Great Fit But (a career story)

13 Feb 2024. Jackie Gayle with Bob Kaplan

I've always had an interest in teeth. My great-grandmother, who I spent a lot of time with In Jamaica, didn't have any teeth. A lot of people in Jamaica don't. She would dip her bread into hot chocolate to soften it. When she did that, I'd turn my head away. Frankly, it made me sick. That's the one thing I didn't want, not to have teeth. Some people look at people's eyes. I always look at people's teeth. That's my go-to facial feature. That's what attracts my attention.

I am happy I came to the United States and I'm happy my interest in teeth followed me here. When I arrived, I was fourteen years old, in time for eighth grade. My family didn't know anything about the educational system in New York City. I knew nothing about it either, literally nothing. But I knew how to help myself, and I knew I wanted to study something medical.

You have to decide which high school you want to go to, and I chose Clara Barton High School, which is in Brooklyn, because it is medically oriented. That was my top choice. The school told me if you do the summer program, you are guaranteed to get in. I had nothing else to do, so I said okay.

At that young age I knew what I wanted and I knew what I didn't. I felt more like an adult than a fourteen-year-old, more like an eighteen-year-old than a fourteen-year-old. That may sound impressive but it's different in Jamaica. Children there are like little adults. If you went there, you would see how serious they are. They are very friendly but very serious. You're told, "This is what life is about. You have to understand other people. You have to understand where they are coming from. You have to learn how to relate to people. You have to treat them well. And what if this happens to you? You would have to do this. And what if that happens to you? You'd have to do that."

I made my own decisions starting at a very young age; I had a lot of freedom to do that, a lot of independence. School let out at 3 o'clock but if I didn't come home until 5 o'clock, no questions were asked; well, hardly any. I might decide to stay at school and play sports. I might decide to roam the streets; I was always roaming and looking.

My father was laidback and fun, and my mother was very busy and not paying that much attention. She had her own business. She wanted to make enough money for us to have a nice home to live in. But in their defense, in their minds it was enough and in other parents' minds to feed us children, to clothe us, to send us to school. Any more than that, that's not part of what I'm supposed to do as a parent.

I raised my kids to be independent. I had them navigating on their own at young ages. I gave them so much responsibility. I wanted them, in the event of my death or their father's death, to be able to get along on their own at fifteen or sixteen. My daughter was an only child until she was twelve and I was still 90 percent Jamaican. I didn't know much about American culture when I was raising her: What's a sleepover? What's a play date? But I did know I wanted her to be her own person. I told her that she needed to learn to walk alone. I told her she needed to go the mall by herself: "You need to decide what clothes to buy. You don't need your friends to tell you how you look. You need to learn to love yourself."

Making my own way at her age, I am so happy I picked the right high school. Clara Barton offered four programs: nursing, dental assistant, science, and typing/secretarial. You spend half of a school year in each one. After that, you choose. I didn't have to think about it. I knew which program I wanted: dental assistant. I even dreamed about it. I didn't care for the other medical option, nursing. I had to work too hard at it.

In junior and senior year, I studied to be a dental assistant, and that's what I expected to be after I graduated. It so happened, though, that my teacher for those two years was a dental hygienist, not a dental assistant, and she told me about her work. That was good luck. And then, when I was a senior, the New York City Technological College came calling. They were recruiting students for their dental hygienist program. My teachers recommended me; my grades were very good and I was good at being a dental assistant.

But I didn't want to go to college; I knew that. I love to learn but I don't like to study and I don't like deadlines. But I went to college anyway. What won me over is that the hygienist is licensed to treat patients. Also, the hygienist has her own room. I wanted the added responsibility and the added independence.

I like the oral cavity, I really do. Dental hygiene, it's a beautiful thing. Beautiful, that is, unless someone is missing their front teeth. That still makes me nauseous. Or unless there's food in someone's mouth, bits of lettuce, bits of bread. If I were a better person those things wouldn't bother me. But as soon as I get down to work, I'm happy. I love being in people's mouths. It's a good place for me.

I love patient care—the teaching aspect. "No," I say to the patient, "you are not supposed to have bleeding gums." "No, you are not supposed to lose your teeth." "Yes, it's good that you brush your teeth but you're doing it the wrong way. Let me show you." "Yes, flossing is good but you're not supposed to jam the floss between your teeth. You'll injure your gums."

I tell new patients, "I want you to know why you are here." I always make it clear to new patients that disease starts in the mouth; this is where it enters. Often their gums bleed when I scrape the plaque off their teeth. I tell them that bleeding is a sign of gum disease. That and inflammation, which could lead to other problems. I want them to understand it's a disease and it needs to be treated. If I see bleeding, I make a big point of it, even if it's a patient I've seen for years.

