An Online Literature and Art Journal

The Efficacy of Pain

By Kathleen Thompson

Pain has no appeal here. Camouflage, I’ve learned, is the key to happy dentistry: tranquilizers, personal headsets, laughing gas, so while I wait here—and I hate waiting for anything—I just settle back and relax and think of ways to showcase my newest real estate listing.

My teeth were weird from the start. Until the day I met Dr. Maniscott, I had never smiled for a picture. I grew up missing a permanent incisor on top and two teeth on the bottom. Never mind that I knocked my front baby teeth out on a see-saw. Those came back in fine. But next to them on either side was a “pegged lateral,” little pointy teeth, miniature stalactites that earned me several nicknames. All the bottom teeth were little squat, squeachy yellow things—misshapen stalagmites. To say I’ve always been concerned about the way my teeth look would be an understatement; frankly I’m compulsive about it.

That first day Dr. Maniscott announced we would start with the pegged laterals. He plastered on something like modeling clay. “Think about it for a day or two, “he said. “Then we’ll start the makeover.” But when I smiled into the round mirror held before me, I knew I had found my salvation. Dracula no more. I would drive through Highway 280 five o’clock rush hour every day and sit and wait thirty minutes to an hour, if necessary, to see him.

On the other hand, no pun intended, seeing a cosmetic dentist so soon after my recent hand surgery is about as gut-wrenching as showing a new client a house with a possessive pit bull left locked inside. My physiotherapist Elnutta feels pain is a virtue and has no equal. She hates scars the way I hate waiting. I’ve only met one person so far who isn’t afraid of Elnutta: her receptionist. This jewel of an employee wears miniskirts to show off a tattoo high on her thigh that you can’t quite make out as she walks, but because she always wears sleeveless t-shirts, you can clearly see the intertwining snakes on each of her biceps. She sets the tone like the cold heat of one of those electric currents Elnutta hooks up to shoot through my scarred palm.

Bea, the dental receptionist, is nothing like Elnutta’s receptionist. If Bea were a For Sale by Owner, she’d be the one that would sell the day the sign went up, before a realtor could even come close. She’s just what a dentist needs, especially one who alters not only teeth, but the lives of other people.  Bea knows realtors always run late, but not me. She knows I run punctual to early. Cheery salutations and valedictions, accommodating appointments, attractive salt and pepper bob. That’s Bea.

“How’s the hand today, Violia?” asks Bea.

I open my right palm to show her the three-inch gash under my pointer, middle, and ring fingers. The scar from Trigger Finger surgery is still puffy and itching some, which I take to mean it’s healing.

Elnutta takes the puffiness to mean I’ve not had enough pain inflicted. She’s an out and out sadist. One of her favorite procedures is inching a woven metal glove onto my hand and hooking it up to electrical currents. Invariably, she cranks the juice up so high it jerks my hand up off the table at first.

“You can always turn it down if it’s too high,” Elnutta condescends.

After various such “modalities” are used, Elnutta casually slips into her diatribe about scar management. I frankly feel like screaming to her that I have absolutely no concern for scars in the palm of my hand and how they might look. But I can’t protest. My teeth are clenched in pain.

“You might want to thumb through this,” offers Bea, still smiling. Bea hands me a notebook of photos that show off Dr. Maniscott’s work. He’s not just your average two and one-half bath dentist. Yes, he fills and caps and pulls and crowns, but he’s a hot tub, free standing glass shower, and bidet all rolled up into one.

An amazing number of his patients with teeth as bad as or worse than mine are pictured in the notebook. If you were to put all the before’s together in a room, you’d swear they were all clowning around with some mail order teeth from Dr. Bukk. The dentist I just fired made the mistake of greeting me with his special pair of Dr. Bukk’s. No way is my idea of a good laugh to have my dentist showing up with green, misshapen, and gross teeth.  The after’s on the other hand, are enough to make somebody like me weak-kneed, so many perfect sets of even artistry: gleaming teeth, none exactly alike, but sculpted to fit each particular face.

