On television you have this thing called drama. Characters are usually supposed to have interpersonal conflict in order to make the story interesting. Settings of realistic fiction usually require a bit more interpersonal drama to make up for the lack of world-shaking extrapersonal drama. In medical dramas, the writers usually combine this with the tension involved in complicated operations to make for a compelling scene. So you'll have people in the OR getting into arguments -- "We're losing him! This is your fault, Jessica! You never listen to me!" "Well you never listen to your wife, Bob! That's why she left you!" And then you'll have doctors getting angry at the patient for dying and saying "Live, dammit, live!" And then they bring out the giant shock-paddle defibrilators and yell CLEAR and then they all cry when the patient dies.

Admittedly my experience of hospital dramas is based on watching a few seasons of M*A*S*H and reading a bit about ER circa 2003 but the former show definitely got involved in the hospital-room arguments.

The thing is, an actual Operating Room is not conducive to drama, especially not interpersonal drama. Surgeons usually speak to each other calmly and quietly, confirming instructions by repeating them. They say things as quickly as possible, using jargon and acronyms that a non-surgeon wouldn't understand, because sometimes seconds count. There's tension there, but as for drama...in Scrubs, of all TV shows, Emergency Room work (where one would expect the most drama, to the extent that there's an entire medical drama called ER) is treated as "stressful but tediously undramatic"1

Starting an argument in the OR that took one's eyes away from the patient, as seen frequently in M*A*S*H, would be a good way to LOSE the patient.


1. Source: TVtropes "Gurney Scene" page

Monday 7am

He's leaning against the door, dozing fitfully, when I arrive to unlock. I've been doing this job for three months, and that's long enough to diagnose the problem. Our surgery is two doors down from the pub. He got drunk, got in a fight, got his teeth knocked out. "Come on, Sunshine, up you get," I say as kindly as I can, hooking him under his arms to haul him to his feet. "We can't get this sorted until you let me open the door." I take him straight through to the spare surgery. It's Rish's day off so he can wait in there, away from the less smelly patients.

The dentist looks grim when she sees inside his mouth. "The roots are still in place," she says, "and they are abscessed". Her voice is muffled and her face obscured by the double masks we are wearing to fend off the smell of the alcohol. I've rung through to the pub and asked what time he had his last drink. The news isn't good. "Five o'clock," I say, "and he's a regular". My voice is muffled too, but she can hear that when I say "a regular" I mean "an alcoholic who will never be sober enough to anaesthetise". She can hear that I'm scared, too. You get close, working like that, eight hours a day, every day, in a room together. I see her pull herself together, into that hard place inside her.

"We're going to take the root out," she says. "I'm going to need everybody to do exactly as I say. I can't use any anaesthetic. And I can't leave you in this much pain. Nemosyn, I need extraction tools for a 34, abscess kit, and sutures."

"Ready when you are, doctor," I reply, matching her steel with my calmest, most reassuring tones. I've already snuck down to the steri room and smeared eucalyptus oil across my top lip, and now I pull down my mask so the drunk and terrified man whimpering in the chair can see my whole face. It's her job to do dental surgery medieval style, without anaesthetic, causing him horrifying amounts of pain. It's my job to smile calmly no matter what.

Tuesday 2:35pm

The surgery is silent.

Not really silent, not like the silence of space, or even like the silence of a desert at midday. This is the special kind of silent that is so loud you feel that if you screamed you would barely hear it.

The drill is softly whirring, the automatic water jet whistling just above the range of my hearing, the bur bumping against the hard edges of the healthy dentine beside the caries. My suction is hissing and gurgling, holding this patient's very active tongue safely away from the drill. Above all that I can hear my own stertorous breaths forcing air past the wired edges of the mask over my nose.

The drill falls silent, just in time to hear where the cassette skips. "I- I- I'm mad - about the boy," croons Dinah. "And I know it's st-to be mad - about a boy." My jaw clenches and I avoid looking at her. I know she hates jazz, but she's outvoted. She knows I like jazz, but she also knows that I hate the skip.

