Pulling of the Pretzel – Jan van Bijlert

I couldn’t get over the crunchiness. It was those gluten-free pretzels my mom got recently. I was visiting my parents. I have been visiting them a lot lately. I am grateful that they are only a 30 min bike ride away. I take that for granted. Both of them had to leave their parents and their familiar lives to find better opportunities. I think my mom barely knows what gluten is, let alone why it might be good or bad for you. But may be I am making assumptions. The legend has it that in 610 AD an Italian monk invented the pretzel, or ‘pretiola’ (latin for ‘little reward‘), as a reward to children who memorize his prayers. It is such a nice little reward, isn’t it? I couldn’t help but think how without my teeth in good health I couldn’t have enjoyed that moment as much as I have. Those pretzels are quite hard if you think about it, unless you’re having the softer doughy kind. If you’re not a dentist, you’d be surprised to find that a lot of patients break their teeth eating bread. It never surprises me, because I love bread and chewing bread. Breaking it’s hard shell and pulling enough of the softer ‘pulp’. The inside was my ‘little reward’ when I was a child. Imagine chewing that without one of your back molars. It is surely less exciting than a full set of teeth. We take for granted that odd feeling of pleasure we get from the act of chewing and the subtleties of different textures as teeth cut, tear and grind through them. I surmised that in the ungodly scenario where I lose my sense of taste, that I would hope to still have my mechanoreceptors intact. And that made me want to share a story that I hope will inspire dentists to frame their practice of dentistry around preserving that odd feeling of pleasure.

I wanted to share a story about a patient; a patient who has infinite patience. She too is a patient. She’s not my patient. But she cares for my patient. Today she said… Actually she did not say. Today she reminded me: it has been two years since I first met her husband. My patient. A stroke patient. He had a stroke two years ago. Can you imagine what it is like to have a stroke? How terrifying it is to experience that? One moment you are talking, walking, laughing, chewing, scratching your head, going to the bathroom on your own. The next moment your whole existence is stunned back into a state you probably only marginally experienced as a new-born fetus

I could tell that he was a character. Even back when I first met him. I can tell that this couple was a special couple. A hard working couple. Every appointment – and there were many – she brought him in. She was battling an illness of her own. I learnt later on. It was back-breaking to treat her husband in the beginning, I remember. I almost feel ashamed to say that I dreaded it; that it caused momentary anxiety. And part of it was how you had to lower your own standards when it came to perfection. Because the conditions for perfection were precarious, no pun intended. You wanted to think “I wish it wasn’t me doing this”. But immediately after that feeling you had this other extremely empowering sentiment of “But I have to do it. There are many who won’t do it or can’t do it. And I got to work hard for this guy”. You had to try your best. You had to believe that he had a chance. A chance to get better. She believed that; she was not letting him deteriorate. Frankly, you had to believe that he deserved the best treatment possible every bit as any other patient if not more.

I had the sense that she was there all the time. Looking after him. Pushing him to get better. Today she reminded me it was two years. But she was not talking to me. She was talking to him. Two years ago I was treating him while he sat in his wheel chair with his tilted head cradled in my arm. Today he is able to transfer to my chair with help. Her husband has just become this fun guy who I can still barely communicate with verbally, because she understands his dysarthria but I don’t. But I do connect with him. He understands me. It’s nonverbal. But I believe that at some point in the future, I will have a full on conversation with this man. Perhaps we’ll finally talk about our mutual favorite soccer team whose hat he always wears. And it’s because his wife was an agent in his care. She brought him in. She listened to what I said. She followed my instructions. As silly or excruciating as they may have been, she would do it. I did so many restorations on this man’s teeth. I was constantly asking myself, if I was doing him a disservice. But she was there to reassure me, verbally and non-verbally, when I went over my findings, risks and prognosis. And today, I told her “You know? I’m so glad we did those fillings. They slowed things down. I still think he will lose a couple of teeth but we will save most”.

Now imagine if had a defeated attitude where I assumed that this man doesn’t have a chance; That his teeth don’t have a chance. That my own standards of perfection mattered more than his slim odds at preserving his teeth. Sometimes I was able to put a dental dam on. Other times I was not. Sometimes I had to redo a filling, once or twice. Sometimes the assistant wasn’t adequately prepared. Sometimes I didn’t adequately prepare the assistant. Sometimes the patient arrived late or had to be picked up too soon. All of that. There were so many considerations. There are so many incredible learning opportunities. This is how a patient’s family can be agents in their care. And that type of agency is inimitable. And we need to talk about it. We need to talk about her. We need to talk about them.


I am a general dentist and hospitalist with an expansive interest in education research. I come from a basic science, and immunology research background, and am currently pursuing a master in community health with a health practice education focus.

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