On Paper

On Paper

James P. Hughes, D.D.S.*:

At some point, I began to measure events and periods of my life in decades instead of years. How did this happen? One day I was talking with a friend about my newborn  daughter, and in the next instant I’m telling him about my grandchild playing t-ball. We were seemingly the same people, but in the blink of an eye, 40 years had passed and we  had changed. 

And so it became time to consider how to go about wrapping up my career in dentistry. I had it all planned out. I would retire on my sixty-second birthday debt-free, sound of limb and wit. It was just that simple, and everything was in place to make it happen. So there I was, cruising along the Happy Dentist Expressway with the top down, Steely Dan blasting from the speakers (one is never too old for The Dan), and the GPS set for that Golden Years exit just a few miles ahead.

I was about four years away from my goal when I began to notice a slight tremor in my right foot. It would occur mainly during episodes of acute stress (what, in dentistry?), so I wrote it off to getting older, added it to my growing list of Symptoms Attributed to the Normal Aging Process, and filed it away in my head. Whatever the etiology, however, the tremor was not to be ignored as it gradually increased in intensity and frequency. Additionally, my gait changed as my right foot slapped the ground when I walked, and my right forearm would cramp with the slightest provocation. My staff began to notice and, God bless them, began to express their concerns. It was time to have the situation  medically evaluated.

So, after a battery of tests in the movement disorders clinic and an MRI to rule out a brain tumor, the neurologist announced in a professionally detached manner that, in spite of there being no definitive test to make the diagnosis, he felt that my symptoms and test results were consistent with those of Parkinson’s disease – Young Onset Idiopathic Parkinson’s Disease, to be exact. He went on talking, but I heard none of it. The first thing to come into my mind was my wife’s admonition to me as I left her in the waiting  area: “Remember now, you’re not allowed to have Parkinson’s disease,” she said, forcing a grin. 

“No problem,” I replied.

My wife and I both had Parkinson’s disease (PD) on our short list of possible diagnoses, but now our worst fears had been confirmed, and my mind was whirling with images of  Michael J. Fox, Muhammad Ali, and, of course, Lyle. Lyle was a patient of mine I had treated for about 12 years. He had already had PD for 15 years when I met him. At that  time he could walk, but his voice was a rough whisper. And he shook incessantly. The last time I saw him his entire body was rigid, he could not speak, and he had been hospitalized five times in the last year with pneumonia caused by aspirating his own saliva. He has spent the last eight years in a nursing home, and lost his wife in 2006. I have  not visited him there. It was too frightening tosee him gradually deteriorating, and I could not help but see a little of my own future when I looked at him. 

Parkinson’s disease is a progressive disorder of the central nervous system that affects the way the brain controls the body’s movement. It affects 1.5 million persons in the  U.S., and is characterized mainly by resting tremor, rigidity, bradykinesia (slowness of movement), and postural instability. Also seen are dementia, hoarseness of speech, muscle  cramping, constipation, difficulty swallowing, anxiety, depression, shuffling walk, stooped posture, muscle weakness, micrographia (small handwriting), freezing, mask-like facial expression, dystonia (muscles in constant state of flexion or extension), REM behavior disorder (a sleep disorder), fatigue, and loss of energy. Like a firstyear medical student studying pathology, I feel that I am experiencing all of these symptoms to varying degrees. Some are mere nuisances, and others are causing serious problems for me, such as  being unable to practice dentistry. I have good days when my voice is strong, my balance is good, and I feel motivated and ready to go. Then, on other days, I’m hoarse, tired, lethargic, and clumsy. 

As some of these symptoms gradually worsened, it became clear that I would have to sell my practice and retire. I wanted to leave before my work began to deteriorate. It was not, however, a good time to beselling a dental practice. Most of the dental magazines and newsletters were reporting that it was a buyer’s market, warning readers not to  count on the sale of their practice to help fund their retirement, and stating that many dentists were simply walking away from their practices, unable to sell them. But in my case, I was fortunate to have had several buyers from which to choose, and the sale of my practice went relatively smoothly. I began life as a retiree. 