The longer I look at these makeovers, the more my expectations magnify. Just like real estate. A person may only be window shopping for a house, but in my mind a first phone call signals dollar signs. The caller wants to spend a cool million, and I aim to see that she spends it with me. Likewise, with my new teeth, along with a little nip and tuck of skin here and there, and some microdermabrasion around the lips, the sky—pardon the cliché—will be my limit. I can picture myself in Homes and Land. For years my business card has had only a practiced Mona Lisa smile. Perhaps in my new ads my elbows will be propped on the table, hands freshly manicured with a sales contract in front of me, and a full, toothy smile.

That is, if my fingers aren’t triggered tightly back into my palm again from failing to hurt myself with hand exercises the way Elnutta threatens if I don’t meet her demands.



         “It’s a good thing we don’t have many surprises like the last one,” chirped Marissa to no one in particular as she sanitized the tray beside the dental chair. Dr. Maniscott was there but he never listened to her. She coughed once or twice as she wiped down the tray and chair with a disinfectant solution. It was the only smell Marissa minded about her work. A lot of customers complained about the odors of cement and temporary fillings. Not Marissa. She knew the Eugenol they smelled was from a clove derivative, so she imagined gingerbread baking instead. She was always happier in the company of spices and herbs.

Marissa planted several pots of herbs each spring. Any time she wanted to get away from the sound of drilling teeth, she simply took herself mentally to one of the wicker arm chairs on her screened porch, sat down, and soaked up the birdcalls in the woods bordering her tiny back yard. She imagined her sunny deck—crushing a stem of rosemary, snipping some basil leaves to mix with tomato, or stripping off tiny thyme leaves.

Today she’d been jolted back to reality when Dr. Maniscott, ready to replace the last patient’s metal filling with a porcelain crown, discovered a small cavity. They were now running thirty minutes behind schedule.

“Mrs. Sanford is next and she ‘just can’t stand it’ when she has to wait,” said Marissa, trying to get Violia’s exact intonation. Sure enough. No comment from the good doctor behind his loops. She put the impression gun back into its drawer and checked off the clean instruments she had just taken from the Autoclave: mirror, hemostat, scaler, cotton pliers, retractor… .

Dr. Maniscott was still writing on the previous patient’s chart. A chart was his personal wall against sound or people; you could see the invisible wall rolling up slowly like the top of his Lexus convertible.

“How’s that, Marissa?” he murmured, closing the folder.

“Oh, nothing. Mrs. Sanford’s up next.”

Dr. Maniscott ducked out the back way. Marissa wondered if he knew how goofy he looked wearing those ogle-eyed loops.

Marissa led Violia into the room, took her yellow Louis Vuitton knockoff, and hung it on a hook beside the sink.

“Did you close on that house in Mountain Brook, Mrs. Sanford?” asked Marissa.

“Yes, but call me Violia,”

Dr. Maniscott insisted that Marissa keep up with what the patients were involved in, their food preferences, or favorite movies. That way he didn’t have to. Violia was one of the top-selling realtors in the area, and Marissa knew she specialized in the high-end homes, none below a million.  She’d had surgery on her hand for something Marissa had never heard tell of, but it had not slowed down her obsession with selling.  She wore a cell phone headset like a hair ornament. Marissa insisted that Violia put the headset into her purse.  “How can a client understand you with a numbed mouth, or over the buzz of a drill?” Violia still refused to turn the ringer off. Marissa noticed that Violia looked longingly toward her purse each time her phone rang.

Nice purse, Marissa thought. Violia looked a lot like Marissa’s grandmother, and actually dressed a lot like her, too. Her grandmother liked the look of high fashion, but more often than not, mostly shopped the one-day sales at Rich’s. They both wore Stuart Weitzman shoes which you could only get at J. Bowyer, so Marissa guessed she might have a wide foot as well.

Violia was actually very likeable because she was a talker. Marissa preferred talkers. Patients were a little like dogs. It was not the ones that barked that you had to worry about biting you. The body language of the quiet patients told you they were there only for their personal transformation. Nothing more, nothing less. They needed a new smile and they had heard Dr. Maniscott could do it. And “law suit, buddy, if you don’t get this right.” This kind of pressure always made Marissa’s skin crawl. She was apt to drop instruments, or to make little mistakes in mixing the filling compound, or accidentally miss a hunk of the amalgam with her suction.

