More from Diagnosis: Where Every Day Starts the Same and Ends Differently

So, within just a few days, I got the hang of everything. I was honestly surprised at how quickly it all started to click. 

There I was—freshly minted, still half-expecting someone to tap my shoulder and say, "Just kidding, you're not really a doctor yet." But within days, something clicked. The motions became fluid: taking histories, probing cavities, explaining treatment plans.

This was my first real experience working as a professional, and once I created my own flow, things began to make sense.

For most of my time in this rotation, there were only two other house officers working alongside me. They were both helpful and easy to talk to — whenever I had questions or needed a second opinion, they were there. That made a huge difference. One of the things I was most nervous about before starting was whether I’d fit in or feel lost in the mix, but having people around who were kind and supportive really helped me settle in. 

I slowly got used to the environment of the dental clinic as well. We practiced dentistry in what felt like a broom closet - 2 broken chairs, a flickering overhead light that treated every procedure like a moody photo shoot, and glove shortages so predictable we rationed them like wartime supplies. Infection control? More like infection suggestion. But this was a government hospital; we worked miracles with what we had.

Our caseload read like a dental pathology bingo card:

• The Usual Suspects: Rampant caries, pulpitis (both the "maybe we can save it" and "yank it now" varieties)

• The Drama Queens: Space infections that made cheeks balloon like blowfish

• The Rare Finds: That first ranula I saw - could have been lifted straight from my oral pathology slides. For once, reality matched the textbooks exactly.

Most of the cases we saw on a day-to-day basis were pretty routine: dental caries, pulpitis (both the "maybe we can save it" and "yank it now" varieties), acute and chronic apical periodontitis. Occasionally, we’d get something a little more complicated — a few space infections, abscesses, ranulas, mandibular fractures, and periodontitis cases. 

When the consultant was around, we upgraded to Oral Medicine: Hard Mode—trigeminal neuralgia cases that made my own face ache in sympathy, leukoplakia patches that had me mentally reviewing carcinoma risk factors.

We'd also see cases of lichen planus, and even a case of oral submucous fibrosis. One particularly sad case came in for a biopsy and later came back as squamous cell carcinoma — that one stuck with me.

The rotation itself wasn’t hectic. Our busiest days had maybe 15 patients, while the slower days could drop down to four or five. It was a manageable pace, and that gave me space to actually learn, not just survive.

Then she walked in, her swollen jaw telling half the story. The other half would haunt me for weeks. And suddenly our glove shortages suddenly felt like the least of our worries.

A case that jarred me — not just because of the clinical aspect, but because it forced me to confront the complete lack of systems in place for victims of domestic violence.

A woman came into the clinic alone. At first, I couldn’t read the situation clearly. I began taking her history, just like any other patient. When I asked why she was there, she hesitated, then quietly said she had been hit. She didn’t say by who at first. But as we talked more, the full picture slowly came into view. Her partner had hit her during an argument — a misunderstanding, she said.

Then she narrated her series of events:

1. First Clinic: Painkillers handed over without questions

2. Second Clinic: A referral slip instead of help

3. Our Turn: The visible swelling, the way she winced when I palpated her jaw—this wasn't just pain. This was damage.

"We need an OPG," I said. Her face fell.

"How much?" she whispered. 

Then she started explaining to me that they couldn’t afford it.

When I told her that we really needed it and we can't proceed without it, she called him in—the partner whose "misunderstanding" left her jaw swollen.

We explained as best as we could how serious her injuries were — that she needed this x-ray before we could even begin to treat her. Her partner said they’d go and look for the money and come back the next day. Honestly, I didn’t think we’d see them again.

But she returned the next day. Alone.

We took the OPG, and it was bad — an unfavorable fracture at the angle of her right mandible, just behind the last molar. 

To make it worse, she was also missing her upper left central incisor. When I asked her how that happened, she admitted again — "Him. That was him too."

At that point, even the dental assistant and another dentist stepped in. They started asking her more about the situation, encouraging her to think about ways to support herself and get out. 

But then we hit another wall: the treatment she needed would be expensive. Intermaxillary fixation (IMF) might not even an option because she had missing teeth. She’d might need mini-implants — something far more costly.

And the thing that kept circling my mind was, they had to scrape money together just to pay for the x-ray. How on earth was she going to afford surgery?

There’s a small chance the surgery might be done for free — some consultants in government hospitals will take on special cases like this, but nothing is guaranteed. I even found myself asking if there was any kind of support system for her. Were there social workers? Counselors? Anyone to give her more than just a painkiller and a referral?

Because here’s the thing — victims of abuse don’t just stay because they want to. They stay because they’ve been broken down so completely, they can’t even see a way out. And here we were, watching her walk back out into that situation, and there was nothing — nothing — we could do.

The System’s Brutal Failure

1. Clinical Limitation:

   • No intermaxillary fixation (IMF) possible due to missing teeth

   • Mini-plate surgery required—far costlier than they could afford

2. Institutional Gaps:

   • No social workers or counselors on standby

   • No protocol for mandatory reporting (unlike in Western systems)

   • Just whispers among staff about maybe getting surgeons to waive fees

3. The Abuser’s Audacity:

   • He stood there, chest puffed, knowing no consequences would come

   • She left with him—again—because where else could she go?

I kept thinking: in another country, this might’ve triggered a mandatory police report. It might’ve been treated as the crime it is. But here? Her partner didn’t even deny it. He stood there, cocky and confident, because he knew nothing would happen to him. No consequences. No fear. Just another day.

I honestly hope she finds a way to escape that situation. But it left a bad taste in my mouth. Watching her leave with her abuser, knowing we had no tools to help her — no pamphlet, no shelter contact, not even a number to give her. Just her x-ray results and a referral.

What Kept Me Up at Night

• The way her fracture might heal malaligned, requiring another surgery she’ll never afford

• That in another country, this would’ve triggered police involvement

• Most of all: Our powerlessness as healthcare providers when society fails its vulnerable

This wasn’t just a dental case. It was a crash course in how medicine intersects with systemic injustice—and why some wounds go far deeper than radiographs can show.