No worst, there is none. Pitched past pitch of grief,
More pangs will, schooled at forepangs, wilder wring….

O the mind, mind has mountains; cliffs of fall
Frightful, sheer, no-man-fathomed. Hold them cheap
May who ne’er hung there…

Gerard Manley Hopkins

At the very opposite end of the pleasure spectrum from whatever daydream you let drift away before reading this, there is oral surgery. At even further remove, there is oral surgery with complications. The most excruciating pain of my entire life, relentless, beyond any measure I knew, has been mine for the last ten days, punctuated by dream-like episodes of misdiagnosis, mistreatment and misprescription by doctors and dentists.

This is a long post, not meant to instruct or educate so much as to unburden myself of my solitary descent into pain and my slow climb out. I’m writing about it in the hope that its public expression will bring some sort of dilution. Pain is a pure elixir, concentrated by the lonely impossibility of communicating it. If I can share it, perhaps I can lessen it. Continue, therefore, only if you want a share of it.

I had a tooth. It’s gone now. Second molar, lower left. It had cracked, and got infected, which led to a series of abscesses in my jaw.

How bad is this?

An abscess is essentially a space created by and filled up with pus from an infection. Because they infiltrate the space between your bones, muscles, and nerves, and push and swell — they hurt, very much. If you’re unlucky, an abscess can migrate and spread up to the brain (septicemia of the brain) or down through your pharynx to your chest cavity, to either your heart (endocarditis) or lungs (pneumonia). Any of these little voyages can kill you.

As an Atlanta dentist explains, “the most serious worry is death.”

This was a tooth slated for extraction, to be replaced by an implant. My dentist recommended an oral surgeon, and all I had to do was go down there, grimace, get the tooth pulled, and go home with a two-day ache. For various reasons of convenience, I put off the extraction. Big mistake. My cracked molar produced three abscesses: two under and around my jawbone and one in the throat area.

On Saturday, August 9, at my house near Hudson, NY, the tooth begins to twinge. Since it had a shallow filling that had begun to wear thin, I go to the drug store and buy some emergency dental filling, which I press into the tooth. Another mistake: I think all I did was push the cracked tooth apart. That evening, the pain begins to get serious. By serious, I mean that it couldn’t be ignored, but claimed its place as the first for my attention, which it has not yet ceded as of this writing. At around midnight I go to Columbia Memorial Hospital in Hudson and wait in a completely empty ER, rocking back and forth in my chair, holding my cheek. After an hour of elevator music, an admitting nurse takes my pulse (high, she warns me, as I rock), takes a few notes, and leads me to a bed, where I wait another hour before the ER doctor prescribes a pain-killing shot of something, some penicillin, and hydrocodone (Vicodin). The doctor tells me that I have an infection and the course of penicillin would get rid of it, after which I should remove the tooth.

Sunday, August 10, is Day One of the Real Pain. I wake up very early when the painkiller wears off, then moan, groan, and whimper my way to 8 am, when the drugstore opens and I can fill my prescription. I take a double dose of the hydrocodone, which after a terrifying 30 minutes of no effect, puts me to sleep for a few hours, though I awaken to an intensified pain. This pattern continues throughout the day — intense pain shading into delerium, take the painkiller, collapse, repeat. At this point I determine that I must see a dentist right away; I need to get this tooth out of my head. This means waiting for Monday, when a dentist’s office would open. I regret being away from New York City, but I’m in no shape to drive there.

The morning of Monday August 11 finds me driving around Hudson, bellowing to myself inside the car, stopping at each one of the dentists offered as a possibility by Google Maps. At this point my “thinking” consists of repeating the same phrase to my self out loud, over and over and over again, in counterpoint to the shrieking throb in my mouth and neck, a mantra instead of a groan. Of note that morning were: “Oh the humanity” from Herbert Morrison’s broadcast of the Hindenburg disaster; “Don’t trust your life to no backwoods southern lawyer” from Vicki Lawrence’s The Night the Lights Went out in Georgia, though I substituted “doctor” for “lawyer”; and finally the wildly inappropriate Is That All There Is? by Peggy Lee.

Walking into a dentist’s office with a big swollen jaw, looking like a war zone refugee, barely coherent in pain, you’d think to be greeted with (at worst), “Hold on, let me see how quickly we can see you.” Not even close. Nothing But the Tooth (Alan Pizer DDS) tells me they are not seeing new patients that day, but that I could come back at 2:30 to fill out an application. Norman Meisner DDS has a pliable receptionist, who goes back to ask him, but the man himself is implacable: “No.” The humanity!

Down the street, Ron Chiminelli DDS agrees to see me. I get a shot of novocaine (sweet relief!) and a referral to an oral surgeon, along with this completely incorrect advice, which cost me two more days of pain: “No-one will want to pull that tooth until the infection subsides, in case it spreads.” I am told that I should wait at least a couple of days until the antibiotics kills the infection.

