This morning at James Square nursing home I was trying to get my dentures out for cleaning but couldn’t. One of the aides said, “Did you use too much Polident?”
I replied, “I don’t use any Polident. I have a very good dentist who made such good-fitting dentures that simple suction holds them in.” Which brought us to Dr. Patrick Smith, director of the residency program at SUNY Upstate Medical Center’s Dental Clinic—and the only good thing that I know about Upstate, which otherwise treats patients like lab rats.
I have a friend in her 70’s who is underweight and has a colonostomy. A couple winters ago she needed to have a diagnostic procedure done which involved taking off all her clothes, putting on a paper gown, and drinking a potion. She was then relegated to sitting on a metal folding chair in a back hall for about an hour. That has become my enduring image of Upstate Medical Center: an elderly woman in a paper gown sitting on metal folding chair in a back hall in the middle of winter. Lab rats get treated better.
Around the year 2000 I was getting my dental treatment at St. Joseph’s Hospital’s Dental Clinic when they told me that they did general dentistry and I needed something pretty fancy in the way of building new dentures. I never really understood the dilemma but it seemed to be a peculiar architectural design problem, so they referred me to Eastman Dental Center in Rochester.
Eastman was awful. Roundtrip Medicaid wheelchair transportation took hours, left me exhausted and bedridden for days, and cost the taxpayers (that would be you) $350 per trip. The first appointment turned out to be only a five-minute look-see, which they hadn’t told me about. Thereafter, it was always impossible to get a live person at Eastman to answer or return calls.
At the third appointment, they told me that I would need at least thirteen appointments to fill a cavity, do a root canal, and then have repeated surgery to “elongate the teeth.” What they meant was they were going to cut down the gums. Then they would build a full set of dentures.
The reason I was sent to Eastman Dental Center—also known as Eastman Institute for Oral Health at the University of Rochester—was because it is a teaching center staffed by residents and therefore accepts Medicaid. Cheap is the way to go when the government is paying the bill, except that paying full price in Syracuse, plus $50 for transportation, would be cheaper than paying for cheap (and inexperienced) dental care plus $4000 for transportation.
I called around and got exact quotes for dental care and medical transportation in Syracuse and then called Medicaid and asked them to combine the two and then let me stay home, conserve my strength, and get the dental work done locally at full price with next to nothing for transportation.
And you know what they said, this government of the people, by the people, and for the people—this representative of your interests, not to mention your cash outlay for taxes? They said, “We can’t do that because transportation and dentistry come out of different Medicaid accounts.” It’s an accounting problem. That is an answer that leaves me breathless with outrage.
So I talked to Eastman and they agreed that, well, yes, filling the cavity and doing the root canal were not super-sophisticated things that required Eastman’s expertise; I could get them done in Syracuse. So I called around and Dr. Smith appeared in my life.
Dr. Patrick Smith grew up on a farm in the North Country and wanted to be a landscape architect except that the North Country tends heavily toward snow, ice and rocks, and he needed steady work so he went to the University at Buffalo School of Dental Medicine, practiced here and there, and ended up as director of the residency program at Upstate Medical Center.
In the early years, Dr. Smith had yet to hone his skills at picking good candidates for the residency program, consequently, when I called for an appointment he was doing hands-on patient treatment. Two of his residents had quit the residency program and removed themselves to Canada, taking with them an expensive piece of Upstate’s equipment. They said Dr. Smith had given it to them as a Christmas present.
He said, first, that he didn’t give hospital property away as gifts and, second, they were Muslims and didn’t celebrate Christmas. Ultimately, the hospital’s lawyers prevailed in settling the dispute, and I ended up in Dr. Smith’s treatment chair.
The first problem was could I tolerate an injection of pain killer? It was 2001. My immune system had been reacting to all pharmaceuticals for months. Physicians had been consulted and they said they didn’t know. Finally, one of them wrote a letter saying that I hadn’t reacted to lidocaine before and he saw no reason not to use it now. I was pretty sure he didn’t know what he was talking about, but I didn’t challenge it.
So I sat in Dr. Smith’s chair and he prepped my gum for the lidocaine with a rub of Anbesol, which is benzocaine, most commonly used for babies who are teething. And I immediately had a hypertensive reaction. We never got to the lidocaine.
And Dr. Smith went very calmly, quietly, ballistic. He’s got this patient in his chair who is spiking an horrifically high blood pressure, like, I’m gonna have a stroke. He says he will send me to the Emergency Room. I say I won’t go. I’ve been there and I’m not going again. “Um,” he says, “yeah, you are.” I say “No, I’m not” and then propose that I will go to Prompt Care. Dr. Smith agrees to that and trundles me off to Prompt Care, which takes one look at my blood pressure and sends me through the tunnels to the ER, which takes one look at my blood pressure, listens to my story, and spends several hours watching my blood pressure slowly return to normal.
That was the first time Dr. Patrick Smith and I met.