Dr. Maniscott was exceptionally understanding when these accidents happened, given his lack of patience if his instruments were laid down in the wrong order. He almost seemed to relish her accidents. No matter what Marissa dropped, or what trash she missed in mouths, the patients always came back anyway. Ugly ducklings wanting to be swans, frogs dreaming of turning into princes, or Easy Spirit walking shoes aching to be a pair of Prada slingbacks. No inconvenience, no price seemed too great.

Violia was a talker, all right. She’d let you know that she had told many an agent, “See you in arbitration.” You sometimes couldn’t shut her up. They had to schedule in extra time just to cover her chattering. She warned both Marissa and Dr. Maniscott on the first visit, “I’m not an easy patient.” And then she explained herself further.  Her internist insisted she needed to take Lipitor. She had been a smoker. Her oldest sister had had several strokes. But she had never taken any drugs regularly except hormones, and she had no intention of starting now. What do they really know about cholesterol yet? she declared, and cited several personal cases of people who were not overweight, who ate healthy foods and exercised, but who still had high cholesterol. So there, she said, laughing again. Proof enough.

Marissa fastened the paper bib around Violia’s neck and handed her a tissue for lipstick.



         “Good morning, Mrs. Sanford,” said Dr. Maniscott, as he came back into the room. He patted her on the shoulder, adjusted his mask, and started pulling on gloves.

“Violia,” she insisted, “Violia. Please.”

How about Ms. Take-Charge, he wondered, but simply smiled at her. She had a tendency to upbraid and scold him as if she were his mother.

“Explorer,” he prompted Marissa.

This Violia was pushing sixty, but without the aid of his loops, he probably wouldn’t have guessed. Hair solid gray and scrunched down from wearing the headset so much, crow’s feet not that noticeable, yet her lip lines were the dead give-away. He guessed she’d been a smoker. And a bargain hunter. Her fillings and crowns looked like something of a train wreck with different boxcars and sleepers all jumbled up together. She must have taken advantage of some dental school trainees. One good thing, though—she still had a great foundation—healthy pink gums.

“Open wider,” he instructed.

He took a long look, tapping and poking here and there. One upper molar was undoubtedly the worst filling he’d ever seen, bumpy and ugly. Should’ve been a crown.

“Today we’ll start with correcting your bite, so we’ll numb you up a little.”

He looked toward Marissa, “Mandibular block on both sides.”

“We’ll also do a bit of gingival contouring on both the upper and lower front teeth. How’s that sound, Mrs. … ” and after hesitating, “Violia?”

“I’m ready, I think,” said Violia, but nervously looked around. “Forgot my hand putty.”

“Would this work?” asked Marissa, handing her a small rubber ball.

“First, a local anesthetic,” Dr. Maniscott continued. He jabbed a cotton swab inside each jaw. He hoped Marissa would give him a verbal clue to remind him why Violia needed hand putty.

“Allergic to any medicines?”

Surely with this mouthful of metal, she’d had plenty of Novocain before, but he was required to ask.

“Nope,” she said, laughing. “Don’t trust medicines.”

He would be working on her whole mouth today so the entire thing needed to be numb. After the first two injections he saw that she was gripping the ball tightly. By the time he had finished all eight, she had completely flattened the ball.

“Are you sure we need so many shots?” she mumbled.

“Blanket,” he ordered Marissa. Violia had begun to shiver.

Marissa tucked the thin green blanket around Violia’s legs. Marissa was little help with Violia’s chit-chat. He had to stop several times to interpret the grunts. If he didn’t avoid some of Violia’s meaningless babble today about interest rates and buyer’s market, he would never finish. He and his son were going boating on the river at four, and Bea had given him no slack in the schedule.

Violia began to giggle. She gurgled something about finding a big house for him on Smith Lake. Dr. Maniscott ignored her. Timing was critical with an anesthetic. He had two other patients who’d had cleanings with the hygienist to check before he could get back to her. Also he had the Big Guy to deal with.

Marissa named the Big Guy on his first visit. He wanted big teeth and he got big teeth. He insisted upon white teeth. His were dazzling. Now he had decided something wasn’t quite right with his big, dazzling white teeth. It was Dr. Maniscott’s job to convince him his smile was the perfection always provided by a licensed veteran cosmetic dentist with annual training in the Hollywood area.