Occasionally, I do temp assignments in poor New York neighborhoods. I tell people, "No, you don't have to lose your teeth." They think that teeth fall out when you get older. I tell them not to replace their missing teeth with dentures. Replace them with implants, something that is stable, nothing removable like dentures.

In my work I really need to feel like I've accomplished something, that I've made a difference. My day could go sucky but if late in the afternoon one person comes in and this time there's no bleeding, that makes my day because that's accomplishment, that's success.

It's easier to see progress when a new patient is in bad shape. The gums are swelling; they bleed without being touched. I take a photo, and I tell them, "This is not to make you feel bad; It's so you can see the before and after." Later on, when they do see the difference, they get excited and so do I.

I've been on a campaign to make a difference, and I have had a lot of fun because my patients have been so receptive. They say, "Show me." "Tell me what to do and I'll do it." They are receptive partly because they have the resources to take care of themselves. I did not choose to work in a low-income neighborhood. I wonder if I have done wrong. But I know myself. I would not have loved my work so much if it were a big struggle. I would have been frustrated, not towards the patients, and I probably would not have lasted as long.

I did have the chance to work with a low-income person in our own practice. The dentist, who is a good guy and a good boss, had donated dental services to people who could not otherwise afford it. The dentist sat down with me and went over the patient's situation. She had tons of medical problems that included gum issues. Her gums were swollen to the point where she couldn't touch them, it was so painful. Could I treat her, he asked? I told him only if I can treat her the same way as the rest of the patients here. Of course he agreed. In this office, you're going to get first-rate care, no matter who you are.

Her name was Annie, a 67-year-old African American who came from the South. She walked with a cane. I called her Miss Annie because I wanted her to feel respected. Once she got comfortable, she was so easy to talk to. She told me she didn't want her gums to hurt so much. That meant deep scaling; to do that she needed an anesthetic. I also gave her an antimicrobial rinse and inserted tiny antibiotics under the gum. She got the full scope of what it takes to strengthen the tissue, to make the gums healthy.

By the time we were done—it took four visits—there was not a drop of blood in her mouth. She couldn't believe how little it had taken to give her relief. She did her part, too, everything I asked her to do. I just loved treating her and it gave me a wonderful sense of accomplishment. I wish I could see her now.

Although this is a great job for me, in one big way it is absolutely not. I am very introverted. New situations are very difficult for me. It's amazing how you can be so shy. You will never see me in a crowd. I never go anywhere without knowing who I am going to be with. I won't go anywhere unless I am sure I will be super comfortable.

With a new patient or someone I am not yet comfortable with, I'm so nervous I'm sweating all over, except fortunately for my face. But I hide my nervousness. I have to. I have to have them come back. That's how I make a living. It's like I have a disease but I have to pull myself together. I have to keep my nervousness from interfering with patient care.

Many people coming to our office are scared and I'm the one who greets them and it's my job to make them comfortable. The fear factor, disappointing to me but I put that aside. I have to be braver than the patient. Even if I am not relaxed, I know it's my job to make the patient relax. And I know the hour will soon be up.

I am painfully shy and yet I love being around people. I host dinners all the time—the key is people come to me, I don't go to them. I am attracted by people and I can talk with them all day—as long as they're not extroverts who overwhelm me, who make me nervous, because they want to know too much too fast. I love entertaining, but as soon as people leave, I welcome my solitude. But I truly do love being around people.

You might think that, after all these years of working with people, I would have outgrown my shyness but, no, I haven't, not to a significant degree. Even though I know that it's probably going to be fine, I still go in there thinking it's going to be bad. I still go in there nervous as can be. I haven't changed but what has changed is that most of the people on my schedule I have known for 20 years or more. That's an easy day for me. That's the beauty of being in an office for so many years.

I am no less shy and no less nervous but I have grown in another way: I am a lot less frontal. I use a lighter touch. If I find bleeding, I might still say, "Who taught you how to floss like that?" but there is humor in my voice and there is laughter in the room. I have added to my bag of tricks.

With my children, it used to be that in arguments I would get upset. I would say my last words and I'd walk away and I wouldn't come back. That is what I grew up with: "That's what I said, and that's what I meant." Now after a minute I realize I feel so bad and that I should go tell that to those people. Versus feeling bad for months. My kids have noticed the change. They feel I am better at talking with them. I ask them what they think. My adult daughter told me recently, "You've grown a lot."

Generally, I am less frontal, less blunt, but I have my well-chosen moments. It's when people are not listening. When I can't get through to them. Then I will say, "Smell your floss; that's what your partner smells." That one is in my hip pocket: "Smell the floss—be nice to your partner."