I feel like she has stopped the drill just now on purpose.

I try not to grind my teeth together. This is a dental surgery. We don't grind our teeth. In fact, I carefully relax my jaw altogether. I don't need an inflamed temporomandibular joint on top of everything else. 

"Etch," she says, nastily. Is it really nasty? Really? Or am I reading into it? I pass the tiny cotton tip coated with etchant.

She dabs it neatly and stares at me while she counts to ten. Can I really see that she's looking at me with hate? Do I just want her to hate me as much as I hate her right now?

I continue to avoid eye contact, shuffling instruments on the tray. The flat plastic bumps into the probe, the tiny chink of metal on metal echoing around the room.

"I must admit the sleepless nights I've had," Dinah continues, oblivious.

The water jet squirts and my suction gurgles offensively, sucking up the acid etch.

"Bond," she says coldly. I make sure I hold out the cotton tip as quickly and efficiently as possible, just to annoy her. She likes it when I fumble, giving the tooth surface time to get a coating of moisture from the patient's humid exhalations - or when I squeeze out the oppressively expensive liquid a little too early, letting it half-cure on the cotton tip.

"Composite," she says. Her eyes narrow in anticipation as I carefully squeeze just the right amount of yellowy goop into a tiny cup. But I've been practising for this. I hold the cup between my thumb and forefinger, the flat plastic rests on my middle finger and the ball burnisher on my ring finger. I hold both instruments away from her as she takes the cup. "Flat plastic," she snaps. I flick it around to her preferred angle. "Ball burnisher," she snaps again, and I take the flat plastic while flicking the ball burnisher into her waiting fingers, all the while continuing to hold that wandering tongue out of the way with the suction using my other hand.

She carefully smooths the edges of the filling. She truly is a master, an artist, the finest sculptor I've ever seen. And she's an evil bitch whose main joy is to make my day hell.

Her eyes crinkle at the corners as she surveys her work. She glances over at my hand, ready with the sickle probe and flat plastic; at the tray with a spare mirror, tweezers and a variety of cotton tips and gauze. Her gaze wanders back to mine, happily anticipating. My toes curl, tensing.

"Cone burnisher," she snaps, triumphant.

Wednesday 4:55pm

I'm leaning back in my chair, looking at the clock, while Rish explains the procedure to the patient. Absently, I check the expiry date on a vial of lignocaine, crack the top and pass the syringe. Rish and I have privately agreed that these big old-fashioned metal reusable syringes are probably at least half of why patients are so nervous. Who wouldn't freak out seeing that heading for their mouth? But this is a regular patient, I know he's pretty relaxed about the whole thing as long as Rish keeps telling him appalling jokes.

As if Rish had any other kind. I point this out regularly. It's important to keep Rish humble. He's the same age as us assistants. He went to school with my boyfriend. He went to America and bought himself a fake Oscar statuette that says World's Best Dentist, for heaven's sake.

I hear the familiar sound of Rish's best golf joke, which means he is about to start injecting the anaesthetic. Did I say best? I mean worst. I roll my eyes at him, but he's concentrating on his job. Fair enough. He's an inch deep into the patient's gum.


The tray with all my sterile instruments neatly arranged flies off its stand and hits the floor, scattering everything. My head whips around. The patient's hand is in mid air, where the tray should be, and it's shaking wildly.

"RISH!" I shout, as the patient's whole body starts to convulse, but Rish is already moving. Before the word leaves my mouth he has the whole syringe out of the patient and up in the air, held up at an angle pointing away from all of us. Rish slams his foot on the 'return' pedal, starting the dental chair on its slow ride back to the upright position as I dive across the writhing body, pushing the bank of drills away from the patient. "Down!" I shout at Rish, nodding frantically in the direction of his feet. He slams the pedal again, lowering the chair back as close to flat as it will go, and dropping the whole contraption nearer the floor. Rish turns to the sink and drops the naked sharp in where it will be safely contained for now. "Get help," he bites out, and I run down the hallway to the boss' surgery. "Medical emergency, we need you," I gasp, before turning back and heading out to the reception. "Triple oh, patient having a medical episode, need an ambulance," I mutter to the practise manager, trying not to shout it out to the whole waiting room. I frantically recheck the patient's chart. Nothing about epilepsy or seizures.

