Jeffery N. Trester, DDS, MAGD is a 1973 graduate of Northwestern University School of Dentistry. He has a broad and deep professional background, including: A General Dentistry residency with the USPHS Indian Health Service, Director of Pedodontics at Mt. Zion Hospital and Medical Center San Francisco, CA, Master level of the Academy of General Dentistry, Board President of the Southern California Academy of General Dentistry, Member of the LD Pankey Dental Foundation, and Member and President of the LD Pankey Study Club of Southern California.
Jeff has authored several articles which have appeared in A Manual of Hospital Dentistry, General Dentistry, GP News, and Dental Economics. He has a solo private practice focused on complex restorative dentistry & orthodontics in Ventura, California.
By Jeffrey Trester
George, my patient of 15 years, was in a wheelchair, a whisper of the man he was five years ago. He was not more than a skeleton with skin, really. Cancer does that to a person. His legs had braces because they were too weak to support his body alone, and his back was hunched over, I suspect from the invasion of the disease into his spinal column, or maybe he was just too weak to sit up straight.
The old George I used to know always wore a western belt with a big silver buckle, and a smile. But that day, he was too bent over for me to even tell if he was wearing a belt at all. The boyish face that had remained young even after we had both watched his children grow up, was drawn and tired from too much suffering. The bone cancer, like the bullets of a hidden sniper, had put holes in his bones; holes that now leaked their poison into the other parts of his body.
Before multiple myeloma struck, our conversations were of Indians, sand-cast silver buckles and rings, turquoise and places in the Southwest we had both visited; places such as Flagstaff, Sedona, Betatakin, Canyon de Chelly and Winslow, where I lived for awhile. He would tell me about his travels to Utah and Arizona on vacation with his family, and he would take delight in my stories about Navajo children in Chilchimbito, Dilkon, and Dinehotso. We’d talk about how blue the sky was and how clean and sweet and dry the air was to breathe.
At one time, I had been a dentist on the Navajo Indian reservation – sort of a southwestern “Northern Exposure” on the “res.” George’s love of the Southwest created an immediate interest and affinity when we first met. But this particular day, he talked only about the shunt in his left arm that they had been using for dialysis.
These shunts are large tubes to which the dialysis machine is attached; they are inserted into veins and protrude through the skin. He had shunts in both arms, but the shunt in his left arm wasn’t being used, and he lamented how bad it looked and how he wished they would take it out. He had asked, but been ignored. I wished I could do it for him.
The reality is that the medical establishment of today often places little or no value on patients’ emotional needs. Those who were once “doctors” have now become “providers.” Those who were once “patients” have become “subscribers.” Words are powerful forces that change the way we think about people: If you are just a provider, why care if a subscriber loses his dignity? “He probably won’t live long, anyway.”
I think of George sometimes when I see a piece of Navajo jewelry or a rug, or when I revisit the Southwest – as I sometimes do – and I am sitting on a Utah plateau in a quiet, red–rocked, remote cliff dwelling while looking down into a sand-washed ancient canyon laced with a silver stream and dotted with spring-green cottonwood trees. I think of him, too, when I am tired and out of patience and have to restrain myself from treating patients as subscribers instead of people.
When he left on that last day, I wanted to hug him because I knew I would probably never see him again. But I did not. I will always be sorry about that.
Jeffrey Trester, DDS, MAGD, has been in private practice since 1979. Prior to receiving his Mastership in the Academy of General Dentistry, he served in the U.S.P.H.S. and completed a two–year general practice residency. Dr. Trester has studied at the Pankey Institute. He is the father of UCSF pharmacy student Marissa Trester. Contact him by e–mail email@example.com.
This article first appeared in the October 14, 2010 issue of Synapse.
This is a wonderful story, certainly one that we can all relate to as well. Personally, I have a handful of patients in an “end stage” situation in their life. I am always impressed by their courage and resiliancy. These are typically older patients who are of “the greatest generation”, those who survived WWII experiences at home or abroad and so forth. Some are younger, but they all have “grit” and tremendous character.
These are attributes which I see less and less often today, as our culture is much more “me centered”. As a result, these people are a true breath of fresh air, and – I believe- are showing us a much more virtuous way to live.
On another note, I can relate to Jeff’s comment about his regrets about not hugging his patient. Many of us were raised in homes where hugging (particularly among the males) just did not happen. We habitually learned that touching of that nature was inappropriate….perhaps even a violation of our own or the other person’s boundary. In those cases, we need to become more self-ware and re-learn some new patterns of interaction.
I also think that today’s culture has moved too far in the other direction, where hugs are often given to those who are not ready to recieve them. Finding the middle ground is the key….being sensitive to readiness for a little bit of authentic love. And we all can use more of that.
Joy in looking and comprehending is nature’s most beautiful gift.
When I was a resident in general dentistry 35 years ago, I was lucky to have as my orthodontic instructor Dr. Donald (Skip) Ferguson. At the time he was a relatively new orthodontist in private practice who, besides running the orthodontic portion of the residency program at Mt. Zion Hospital in San Francisco, was also doing research on bone biology at the University of the Pacific under Dr. Gene Roberts. Skip eventually went on to publish a number of papers of his own and to head orthodontic programs at Boston University, Marquette University, St. Louis University, and now is Dean of Post Graduate Dental Education at a university dental school in Dubai. Gene Roberts, D.D.S., PhD is now Professor Emeritus of Orthodontics at Indiana University and is highly respected in the field of bone physiology and treatment planning. At the time I knew Skip, he regarded Gene with an almost reverential awe. Skip was a great teacher; we had about 3- 5 selected literature articles to read and discuss each week, and each resident (there were just 3 of us) saw several orthodontic patients needing a variety of major and minor orthodontic treatment. By the end of my second year we had covered a lot of territory in the orthodontic literature on everything from bone physiology and healing as it relates to tooth movement, to diastema closure, rapid palatal expansion, and the roles of muscles in malocclusion; and had done a number of minor types of orthodontic tooth movements suitable for the general dentist, and at least one full banded case.