There comes a time in nearly every working person’s life when his or her position in society changes from that of a producer to that of a consumer. The producer creates personal income, goods or services, or ideas and information. The consumer, on the other hand, uses things, services, and ideas provided by others. Such is the transition from  working person to retired person and, for some, it presents a difficult passage. Many have traditionally defined themselves by their work, so when this part of their lives is gone,  they lose a large part of their identity.  I, however, had been born with a remarkable capacity for underachievement. Therefore, when it became my turn to make the transition  from producer to consumer, I slipped and stumbled my way to the other side with relative ease. As a matter of fact, my wife and I threw a party to celebrate the event. About 150 patients, staff, and friends were in attendance. Stories were shared, and farewells were exchanged. I had exited the expressway on an earlier exit and was heading down  this new road with a good feeling about the future, in spite of the Parkinson’s disease. But there was one more detail with which I had not yet dealt. 

I guess that I have spent  most of my life expecting good things to happen. However, those of us with such Pollyanna views of the world are often blind-sided when our  rosecolored ying is confronted by the cold grey yang of reality. About a year into my retirement, I received my dental license renewal application. Because of the slow but  continued progression of the PD symptoms, I had known for some time that I would not be renewing my license to practice dentistry. But then, at that moment, as I stood by my mailbox, I faced the reality of actually surrendering my license. In the past, the invitation to renew my license had presented no particular emotional challenge. I would verify my address and working status, mail it back with a check, and that was it, licensed for another year or two. But this time it was obviously and ominously different. I would be voluntarily surrendering my license for good. Returning this card was an irrevocable action. I had accepted this intellectually, of course, but I was in no way prepared for the emotional impact this action would have on me. 

The bottom line was I had worked so hard to get my license, and now I was giving it up. Anyone reading this will have either first- or second-hand experience with the trials and tribulations of earning the license to practice dentistry. Keeping the G.P.A. up for four years to get into dental school, the failed patients, the practical clinical exams, lunches  that smelled like formalin, bad impressions, open contacts, four-hour crown wax-ups, pharmacology, sticky wax, first denture – 13 appointments, good impression according to  clinical instructor – five minutes before the end of the clinic session, nearly extracting the second molar instead of the third molar, red lights, signatures, ten hour days, loans  and more loans, all constitute the shared experiences of dental students. And if you passed the exams, wrote the papers, completed the clinical requirements, passed the national and Regional Board Exams, and got all of the signatures needed to prove you had satisfied the requirements of every department from removable prosthodontics to instrument sterilization, you paid the fee and they sent you your license to hang on your wall. That single, irreplaceable piece of paper identified you as a licensed dentist, with  all of the rights and obligations accorded to you as such. 

But the process of surrender seemed so anti-cathartic when compared to the drama of obtaining the license. Scratch a check mark in the little box, sign, and it was done. Eight  years to get it, ten seconds to give it up. This seemed completely out of balance, so I included a short note to the board in which I tried to explain what surrendering my license meant to me. Here is the text of the letter I sent along with the voluntary surrender of my license: 

With this letter I am voluntarily surrendering my Dental License #D8682 effective March 31, 2011. The reason is that I have sold my practice and am fully retired. Enclosed find a  renewal application with my intention to not renew for the next licensure period indicated, signed, and dated. 

My license to practice dentistry was not earned easily, and I have cherished it for nearly 33 years. It was not easy to get, and it is just as difficult to give up. This is one of those major milestones in my life. I am thankful for having had the  opportunity to practice, but it is time to move into the next phase, whatever that may be. So here it is a few months later, and I am settling into this new phase of my life. The feelings of sadness and loss have moderated. The PD is slowly progressing, and I am considering selling my  beloved Harley. We are probably moving to Texas sometime in the near future. Lots of changes, and change is good. But as for this very moment, it’s 1:30 p.m., and I am going  to put Pretzel Logic on the CD player and take my very first nap.



Here is an update on Lyle. Not only is he alive, but last weekend he was the King for a Day at the annual parade around the parking lot at the nursing home where he has lived  for the last eight years. It coincides with Winona’s summer celebration, Steamboat Days. He and Queen Dot led the procession on his motorized scooter that he controlled  himself. When Lyle was asked how it felt to be the king, he replied, “It feels great.” 

And, finally, the following appeared in the July 16th edition of the Winona Daily News: Lyle B., 84, of Lewiston, Minn., died Thursday, July 14, 2011, at the Lake Winona Manor in Winona. Despite having Parkinson’s with its many limitations, Lyle handled his disease with patience and dignity while surrounded by his family and Lake Winona Manor family.