After the paramedics wheel the shaken but no longer shaking patient out the door, Rish and I strip off our gloves and masks, and drop them on the floor before staggering down the hall to the staff room. Rish carefully shuts the door behind us and drops into the nearest chair. I flick the kettle on.

"I've never had a real medical emergency before," I say, shaking (but not as much as someone who just had their first grand mal seizure).

"Me neither," says Rish. He sounds as bad as I do. "I mean, of course we trained for all this stuff but this is the first time I've ever had to do it."

He stands up and hugs me. We cling to each other for half a minute, both pretending we aren't crying.

Afterwards, we pretend we never hugged.

But I never pick on him about his Oscar again.

Thursday 11am

This lady is old. I mean, really old. We've left the seat mostly upright because there's no way we can lay her back flat. I grabbed a cushion from the staff room sofa and wrapped it in a plastic bag to at least pretend at hygiene, and I've propped it behind her head, and tilted the whole chair slightly backwards. She's clutching at the armrest, getting comfortable, shifting slowly, talking the whole time.

"That's a London accent," I say when she pauses. "How long ago did you leave England?" 

She is surprised. "I have a friend with the same accent," I explain. "She's from Mortlake."

"Oh!" exclaims this tiny lady, her whole body lighting up. "I'm from Barnes!"

"But that's just down the road!" I smile back delightedly.

The dentist crouches down in front of her, dragging the light around to get a decent view in this ancient mouth. She might be the sternest and coldest dentist I know but she's also the gentlest and I'm glad this lady is here with us. We'll take the best care of her.

"I only have one filling!" quavers our patient.

The dentist beckons me and I lean down to look. It is, no joke, the biggest amalgam filling I've ever seen. It seems to occupy the whole of her lower left first molar. There's hardly enough tooth left to hold the metal in place, just a few carefully spaced claws, like it was done by a bizarre but talented jeweller. The surface is worn, eroded, as are the teeth around it, and the metal isn't quite the same colour as the amalgams I've seen before.

"When was the filling done?" asks the dentist, in a neutral voice that, for her, indicates high excitement.

"Oh well, love, it was a while ago. It was before I left school, I must have been in second form."

"High school, you mean?" I ask, because I know the dentist isn't likely to be familiar with the old fashioned terms but also doesn't like to draw her attention to her foreignness, her ignorance about western culture. "So you were, what, twelve? Thirteen?" 

"Something like that, yes. I remember I had a half day off for it."

I slide the patient's chart closer and look for the date of birth. 

"1927," I whisper. "This filling was done around 1927."

The dentist's eyes widen and we both just sit back on our heels and contemplate it for a minute, the oldest and biggest filling we've ever seen.

There's nothing at all wrong with it. This is just a check-up.

Friday 9:45am

There are two rules in the surgery. One: always assume the patient is conscious and can hear you. Two: always assume the patient is unconscious and needs your help to breathe.

It's Karen's turn to hold the airway open. It's always Karen's turn to hold the airway open. She jealously guards this role, holding the patient's jaw aloft with elbows aggressively cocked to ensure I don't somehow muscle in on her territory.

Normally when someone has a general anaesthetic you just chuck a tube down their throat to hold the airways open, and hook them up to an oxygen mask. You can't do that in oral surgery, of course. The tubes would get in the way of the dental work. Instead we carefully place big orange plastic bite blocks between the patient's teeth to hold their mouth open, and Karen applies delicate pressure under the mandible to keep the airway open and clear.

