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November 15, 2004

My Teeth Got In the Way

Slight change of plans. While I wanted to use my notes from the conference I attended last week for this project, my interest in the whole 15 hours is proving to make the limiting of it to a size appropriate to this assignment difficult. I�ve decided to use notes I took during a recent visit to the NYU Dental Clinic instead. Because this experience is an extreme case where not only am I very attentive to recording my perceptions of the event, but so is everyone else, as I am asked over and over, �Are you O.K?,� using my visit to the NYU Dental Clinic for this assignment is an opportunity to explore some of the benefits and difficulties that arise with the use of heavily experiential methods of fieldwork.

This entry is organized as follows:
I) Preliminary Checklist
II) Transcribed Jottings
III) 30 minutes of Full Fieldnotes
IV) Reflections
I) Preliminary Checklist
My checklist for this set of field notes was sparked by my question of how the fact that the NYU Dental Clinic is a teaching clinic would affect my experience as a patient.
Having heard some rumors of bad experiences, but that were not in enough quantity or detail to discourage me completely, I wondered simply if it was possible that it could be any worse than the number of bad experiences I�ve had with dentists in the past. Following from my these experiences the basic question that I had was whether I would have a better experience because the performance of the dentist is under scrutiny or would I have a worse experience because the dentist has less experience treating patients. In part giving NYU Dental Clinic the benefit of the doubt, and in part because my negative experiences were all colored by a sense of receiving false or inadequate information if I received information at all, I decided to set out to collect field notes that would address a general theme of pedagogy. I came up with the following list of questions to use as a guide.
How closely, and when are the actions of the dentist under supervisorial scrutiny?
How is a student dentist taught without compromising his or her credibility in the eyes of the patient?
How much of this teaching from supervising dentist to student dentist is understandable to the patient?
When, how, and by whom is it translated?
How do these translations affect the relationships between the patient and each of the doctors?
How do these translations, their style, or lack, color the patient�s perceptions of each of the doctors?
What are the different methods that each of the dentists use to teach the patient about what is entailed in their understanding of the patient�s role in their own dental care?
I took four pages of notes over a two-hour period. For the purpose of this exercise I have transcribed all four pages of jotted notes and transformed the first page into full fieldnotes.
II) Transcribed Jottings
Page 1)
DDS doct of dental surgery
Tongue suddenly very larg 4x as big as usual
Tongue where nerves come together extra anaesth
By tooth lingual nerve and from cheek to front
Of jaw infection means anae doesn�t
Work as well using smaller needle
I�m sorry I�m sorry kissing project � still
involves the mouth, other dr. again
told me again that there was a risk we might
still lose
going to clean around the tooth
contraption might limit my notes

does it hurt? At the top d�thats weird
cleaning around tooth � less sensation at the tip
of the tooth, my body is shaking
as I hold up book I try not to look
at his face, keep everything abstract
he tells me as I ask
binding material still stuck on, will polish off
w eyes open

cleaning the chimney out � layman�s terms
switching back & forth

Page 2)
breathing having trouble he promises after
putting �rubber dam� in to keep things
I had to ask
Saliva ejector
from falling down
d: you ready? Begins drilling
this burr doesn�t want to cut�let�s try this one
close my eyes still see the light
I�m trying to do asst job glad Im left handed
wondering about pain and earlier comment of
shape & clean out canal longest & strongest
I can tell others w horror stories
he was getting pus out
bleach will irrigate, calling reason for dam
file like a mini drill
glasses 2 1/2 x a drill
Ruok w bleach comes out w
no puss

endodontic files

Page 3)
takes x ray asks for my finger � not rt, left, writing finger
raincoat I laugh as he reaffixes this piece
with the dam over it � he says you
should see yourself says he will give me a mirror
radio station
Shania Twain 4 ever & 4always sound of hiss from sucker
-cleans w bleach again
going to go check on xray & go
file looks clean
radio disco tune turns off sucker

other dr asks if reduce occlusion then take a
I am taking notes so new measurement
I can do my own if it is close is � I that is fine
root canal Shortening the tooth so
I�m not biting on it

Billy Joel on radio
I�m getting nevous about taking notes wish I had
explained better to both doctors about what and
why I was doing this

2 1/2 was long ceiling symmetry
Staticy Stevie Sunshine of My Life
at my question
Irrigation w 4 r�s drills get cleaned
and sterilized
In Your Eyes bent ones get replaced
they are cheap
I thought he was still getting pus
Throwing each one a nice burst of pus

Page 4)
It was more prone to infection bleach on work
Because it was dead? Yes table
in plastic cup

no more blood � antibodies
head on lap finger on face intimacy Hasta la vista
have dr Kao take a look b 4 closing up Hasta luego

are my notes private or public for
Another student dr comes in to ask dr kao if he got something

