Sunday, October 9, 2011

After the Dentist

This was my little darling at the dentist's office when we first arrived. She was very relaxed and happy and so was I. What I am about to tell you is without embellishment. The reason I'm going to give you all the details is so that you will always be ready to advocate for your child and protect your child and yourself, your rights as a mother, when you least expect you have to. Please keep all comments positive and respectful. The last thing I want to read is that I should "trust the professionals."

The night before my daughter's appointment, the anesthesiologist called me to go over the sedation procedure. The drugs were going to be given as follows: Versed, nitrous oxide, insert IV, Propofol. I told him that I was not willing to give my daughter the Versed or nitrous oxide unless she needed it, as long as he used a local numbing spray before inserting the IV and as long as her veins looked good for insertion, meaning that he wouldn't have to dig around under the skin for a vein. After some conversation, we agreed that we could probably skip one of the premed drugs, but he was willing to meet my daughter and look at her veins before deciding. I was happy with this.

I am a person who believes that you do not put any drugs into a body unless there is a need to do so. Many of the drugs routinely used on children have not been tested on them. We do not know the long-term effects of most of these drugs. Many drugs, including Versed and nitrous oxide, do not often work as the doctors would like to make you think they do. Versed is supposed to make children not remember, but many, a whole lot, in fact, do. Nitrous oxide can cause panic attacks.

Promptly after arriving in the waiting area, the dentist appeared. He is a large man, tall and completely bald; a very imposing figure. He immediately began a militant tirade in a raised voice, looming over me, of how he is in charge and his word is the final say, over the anesthesiologist, and my daughter will receive exactly what he said she will and that I have no choice at all in this and that he will not change what he does and if I do not accept this I can go elsewhere. He ended with the order to, "Think about it," then left.

I cannot remember if, during this tirade I got one word in, or if he came back to have another go at me, but I did tell him that I had already made an agreement with the anasthesiologist, after which he announced he was in charge and no one else had any say in the matter. I also told him that my daughter was not the same frightened child he met four months ago, that we'd been through more medical stuff and she now trusted me and knew enough English that she was well-prepared. I mentioned that children raised in orphanages often lived with high cortisole levels, a stress hormone, that made them react differently to Versed, namely, that it didn't work well on many of them. I also told him that any decisions concerning my daughter are not his; they are mine, as her mother. He ranted further at me, glared, etc....

Some time between the first and second tirade, I prayed that I would know if my daughter should have the premed and agree with the dentist or if the dentist will realize that my daughter didn't need the premed and would relinquish his demand.

Through all of this, I was calm. I looked him straight in the eye. I never raised my voice. I stuck to facts. I was so strong! I also was given the insight to recognize this as a tactic. I could clearly see his side. He must have to deal with hysterical, know-it-all, bossy, scared, nutty parents and their children all the time. I even said so to him. He was a master at intimidation and getting these parents "into line." I felt sorry for him, but I was appalled that he'd resorted to this, especially with me. It was terribly unprofessional and I've had it up to the top of my head with unprofessionalism!

Finally, he said from down the hallway, "I don't want to stand in the way of your child's care."

I asked, "Does this mean you will send Dr. M in now?"

He replied, "Yes."

Enter Dr. M, the anasthesiologist. Nice man. Also large and imposing, but relaxed, personable. I asked what the problem with the dentist was and he said that that dentist was just used to doing things a certain way. I said, "I thought we had an agreement..." He said we still did and that we'd bring my daughter into the room and get started and see what happens. I said, "Just pull up her sleeves now and look at her veins. If they look good, let's get the show on the road. If not, we'll follow your usual protocol, starting out here, as usual."

He did as I said, found a good vein. We went into the room and my daughter was amazing. She tried to see what was going on, then I told her I'd tell her when the poke was coming. She was curious, nervous, but doing very well. I told her to look at my eyes and I sang to her. She didn't feel the needle go in, thanks to a topical spray and in seconds, she was unconscious.