One patient gave me such a hard time she brought me to my knees. She was full of complaints. "I don't want Listerine in the water," the water for rinsing your mouth. "I don't like that headrest." I had to scurry around to find a different headrest. The list went on and on. But it wasn't only the demands she made. It was the tone she took with me. She was so difficult that I actually got physically sick and couldn't go to work. The doctor knew how bad it was.

Finally, I said to myself, "Look, you're competitive, you like to win; you've got to fight back." I decided to change my approach. I certainly wasn't winning by getting angry every time. I decided I would give her every single thing she wanted—with a smile. It got a little better but it was still like an armed truce.

Then out of the blue I said to her, "You talk about your father but you never talk about your mother."

"I hate that woman!" she flung back at me. "That's why I left home at sixteen." There were times I couldn't stand my mother but I never hated her. I thought to myself, "Maybe that's why she has a hardened personality."

That brief exchange between her and me, that's all it took. She stopped being abusive. She started treating me with respect. She laughed where before, all I ever got was a little smile.

"How often can I come in?" she asked me.

"As often as you want." Normally, people get their teeth cleaned two or three times a year. She came in every six weeks. For what? She must have needed the conversation. I was happy to get onto good terms with her but I felt for her. She must have hurt a lot of people and never knew it. It's too bad: she is such an intelligent person with so much to offer.

A lot of people think all I do is clean teeth. Yes, I do clean teeth—I remove tartar, hardened plaque—from patients' teeth. But to me the dental hygienist is much more than that. To me the hygienist is a clinician. I am a clinician. I pay attention to the patient's whole body, not just their teeth. I am always watching the person's gait as they walk into my room. As people get older, the way they walk could be a sign of disease. Throughout my career I've studied medical things and I've learned a lot about the body. Oh, you have diabetes or you are borderline diabetic. Diabetes is a systemic disease, I say, and this is what happens to the mouth. When you are in my chair, it's the whole system.

When I graduated over 30 years ago, hygienists waited for the doctor to come in. But I didn't wait. Initially, he was surprised. I don't just take X-rays. I study the X-rays, looking for cavities that don't meet the naked eye. I assess the state of a person's gums. There are two features to that. First, how much have they receded, which indicates how well the teeth are embedded in the jaw bone. To measure that, I insert a probe around each tooth to check for bleeding and bone loss. The higher the number (from 1 to 12 mm), the greater the risk of losing the tooth. Poking in those sensitive places, I have to be gentle.

I have started checking for Human Papilloma Virus (HPV), a sexually transmitted disease, which is on the rise (not all HPV strains are serious). Also, I am also very big on doing an oral cancer screen. I Iook at the side of the tongue and the underside. I check out the glands; there are specific spots I am looking at and feeling for. I also check out the tissues in the back of the neck. I told one patient there was something on his lymph node that needed to be checked out. A few days later I got a phone call from his wife. I thought, "Oh God, I did something wrong." Quite the opposite. During the visit to the doctor, it came out that my patient had been unusually tired but hadn't said anything. He was immediately admitted to the hospital for open heart surgery.

He sent me a dozen roses. "You saved my life," he told me. I dried one of them and had it framed. It sits on a counter in front of me. Every once in a while, I am a little lazy and I don't feel like doing the cancer exam. But that rose reminds me: Okay, I will do it.

The whole time I've been in practice I have gone to school. First, I took classes to become a nurse but I couldn't look at a wound, so I stopped that. I took a few classes in social work and realized that was not for me. Then I took courses in health administration. I should have finished the program. Still, a lot of what I learned from that program applied to my job, especially how to deliver health-related services to people. How do they learn, how do they speak, how well do they listen, do they listen attentively? I started watching people, myself included, and realized I didn't listen well.

I have worked on that. It used to be I would get a diagnosis and I would ask one question after another. Now I just let them talk for a couple of minutes. I've learned I don't have to say anything.

My son told me recently, "I like talking with you."

"Why?" I said.

"Because you're a brick wall."

"Is a brick wall a bad thing?" 

"No, because you always listen." 

Lately, I have focused on grief because a lot of patients are losing their parents and even their spouses. At first I didn't know how to talk to a patient who had lost a loved one. How do you feel—that's a dumb question. I have been afraid of that subject but I kept trying to relate to patients who have lost someone. Now I am less afraid to talk about grief. I have a patient who lost a child, and every now and then I ask her about it. I don't forget. You have to keep getting better in all ways. You can't get lax.

I have been at this, dentistry, for 36 years, my first five years as a dental assistant and 31 years as a dental hygienist, and I am just as eager to get into the next person's teeth. I can't wait for them to open their mouth.