Only sympathy

As rewarding as treating emergency pts may be,
its never fun to treat pts presenting with pain... especially when u caused it

10 yrs from now... long into my career, I prob will never forget this patient I hav
she was the first patient I treated since 2nd yr
and in the 2 yrs Ive seen her, her mouth is almost a living proof of all my mistakes, my clinical incompetence...a reminder to myself to do better next time
In a way, I really owe her my career given that ive tried just about all treatment types ive ever learnt on her

Since the 2nd yr, I scaled and root planed her teeth for over a yr
when I learnt about root caries, there she was...my first clinical case of sort
when I learnt of patients with hyposalivation, she was one...always was one... I was just too dumb to recognised it in the 2nd yr when I first saw her
she was the first patient who seriously challenged my operative skill
one poorly accessed, packed and marginalised filling after another followed by a root canal treatment because of my failed interventions
I prob will make a crown or extract her tooth some times in the near future too...perhaps making her a denture

My perio treatment didnt 'heal' and she came back with root caries
I learnt then that I shouldve applied fluoride after root planning
The root caries were the deepest I'd ever attempted to fill. I couldnt isolate, or fill the tooth well
my second attempt failed just as miserably.
I learnt then how to adapt the matrix band well and the method of packing GIC
She was still in pain because the fillings were very close to the pulp
In the end, I had to take the pulp out and wasted all the treatments I tried before hand
In the process, I perforated the root and learnt once again how to refine my endo access preparation

I had an argument with the demonstrator over the treatment option and was really annoyed The tooth had no long term prognosis. I couldnt make a crown for her even if root canal treatment was successful.
I tried filling it 3 times, I knew how far down the margin of the tooth was.
If I took the tooth out, the gum condition of the surrounding teeth may improve as well as her cleaning. The demonstrator told me to keep it.
This situation is classic. Never root canal treated the tooth that cannot be restored.

Prof Morgan's lecture this week really put a lot of things in perspective too.
In public dental health, we are concentrating on treating the population and not the individuals. we cant afford luxuries in public health and should be spending time treating patients to an acceptable level of dental health instead of wasting money, time and resources on teeth with hopeless prognosis.

If Dr. Stacey reviewed this patient in the final year case presentation, I will never be qualified as a dentist.
This patient is a classic example of what not to do in term of treatment planning.
-A patient with poor oral hygiene but has a mouth full of root filled teeth which prob will fall out in a yr or so

Just last week, I filled another tooth with root caries. I told her that the radiographic evidence showed that there was a decay underneath the filling.
Though I thought I did a good fill on that tooth, she called up this week with severe radiating pain coming from that tooth and a facial swelling.
The pulp was taken out in primary care. Again, this raised a question whether I should've filled it.
The patient was asymptomatic. Most patients would not be happy if they get pain after the dentist intervened with the tooth which was initially fine.
By leaving the tooth in a diseased but asymptomatic state, we may be able to buy more time for the tooth, maybe for a better restorative technology......who knows

I learnt... not to let these things bother me...
cos theres nothing to be sori for
cos I still believe that clinically it was the right thing to do...to attempt a fill

so...No regret, only sympathy

07-08-08 : I was right. The tooth prognosis was poor but who wouldve imagined it giving away so soon. The patient came back with fractured fillings all around the tooth. It has been extracted today.

Illusion

Had one of the best dreams today
pictures of me. pictures of you.
As wishful as I may be,
sadly it'll never come true

Pause away

Today, us dental students were given a talk on the topic of communication by an external speaker

The key idea for the seminar was to "pause and relax"
She said that the occasional pauses allow us to think about what we are about to say
and at the same time, consider what others were saying. This trains us to be mindful, to be patient and good listeners

We started off the exercise by meditating for several minutes
The speaker guided our thoughts using the sound of a bell and her descriptive instructions which overall, was pretty much like being hypnotised
Once my body was relaxed, two immediate effects were apparent.
I felt sleepy and I also felt like farting

We then continued to the next activity which was kinda like speed dating
We engaged in a conversation with another fren whom we don't know very well...
of course, since this was about "pause and relax"
there were breaks in between, marked by the bell sound

some findings:
- in our needs to fill the silence, we tend to talk a lot of junks and unnecessary stuffs out of habits
- we are all eager to get into a conversation, to have control of the conversation, to impress and to project ourselves in a certain way
- i'm normally quiet but when Im saying something, I usually have a lot to say
- its frustrating when i dun get to say all i want to say. this blog is a good example. whats left in my head goes in the bin.
- conversation provokes thoughts which allow the conversation to continue. unfortuanately the thoughts provoked were usually about ourselves rather than interests in others. we then go on to talk about ourselves rather than asking or elaborating what the other person just said.
- when I paused, my brain also paused. there were no thoughts nor considerations whatsoever. Just pure blankness and awkwardness. when we pause, its often interpreted as a signal for others to say something even though they dun hav anything to say.
- therefore i think slowing down works better than pausing.

Towards the end of the session, my fren asked a question which made me realise
When the speaker herself was giving the talk earlier on in the session, she actually paused quite frequently

...No wonder I felt asleep

PS. "Be mindful of your thoughts..." - Obi-Wan Kenobi (Star Wars Episode II: Attack of the clones, LucasFilm Ltd 2002)

พระเอก

ดูละครมาหลายเรื่องแล้วรู้สึกน่ารำคาญ
มีแต่คนมาชอบพระเอก นางเอก อยู่นั่นแหล่ะ
แล้วก็เข้าใจผิดกันไป เข้าใจผิดกันมา
เห็นแล้วก็ขอเป็นพระรองดีกว่า ดูชีวิตมีความสุข เรียบง่ายกว่าเยอะ
แล้วก็ไม่ใช่ว่าแฟนพระรองจะไม่สวย คนอื่นตามันถั่วเอง... เฮ้อ...

The 4th pothole

Through iron core and butter field, he drilled
In search of a map...in search of thrill
Through the mine field, he dug around
One..two..three....four potholes he found
But his mind was only playing tricks
There's no DP canal in 26
Too soon to celebrate, he realised
It was a perforation in disguise

สิ่งตรงข้าม

สิ่งตรงข้ามกับ..."รัก"... ไม่ใช่... "เกลียด"...แต่เป็น... "เฉยเฉย"

sms

Been deleting msg from my inbox and it saddened me how time flies
every times i sit back and clear the inbox, its like replaying my life in the past month/few months

clearly, its been too long since I last played games...

happened over a month ago
- the soccer game and dinner with dent frens
- the last time I got together with Thai frens
- some med frens left for home
- the passing of my club committee's term and the messy paper work

I saw a msg for dinner at fren's place around swot vac time...
they were so stressed
now they've finished and gone home and what have I done?...nothing worthwhile

The month of June has passed...I didnt monitored my mood... cos i thought the graph would be too unrealisitcally positive
as it turned out, prob more like a crater...with Po standing on a tiny spike in the middle of it