to katie: about fear, pain, and damage

Dear Katie:

I am going to tell you about one of the biggest mistakes I have made in my life. It has to do with fear, pain, and the difference between pain and damage.

I avoided going to the dentist for ten years. That was the mistake.

Why I avoided going to the dentist for ten years is complicated enough to deserve a letter.

Madeleine L'Engle, the author of A Wrinkle In Time, explained something about her faith once that stuck with me. She said that in the Episcopalian Book of Common Prayer, you ask forgiveness for two kinds of actions: wrong actions of commission, which are wrong things you do (or wrong things you commit), and wrong acts of omission, which are right things you did not do.

I read that when I was in college, but I think about it all the time. It's a complicated thought. I think it's kind of easy to avoid doing wrong things. Don't tell lies, don't steal things, don't punch your sister. It's usually sort of simple to think, "Is this action wrong?" Then if it's wrong, don't do it.

But I think that "not doing good things" is more confusing. There are so many good things to do: good things to do for your friends and family, good things to do for charities for people who are less fortunate than you are, and good things to do for your body and your health. In fact, there are so many good things to do that there are not enough hours in the day to do every single good thing you can think of.

So you will have to choose which good things you do, and which good things you leave for someone else to do. That's just part of life.

I know I've said this before, and I'll say this again, but now is a good time to say this: You can do anything, but you can't do everything. It's what you choose to do that makes you who you are.

Choosing something because you are afraid of it is almost never a good choice.

One of the ways that I am fortunate is that I have a very high pain tolerance, which means that a lot of things which hurt other people do not hurt me, or do not hurt me as much as they hurt other people. When I was a kid, I would come in from playing and Mom would ask how I scraped my knee, and I would be surprised, because it had not hurt me when I got scraped up.

There were two big exceptions, places where I felt pain: my hair and my teeth. When I would brush my hair, every tangle would hurt my scalp, so I did not like letting other people brush my hair. And I have sensitive teeth, so things that are very cold or very hot bother my teeth more than it bothers most people. Especially your Gramma, who puts so much ice in her drinks that it hurts my teeth to look at them! I'm kidding, it doesn't hurt, but I could never drink a drink that cold without a straw (so the cold goes past my teeth).

Lucky for me, I always had great dentists when I was a kid. I even had good experiences when bad things happened: I knocked out some baby teeth, I had to have surgery before I had braces, and then I had braces for three years. But I had great dentists and orthodontists for all those things (many thanks to all the Dr Specks of Houston!).

My high pain tolerance meant that I was not afraid of getting hurt, because I almost never felt pain anyway. I was a girl who would always try new things, and not be afraid. And I liked that about myself.

But now I'm going to tell a story about how I learned to be afraid of pain because of one crazy tooth. If you are afraid of dentists, then you do not need to read this story. You can skip to the part where I say "The End".

The Tooth That Taught Me Fear and Pain
I have a weird mouth. I know this because almost everything any dentist, orthodontist, or dental surgeon has ever done to my mouth has been followed by them saying something like, "Wow, that was way more complicated than I expected it to be."

I knocked out one front baby tooth when I was 3 or 4, and the replacement tooth didn't come in for a few years, and when it did come in, there was a big gap between my front teeth. When I was in middle school, a friend of my sister's put me up on his shoulders, but something went wrong when I was getting off, and I hit the gym floor with my jaw and knocked out all my remaining baby molars, and needed emergency surgery to take out all the baby tooth pieces. When I started high school, the orthodontist realized I had never lost a couple of baby teeth on the top, so they had to do surgery to pull those out and attach gold chains to the adult teeth so they could pull them into place ring by ring with braces. So, really weird.

But I always had great, friendly dentists who explained what was going on, and they used laughing gas if there was going to be anything scary. I liked dentists. In fact, I liked my orthodontist so much that Mom started working for him when his bookkeeper retired when I still had braces on in high school! So when I got out on my own as as adult, I went to the dentist regularly, and did everything I should to protect my mom's investment in my teeth.

When I was about 23, I got bad news about the middle molar on the bottom left: the cavity filling was not enough to stop the tooth decay, so I needed a root canal. The dentist I was seeing thought that you should not use laughing gas if you didn't need it, so I let him talk me out it. That was a bad idea - laughing gas helps you not worry, and it helps you relax, and it helps you forget, so if you are going to do something scary where you do not need to be fully awake, it's a good idea to use laughing gas.

The root canal was complicated because the roots have something weird with them (they bend funny or something, I don't remember exactly), and the shot they had given me to numb me must have worn off, because I felt pain. It was a lot of pain - more than I had ever felt, even more than when I knocked out all those teeth (I think I was in shock when I knocked out all my teeth, so I couldn't really feel anything).