Karen was brought across from the old surgery, and likes to think that makes her the chosen one. I had to leave my old dentist because she got sick and retired. So I'm the new girl, I only started a week before this fancy new surgery opened. But I've already made myself kinda useful. I'm not really much of a dental assistant. I never expected to do a practical job, passing and carrying and cleaning. Let's be honest, I'm no more than average on a good day. But I have other skills. I read up on the legislation and regs, and used them to write a full set of policies and procedures for the surgery. And I used to go to school with the practise manager, who was surprised to see me in such a menial job but quickly put me to work writing the announcements and invitations for all the opening parties and things.

Plus I'm the smartest person in the surgery. The dentist realised this when he interviewed me. He slipped a Shakespeare quote in, one of the filthy ones, with the air of someone who is being secretly clever. I cocked an eyebrow at him and responded with Rochester. He hired me on the spot. After his wife realised that I wasn't going to have an affair with him (and to do him credit he never even tried, no matter how obviously he wanted to), she even agreed that I should be paid the frankly ridiculous wage I'd asked for.

I haven't mentioned any of this to Karen.

The patient is drifting off into unconsciousness, and Karen has taken up her station to one side of his head, airways open and monitored vigilantly. Benny, the anaesthetist, has already lost interest in the patient and taken out his phone. "Ready when you are, Angela," I say politely. Karen sniffs. "Angelo," she mutters reprovingly. 

Angelo turns his head so Karen can't see and rolls his eyes at me. "Sickle probe, Hazel," he says. I pass the probe. Karen's eyebrows twitch together in a frown. She doesn't dare say anything to Angelo.

"Are you still calling that poor girl Hazel?" calls Benny from the far end of the room, where he has now opened his laptop and fired up a spreadsheet. "You're such a sexist old wog, Angelo." Benny is a Jew and he hates Catholics, especially his wife.

"Ah, shut up," replies Angelo, amiably. It's going to be one of those mornings.

"Why stop now when it's working so well?" I volunteer. "I saw Mrs Watson in the plaza last week and she called me Hazel. Half the patients think it's my real name. You're gonna have to get my name tag changed."

Karen sniffs again.

Benny is on the phone to his wife. They're arguing about the kitchen renovation. His wife is shouting so loudly that we can hear her at the other end of the room. Benny is calmly and viciously quoting dollar figures out of his spreadsheet. He wants the cheapest door handles. She wants the gold ones. They sound like an episode of a bad seventies sitcom, the Italian wife who wants everything covered in bling and the penny-pinching Jewish husband. "Hey Benny!" I call loudly, "we need a top up over here! Patient is waking up!"

Benny waves irritably at me without pausing in his diatribe on the whole race of Catholics, the Italian ones in particular, the Gennaro family in more particular, his boss and his wife most particularly of all.

Angelo sighs and quietly adjusts the drug levels coming through. The patient relaxes once more. I pass him the forceps and hold out a cup to drop the extracted tooth into. Eventually Benny's phone call ends. His wife has hung up on him, as usual

Angelo turns to me. "Do you think I'm going to need a Cryer's for this one, Hazel?" It's our pre-arranged signal. I nod.

"Benny," I begin, "I was having a read over your patient consent forms. I think I found a few areas that need improvement. I marked them in red."

Benny groans. Karen's eyes dip shut briefly and she winces before she remembers that she prefers to maintain stoic unconcern and returns to her martyr pose.

"I've told you a hundred times, Nemosyn, there's nothing wrong with my patient consent forms!"

"Not if you want your butt sued into next century, no," I agree. "Or if you want to confine your practise to patients who don't read or write in English."

"I'm a highly qualified doctor! I don't need advice from a twenty year old girl who didn't finish school and ended up as a dental assistant!" Benny shouts, indignant.

Angelo's shoulders are shaking but his eyes are serious above his mask. Or at least no more sarcastic than usual.

I settle into my chair. We've got six solid hours of surgery booked today, and we're less than fifteen minutes in.

"One point for the ad hominem, one point for argument from authority," I say to Angelo. "Your turn."

"Hey Benny," says Angelo, "ever heard of a poet called Rochester? He wrote a poem about your dick..."

I love surgery days.

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