where there's pain it means you still got nerve
on some new vocabulary and a trip to the dentist
I spent last spring walking around with a traumatic occlusion and a mouth full of decay. I like that sentence because it sounds like something I might have posted at three in the morning during the years when I felt like a ghost haunting my own body and saying as much on the internet, over and over again, in various permutations, was my primary hobby. (Sometimes when I pay with my debit card the little screen says processing online and it always makes me smile and think: ah, my twenties!)
Traumatic occlusion suggests, perhaps, the distortions in perception that follow an impact so severe it impairs normal functioning, as surely as a fracture in the smooth mirror of the water trails a boat across a lake; a mouth full of decay—an orifice teeming with death!—gestures towards the private conviction that some crucial part of the self did not survive, or else towards the impossibility of articulating an event that refuses to be forgotten or understood. Something bad happened to you, and now you have trouble seeing the world as it is. Shadows are longer; faces loom as in a convex mirror. The taste of ash lingers on your stiff tongue. It sounds like a sentence out of the archives of my miserabilia, but in fact it was the diagnosis I received from a resident at a local university’s college of dentistry after walking into their urgent care clinic with some jaw pain on the final Monday in June.
One of my recent gigs has involved writing multiple-choice questions modeled on the sample materials put out in advance of the new iteration of the SAT for a test prep company to use in their in-house materials. As a result, I’ve spent a lot of time scrolling through the latest headlines of various publications devoted to covering scientific news in a way the layperson can (mostly) understand. This has turned out to be a more emotionally complicated process than I would have anticipated. You simply can’t open any of these sites without being accosted by an unrelenting litany of upsetting developments and concerning discoveries. Every day brings another list of species under threat, another warning unheeded and lesson unlearned, another staple of contemporary life that is making us unhappy or stupid or sick; the forensic examination of the crime scene we’ve made of this planet marches grimly on, with no sign of exhausting itself any time soon.
And yet bad news is everywhere, and easily come by, and if this task confronts me with it when I would prefer to turn away, so too does it offer an unexpected balm in the form of nascent and modest but equally unending attempts to make something a little bit better. These interventions are small, their effects often described in the conditional—a super-white paint might reduce the energy demands of cooling buildings in the summer; a novel process may assist with the partial removal of microplastics from bodies of water, if it can be deployed at scale—and I find them fortifying not out of any faith in the curative powers of technology but because they serve as proof of a certain kind of persistence which is one of very few values on which I place firm moral weight. More concisely one might say that they shame me out of despair. And every now and then real good news sneaks through. Usually it comes in the form of medical breakthroughs, which we can’t use for questions, but sometimes it arrives from another field. For example, in 2022, NASA demonstrated that they had the capacity to program a collision powerful enough to alter the orbit of a celestial body. Imagine what that technology could have done for the dinosaurs!
I’ve started keeping a list of the oddly evocative phrases I come across every so often while combing through dull paragraphs of background information and experimental procedure. Some of these are funny: did you know that to describe the motion of a honeybee at a certain point in the pollen-gathering process, scientists, writing scientific articles in scientific journals for other scientists to read, use the phrase waggle dance? Some of them sound like concepts out of fantasy (blood meal; gastrolith) or science fiction (nonsense mutations; surreal numbers). Some sound like the names of books: A Tangling of Crescents (YA fantasy with a nebulously old-world setting and a complicated if underdeveloped system of magic, the first in a series of four); The Search for Lost Birds (historical fiction with a present-day framing device and in all likelihood an epistolary element); Misjudgments of Serial Dependence (a wryly funny contemporary novel about a heroine with a disastrous love life whose jaded outlook ultimately does not preclude her happy ending).
My favorites are the ones which, like traumatic occlusion, seem to invite the construction of alternate definitions. Abyssal gigantism, for example, refers to the tendency, seen in animals such as the giant squid, for species found deep in the ocean to be significantly larger than their taxonomic neighbors who dwell in shallower waters, but to me it sounds like a concept out of Freud or Jung describing the phenomenon wherein the things in the darkest, deepest part of your psyche stake a disproportionately large claim on your emotional terrain.
Malaise traps—disappointingly just named after a guy named Malaise—could be the nets of languor and self-pity that threaten to bind us by the ankles if we step too far off the path through our spiritual forest, and Malaise trap months, their associated metric of duration, could just as easily refer to the time we lose thus ensnared. (Once more, with feeling: ah, my twenties!)
Embrittlement mechanisms and dislocation hardening, both of which came my way through some journal of materials science, describe the defenses we put into place after blows to the ego that shield us from certain kinds of pain without truly making us strong; a person growing aware of the ways this instinct has guided them unseen might make a joke out of their history of hot deformation behavior.
