“Are You Okay, Sir?”

I’m trying to ask the dentist if I’ll have to come back for the permanent crown once she takes off the temporary one I’ve had for hive years. Between her soft voice, accent, N95 mask, and face shield, I can hardly make out a word.

“Will I…” I start.

“Have to pay?” she finishes, “Yes, you’ll have to pay your deductible…” she says something more that’s lost between the accent and the face shield.

I look over at my faded orange rain jacket I tossed on the chair in the corner. Discarded and barely used even though I had walked from my house to my car and from my car into the strip-mall dentist’s office a twenty-minute drive from my side of town to another because my ACA dental insurance is only accepted at a handful of places. And the list of dentists that both accept my ACA dental and were taking new patients is a Ven diagram with minimal overlap.

The dentist being consumed with thoughts of money should have come as much of a surprise to me. After all, the receptionist came in with the dentist after my initial evaluation to explain the “treatment and payment plan.” Were I astute on that initial visit, I might have noticed the laminated sheets of paper explaining that the office only charges a supposition of the total cost and negotiates after the fact with the insurance companies and that I may or may not get a bill in the mail. Near the bottom of the paper it kindly explains that, should I have a complaint or question about the payment process, I should direct all inquiries to the insurance company and not the dentist.     

Cavities alongside the permanent crown.

She cleaned my teeth on that first visit. ACA covered the cleaning entirely. Throughout the procedure, and I don’t use the term lightly, the dentist kept whispering something to me. It took me a handful of repetitions between the whir and whistle of the needle prodding along my gums for me to make out that she was saying, “Are you okay, sit?” then not waiting for a response before firing up the needle again and going to town.

The list of dentists that both accept my ACA dental and were taking new patients is a Venn diagram with minimal overlap.

Truth be told, my fingers were fumbling with my calluses and my toes scrunched my insoles. She noticed before I did. “Are you okay, sir?”

I left the office after my first visit wondering if I should brush my teeth that night or if she had done enough already and I would be beating a dead horse. At the very least, my gums hadn’t started bleeding. I knew that because I looked for blood in the suction tube the assistant stuck in my mouth when the dentist had finished cleaning. And I only looked for blood because one of the questions on the new patient forms I filled out sitting in the kid-friendly waiting room with sings on the walls that said things like “gum disease is the second most common disease behind the common cold” and other such poorly written quips was “Do your gums bleed?” I had visions of the timer on my phone counting down the seconds I spend on each section of my teeth as I scrub, a habit I started nearly a year ago when I figured I wasn’t brushing all teeth equally. I don’t remember the last time I went to the dentist before two weeks ago. And yet, there was no blood in the tube.

Straight from the office I went to the grocery store and picked up more toilet paper because we were out at home and a pint of Ben And Jerry’s ice cream because I had been a good boy and certainly not because I was feeling internalized trauma from the dentist. Visions of the orthodontist’s assistant shaming me for not brushing my braces well enough. A public shaming that involved me standing in the orthodontist’s office with the assistant behind me watching as I showed her how I brushed my teeth. “It doesn’t look like you’ve done this very often,” she said.

The Ben and Jerry’s lasted all of two sitcom episodes.

“Will I…”

“Have to pay?”

There’s the trauma. The trauma of acute understanding that I’m not a patient. Not there, anyway. There I’m a customer. The office sits next to a Pizza Hut and across the street from a combo KFC/Taco Bell. And the office is part of a chain with locations in five states across the Midwest.

“…have to pay?” was not the way I would have continued. Of course, I would have to pay. Or someone would, me or the government. That wasn’t in question then, nor now. Though it explained a little bit about the dentist to me. The locked front door where I waited for a receptionist to hit the button under the counter to let me in, the laminated sheet plastered in full view of every chair in every room. The receptionist sitting with the dentist on either side of me with a calculator and pen running me through every cost that I and the ACA would pay, as though one cavity or one cleaning would mean the difference between groceries and childcare.

They didn’t understand me at all. And I didn’t understand them at first.

Growing up, I was lucky to have the healthcare I did. Was lucky to have access to practitioners who saw me as a patient rather than a debit card.

I’m not cheap when it comes to my health. I’m just nervous. The orthodontist’s assistant standing over me while I brush in the office in full view of other patients meant that fifteen years later I would go from a routine cleaning to a pint of ice cream. And the following week after the dentist shot me up with local anesthesia with only a “little pinch” of a warning, I felt the beginnings of a panic attack saved only by the Ludovico Einaudi-backed 11-hour YouTube video of clown fish to save the day. Some little quip about a stiff upper lip and we’ll leave it there.

cheap/continue