. I understood that the doctor couldn't stop. Today, she had to operate alone. For whatever scheduling reason in her small practice, she had no assistant to prep the equipment, to help her pause what she was doing, or to administer another dose of novocaine to me. There was nothing I could do except lean into the sensations, accept them, and keep as still as possible to avoid distracting her.
The novocaine continued to wear off. After the first burn, there was a second. The sense of it wasn't much worse but it felt janglier, more alive in my nerves. When my flesh stopped searing, I shivered. The contrast in temperature felt so strong, I couldn't persuade my body to ignore it. Next, the doctor grabbed her needle and thread. At the first stab from her, my body shook.
"You're feeling it, aren't you?" she lifted her head to grimace at me.
"A bit, yeah." The needle jab had felt like a sewing accident.
"Shit." She shook her head at me, reproachfully. She glanced around and performed the same mental calculus I had. She had no one to help her. By now, she had observed I was a hell of a bleeder, too. She had complained about it and made me realize I'd forgotten to mention it ahead of time. I should have. I had known how doctors sometimes found it inconvenient. If I'd been thinking better, more in advance of all this, I would have mentioned how fast novocaine wore off on me.
"I don't think I can stop," she announced.
I nodded.
"Try to hold still."
The next few minutes was a good exercise in accepting sudden pains. Although the novocaine hadn't worn off completely, I possessed the full range of sensations in my skin and the flesh underneath. I felt every pierce and pull for every stitch. The jabs produced the most reactions from my body, I thought, and I concentrated on holding still each time. I mostly succeeded in the aftermath to the reflex. But the pull of the thread through my skin produced its own teeth-jangling sensibility. It hurt but, more distinctly, it felt odd.
"Wow," she said as she tightened the last set of stitches. "Wow."
"Everything okay?" I asked.
"Yeah. We're good." She kept working on the tie-off or whatever the last step was. I couldn't see most of it. "You're really feeling this pretty intensely, I can tell."
"You can?" I thought I'd been holding still. "I was trying to be really good. To stay really quiet."
"Well, you were good. You held still." She finished and rose from her chair. She took a deep breath and relaxed into a smile. "But you made some noise."
"I did?" I hadn't been aware of it but, thinking back, I definitely had heard myself emit some kind of sound.
Just as with my previous injections, the painkiller for my vasectomy wore off early. At this point, I was sort of ready to learn the lesson. Although I'm happy with novocaine, I have to say it has a short-lived effect on me. That is, whatever a doctor or dentist seems to expect in terms of deadened nerves, my body gives them about forty percent of the time they're looking for.
If they estimate correctly with most of their patients, I suppose that means something in my metabolism eats up the novacaine a little faster in me for some reason. I don't know why. I also don't know how often it happens but my impression from the vasectomy surgeon is that it's fairly rare. My impression from my best dentist, though, is the opposite. He recognized immediately when the painkiller was wearing off. So it can't be too unusual - just enough to surprise the doctors and dentists who haven't administered topical painkillers to enough patients. There must be a reasonably-sized minority of people who live on my end of that particular spectrum.
The real lesson, maybe, is that I need to speak up. We all do. We need be convincing about our past experiences or at least coherent when we describe them. A doctor might not want to believe a patient who is unusual in some respect but, when you're the patient, you still have to do your part.
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