I read a book in the waiting room. I was calm. The procedure took just over one hour and I had two updates during that time. Things were going well, slightly better than expected, in fact. Afterward, the dentist came in to tell me that he was done, things were fine, that her lips would be swollen and she'd have tape marks on her eyes and nose. He also told me that he gave her Novacaine to help with the pain afterward. He never mentioned this ahead of time. I would have liked to have been able to prepared Jie Jie for this sensation ahead of time. A little while later, the anasthesiologist carried my daughter in to me and I held her as she fully regained consciousness.

I am not ignorant of how surgical patients look after their procedures. I have seen surgeries and have seen how rough certain procedures are because they have to be and how rough they are because of careless doctors. My daughter looked like she'd been beaten. They stretched her mouth open so far that it tore in the corners on both sides. She did go into it having chapped lips, but now they were completely cracked open all the way across both lips. They continued to bleed for two days when she smiled or cried. She still has scabs in the corners.

The dentist acted very matter-of-fact. He did not apologize for or in any way acknowledge his previous behavior. He did not in any way acknowledge that my daughter did a good job and was brave and had come such a long way since the last time he met her. However, all the staff did say what a trouper she was. As I sat there with my little nugget fussing and coming into full consciousness, I heard an 11 year old down the hall getting hysterical over the Versed they were about to squirt into her nostril and listened as she screamed and yelled as she was given nitrous oxide. The comparison was clear. My daughter was amazing!

My friend who accompanied me to China and is a dental hygienist and wife of a dentist said I should write this dentist a letter. Another friend said her kids were with the practice and they left it because they didn't like it. Today, another friend said he'd noticed the dentist getting "grouchy with age."

I don't feel the need to send a letter. I said all I needed to to this man's face. I got what the anasthesiologist and I agreed on for my daughter. I am very unhappy about her over-stretched mouth. She also had skin ripped off with the tape when the IV was removed. I use medical tape on my daughter every day, pertaining to her special need, and another medical grade adhesive as well, and only once in 6 months did I take any skin off and it wasn't from lack of gentleness, but having to remove the adhesive before it's time due to failure of part of it.

I already know that if I stick with the practice, I'll change to a different dentist, but I'm not sure I want to stick with this practice. Again, I truly can see the dentist's perspective so it's less about his tirade and more about the unnecessary roughness with my child's mouth and the tape. Why add to the pain she was already going to be in. Honestly, her lips were more sore than her teeth! I would love to know your opinions based on your own experiences with your child's dentist.

I am posting the following pictures so you can see what is normal after anasthesia, a crying child, still a bit out-of-it, and so that you can see her lips.

All done, going home. Trying to smile.

Smiling hurt too much.

Cozy and safe at home watching Big Bird in China for the first time.

The next evening, Friday.

Saturday evening.
Tape residue still on her forehead and cheek.


Anonymous said...

I am so sorry you both had to go through all this but you are both very brave. Thank goodness she has you to watch out for her. I hope she heals quickly and all the dental work was successful. She is beautiful!

Anonymous said...

She is one of the most beautful little girls I have ever seen. I hope she is feeling better. You are such a good mom.

Much love to you both,

goodiego said...

You were the perfect Mama Bear for your daughter with that dentist. Keeping a cool head when he was ranting is above and beyond anything you could have actually said to him. It is not easy when professionals judge us Mama Bears but we have to hold firm.

Having the knowledge you did beforehand was key to the whole scenario. I have found that using Big Words to describe our DD's medical trauma gets me heard. Using the words Medical Trauma helps too. Tell them she may have a Paradioxical Reaction to the drug you are concerned about. That is having the complete opposite effect of what they want to use it for.

IMHO, I would NOT go back to this dentist or this practice. It is likely he could stand in for someone else at another time, even if you don't schedule with him.

Continue to question the professionals when you know your daughter best.
I have reminded them to think outside the box when it comes to our DD. Unfortunately, some professionals base most of what they do on "the norm" as they see it. Our girls are not "the norm" and that is okay.

Your post reminded me to keep these things in mind when my DD goes for surgery next month.
Thank you for that.

Palmers Cocoa Butter Swivle Stick is just the thing for her little chapped lips,
plus it smells delicious and comforting.

Carrie said...

I'm curious. Was this a certified pediatric dentist or a "regular" dentist who took care of children. It makes a HUGE difference.