Ghost hearts: literally, hearts without cells; metaphorically, hearts without selves.
Volatile abundance: a measure of the prevalence of certain elements in a given location that would serve nicely as a summary of four hundred years of American history that soaked this magnificent continent in blood; it would do equally well, I think, to capture the condition in which many of us find ourselves today.
Catastrophism: can you believe this is not the name of a doomsday cult or of a sect devoted to the worship of ruin itself? Instead it’s a nineteenth-century theory positing that sudden, extreme events have been the primary cause of changes to the Earth’s geology over time. The alternate viewpoint, known as uniformitarianism, argued that the gradual rate of change observable in ordinary geological processes had held throughout global history, and nothing had shaped the Earth which could not be seen operating on a day to day basis. As with the dispute over nature and nurture, the field eventually integrated elements of the two views to forge a consensus in the middle: change happens gradually, except when it doesn’t.
The road to receiving the diagnosis of traumatic occlusion, as you may have guessed, was an unpleasant one. I had felt a pain in my jaw—a sharp, stabbing pain that came in clenching waves—a few weeks prior, while I had been out of town, and it had disappeared on its own quickly enough that I convinced myself it was no big deal and was most likely psychosomatic, perhaps an outgrowth of the same nervous tension I carry permanently in my shoulders and neck that sometimes leads to migraines. When it came back I expected it would fade again soon, but it didn’t. Instead it intensified, an awful, radiating ache that kept me awake and at its recurring peaks had me crying out loud in my dark bedroom.
Almost as bad as the pain itself were the thoughts about the pain. I felt stupid for not having followed up on its previous brief occurrence, for deluding myself into hoping it was a fluke instead of taking steps to prevent this horrible second act. I felt stupid for not having been to the dentist in years of switching jobs and switching insurance and hitting a pandemic and going freelance and putting off the task of trying to find a dentist who would take my shitty marketplace insurance. I kept remembering news stories about people who had died because a lack of access to routine dental care had caused treatable infections to spread fatally into their brains and I was terrified that I was dying and ashamed that I theoretically did have access to routine dental care and had still done this to myself and ashamed again, as I often am when I get stressed about money, that I had opted into a life where I would always have shitty marketplace insurance because I was frivolous enough to want to enjoy how I spent my days.
In the morning I braved my shitty marketplace insurance website and found a local dentist with same day availability who, as far as I could tell, would see me. I made an appointment and felt anxious still but also moderately satisfied with my display of responsibility. When I arrived at the office, though, he took my card and looked up whatever he needed to look up, and then he told me—this is a direct quote—“Ma’am, this is very bad insurance.” I could not imagine how I was meant to respond to that. Did he think I didn’t know? Did he think I had the ability to do anything about my shitty insurance right at that moment? It was such an unfathomably useless thing to say that it filled me with equal parts rage and bewilderment. But I suppose I can’t be too angry at him, because he told me I should go instead to the urgent care clinic at the local university’s college of dentistry. In retrospect it seems clear this should have been my plan all along, but in my defense, I was sleep-deprived and in pain and half-convinced I was dying. Mouth—dentist was about as sophisticated a plan as I could muster up the will to make.
At the local university’s college of dentistry, my journey took a turn. I walked up to the security desk and told them I was looking for the walk-in clinic. They pointed me in the correct direction and they did so nicely. I don’t mean that they were particularly effusive. They just gave the impression this was a normal interaction they were not unhappy to have had. In the waiting room, the woman at the intake desk similarly handed over the clipboard with a reasonably pleasant demeanor, and smiled politely when I gave it back with my paperwork filled out. Once it was my turn, I walked up to the second floor to be seen by a resident who was—believe it or not—also nice; she smiled as she introduced herself and spoke with the kind of lilting sweetness associated with kindergarten teachers in movies (the real ones I’ve known have all had a certain inner steel that enables them to silence twenty-two five-year-olds with a look).
Do these seem like minor details to you? Unimportant, unremarkable, even uninteresting? They did not feel minor to me when I was scared and in pain and worried that whatever very bad thing might be happening to me was on some level my fault. In that state, ninety combined seconds of mildly pleasant human interaction felt like a party drug or a miracle: the fabric of the universe shifted before my eyes, and I was a kind of glad I had never been. It shocked me how much better I began to feel even before I made it upstairs. It was as if the atoms of my body reassembled themselves in the holy presence of someone kind of nice communicating that someone else was going to try to help me.