We paused and got me more painkillers and got me on laughing gas, but I remembered that pain, and I did not want to experience it again. The dentist said I should not have been able to feel that, and the way he said it make me feel like he was blaming me for feeling pain! I decided not to go back to him ever again, which was a good choice. I found another dentist and tried not to be afraid.

About a year later, when I was about 24, the tooth felt like it was moving. X-rays showed that a wisdom tooth had started growing right under that same tooth, and was trying to push its way up to push that tooth out. I insisted on laughing gas, and I am glad I did. The surgery to take out the wisdom tooth was complicated and took much longer than it normally takes - the roots had wrapped around my jaw bone or something crazy - something they could not see on the x-ray. In fact, it went so long that I started feeling pain. Not as bad as the root canal pain, but I could definitely feel pain, so they stopped to get me another shot.Once again, the dentist was surprised that I needed another shot, but he did not try to make me feel bad for needing another shot. I still was afraid of the pain I had felt, so I found another dentist.

About two years later, when I was about 26, my tooth started shifting again. Sure enough, another wisdom tooth was trying to grow in in that exact same spot! When I was 24, the dentist had said it had "no chance of growing this late in your life" even though I told him my teeth came in really slowly. At this point I should have just let that tooth come in and replace the crazy problem tooth, but I did not know that at the time. This new dentist gave me extra pain killers in addition to the laughing gas when he took out my wisdom tooth, and sure enough, there was some kind of complication with the roots on that one too. Thankfully, I did not have pain, and I kept going to that dentist.

About two years after that, when I was about 28, my tooth started aching again, like it did before the root canal. It turned out that I needed another root canal. I asked the dentist to just pull the tooth out, but I let him talk me into just doing another root canal on it instead. I was on laughing gas, and lots of pain killers, but still, something got complicated, and in the middle, once again, I experienced a lot of pain.

At that point, I let my fear of pain overcome my desire to have a healthy mouth, and I stopped going to the dentist. For ten years. I did not even go to the dentist when that same tooth started aching again. I let three jolts of pain undo all the good that all my childhood dentists and orthodontists had done for me. It was a bad decision.

The End

So here is what I think happened: I let my fear of pain be more important to me than my health. That was backwards. Sure, I might experience pain again at the dentist, and yes, that will be very unpleasant, but all my other teeth don't need to suffer because I'm afraid of one bad tooth. Pain is not fun, but it does not always mean something bad.

Pain can be helpful. If you put your hand on something hot, pain helps you realize to move it before you burn yourself, so that's a good reason for pain.

But sometimes pain is not helpful, like when a dentist is doing something good for your teeth. In that case, it's just a signal from your brain that you don't really need because nothing is actually wrong, and it really is okay.

There is a difference between pain and damage. Pain is information - your brain is sending a signal that something might be wrong. Damage is when something is wrong and needs to get fixed, like a broken bone. It is good to avoid damage, but it not always good to avoid pain.

Sometimes a little pain happens when you are doing something good. For example, if you start lifting weights or learning to jog, you may get a little sore. If you learn to play guitar, the tips of your fingers will be sore until your fingertips get tougher. In those cases, your brain is sending information, saying "You pushed it far enough. And be careful because if you keep pushing, you may damage your muscles or your fingertips." But that kind of soreness pain also means your muscles or your fingertips are getting stronger, which is great. That is not pain to avoid.

I was avoiding pain by not going to the dentist, but I was also causing damage by letting other cavities get worse. Not good. Not smart. Not the right choice.

John Wayne said, "Courage is being scared to death, but saddling up anyway." I agree with him.

I finally stopped ignoring my toothache, just a few weeks ago, and I went to the Internet and read about dentists in Austin. I found a dentist who had a lot of information about being afraid of dentists, and a lot of information about laughing gas and other options to reduce pain and fear. I was "scared to death" as John Wayne put it, but I "saddled up" and saw him anyway.

My new dentist gave me great news: he wants to pull my crazy tooth out. Yay! I think it will be good for me. I mean, I know that it's better to try to keep all your teeth, but this one is just not behaving, and it just needs to go. My whole mouth will be healthier without it.

My new dentist also gave me bad news: I have other cavities which are worse now because I avoided the dentist for so long. That was not a surprise, but I am still sad that it was true.

The best part has been that my new dentist has been very understanding and very nice. And the dental surgeon who is going to pull my tooth was willing to listen to my long crazy tooth story, and he says that he is prepared to look carefully so that he "will not miss anything weird" and make sure that it all goes well. So that research I did about dentists really seems to have paid off.

I'll try to wrap up all those thoughts.

How about these: "Courage is when you're really scared, but you do the right thing anyway" (really it's just what John Wayne said), and "Avoid damage, not pain" (that one is mine).

Love you -
Aunt Angie