Story of Alex�s root canal inflamed but not dead root
lots of tooth structure yet
- he explains it was H2O/bleach that prompted
mental note comment from Kao
we can still go deeper about if there
was still something
in there
tooth approx this long
there are more drills added
thouroughness vs possibility of getting
into surrounding tissue
off to look for paper pts.
My eyes hurt story about people who can�t
Close eyes almost done next time
Cher on radio almost dry shaping
& filling
3/4 done shaping shapes cotton pellet
where I can see it
I will survive � comment clears floor of guys
temp mat like Silly Putty
drills on tray
suckers to my left on
attachment to spit sink

III) 30 minutes of Full Fieldnotes
Page 1)
I�ve been talking after class with Tina and I�m running about five minutes late for my four o�clock appointment at the NYU Dental facility. Alex, whom my appointment is with, is standing in front of the reception desk talking with the receptionist, or maybe with his supervising doctor who is also there, Dr. Kao. I can�t tell exactly because as soon as he sees me he turns his attention to me, greeting me warmly and dismissing my apology at my lateness. He leads me down the hall to the exam room, the one at the very end of the hall that we used on my initial visit two weeks prior, where it was determined that I would need the root canal that we will undertake today in order to get rid of the infection that has been bothering me for the past few weeks. There is a dentist�s examination chair flanked by several jointed metal arms attached to various devices and trays, as well as a sink for the patient to spit into on one side and two rolling stools on the other. Just to the right of the door there is a counter with a supply cabinet beneath it.

As I hang up my coat on the wall hook in the back corner of the room I ask if it is ok if I take notes on the visit as practice in the composition of ethnographic field notes for a class I�m taking. I�ve already pulled out my notebook and pen. He sounds curious, says it fine. I�m nervous though, I add some kind of disclaimer that this really doesn�t have much to do with my own research, its just required for a class, and its just practice for me. In response to his question, no, I tell him, it isn�t going to be used for anything. The door to the room is open and I can hear people walking back and forth in the hallway.

�Is a dentist a doctor?� I�m thinking about my past experience negotiating dental problems in a hospital environment where dentists were not welcomed as peers. I�m also curious as to his soon-to-be realized status; during my last visit he told me he will be graduating next April. And perhaps most pressingly, I ask the question because I�m looking for a way to break the ice and keep conversation flowing despite my notebook, which feels obtrusive to me. Alex, explains that D. D. S. stands for �doctor of dental surgery.� At my last visit, Alex was seemingly reticent to disclose his last name, Pilavsky, as I had to clarify that what I was asking for was his full name, not just his first name. I asked at the end of my initial visit because I was nervous that I wouldn�t be able to identify him again if I need to refer to something that had happened. I really couldn�t fathom why he wouldn�t have wanted to tell me. But he did tell me, so perhaps I�m just not used to the informal atmosphere of the teaching clinic. Perhaps he just doesn�t want to risk being called �Dr. Pilavsky� before he actually receives the degree, which I might well be inclined to do. He asks if I�ve been taking the antibiotics that Dr. Kao prescribed for the infection that is in the bone under my tooth. I say yes, remembering that it is time for me to take one right then. He gives me a plastic Dixie cup of water to take it with. After the appointment I realize that I took the pill about two hours early. But I did swallow it then and he after which he asks if I had bought and started using the fluoride rinse he had strongly recommended to help prevent my cavities from getting worse. I say yes again, feeling like a patient who has done my homework.

�Wow,� I tell him, �that needle is really big.� As he injects the novicaine into the flesh of my gum just below my rear molars on the right side, my tongue feels suddenly very large, I say out loud that it feels four times as big as usual. As a possible explanation, Alex explains that the tongue is where a disproportionate number of nerves come together. The way he offers explanations doesn�t seem attributional necessarily, more suggestive of likely possibilities. At my initial flinch which seemed to me to be because the topical anesthetic had been swabbed just below where he inserted the needle, in what sounds like an attempt to comfort me, he tells me that he won�t inject all of the anesthetic. He tells me he will go slowly, and it does seem to be taking a long time. Since the first flinch was really the only part I felt, I wonder if he changed his mind, deciding to avert the risk the anesthesia might wear off, and did in fact inject it all. I didn�t ask. He gives me a second injection in the gum just below the tooth he plans to work on, the right canine. Before he makes the injection he tells me it will be a much smaller needle. I realize that after I noticed the size of the first needle, and vocalized my surprise, I�m trying not to pay attention to the needle at all. But I look, and see that it is indeed smaller. Even with this smaller needle he apologizes repeatedly while giving the injections. On the one hand, he doesn�t really have anything to apologize for; obviously I do want him to do this to avert the possibility of a much more intense pain. But on the other hand, it does hurt, even if only a little bit, and even if it wasn�t simply nice to hear that he regrets that it has to hurt, it�s also a kind of comforting repetition.

