THE DENTAL TANGO

"Life is a shipwreck but we must not to
forget to sing in the life boats"

-- Voltaire

The dance between the dentist and the patient is unpredictable. Each person's style requires a unique choreography. Some take the Two-Step, others require the Waltz, but with Tanya it was definitely the Tango.

She lay reclined in a motorized wheelchair; bellowing cheeks, bright eyes, curly, muddy-red-blond hair, huge lips, exaggerated make-up, no neck, hands that appeared to be plastic and a dress wrapped around a small ovoid body. A mouth stick was attached to the wheelchair near her chin as she gasped rhythmically for air.

Polio had affected Tanya's spinal column at a level of C-3 at a young age in the 1950s. Her lungs were not involved, but the intercostals muscles of her chest, abdomen and diaphragm were paralyzed.

Most people in this condition are confined to an iron lung, but Tanya was an exception. She skilled herself in getting people to do what she couldn’t. And for routine dental care without hospitalization, she taught me to perform the "Dental Tango."

Our procedure worked between Tanya's breathing for air and my brief invasive interruptions. Tanya would gulp, gulp, gulp, then I would drill for five seconds and get out. Gulp, gulp, gulp. Drill five seconds. Get out. The routine became second nature. Sometimes she would speak between gulps, and the pattern continued for the whole time she was in the chair. I was particularly proud of myself when we restored a maxillary second molar. On prior visits I feared that Tanya become overly dependant on our office for her care, ironically I now realized that Tanya had just trained me well.

Sometimes I'd go to her high-rise condo in downtown St. Paul to clean her teeth with a portable hand piece and conduct a limited visual exam. She was on state assistance but the high technical quality of her home was surprising. Her iron lung had a life-depending back-up generator, and this was not the easiest item to locate in the housing market.

Tanya also required a personal attendant to feed, bath, move her and perform all daily activities, and it was apparent their special relationship was built on intimate trust.

Tanya was a dictator. She learned early that if she did not demand the care she needed, she would not survive. She was driven to manipulate, insist, coerce and just plain bully. She did not exclude herself.

Tanya's body was forced into a new form. Her cheeks were huge because she bellowed them to swallow the maximum amount of air. Her neck was wide allowing an expanded airway from base of her skull to her shoulders. The shape of her head was altered by the face masks and elastics to maintain an air-tight seal. Her mouth had developed a big anterior open bite from the wooden mouth stick to operate her computer.

The lack of a working diaphragm and chest muscles affected her ability to clear her lungs. The secretions can act as glue preventing the lungs from proper inflation and causing collapse (atelectasia) resulting in upper respiratory infections and pneumonia. Several doctors told her that she would not survive this condition, but she outlived many of them.

She miraculously learned to mentally control her epiglottis because a ventilator hook-up would have limited her mobility. Fewer than twenty people in the world have learned the art of "pharyngeal breathing."

Tanya was personally affected by the meddling of the legislature over benefits and program cuts. She lobbied successfully on behalf of the disabled, and she was elected ‘Miss Wheelchair Minnesota.’

Tanya was our dental patient for more than fifteen years and she never had a bad day. She was a fighter who showed us that attitude can do it all. If we can’t control what knocks us down, we can choose how we react to it.

For Tanya, it was the dance.


--Patrick J. Foy, DDS, Minneapolis