One of the most challenging skills we pediatric dentists must develop is the ability to size up a patient. In my role as an educator of future pediatric dentists, I encourage my students to "look beyond the teeth," especially with respect to determining what behavioural aspects—such as temperament and social history— will affect the case. An understanding of the family dynamic can provide insight into what approach may work best for the child. The concept of looking beyond the teeth was certainly broadened for me when I met the conjoined twins, Tatiana and Krista Hogan.
As one of 4 staff pediatric dentists at the B.C. Children's Hospital in Vancouver, I spend 1 day a week providing dental treatment for children in the operating room. When I discovered that I was to be part of the team being arranged for the twins' dental surgery, my initial reaction was curiosity. I had no idea who these girls were; I had recently relocated to British Columbia and knew nothing about them. Then I learned that they were conjoined at the head. The novelty of the situation would surely require considerable planning, from both a medical and dental perspective. My next reaction was, "Wow, this is cool and I better take pictures," which quickly gave way to thoughts of the unique technical challenges the case would present. I did some background research to review the evidence relating to craniopagus conjoined twins, but found little helpful information.
Before the date of the surgery, our hospital's media relations person contacted me. Would I agree to an interview for a documentary being filmed on the day of surgery? I was beginning to question the motivation behind all the media hype building around this case and whether I should be involved in it. Shouldn't the girls' privacy be respected? I reluctantly agreed to the interview although I was more concerned about the specifics of the dental treatment, especially the potential risk of the surgery.
According to usual practice, on the day of surgery my colleague and I planned to meet with the parents pre-operatively to review our plan, hear their concerns and answer any questions about the care we were to provide that day. On entering the day surgery unit, I could see the girls playing with toys, having a spat and sparring with one another, like typical siblings. Not only were their mother and grandmother there, but a number of other family members had also come along to provide support. They were obviously a very tight-knit group. At that time I was also introduced to the agent the family had hired to take care of the documentary film crew, who were present that day. Indeed, the day surgery unit was literally bursting at the seams with people!
After dealing with the crowding, commotion and the family's preoperative concerns, delivering the dental treatment was almost anticlimactic. Surgery went very well. I spoke to the family afterward to review our findings and treatment and reassure them that all had gone smoothly.
As agreed, I completed an interview with the film crew for the documentary. I learned later that the family had agreed to do a number of other documentaries as well, and it became clear why they needed an agent (in fact, they have 2). Apparently their agents help negotiate fair terms on their behalf, ensuring that all projects are in good taste and not exploitative in nature. The gifts-in-kind that the family received for doing these documentaries have allowed them to protect their discretionary income, which is needed to offset the many extra costs that all caregivers of children with special health care needs sustain. But the primary purpose, according to the girls' grandmother, "is to educate people that our girls are just like any other, with some uniqueness." Their desire for these little girls is to let them experience all that typical childhood offers, with hope that they can be accepted for who they are.
Following the surgery, I was captivated by their personal story and became curious to learn more. I reviewed a 45-minute CBC documentary, which was archived online. This further helped me appreciate and respect the family dynamic I had witnessed in action. These very special twin girls, who had such a remote chance of surviving infancy, still had many odds stacked against them. I thought, "How fortunate for them to have this wonderful and loving extended family rally around them." I found this all very inspiring.
Post-surgery, the twins progressed well and I had the opportunity to see them with their mother and grandmother at a follow-up visit a few weeks later. Dentally, things looked marvellous and I was encouraged to hear that they had gained weight. These were all good signs, and I was very pleased. I listened further as the grandmother explained their progress through other medical tests, which necessitated numerous 4-hour trips back and forth between B.C. Children's Hospital and home, with many more in store. The girls were cheerful, cooperative and patient throughout the examination process. I was quite taken by their bright blue eyes and how well they engaged in conversation with me. What a difference from my first impression on the day of surgery.
I'm grateful that I have had the opportunity to become involved in a small way with this extraordinary family in their fascinating health care journey, and will continue to be part of the team that provides care for the girls at the hospital. I am rooting for these determined little girls as they continue to face new challenges. Again, I quote their grandmother, "The sky is the limit as to what these 2 little girls are able to do."
I suppose some would say I should maintain my professional distance. But if we limit our focus to "drilling and filling" we might miss unique opportunities to interact with interesting people. One can only achieve this enrichment by looking beyond the teeth, taking time to connect by questioning and listening with genuine interest to gain a deeper understanding of the lives our patients are living. I believe this process makes us more sensitive as health care providers and enriches our daily work. Of the many children I have met in my career, those with special needs and their families have offered the most potential for enrichment, sharing compelling stories of life's successes and hardships. As for me, I am formally "hooked" on learning more about my patients.
Whether you engage in general or specialty practice, recognize that you likely have opportunities right at hand to enhance your career satisfaction. I encourage you to seek out the real wealth that lies beyond the dentistry.