BEFORE
Her name was Melinda Grey, and I should have known right away, when she walked into my office some six months ago, that she was a problem patient. We’d talked about them in dental school somewhere in between local anesthesia and oral pathology. Problem patients. You wouldn’t have known it to look at her, for her small size seemed to contradict the barracuda she was. She was a pleasant-looking woman, approaching middle age, with soft brown hair and benign eyes, the kind that made great contact when she talked.
Ms. Grey presented as a phobic patient. She blamed it on an extensive dental history complete with emergency everything—root canals, abscesses, a fractured tooth—and a habit of choosing dentists with a lousy bedside manner because they tended to be cheaper, their appointment openings more readily available than someone like me, who had a calendar full of patients, until I met Ms. Grey, at least, and then suddenly I had time in my day to spare.
Her dental insurance was lousy, which she admitted to me, another red flag. I should have ended our appointment there and had Stacy look into coverage before I did any work, but Ms. Grey was the last appointment of the day, an emergency walk-in, and she was in a great deal of pain. The tooth was decayed; that I could clearly see. It would most likely need to come out. I offered a root canal as an alternative to extraction—a root canal, which would cost her three grand or more with the crown—but she shook her head and said that was more than she could afford. The tooth was a molar anyway, and she didn’t care to save it. By comparison, an extraction wouldn’t surpass a couple hundred dollars at best, and, seeing as Ms. Grey had no plans for an implant and intended to leave a hole in the back of her mouth that no one would see, the procedure would be relatively cheap.
It was a simple extraction. The tooth was completely above the gum line and required only a local anesthetic. I used nitrous oxide to help calm Ms. Grey’s rattled nerves. I lifted and pulled the tooth with my elevator and forceps; I packed the wound. I sent her home with pain relievers, though I made the decision not to prescribe antibiotics because, in my professional opinion, they were overprescribed, a problem that led to antibiotic resistance and a whole host of other bad things. I was strictly opposed to the use of blanket antibiotics. Ms. Grey was forty years old and completely healthy. She didn’t need antibiotics. Still, as always, I told her to keep an eye out for signs of infection: puss or other discharge, the formation of an abscess, fever or excessive pain. I said it out loud, maintaining eye contact so I was sure she heard. “There’s always some degree of pain following a tooth extraction,” I remember saying, perched there beside Melinda Grey on my burgundy stool, unpinning the bib clip from around her neck, wiping the last of the bloody saliva from her lip with a napkin. “What you want to keep an eye out for is excessive pain. Severe pain or swelling in two or three days from now. If you feel like something’s not quite right or if you have any questions—any at all—please, don’t hesitate to call.” And she nodded her head as if she heard.
I told the hygienist to make sure Ms. Grey had my business card before she left, one that listed the office number as well as my cell phone, which I always gave out so that I could be available to my patients twenty-four hours a day. It seemed like the ethical thing to do. I never wanted my patients to feel they were lacking for care. I also told my hygienist to schedule a follow-up appointment for Ms. Grey in one week, so I could be sure the wound was healing as it should be.
Ms. Grey never called. She never returned for her follow-up appointment.
What I failed to realize was that one of my hygienists was out for the day, home sick with a strep throat infection that had already blitzed half our staff, and the other was up to her neck in patients, taking on the workload of two. In the middle of all that chaos she had apparently forgotten to have Ms. Grey give informed consent, signing a simple form that indicated she knew the risks associated with the procedure.
I also didn’t realize it was the beginning of the end for me.
A new air-conditioning unit costs upward of five thousand dollars, installed. To have the existing unit repaired—assuming repair is even possible—would cost in the vicinity of one hundred to nine hundred dollars, depending on what needs to be fixed.
“How old’s the unit?” asks the HVAC guy on the other end of my phone line, and I say that I don’t know. He walks me through a number of estimates before I thank him for his time and set the phone down, tallying up the prices in my mind, though not those for the air conditioner. Nick’s wooden casket cost two thousand dollars; embalming, which oddly enough wasn’t required by law, was an additional eight hundred. These are the figures I add up in my mind. The funeral home charged us for near everything, from the preparations of the body—combing through Nick’s blood-tinged hair, dressing him in his Sunday best, a refrigeration fee of fifty dollars a day and more—to a service fee for the funeral director, who was quickly making a killing off my loss. I sprang for the prayer cards, forty bucks for a hundred, with Nick’s handsome face printed on the front in black and white. I thought it looked classy, stately, but Nick’s mother said I should have used color; the black and white made them dated, she said; they made Nick look old, though Nick would never grow old.
The cemetery, too, charged an arm and a leg for the cost of the plot, the cost to dig the plot, the cost of a headstone and the graveside service, for all of us to stand around the uncovered hole and cry. But that wasn’t all. There was still the cost of a hearse to carry Nick’s body from the morgue to the funeral home to the cemetery, the cost of flowers that I didn’t want or need, but were tradition, as the funeral director told me, and so I ordered those, too, sprays of white that filled the church.
The credit card has been maxed out.
I can’t afford to fix the air conditioner or have it replaced. For now we will have to sweat. My father wants to help, he’s told me, with the funeral fees. “Please, no,” I said, laying a hand on his arm. My parents aren’t lacking for money, and yet retirement put them on a fixed income, which my mother’s never-ending medical expenses chip quickly away at. It will be years still until social security and Medicare kick in. But there is money, my father has said, though I’ve told him no. “Please, no,” I said, wanting him to save that money for his and my mother’s needs, remembering the bounced check from my mother’s internist and trying to decide if it was for lack of money, or a simple mix-up with the bank.
Nick’s mother and father have money, but never once have they offered to help.
* * *
In the afternoon Maisie, Felix and I drive to the store. It took great cajoling for Maisie to climb in the car. There were many things she wanted to do apart from grocery shop. A new episode of Max & Ruby was about to begin, she was thirsty, Maisie—who never likes to pee—needed to pee. Three times. And then once inside the car, coaxing her into the car seat and beneath the smothering straps of a five-point harness was another matter, a feat only accomplished after handing over my smartphone with its Candy Crush app. Oh, how Maisie loves her Candy Crush, matching her pieces of candy and swiping them from the screen. With the phone in hand, she almost forgot she was confined to a chair, in the type of contraption that only days ago collapsed under the burliness of a white oak tree.
But for me, the fear was still there.
Maisie’s hand goes to the harness, and I snap at her, “Don’t touch it. Leave it be,” hoping she won’t see the swelling or redness of my eyes. Undoing her own harness has become Maisie’s latest pursuit. She’s discovered that pressing the buttons will undo the whole darn thing and set her free, though her fingers are too small, her fine motor skills too gauche to do it herself. And yet she tries, quite an undertaking for a four-year-old, but something she’ll figure out soon enough. “Play your game, Maisie,” I say so that her mind will go elsewhere and forget about the car seat straps. And it does.
We drive. As we make our way down our street of older historic houses, past the park and the small shops of an upscale