By evening the novocaine has worn off; I am stumbling around my house, lurching from doorframe to chair back, clutching at anything steady only to launch myself again out to the next landing spot, swallowing hydrocodone at the rate of one every half hour, repeating over and over with each breath, Kick it in now second wind, a tribute mantra to the bad Jimmy Buffett song of the same name. I want the drugs to overpower me, give me some rest, but it’s not happening, and eventually I drive my ragged body back to the emergency room at Columbia Memorial.

The tune in my head has changed to a song I loathe, Sting’s “I’ll Be Watching You.” As with all my pain mantras, everything’s mixed up, out of context. “Every breathe you take” and “every move you make” — I feel as if this pain is on me, an alien living at the base of my skull, wrapping its tentacles around me, monitoring me, filling my every small respite with a new dose of virulence. The admitting nurse at the hospital takes 20 minutes to chit-chat with a mother and child about day care, then takes a 20-minute bathroom break. Again, the blood pressure, which she warns me is high. I’m beaten down and can’t answer this absurdity. Eventually I’m led to a semi-bed in a semi-private semi-room, where rather quickly I’m seen by the attending doctor. I’m told again that I have an abscess, I’m told again that no-one will extract the tooth until the infection goes down, and I’m given a new set of drugs: Clindamycin (stronger antiobiotic) and oxycodone (a.k.a. Percoset, a stronger pain killer). I have to sign a bunch of papers which tell me that they are not responsible for anything to do with my health.

No-one tells me I had to have the abscesses drained as soon as possible; everyone tells me that the source of the infection (the tooth) would have to remain in my mouth until the infection is gone.

Tuesday, August 12 at sunrise, and I am hopeful. Just two more hours until the pharmacies open and I can get the super antibiotics and super painkillers that will return me to a normal state. The pain is so intense that it exhausts me quickly, so I am in a pattern of wake up in pain, take pain pills, stumble around howling for 1/2 hour, fall asleep for two hours.

The pharmacies open and I’m there at first bell. The tune in my head is a desperate ode, Phil Ochs’ Cops of the World. I’m not sure why. My soundtrack doesn’t seem to have any pattern or reason. By mid-afternoon a new reality is established: the oxycodone is more effective in massive doses, but it puts me out quicker too. I’m supposed to have one very four to six hours, not to exceed six per day. By the time the sun sets I’m downing one per hour, basically whenever I wake up.

Wednesday August 13 I call an oral surgeon in Manhattan at 9 am. Now I’m wise to the “not yet a patient” runaround, so I pick one who did an implant for me five years ago. The receptionist is dubious: “We don’t have any appointments available.” I tell her I’ll come in and wait just in case. “OK,” she says, “but you might have to wait a very long time. Do you hear me? Very long time.”

Now I have to drive 2.5 hours to New York City. I can barely keep my eyes open from the couch to the bathroom. Zombie-like, I prepare to leave. Turn off the hot water, bag the trash, shut the windows. My breath is not so ragged now, it’s shallow-sleepy, dangerously so. Stanley Brothers’ Stone Walls and Steel Bars playing in my head, the line that goes “I’m a three-time loser, I’m long gone this time.”

You may be thinking, “Doesn’t this guy have any friends or family to help him?” Yeah, well, I’m kind of slow. Pain is internal. Someone could be right next to me and not even sense the tendrils of pain. I kept thinking, why tell anyone? All they could do is wring their hands helplessly, and I’d have to look after them as well as myself. So my thinking goes. Nonetheless I text my Dad that I’m in pain and driving to the oral surgeon in the city. I do this in case the Taconic State Parkway proves too much for me.

I float down the highway, listening to to bad talk radio, with my head half out the window, the left side of my mouth open, sucking air past my tooth. Normally this would hurt, but I’m so drugged up that I feel just a little, and it keeps me awake. I get into Manhattan, drop the car at the garage, and walk to the oral surgeon’s. My Dad is waiting outside. “Oh,” I say. “Hi. What are you doing here?”

He walks me into the office of Andre Stein, DDS. I am relieved, I am in competent hands. My Dad is there to help me. My new pain song, over and over again in my head, is Hank Snow’s 90 Miles an Hour Down a Dead-End Street. I have no idea that the real pain is only just beginning.

More pain in Part 2, later this week.

Tags: pain, infection, dentist, oral surgery, antibiotics, abscess, hydrocodone, oxycodone, penicillin, clindamycin, Columbia Memorial Hospital, Hudson NY, Andre Stein DDS, Ron Chiminelli DDS, Alan Pizer DDS, Norman Meisner DDS, Hank Snow, Stanley Brothers, Phil Ochs, Jimmy Buffett, Sting

Posted by Antony in: General