The resident, who had enormous coal-black eyes and shiny black princess hair in a ponytail, poked around in my mouth and identified the issue swiftly. I had a traumatic occlusion, and I’ll confess I did not attend to the particulars of the dental definition of that phrase beyond picking up the fact that one of my never-removed wisdom teeth had at last betrayed me but I wasn’t dying. I can tell you that later, after deciding I should probably start flossing more, I discovered that the tooth in question had at some point cracked in two, leaving me with a jagged half that I keep running my tongue over to attempt to neutralize the existential queasiness it provokes in me. The trauma, as best I understood, had enabled decay and thus infection to seep in, and it was this that was causing me pain. As if that were not testament enough to the human body’s astonishing gift for metaphor, it turned out that the tooth in question wasn’t even the tooth that hurt. It was my upper right wisdom tooth that was fucked up; the pain I had been feeling in my jaw was refracted from the site of the root cause.
My resident set up a consult for an extraction in another part of the building and prescribed antibiotics for the decay, which she said would take care of the pain (she was correct, thank God; I felt fine after a day or so, although I dutifully completed the course). She also asked if I would like to establish myself as a patient for ongoing, non-urgent dental care; given that I had spent the past twelve hours staring into a vision of a hideous death brought on by procrastinating on the task of finding a dentist, I said yes. I have now been to the dentist more times in the past year than in the rest of my adult life combined, for measurements; X-rays; a two-part deep-clean for which they needed to numb half my face each time, my resident cooing I know soothingly as she injected me with the anesthetic; and a follow-up to see how my gums had responded to the deep-clean (well, apparently).
During these visits I have discovered an unanticipated appreciation for the peculiarities of going to the dentist at a college of dentistry, such as the newer resident who has begun assisting my original resident, who now occasionally explains her technique as she’s working in jargon I don’t understand, or the faculty supervisor who occasionally appears to sign off on some plan and who seems to me a specimen from the other side of some generational divide in the field, as he is the only white person I’ve ever seen working there and the stark difference in his demeanor compared to that of everyone else suggests perhaps the school has implemented some lectures on the importance of bedside manner that he never had to attend. My X-ray appointment ran close to closing time, beyond which the residents are not permitted to work because faculty goes home promptly at five, and as my resident was struggling with placing a doohickey in my mouth (I have a “narrow arch,” I was told, that presented an unusual challenge), another resident came by the X-ray corner and asked if she wanted him to do it. Sheepish but grateful, she said, Actually, yeah, and the other resident, whom I imagined to be perhaps the acknowledged champion of X-ray doohickey placement among their cohort, made swift work of the task while I sat there feeling not unpleasantly like I was in an episode out of a workplace dramedy with a particularly unglamorous setting.
The experience of that first day in the urgent care clinic has stayed with me, which I recognize sounds like a weird thing to say about a trip to the dentist. But, for example: my primary involvement with our local mutual aid network these days is helping to run the evening shift on the days we’re open for neighbors to shop for free clothes. I believe what we do is important, but it’s not surgery in a war zone. I’m not even on the food team—they wake up way too early for me—although usually there’s some bread left over from the weekly pick-up at a bakery the day before. I’ve always thought that part of what we offer people is not just clothes but a place to go where they can expect to be treated decently, but I’d also always been troubled by how self-serving that belief seemed to be. Clothing is important, but most people need so much more; feelings hardly seem to rank in comparison. That worry no longer concerns me, ever since my own experience of walking into a new place afraid and ashamed and in pain and being treated with a baseline level of interpersonal decency by the people in charge. I know in my body in a way I didn’t before that the immaterial can in fact matter—and does. I understand more keenly the responsibility of moving through the world in a way that communicates that you respect the fundamental humanity of the people you encounter, and I also understand what a sacred gift it is not only to receive this when you need it most but to be able to give it to someone else who does not even know your name.
Reflecting on that day has even made me think a little differently about my work. My primary gig is tutoring, mostly test prep for students applying to college or to private or specialized public high schools; I enjoy the work, more than I thought I would, but it’s not a job I feel great telling people about at parties. My students are mostly pretty sweet—most teenagers are, I think, if you get them one-on-one—but my default expectation is that they feel about their sessions with me the way most people feel about going to the dentist, which is that they understand the purpose but wish it weren’t necessary. Sometimes after the final scores are in, I get an email from a parent in which they go beyond the standard thanks into praise that suggests their child enjoyed or found something of personal value in our work together, and to be honest with you, my habit has been to assume they’re just being nice. What teenager finds something of personal value in test prep tutoring? But after finding something of personal value in going to the dentist, I found myself reconsidering not so much the veracity of any individual statement as the limits of possibility I had drawn around the question. Maybe there is something of value in undertaking a long and tedious process with someone who is basically nice and wants to help you. Maybe being a slightly awkward but more or less chill adult is as much of a benefit I bring as my ability to explain negative exponents. I don’t think that makes me particularly special, but maybe—can you imagine!—there are times when being special is less important than being kind.