I think of the performance Kissing Exam done by Hayley Newman in the �Sensation� exhibition at the Hamburger Bahnhof in Berlin in 1999, that serves in some ways as a model for the current notetaking I am engaged in. In Newman�s project, this artist found a volunteer who agreed to kiss her for an hour while she took notes on the experience, later including reflections of the experience in her doctoral dissertation. Newman�s performance was one that attempted to engage some of the difficulties of writing about an experience while simultaneously experiencing it. I thought it an appropriate model both because it involves the mouth and a concurrent difficulty of speech, but also because the potential for pain in the dentist�s chair might be said to be similar to the potential for pleasure in the act of kissing.

I mentioned the Kissing Project to Alex with a brief explanation, in part to establish a precedent to what I�m doing, but also just because I�m thinking about it as I sit there. As I say it I wonder if he might think it inappropriate, or will know how to respond to a reference to sexuality implicit in a reference to kissing. I note a brief pause, he�s doing something that I can�t see, but he makes a relevant comment, and seems unfazed.

Dr. Kao comes into the office and begins telling me something about my teeth and what is going to happen today very rapidly and that I don�t quite understand. After a minute or two of listening I realize he is repeating something he told me at the last visit which was that though the root canal was an alternative to pull the tooth entirely and would clear up the infection that I was suffering from, there was a possibility that the tooth would have to be extracted anyways if it didn�t heal properly. Though he didn�t talk about cost, that was part of the issue, the root canal will cost me around $400 and extraction is covered in the NYU Stu-Dent insurance plan that I have purchased. He tells me it is standard practice to try to save the original tooth, and that he recommended it particularly in the case of this tooth because it is in the corner of the mouth; extracting it would greatly compromise my bite. He does talk about the possibility of doing the extraction and going straight to doing an implant but tells me again that he recommends trying to save the original tooth. Once I realize what he is talking about I interrupt him to let him know that I understand what we are getting ready to do and that I really do want to do it. Since I have had invasive medical procedures done to me where all of the options were not fully explained to me, I also made sure to tell him that I appreciated that he had checked again.

Dr. Kao and Alex talk a bit over the x-rays before Dr. Kao leaves the room. Alex tells me he is going to clean around the tooth as he attaches a square of flexible plastic to a metal frame. I can�t really tell what it is except that it seems to allow him isolated access to the area he is working on. I have to keep my mouth open and the device is uncomfortable. He says I probably won�t be able to swallow so he hangs a plastic tube on the edge of my mouth to suck out the saliva. I�m worried that the vacuum will dry out my mouth and notice that I actually can swallow, so I mumble that to him and he removes the tube. I�m worried that the uncomfortableness of the contraption on my face will limit my ability to concentrate on taking notes.

�Does it hurt?� Alex is using a small metal instrument to clean around the tooth. I feel a sensation that I describe to Alex as being at the top of the tooth. It actually feels like the top of the tooth just to the left of the canine, a tooth that I actually lost four years ago, but I don�t say that. In line with the general familiar tone that Alex has maintained, he remarks, �That�s weird,� since he is cleaning at the base of the tooth, and the whole area is pretty well anesthetized. He tells me that there is usually less sensation at the tip of the tooth.

I hold up my notebook so I can see where on the page I�m writing and notice that my body is shaking. I�m not sure why, am I just cold? No, I am a little cold, but that�s not all of it. I�m really glad I�m laying down. I try not to look at his face. Try to keep everything in my visual field abstract. I fear that if I focus on something that I might either pass out or throw up. Maybe I�m not quite getting enough oxygen? I am having some trouble breathing through my nose. I try to stay still. I pause briefly from in my note writing, considering that I need to pay attention to my body and what it needs me to be conscious of, be that breathing, or simply that my body is being manipulated. I�m not sure how much time passes while I am being still and quiet. I don�t really want to risk my notes to being overly cautious, but the rate at which I take them does lessen considerably for a few minutes. Most of the shaking has subsided when I notice a rough scraping sound that I mumble out an inquiry about. He tells me that it is a little bit of the binding material that remains on the back of the canine from where the bridge for the missing tooth to its left was affixed. He says he will polish it off later on. My eyes are open. Alex describes what he is about to do, is switching to doing, as �cleaning the chimney out.� He describes the canal as a chimney, and it is the pus from the infection which he removed with tiny metal files that arelong and skinny. It is interesting for me to hear him switching between the terminology he uses with Dr. Kao, some of which he uses with me, and the analogies which he both makes note of because at this point he knows I�m interested, and to help me understand what he is doing.

