Counseling My Way to a Tooth Extraction

After more than ten years of working with dentists to keep the root of a tooth and two crowns, I recently discovered that the whole thing was infected. It was time to start over. So my dentist, two specialists, and I made a plan to remove the entire tooth, let the bone heal, and then install a metal screw and a permanent crown.

During my first consultation with the oral surgeon I expressed my interest in not having sedation. He looked surprised, said he would do whatever I wanted, and then went into the gory details of what he’d need to do during the procedure. (Because of the infection, it wouldn’t be a typical extraction.) He said he’d be happy to do it without sedation but he wanted me to be prepared for what it would be like. “There will be some white-knuckle [scary] moments.”

I said my first thought: “Could we do sedation without Versed?” [Versed is a sedative that keeps memories from forming.] He said the other parts of the sedation wouldn’t do much without the Versed and that I’d do better with no sedation at all.

I decided that until the surgery I would work in all my sessions on the sedation decision and any feelings about the impending oral surgery.

Week 1: During the first week I started to think outside the binary sedation-no sedation option. I called the clinic and asked if I could start with a local anesthetic and then, if things became too difficult, switch to sedation. I was told that the clinic had local anesthesia appointments in one part of the day and appointments with sedation in another, so I would need to decide which I wanted before making an appointment.

Week 2: I went into the second week thinking I would opt for the sedation. The white-knuckle moments sounded gruesome, and I wasn’t sure I wanted to remember any of it. This brought up heaps [lots] of feelings about being a “bad Co-Counselor.” I wondered what my Co-Counselors and Area Reference Person would think if I opted for sedation. My counselors said they were confident that with discharge I’d make the best decision for me. My thinking started to move toward a local anesthetic only.

Week 3: My counselors encouraged me to explore what I was still afraid of if we assumed that I could discharge any distress from the procedure. I discovered that I was afraid that if I were awake I might flinch at a sound or a movement and cause a mishap during the surgery. After counseling on that, I talked with my dentist. He said that with the local anesthetic and a headrest, he wasn’t at all concerned about my moving and that he trusted the surgeon he ‘d referred me to.

Week 4: I decided not to have sedation and made an appointment. The receptionist told me that since I wasn’t going to have sedation, I could drive myself home.

My plan was to bring headphones to the surgery and do my best to check out of [mentally leave] the world—essentially provide my own sedation. I thought that if I did it right, I wouldn’t remember anything. Then in my sessions I started to explore this idea. If I was going to check out, why had I gone through the deliberations and sessions of the earlier weeks in an attempt to not use sedation? The purpose of sedation was to not be present—and I was proposing doing the same thing, just without chemicals.

One counselor told me how Diane Shisk (the Alternate International Reference Person for the RC Communities) had had major surgery with a local anesthetic and no sedation and that she’d approached the situation with great curiosity. That was an angle I hadn’t thought of.

Week 5: During one of my sessions my counselor and I were talking about how the day of the surgery would go. I said that I was going to drive myself, and she stopped me: “You’re going to what?” With my persistent “do it myself” pattern, as soon as sedation was out of the picture and I didn’t need someone to drive me home, I hadn’t thought of anyone coming with me. I texted my partner and asked for a ride and got an immediate “yes.”

Week 6: A week before the surgery, fear of the actual procedure took over [dominated] my imagination. Another counselor asked how I would like the morning to go, and I thought back to Diane Shisk’s curiosity. I said that if I wasn’t going to mentally check out, I would like the surgeon to narrate the entire thing for me. (My fear was about not knowing what was happening and my imagination running wild.) I thought it would help if he said, “And now I’m going to do this,” or “In a moment you’ll hear a noise, and it will be me doing that.” By the end of the session I had concluded that I’d ask the doctor for what I wanted and had practiced doing that several times.

A few days before my surgery I got a reminder call from the clinic. I told the caller that I wanted to know how long the procedure would take because I wanted to tell the person who’d be driving me. The caller said, “You’re not having sedation, so you can drive yourself home.” I said I knew that and that I wanted someone to be there with me. “But you don’t have to have anyone drive you,” the person repeated. It reminded me how our society encourages us to not seek help when it isn’t “necessary.”

Surgery day: My partner gave me one-way time to discharge before we left the house and more time while we drove to the clinic. We sat in the waiting room together, and then someone called my name. I told the person that I wanted to listen to some music on my phone but with just one earbud [one small speaker in one ear]. I then asked the doctor to tell me throughout the procedure what he was going to do. He said he was happy to do it.

At one point in the procedure, I asked the doctor what he was doing and he remarked, “Oh, you want to know everything I’m doing?” “Yes,” I replied, and he got even more detailed in his narration. By that point, curiosity had replaced fear and I wished there was a camera on his head and a video monitor in front of me so I could see what he was doing.

After he had finished and explained the aftercare, I reflected on how easy the extraction with local anesthetic had been. But it was only because of all the discharging I had done in anticipation.

Josh Feyen

Madison, Wisconsin, USA

Reprinted from the e-mail discussion list for RC Community members

(Present Time 193, October 2018)

Last modified: 2022-12-25 10:17:04+00