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Well, life was quite a bit different the last time I wrote down anything here. Here we are, in the midst of the worst global pandemic since the Spanish Flu of 1918.
Forgive my poor writing, the parts of my brain that handle reading, writing, and higher order thinking have been exhausted. Here’s a synopsis…
So it took me 90 more minutes that usual to wrap up at work yesterday; had some quite-difficult CEREC crowns to do. I’m a perfectionist with the scans, and after powdering the teeth, I just didn’t have the contrast I wanted. So we cleaned them, used the diode laser again, and finally got a nice powder and picture. We battled for good isolation, finally got things to a place where I could bond in the absence of contamination. What a relief to see a good result after so much hard work. Our patient was a champion.
Patients, Pressure and Profits at Aspen Dental
Lili Reitz, executive director of the Ohio State Dental Board, said last year a quarter of her complaints – or 140 – were against dentists at corporate chains. Yet she has little authority to take action against the companies. Instead, her power comes from having control over the license of individual dentists.
I’ve taken 14,086 pictures with my camera since I purchased it nine years ago, and I’ve found something wrong with every single one. I do not have the brain that goes “oooh I love that one that I took… let’s blow it up!” I have the brain that goes “I wish the light had been from the right instead of the left” or “I wish I had shot higher resolution” or “the dust on the sensor is really noticeable there” or “that flower is past its prime”. This type of analysis is exhausting and difficult to shut off. Take that brain and have it paint a room and you produce a very dissatisfied person at the end of the project: seeing only the flaws and, for whatever reason, lamenting the inexpert hand that produced them. I do not know why I expect perfection when I am beginning to learn these things.
I can’t believe how much I’ve changed since I started writing this site. When I began jotting down my thoughts in 1999, I hadn’t been to high school, undergrad, or dental school. I didn’t have student loan debt. No car. No home. No bills. I paid no insurance. No paycheck. My biggest concerns were how fast the summer seemed to pass by and how much homework I found myself working on the other part of the year. My writing showed few reflections on what drove me to try so hard in school, or where I wanted to go in life. And anyway, the style of writing online at the time was simply to recount what you’d done that day, a literal journal of events, and I always talk about trying that again here but never quite seem to gather the courage to simply go back to that: “Here’s what happened today.” I always seem to be pursuing giant revelations, trite truisms articulated thoughtfully, advice to myself, or all three in an exhausting, overwrought, unholy blend. No matter how many times I edit those hackneyed paragraphs, it gets published as tangled prose, heavy writing. Let’s try the old way this week, ok?
About a week back, I helped decorate the tree at my parents house. It is the same tree my family has had since 1991, and it is aging pretty well. I did notice it was shorter and a little more see-through than I recall — yet I still love to look at a Christmas tree on these long winter nights. It has to look a very certain way, though. I’m extremely particular about the type of lights: I can see the 60Hz flicker of LEDs (if you can’t see the flicker, try looking at them out of the corner of your eye) so I’m a staunch supporter of incandescent lights, the bigger the better. The fact that I notice, dwell on, respond to, take pride in getting these details right, things like color temperature, replacement bulbs, wattages, things that seem insignificant to most — I used to think that was a part of me to minimize, to downplay, to somehow outgrow.
I like to keep patients safe. I like to work on clean, isolated teeth. My endless (ask Mykala) reading of primary literature makes me love what is called a “dry field” to work in (no saliva, no tongue). So, I’m in favor of rubber dams. Very much in favor. Here is one of my favorite photos, ever:
I just finished revisiting some regex code that begins like this:
preg_match_all('%{\$([^} ]+?)}%u', $template, $templateTags);
and becomes a rather bit more complex after that. I wrote it back in 2008. That aging code was sound but needed some updating; actually, I remember walking through Saint Paul, on my way to workout at St. Thomas (at a gym that no longer exists), puzzling through the right way to do nested parsing of template code. I wanted to be able to write these nice clean templates that this chunk of code would then take a look at and replace with content. What I mean is, if you can keep content apart from presentation, you are afforded a lot of flexibility. So, if in the future webpages are written in a completely different language, or if I want to produce an archival version of the site (say, a printed book) in a different format, then this code is the bridge between raw information (content) and final output (presentation).
Took out a really really difficult tooth today. #18 (lower left molar), root canal treated, very broken down. Nothing, and I mean no-thing, above bone. Whoa. Elevated a nice flap because I learned the hard way what happens when you do NOT do that… you end up with tissue that looks like hamburger when you are done, and at this point you start to wonder, seriously, that hackneyed phrase from your oral surgery attendings: “if you treat tissue like that, you’re no different than a butcher”. So, yeah, the tissue in this case was in great shape. Good to see. These roots, though, man. They currrrved into bone, down, and down.
Ben Goldacre: What doctors don’t know about the drugs they prescribe:
Publication bias affects every field of medicine. About half of all trials, on average, go missing in action, and we know that positive findings are around twice as likely to be published as negative findings.