         I was so suddenly cold a rabbit ran over my grave. It was then I realized I was going to die. The shivers were constant. Marissa began asking me whether I could feel this or that. She was poking around on my gums with a sharp metallic instrument. I could still feel some of the places she touched. But finally I could feel nothing. The whole bottom half of my head was numb. I thought of my throat. I never think of my body parts separately until they hurt. I felt the need to pinpoint my throat with my thinking. Maybe it was the spittle running from the corners of my mouth. When I did get a bead on my throat, it wasn’t working. Maybe it wasn’t even there. I couldn’t swallow. I tried to grunt and point to Marissa that my throat was filled up and overflowing with saliva, and that I couldn’t swallow. When she understood she said, “You’re swallowing. It’s okay. You don’t even need to swallow.” But of course I needed to swallow. I needed to swallow so that I could breathe. I grabbed her hand. I growled, “Uh an’t swuwo.” She was reassuring. “You are swallowing. You just can’t feel it.” But I didn’t believe it. She was lying to me. I was going to drown in my spittle. These injections were going to kill me. I never take medicines. Something had gone terribly wrong. And what if Marissa just whipped out of the room the way Dr. Maniscott had? What if I had to die alone? I could hear Dr. Maniscott next door laughing and talking with a patient. Laughing and talking as I lay dying. A guy was complaining that his smile might be too white, too big. They had no idea that I was drowning in the next room here while they argued about the color and size of teeth. “on’t eave ee,” I begged Marissa, reaching for her hand. She was my only hope. At least she could call someone when I did finally drown. I squeezed her small hand so hard it was hurting mine. I was going. I knew it. “Next time you might want to take something before…” I didn’t let Marissa finish that ridiculous sentence. I shook my head no and tried to scream. Marissa looked at me the way a mother looks at a child in distress. She blotted the corners of my mouth with a tissue and dried my eyes. She was a good girl after all. She was not in on this plan to kill me.

“Just relax,” she said. “Were you upset about anything when you came in?”

I nodded no.

“Relax if you can and just breathe deeply through your nose.”

My nose? Where was my nose? I couldn’t feel my nose. Could I breathe through my nose? As I considered my nose and its capability, I felt a finger of pain traveling up the side of my face past where my nose used to be and up into my forehead. I could tell I still had a broad forehead. The path of the pain stopped with a throbbing ache right in the middle of it.

Oh, my Lord, this medicine has gone to my brain. I will never get a new photo for my business cards with or without a great smile. I should have emphasized to the doctor how sensitive I am to medicine. I’ve allowed him to kill me.

“Oh, don’t cry,” pleaded Marissa, handing me tissues. Her mascara was smudged a little under one eye. Her eyes were as blue as cornflowers, like my mother’s eyes.

I pointed to my head and sobbed.

“Headache?” asked Marissa. “Want an Advil or  Bayer?”

“O, o.” I blurted no over and over and turned my head away from her.

Dr. Maniscott breezed in like Mickey Mouse. All he needed was a pair of ears to complete the get-up with those glasses he wore.

“She’s upset because she thinks she can’t swallow,” Marissa explained. “I told her she’s swallowing, but she has gotten herself worked up into a little tizzy.”

“We’ll make this quick,” he said evenly, as if Marissa had said nothing more important than the name of the street where I lived, or the name of the city I had most recently visited.

“Ut is this orma?” My mouth was filled with his hands and a fistful of metal. I knew I was garbling the words. What I wanted to scream was, “Is this normal? Am I dying? I can’t feel my throat and nose. Am I supposed to have this headache? What is happening to me? I can’t swallow at all. I’m dying here.”

Dr. Maniscott looked to Marissa to interpret and answered, “You are swallowing. I’m sure Marissa has told you that.  Sorry I’m late getting back in here. This reaction is surprising. You’ve had plenty of dental work done before. I’ll work as quickly as I can before the anesthetic wears off.”

Just at that moment I was able to force a half-swallow. I could actually feel my Adam’s apple move. I couldn’t repeat it, but I knew at least it had happened once. There was hope. I breathed luxuriantly through my nose.

As Dr. Maniscott cut away the gum tissue from the top teeth, I began to feel the pain. My signal to him that I felt anything at all was to raise my left hand. I had released my grip on Marissa so she could assist him. I raised my hand, and he stopped grinding.

“Know what the Marines say, don’t you?” He didn’t wait for a reply, but laughed and said, “Pain is weakness leaving the body.” If this was his way of joking, I didn’t get it.