I worked in a clinic like the one you described as an RN doing the recovery stage. I worked with a variety of pediatric dentists over several years and I never saw anything like this. The dentist should tell you everything he is planning to do. It is part of the informed consent that you signed before the procedure.

I will say that occasionally I did see tears around the corners of the mouth, though it didn't happen very often. They could have moistened her lips with something. Depends on what gas is being used (sometimes KY jelly and Vaseline are flammable) but at a minimum they could have used a little water.

It is up to you, but I would switch out of the practice unless you know that this particular dentist will never touch your child again. Unfortunately, sometimes they cross cover so it may be easier to move than to stay, but that is up to you.

Good job doing your research. As a nurse, I know that the medical staff are more likely to listen if you do your research and know what you are talking about. Unfortunately, there are a lot of people who don't and often that is where the true conflict is.

Good luck on your future experiences. Hopefully they are better. I enjoy reading your blog!

Anonymous said...

you are an amazing mother. i've learned over the years how important it is to be pro-active and informed when dealing with medical professionals. and CALM! although it can so frustrating sometimes.

mom2joy said...

I also agree. I would never stay with that practice. It seems he was deliberately rough to get even with you and there was nothing you could do at that point. It would not hurt to send a letter to the State Dental Board telling your story.
Your daughter is absolutely lovely and precious as she can be. And you are a wonderful mother. I check your blog regularly for updates. Thanks for sharing.

Carolyn (mother to a teen from Hefei; adopted 9.23.1997)

AandAsMama said...

You are such an amazing mother and advocate for your daughter. I agree with the other commenters about taking her somewhere else next time. While I agree that the dentist may have had to handle hysterical uneducated parents in the past that was clearly not the case with you. And that he used the novocain without talking to you about it bothers me as well. And her poor little lips alone would make me never want that man to touch her again.

I hope she is doing well now. She is a brave little girl and it's amazing to see how far she has come since she has been home. I loved seeing that first picture of her before the procedure at the dentist and how calm she is. It says so much.


Kris said...

I agree with the commenters that are telling you to not return to this dentist. What happened to 'bedside/chairside' manner? He needs to have a letter sent to the State Boards, sorry if he claims to work with children, then he needs to show it. Congratulations on keeping your cool...I would probably have walked out with my daughter. On a better note, I am so very happy she is doing ok now. We were praying for you both from here. You are an amazing family! :-)

God's Blessings to you!

gail said...

I am so very sorry you had to deal with a dentist who was very uncaring and rude. I have dealt with a few of them over the years with some of my children. I never returned to that practice. Going to the dentist is scary enough without dealing with one who treats our precious children this way.

I adopted a sibling group from foster care who had been in my home 2 years. The 4 year old needed numerous cavities taken care of. The dentist was very good with us. He explained everything he was going to do both in his office and at the hospital. Having her dental work done at the hospital was a decision that was not taken in haste or lightly by us. The whole experience was amazing. She did wonderful and recovered beautifully. Her lips were very dry afterwards, but we kept putting Burts Bee Lip Balm on them.

I am thankful that JieJie has a mother who is not afraid to stand her ground and her beliefs. God picked you especially for her. He knew she needed someone like you to care for her and nuture her as you do.

Awesome job Momma Bear!!!!!

JieJie is beautiful and glows so much in her pictures.

mom and girls said...

Curious why the dentist didn't slather vaseline all over her lips before he did any work??

Two of my 3 kids see the "grown up dentist," and one of mine goes to our amazing chinese pediadontist. Our pediadontist is amazing. He can do fillings in about 10 minutes flat and my kids never flinch. He lets me back in the room with them. He is gentle, kind, and knows what he is doing. All the moms keep begging him to do adults!!

Vernell Leider said...

Oh, that's very bothersome. It's sad that your daughter encountered a careless dentist. I just hope she wouldn't develop a phobia after that. She's brave to have surpassed that procedure. Thank God she has a wise and loving mom. I hope you find a very good dentist for her.

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It's important to get an early start on dental care, so that your child will learn that visiting the dentist is a regular part of health care. The first step is to choose a dentist for your child.

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