It’s funny; I had a conversation about this once, sort of. It was the first Thanksgiving after the vaccine, and I was at a friend’s apartment, chatting with her boyfriend—small talk I mostly don’t remember about work, life. We were talking about my job and I mentioned a very kind email a parent had recently sent where he’d said, among other things, that his kid looked forward to our sessions together. To my recollection, I didn’t share this as something sweet that had happened to me. I described it with a bemused incredulity, as if it were a funny puzzle I could not imagine an answer to and assumed no one else would be able to, either: Isn’t that weird? Like, we’re just doing math. My friend’s boyfriend—a very sweet guy himself—said something to the effect of: You shouldn’t be surprised that people want to see you. And the world stuttered slightly at my periphery. The conversation moved on; the party drifted forward. My memories of that evening are a happy wine-soaked and weed-clouded haze, but I remember that moment. I remember thinking: I don’t know you well enough to tell you that you have accidentally spoken to the core fear of my life.
Because it’s true—I suffer from a traumatic occlusion: something bad happened to me, and now I have trouble seeing the world as it is. I have trouble discerning how I exist in other people’s lives; in fact I have trouble believing I exist to them at all. I am reliably startled when someone remembers my name. If I try to picture myself as others might see me, all I can muster is an image of an empty-handed specter whose ghost heart beats soundlessly, a nothing of a person with nothing to offer that anyone might want. Perhaps this is a form of abyssal gigantism: the monster whose memory resides in the deepest part of me casts a shadow so huge it obscures the sun. Or it could be the consequence of my standard embrittlement mechanism, that instinct of reaching for the safe certainty of separation hardening over time into an enclosure that obscures my view of the expanse beyond, trapping me in my own malaise. I don’t remember ever feeling sure that I am part of the living world.
And yet; and yet. And yet I have always been loved, and sometimes I have felt it. Sometimes—often, these days—I am happy—some days so happy I can hardly believe I was ever anything else. Each year I learn to navigate a little better the volatile abundance I carry with me, which has set me ablaze with joy as often as it has drowned me in despair. And if the topography of my interior has been shaped by catastrophe, it has also shifted gradually under the steady rainfall of ordinary human touch. The days I did more or less what I intended to do, and the nights I remember as laughter and light. The friends who have welcomed my friendship, the writers who have admired my writing, and also the T.A. who almost certainly doesn’t remember emailing the dean to share his sincere concern about the nineteen-year-old who kept falling asleep at the round wooden table in his expository writing seminar, but whom I will never forget. The evening shift a few weeks ago when I watched a young child follow on her tiny feet as her mother browsed our racks for clothes and I realized I remembered delivering her diapers during that first winter before the vaccines. The neighbor who kissed my cheek when I asked after her sick husband. The dad who emailed me to say his daughter had had a difficult few years and our work together had bolstered her confidence. Small talk at Thanksgiving with a guy I barely knew back then. A woman smiling as she handed me a clipboard when I was afraid and understanding afterwards, even if only in glimpses, that it doesn’t take anything remarkable to be remembered as someone else’s stroke of good luck. Anyone can do it, and not even know.
I couldn’t believe how glad I felt at the dentist last year. The fucking dentist.
In January, I went in for my consult on the troublesome tooth; the guy who saw me stuck a gloved finger in mouth and confirmed, That’s a nice little trauma you have, which made me laugh. In June, nearly a year after the issue was first diagnosed thanks to the backlog at any of the few places that accept shitty marketplace insurance, the tooth, or what’s left of it, will be extracted at last. Sometime soon I’m also supposed to go in for a routine cleaning, but at my last appointment the system wasn’t allowing them to schedule that far in advance, so I need to call to set that up. By then, my resident will have graduated, and her assistant will have progressed to being the one in charge of my care. In March I went to a friend’s party and realized I hardly feel nervous in bars now; I don’t know when that changed. Recently, while trawling the science sites for test prep material, I learned that the idiom shouting into the wind is based on a misconception. Sound produced against a current of air is amplified in the upwind direction, not dampened; the dampening effect takes place downwind. The illusion results from the interaction of physics with human anatomy: our ears, downwind relative to our mouths, receive the muffled version of the sound. We hear our own voices distorted into weakness and we assume, naturally, that’s how everyone hears us, but it isn’t true. The people listening to you can hear you just fine.