I tell you all this to give you a picture of the background of how I came to learn about the concept of “clear thinkers”. Skip and I spent many evenings after the clinic closed and after making hospital rounds discussing a number of clinical and more esoteric topics. Skip taught from the Socratic model which is that you may have the knowledge to know the answer, or at least what should be your next step; you just have to be led to discover it. The Socratic Method teaches disciplined thinking. Questions were often answered with another question, the goal being to get you to think rather than just talk. I’m reminded of the scene from the movie, “The Paper Chase” where, at the Harvard Law School, Professor Charles W. Kingsfield tells the brilliant young law student Hart, who comes from Minnesota, “You teach yourselves the law. I train your minds. You come in here with a skull full of mush, and if you survive, you’ll leave thinking like a lawyer.” One of those esoteric topics was the topic of what constitutes a “clear thinker”. “Clear Thinker” was a term Skip used to describe certain gifted colleagues. Gene Roberts was one of those that Skip regarded as a “clear thinker”. As a side note, the Socratic method is best used in a one on one teaching environment. It is not well suited for a lecture paradigm. I hope that every young dentist is blessed to find a mentor who is a clear thinker, even if for a short time. Becoming a clear thinker helps in learning to learn.
What is a “clear thinker”? This, as it turns out, is difficult to define, but not too difficult to recognize. Basically a “clear thinker” is someone who can see through a mass of details and information and focus in on the essence of a problem. This is important because you cannot find a solution until you identify the problem. These seem to be people with knowledge, wisdom, and perhaps a genetic gift of a superb analytic mind that can combine to problem-solve and teach in a way that simplifies, rather than complicates those tasks. You know who they are: they’re the Frank Spears, Jay Andersons, Irwin Beckers, Ray Bertolotti’s and others. Although I didn’t know them, it sounds like L.D. Pankey and Henry Tanner were “clear thinkers” also. I have personally known only a handful of these people in my lifetime. My ex-brother-in-law was one. He started 2 or three companies in the high tech medical fields and took one public. My chief of staff at Mt. Zion Hospital where I did my residency was another. Besides Skip, there have been only 5 or 10 other teachers in the almost 4 decades since I graduated. In my private, practice I think I’ve only known only two specialists who were “clear thinkers”.
“Clear thinkers” are usually not young (it takes a decade or two to accumulate the knowledge and suffer the slings and arrows of experience necessary); they usually have a sort of quiet patience and understanding. You wouldn’t be surprised to see them in the robes of a priest, rabbi, or Buddhist monk. Clear thinkers often have a non-professional knowledge base and interests outside the profession that keeps them “anchored”, mentally, and emotionally strong, and provides the link between the professional and non-professional life. They are aware of universal “truths”. “Clear thinkers” are rarely condescending and get great enjoyment in helping others to “see the light” and achieve understanding. They don’t laugh, ridicule, or make fun of their students’ questions. They like doing what they’re doing. In psychological parlance, they’re “self actualized”. “Clear thinkers” are humble; they don’t see themselves as “special” but merely dedicated to the task or project(s) at hand. “Clear thinkers” are sure of the principles underlying whatever they do, but also know the boundaries of their expertise, and are not afraid to tell you they don’t know the answer to this or that. Clear thinkers are often teachers. Unfortunately, few clear thinkers become politicians, which explain the sad state of affairs in the world today. Clear thinkers rely heavily on making decisions based on experimental data, and therefore read the literature a lot. Clear thinkers listen more than they talk. They’re disciplined and resist the temptation to talk just to talk to impress or brag. But when they do talk, every word is loaded. Clear thinkers, I suspect, spend a lot of time just thinking.
To those uninitiated into the ““clear thinker”” paradigm, clear thinkers are sometimes mistakenly categorized as “smart”. But “clear thinkers” are a sub-group of smart people. When you ask a clear thinker a question, there will usually be a pause before they answer. I don’t know what they’re thinking, but it seems like they’re pouring all the facts through a sieve in their mind, and out the bottom comes a few of the elements crucial to the answer. That sieve is what makes a clear thinker more than smart. There are lots of moments of silence when you talk to a clear thinker. Those moments of silence are exciting because often what follows is something that will be epiphanous for you.
Attempting to arrive at clear thinking makes your own questions clearer and easier to understand. Organizing, simplifying, and giving thought to data and confusions in your own mind before formulating questions, is probably the first step to being a “clear thinker”. Answers from clear thinkers are often more concise and easier to remember; and therefore progress in learning takes place quicker. I don’t know if I’m a clear thinker. But I’m a clearer thinker than I was back when Skip and I talked. Like the practice of dentistry as a whole, clear thinking is a worthwhile process of continuous improvement through practice, study (in and outside the profession) and intentional effort. As Albert Einstein said, “If you can’t explain it simply, you don’t understand it well enough.”