Hi kids,
You probably won’t like your first job very much. My first job was at 3M and its only saving grace was that I met a truly great guy named Chris Rupert. Lacking a car, I was taking extremely long bus trips to work and he was nice enough to give me a ride—he’s one of those people who help out, expecting no overblown credit or glory in return. Just a super nice, stand-up guy. I’m lucky to know him. That’s sort of it from that job, though. I’ll be honest, I did a fair amount of sleeping—3M is where I first learned to sleep sitting up. I’d wear my glasses in the morning, and arrive in the empty, recently sold-off Pharm portion of the 3M building. In a nearly-empty farm of cubicles I’d turn on my computer and then… sleep for about an hour. After that I’d go to the bathroom, put in my contacts, and start my day. During the long afternoons, I taught myself object-oriented programming and wrote large chunks of the software behind this website. None of this, not the sleeping, not the programming, was in any way related to my job. But, I learned the ins and outs of corporate email (send a lot of it, be unnecessarily verbose, CC liberally) and the pure, unabashed joy with which folks greeted “free cake in the breakroom.”
Unaccustomed as I am to air travel (“Oh my god I’m flying! I’m in a chair in the sky!”), much less business travel, it was a mostly new experience to go out to Boston this past Sunday and come back a little over 24 hours later. The purpose of my trip was to learn more about the Bicon implant system, and I was actually comfortable accepting a trip, hotel stay, and continuing education credits from a company for whom I do not work. Why? Isn’t that some type of conflict of interest? It could be, but I had already, during my last year of school, done the research and decided that this system offered the best dental implants for most situations.
So, let’s see, where was I? “Charting the right course,” that’s it. I ended my last post with that seemingly-dull platitude, but I realized I hadn’t fully articulated that idea. Here we go.
The more I work building tiny things in a very forbidding environment, the more I value planning and preparation. Bah, here we go into platitude country again. Let me try again: you can’t do good work on a bad foundation. That’s better. Yeah, let’s run with that analogy.
Instead of wildly speculating, thoughtfully considering, or analogically writing about life as a dentist, I’ve actually been doing it for the past few weeks. Such a disconnect between writing and experience is precisely the reason I’ve tried to make it so easy to post things in this space and exactly why I am troubled when I do not. That is to say: I don’t want to look back and forget what life was like, so I seek to write it out here. And yet, when I seem to be living the most life, I’m not writing… I’m out living. Like coming back with no pictures of your great tour of Europe, because it was too exciting to stop for photos. I guess I’m someone who isn’t confident that memories in one’s head are good enough souvenirs of a life well-lived.
Sometime in 2003, when this online space was only 4 years old, I thought: “I would love to be a dentist.” The journey is the destination and all that, but the destination is pretty great. So, it’s time to start as a dentist tomorrow. My weeks off since graduation have been wonderful, but what’s even better is that I don’t fear the years ahead the way I did the years of dental school. Somewhere, deep down, you know when what you are doing isn’t sustainable. Like 4 hour nights of sleep or back-to-back hotdog eating contests, you know that this is a pace you can’t sustain. This isn’t that. This is an opportunity to learn, to treat patients, and to grow my relationship with my wife.
“George, you’re sitting on my application for licensure in the state of Minnesota.”
“Meow.”
“What if it gets wrinkled?”
“Meow.”
“Ok, fine.”
I am looking for a job as a dentist. If you know anyone who is hiring, please let me know. I’m killing a lot of trees in my search.
Thank you in advance for any information.
Signed,
Alex
And The Trees
I think I’m holding a vigil tonight. And not in the sense of “I think I plan on it,” but rather I mean “I think this is happening right now.” So, what is the subject or purpose of my vigil? I’m reminiscing about life in school at St. Thomas and the U while looking ahead at my life. This involves a lot of mindless clicking around on Facebook, which I usually try to avoid. I find myself regretting things I both did and did not do in my past, and wondering about the future. I’m listening to Sigur Rós. It’s a quarter after 1 in the morning. Mykala is asleep on the couch.
I’m waiting for the right combination: a patient with a sense of humor and a mildly but not-too-difficult extraction, to try out this little gem: “man… this is like pulling teeth.”
Or, it’s possible that I should just keep that one to myself.
Despite my idea that I wasn’t going to write more about it, I might as well record this thing for posterity. I’d like to describe in detail, both for myself, for my wife, for my future children, what it was like to survive “the worst hazing in all of medicine.”
The first thing you must understand is the way that licensing works. Licenses are doled out by states, and certain fiefdoms have been established around the US where you have to take a certain test to practice dentistry there. So, you do not receive your license, that is, your legal permit to do the job of a dentist, from your dental school. You receive it from the state in which you plan to work. Thus, upon graduation, you receive your school’s diploma and then you submit materials to apply for a license. I think that all of us working in Minnesota will apply for “Licensure by Exam”. That requires the following:
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