Saturday, March 15, 2008

Dental damn

This story is sad, frustrating, and gross. Obviously, then, it involves dentistry, my own hypochondria, and health insurance.

Thursday night after a great evening at the gym I was eating a burrito, and had food stuck in my teeth. Ever the gentleman, I ultimately was poking around there with my finger, and found a bump on my gums, near the back, below that ridge where the teeth seem to rest. When I came home I had L look at it and she said, "why don't you go to the dentist tomorrow." What she should have said was, "Oh, everyone has those bumps! They're good luck!" In any event, the night was shot -- I was stressed and trying to not freak out.

I turned to my trusty friend the internet and was horrified by the dental nightmares I was reading about: pus-filled lumps...too painful to close the jaws...broken teeth falling out...Awful stuff. One of my common dreams is having my teeth fall out, tinkling down into my lap like little crystals; my teeth are a locus of my stress. And of course out of procrastination I haven't seen the dentist in a couple years. But finally, my trip through the Internet Dental Hall of Nightmares led me to something that seemed accurate: something called a Tori (really?), a bump on your gum that doesn't hurt and seems to be like a bone protrusion or something. This was kind of reassuring, but not really. It's like growing a knuckle in your mouth.

The next day I got up early to head to 168th Street, to take advantage of the dental insurance I had on L's Columbia student plan. She had armed me with a barrage of phrases ("optional student plan," "Columbia basic") that would help me navigate the system. I spent over an hour in the hospital, repeating these words like a moron, so someone would believe I had insurance and help me figure out what to do. I went to several offices on several floors, trying to register and/or get a card and/or a file number and/or an appointment, at times returning to the same irritated person after calling L for moral support, when she would tell me new words and phrases to say, like an incantation or a prayer.

Ultimately then, in complete disregard of the hundreds of dollars in insurance we paid months ago, I ended up at the clinic for self-paid people -- people who no insurance -- and paid $85 so that someone would see me. That someone, of course, turned out to be the third-year dental students who run the clinic. That means they were people my age, people who are too young to have expertise and are clearly my peers. With all the young docs and x-ray technicians I dealt with, our conversations consisted of bitching about grad school exams and reminiscing about the mid-90s.

Anyways, the guy I saw told me that: (a) my blood pressure was a little high that day (which was bullshit because I was freaking out and stressed from spending over an hour tying to prove that I had dental insurance); (b) the bump was probably indeed a Tori, and it's not oral cancer, because oral cancer grows on soft flesh and besides, my glands were all fine; (c) but he also passingly mentioned bone cancer, which made me pee my pants a little bit; (d) I didn't need a biopsy because it's fine; (e) I have excellent oral hygiene (hell yes); (f) I have a very bright future, which was sort of touching.

I went through x-rays, and got a referral to a dentist, so now I'm going in on Tuesday for a cleaning and general check-up. I am learning to live with my new lil' Tori, and am looking forward to getting a second opinion on it, just in case. Even though the doctor and all my internet research indicate that everything is fine, it will be nice to show it to someone who is both a full-blown dentist and older than me.

But here's the kicker to the story: What the hell is wrong with our health care system? I am someone with a lot of cultural capital as well as an advanced degree, I can read and speak English fluently, yet I couldn't navigate the insurance requirements of Columbia and ended up paying entirely out of pocket. I defer a lot of medical and insurance decisions to L, since she bogglingly decided to work in the health field professionally, but the four hours -- four hours -- I spent yesterday trying to grapple with this stuff was incredibly frustrating. When I go back on Tuesday I will be armed with every document and insurance card I can get my hands on.

I was discombobulated all day afterwards. I self-medicated with soda and an Italian BMT from Subway. The dental clinic was grim and cramped, the guy in the chair next to me was begging to have two teeth pulled because they hurt so bad, the young interns were constantly being admonished by the attending for missing steps of their protocols, and it seemed that many of the patients couldn't understand English well enough to comprehend what these hotshot twenty-something dentists were telling them.

No wonder people don't go to the doctor's. The doctor who told me all those helpful things about high blood pressure, bone cancer, and my glaringly bright future also complimented me on being vigilant about my oral health, since I came in immediately after discovering something strange. But that kind of vigilance is easy to drop in light of the gauntlet that separates you, the patient, from actually seeing a doctor, in a room, where the doctor can check you out and tell you what's happening and send you on your merry way. Who wants to head in to see the doctor when you have to first make your way through an army of insurance company hand-wringers, hospital bureaucrats, inept administrators, and well-meaning but not fully formed med students? I mean, is there a mid-wife or a witch doctor I could see? Or a gypsy or something? Come on. Who has the luxury to spend half a day in a hospital complex?

Thanks for reading all this way, if you made it through.

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