He picked up the impression of my upper teeth from the tray and stared at it through his loops. The teeth looked too small and the gums too large to be mine. Then he turned back to me and patted me on the shoulder.

“But we’re not the Marines here,” he said. “Let me know if it’s so painful you want me to stop.”

But I never raised my hand again. In between his grinding I tried to breathe deeply and think of what Elnutta would say. Suffering produces endurance, and endurance produces character, and character produces hope. I wondered if Elnutta was a member of one of those religious groups that didn’t believe in taking the sick to a doctor. I imagined her thumb over the gash in my hand, pressing, hurting. I imagined it the very first day after surgery when she pressed around the outside of the stitches. I imagined swallowing the screams.

“You handle pain well,” Dr. Maniscott said when he was finished. He chuckled and patted me on the shoulder. “Ever consider the military?”

I was still shaky as I walked back up to Bea’s desk. I don’t know why my legs were affected by the swallowing. Or my head. I felt so suddenly dizzy when Bea looked up at me I began to cry again. I asked Marissa to take me back to the room so I could sit down. She brought me a Diet Coke. She asked me questions about some townhouses going up near her neighborhood, about the current interest rates, questions to distract me. But I wanted to talk only about death, to tell her what it was like to be that close.



         I might have guessed that Elnutta was not in the best mood when I arrived for my appointment that afternoon. She and the receptionist were barking at each other like two realtors in arbitration.

“You dismissed this patient,” said the receptionist, jabbing at a manila folder, “but after one day back with the sanitation department, he’s calling here cussin’ about severe back pain.” The tattooed snakes on her bicep were pumped to the fullest.

“So?” said Elnutta. “His insurance was used up.”

“You call and tell him that,” said the receptionist, handing Elnutta the phone. Then she saw me. “Just sign in there.”

No friendly Bea-like chatter here. If she remembered me or my name, it wasn’t obvious.

Elnutta looked up and motioned for me to go on back into the large room of little oak tables and rehab equipment. A few other patients were either doing exercises alone, or were hooked up to one of the modalities in the room. Elnutta hates germs nearly as much as scars, so I first went to the sink and washed my hands with antiseptic soap long enough to sing Happy Birthday all the way through.  Elnutta’s training.  I then sat down next to the girl whose fingertip was almost cut off with a knife at work in a restaurant. She is looking at a woman’s fingers which have had joint replacements following Trigger Finger surgery like mine. When I am in this circular hodge-podge with all germ-free hands laid out on individual tables, I feel as uneasy as I do when a real estate contract sours. Stories like theirs—spewing up from within that circle like fizz from a dropped coke can—nearly take my breath.

Elnutta came in and checked the splint she’d molded for a man who had fallen and broken his hand in several places. She adjusted her stool up on the other side of my table and began her quiz.

“Do you know why your fingers are buckling up instead of lying down flat?”

When I told her I hadn’t a clue, she was furious. She bent my three fingers back until my palm was spotted with white pain. She whirled a time or two around on her stool so that the whole group felt included.

“Tell her, somebody. You know this. Don’t be so flippant.” She whirled around on her stool. “You all know this. Somebody tell her.”

         She pointed to the girl who had lost a finger in a lawn mower accident. The girl stared at her blankly. “It isn’t about how it looks,” Elnutta moaned as if we were all nitwits for not knowing that simple thing. “It’s all about this scar and your scar tissue. It’s motion. Forget strength right now. It’ll come back normally, but motion won’t. You must work on motion.” She gave an extra bit of pressure on my three fingers. “If you had this inflamed gash on your foot would you jog or run a marathon? Then why would you think you can peel potatoes and chop onions. . . ” and then she stared into my eyes, “or punch in telephone numbers day and night with this hand and have no repercussions? You people don’t listen to me.”

Elnutta often makes points to the whole maimed group by using one reprobate as the example. Last week she began to whack at the chef’s bandage with scissors, carelessly ripping it off.

“Take a look at this hand and tell me what’s wrong with it. See how it’s all swelled up?” She changed directions so fast on her stool, it screeched. “What did he do wrong?” Then she shouted at him, “What did you do wrong?”

The chef who had cut the tips of two of his fingers off while chopping onions couldn’t answer. Tears washed over his face, clamped in a grimace. Elnutta answered for him. He had not wrapped the bandage tightly enough and had started it in the wrong place.

