Happy Day

Much fewer files stacked up today, fewer crying kids( for me at least), and that really made my day. At least I didn't make anyone cry, and I was able to help my colleague finish up treatment who was being difficult.
However, I shall blog about this patient who made this day special, in a way.
Let's call her S, she's 12 and was referred for a filling on a baby tooth. When I saw her, she looked like any 12 year old, dressed in ill fitting jeans too long for her legs. S was accompanied by her grandmother who was more conversant in Malay. I noticed that S hardly spoke a word, and most of the talking was done by her grandmother. I took it as a sign that she was really scared and didn't take too much notice of it.. I mean, who wouldnt be scared of a visit to a dentist for a large filling, which may involve needles and all.
Upon examination, the decay was so severe, so I decided to take an xray to check whether adult teeth were present underneath, to decide on the next course of treatment. In the xray room, I asked S to stand straight to take the large Xray, since she was unable to tolerate the small film, threatening to throw up on me a few times. She started crying and was being difficult. In my mind, I just wanted her to listen to me and get it over and done with.. it was just an xray, I thought and more treatment may need to be done after that and it was close to the end of the day. After coaxing and adjusting her final position and asking her not to move for the umpteenth time, we managed to coax a xray out of her.
While waiting for the film to be developed, I chatted with S, with me doing most of the talking, I lifted the salivary ejector to remove some saliva and she did a little jump, which shocked me cos tears started rolling down her eyes. When I tried comforting her, I realised that her body was very tense, and her hands were cold.
The film came, and her grandmother was asked in to discuss the treatment plan A Malay nurse had taken over as interpreter. Plan was to chabok(take out) the 'rosak'(bad/spoilt) gigi(tooth), I explained in halting Malay, since the adult tooth is erupting soon anyway. S did what any other kid would have done, she cried and shut her mouth. Since she was 12, I didn't want to force treatment on her, and tried rationalising. She opened reluctantly, and the tooth was removed successfully, after my story about swallowing the worm into the stomach and giving her very painful stomach aches, not moving when I'm injecting (I'm blowing a magic balloon into your mouth, so you better not move, if not, the balloon will burst).
After which, unexpectedly, the grandmother shared with S's story. S is studying in a special school. Her dad had passed on, mum is working 12 hr shifts and she has two brothers and one sister. The 2 brothers are being taken care of by her grandmother, while S and her sister stay in an orphanage, as her mother has no time to take care of them, rushing to make ends meet. S would probably have been through a lot during this while, and I wonder if I could have been more understanding towards her behaviour.
Many a times, kids in our clinic come and go, some are really difficult on the surface, but there could be other underlying reasons that we don't know about, that have caused them to behave that way. They may be crying, wailing their lungs out, but that could be their way of seeking attention from their parents who may be too busy to interact with them during other times. I must admit, that it is hard to be understanding towards the kid's needs, when you get a hysterical kid screaming into your ears, threatening to burst your ear drums. However, the lesson behind this incident is that people behave in a certain way for a particular reason, and you may only truly understand when you interact more with your patients. I'm honoured that the grandmother had decided to confide S's background with my nurse and I, and I'm also thankful that the system in the clinic allows me to spend time to interact and understand more about my patient. In other clinics, due to manpower constraints and the large number of patients who are waiting to seek treatment, dental treatment is a drill,fill,bill job and it's hard to inject a personal element into a dentist-patient relationship, when you're just getting your job done and waiting to send off this patient and see the next. That's a common trait in most public healthcare systems in many countries, and I guess it'll be hard to change this deeply entrenched trait locally.
Ok, enough of rambling, countdown to Leave Day! 5 more days!