IV) Reflections

I choose to use my memory to fill in a lot of things that hadn�t made it into my notes, such as what happened before I got my notebook out, and certain spatial aspects of the room that I remember thinking a lot about though I wasn�t writing them down. My jottings included a few small drawings, which do not appear in the transcription both because of the hassle of scanning or reproducing them digitally and the fact that the blog doesn�t support images. I developed some abbreviations throughout the course of my notetaking, such as RUOK, to serve as, �Are you O.K.?,� a question I realized I was being asked frequently. I used �thru� for �through� and a �w� with a line over it as shorthand for the word �with� though I couldn�t find a way to make my computer produce that so I just left it as a �w.� There is a lot of spatial organization in my notes; they are not all linear. Sometimes when I was trying to record different things that were happening simultaneously, or make note of something that was related to earlier notes I would put notes in columns, or against margins. There were some lines and directional arrows as well connecting various passages. I found typing the notes to change their meaning. In some cases though, I was also simply making them legible in cases where in not too much time, my fading memories would make determinations of the significance of my handwritten jottings much more difficult to decipher.

The themes that came out in my fieldnotes might be divided into those pertinent to the practice of notetaking itself, the observation of the work of the dentists, and finally to the recording of my own perceptions. In my notes I recorded various ambivalences that I had about the process of taking fieldnotes and the ways that the fact that I was taking them might affect my experience. When I got out my notebook and was explaining to Alex what I wanted to do, I told him that it was very important to me that he let me know if he felt like my note taking was getting in the way of him doing what he needed to do. While if anything, it seemed like Alex�s sense that my notetaking proved that I really did want to know the vocabulary and mechanics of what he was doing, perhaps prompted extra fastidiousness with the procedure as he articulated it for me going over it again in his head. There were also definitely points where he stopped to answer my questions, prolonging the procedure, and he was clearly distracted at times, perhaps not ones where his full attention was needed, from whatever activity he was engaged in as he attempted to decipher my handwriting, or simply noted that I was left-handed. (He is ambi-dexterous.)

Since both doctors were interested in what I was writing, my notes were not private. In various ways I tried to negotiate this. Sometimes I left my hand over what I had just written, and sometimes I tried to keep my handwriting smaller and less legible. This didn�t always work. At one point in the second half of the exam, Alex asked me somewhat confrontationally, somewhat jokingly, if I had just written, �irrigation� as he was describing the process of irrigation that he was performing, questioning if I was writing down every word he said. I say jokingly because he then added that the word had four �r�s.� I felt sensitive to the fact that I didn�t want to just be writing down what they said, that it might be confrontational that I might want to hold them to their word. That the notebook I as using was actually the wrong tool if their words were what I wanted to record; a audio recorder would be better. I answered that no, I had not written down �irrigation� but then proceeded to write, �irrigation with 4 r�s� and pointed that out to him on the page of my notebook.

Though I didn�t mind being taken as a studious patient wanting to remember the words of an expert, I didn�t want to be taken for what Dr. Kao suggested several times in the mostly, but not entirely joking question, as to whether my notes were so as to prepare me to be able to perform my own root canal. The second time he asked this I realized that though I had made my intentions clear to Alex, Dr. Kao didn�t know what I was doing, and though he didn�t ask directly, really wanted an answer. A little while after this question from Dr. Kao, when the arrangement of tools in my mouth prevented me from being able to speak intelligibly, I attempted to make my notes look more open by writing a question to Dr. Kao, and pointed to it, to which he was able to respond. I managed to position this question at the very top of page 4 of my notes, though, effectively keeping all those that came before concealed.

Part of my interest in concealing the notes resulted from feeling my own vulnerability, moments of loss of control, the proximity of the doctor�s bodies to my own, effectively having my head in the lap of the dentist while he had his hands, despite being gloved, in my mouth and at times resting on my face. My interest in writing a few notes on the sensuality of that part of the experience may have been relevant to the project of writing anthropological notes but would have been inappropriate to add to, not just record about, the interaction we were engaged in as they read along. Considering this also makes me wonder how much of the �sensuality� of the experience was heightened by my attention to it, my own desire to qualify the �experience� as one that could be sensed and recorded through my description of it rather than understood through a quantification of the events as they happened, (if it can be said that they did simply, happen, apart from how they were experienced by any one of the participants). While each dentist would have been simply reading about how I felt, how different would this have been from having a co-worker that I didn�t know very well tell me about the thoughts and physical reactions he or she had when thinking about me and my body?

Posted by at November 15, 2004 1:05 AM