“Ionto phoresis,” she hissed to her assistant, who was asking for instructions for my treatment.

That procedure requires an adhesive-backed plastic patch with a metal snap in the middle plastered over the scar. Wires run from that patch back up to mid-arm where another such patch is placed. This is all wired to a machine and when turned on, creates a tingling sensation around the patches.

None of the modality procedures, however, approach the pain of the final fifteen minutes of my hour of therapy, the “hands on” with Elnutta. The very first day after my surgery Elnutta began to massage outside the row of stitches. If she noticed the pain she was inflicting, it was not evident. Tears mean nothing to Elnutta. She insisted these massaging exercises must be done if I wanted my fingers to work right again. After a few weeks as the wound began its healing progression, she would somehow gather her entire body weight under her thumb as she pressed down on top of the rawest part of my incision. That right thumb of hers has the strength of a boa constrictor.

Elnutta repeatedly indoctrinates her patients with the efficacy of pain during hand therapy. Her philosophy is administered without bias. I think she knows that pain is not the worst thing that can happen to a person.


         I’m still waiting for Bea or Dr. Maniscott to call me back with the new set of appointments. Waiting and wondering whether I could ever go back there again after that last disastrous visit. But I don’t suppose I would give up selling houses just because one deal ended up in a nasty lawsuit. I considered every aspect of the fears I’d had as I sat on my vanity stool massaging my hand scar in front of the bathroom mirror.

On that last visit to Dr. Maniscott when the feeling began to come back to my head and I felt steady enough, I told Marissa I was ready to go. She walked me back up a second time to Bea’s desk. I handed Bea my credit card without asking the amount. Bea said my series of appointments all had to be changed. Dr. Maniscott would never again work on my whole mouth at once, but would take it one quadrant at a time. I wondered whether he was being kind, or just hedging his bets against possible litigation. She said the doctor would call when he had the schedule all worked out.

The light that day shimmered through the stained glass window shaped in a paisley pattern with a red chalice and light brown loaf of bread. With my eye for structural details, I was surprised that I hadn’t noticed it before. I had only ever seen a paisley pattern in glass in a 50s coffee table crafted by a friend in Savannah. There were many surprises that day. Marissa was surprised that I had never taken a tranquilizer. She was surprised that this was my first panic attack, and without being cruel, I think, suggested that it might happen again.

Dr. Maniscott was very surprised that Novocain had bothered me because he had not added epinephrine. He was also surprised that I thought I was dying.

Marissa and I were both surprised when I told her I could live the rest of my life with my ugly teeth. At that very moment I actually believed it.

Now I sit here assessing my smile in the mirror while following Elnutta’s home regimen for my hand therapy. Last night I had a nightmare, one that used to recur but that I had not thought of in years. A rabbit runs over my grave. In it my teeth are all loose, and I’m spitting out teeth by the handfuls.

I stare into the mirror. Half smile. Full smile. Can I stand to go again? I swallow hard and wince as I press and rotate my thumb around the edge of the stitches in my hand. Sharp pain in a still-tender spot prompts the answer. That and the brilliant red chalice of the stained glass window I had not been able to put out of my mind. I look around for my yellow bag. I unzip its little side pocket.

“Just in case,” Marissa had said.

A prescription for Valium. Her favor freely given. Like grace.



Kathleen Thompson holds a BS from The University of Alabama and an MFA in Writing from Spalding University. She is the author of three books of poetry: Searching for Ambergris, Pudding House Publications, 2002; The Nights, The Days, winner of the 2008 Negative Capability Press Chapbook Series Award; and The Shortest Distance, 2008, nominated for the National Book Award by Coosa River Books. Her work has been published in Waypoints: An Online Journal; 2nd and Church; poemmemoirstory PŸMŸS; and Alalitcom. Her story, “Looking for the Lord,” (from Christmas is a Season, 2009, Excalibur Press) was nominated for a Pushcart Prize. Her story, “Envenomation” has been chosen for the anthology, Belles’ Letters 2, Livingston Press, 2017. Her official “coming out” party as a cross-genre writer will occur in early June at a Spalding University alumni reading from her prose/poetry chapbook, Time & Distance, Coosa River Books, 2017.