Songs and Smokes

The summer that I'm fifteen years old, I've finished my first year at an all-girls Catholic high school with Sister Mary Bitch-from-Hell at the helm. I've never held down a job before, and my dad, who is a dentist and has his own practice, offers me on-the-job training as a dental assistant. His game plan is as follows: start me as a dental assistant, move me along to dental school, and preferably obtain my dental hygiene license somewhere along the way. His personal agenda aside, it means money in my own pocket, and I have never been the sort of person to shun hard work if it means that good money follows suit. Call me greedy. Call me mercenary. Just don't call me broke.

One of the first patients I meet on my first day at the office is an insurance salesman-slash-opera-singer named Reni. He is an imposing man who makes an immediate impression. He's well over six feet tall and weighs more than 250 pounds. Everyone in the office likes him, even the other patients sitting out in the waiting room who have never met him before. A lot of his coworkers come here to get their dental work done.

He calls me "K-K-K-Katey," like the old World Warâ…  One marching song. Sometimes he sings it to me, too. I like it. I like him. My parents stopped calling me Katey last year, in favor of Kath. They think Kath sounds more grown up, and I am in high school now, after all. But I'm always fond of anybody who calls me Katey. I find it endearing. Comforting, too.

Reni carries a pack of cigarettes in his shirt pocket. All the time. "So, are you smoking any more these days, Reni?" my dad teases him jokingly.

"Well, I sure as hell ain't smokin' any less," Reni quips cheerfully. "So, how's my K-K-K-Katey?"

"I'm good, Reni, thanks."

He pats his shirt's breast pocket, ensuring that his pack of cigarettes is still safely tucked inside. "That's good, kiddo. Say, you're not smoking these days, are you?"


"Good." He pats his shirt pocket again. "These damn things'll kill ya."

After we complete his treatment plan, we don't see Reni for a while. He misses his cleaning appointment, and if you miss your cleaning appointment in a dental office as busy as ours, you slip through the cracks until you call up with a problem. Which, inevitably, you do. That's how it works for Reni.

"Hey Doc," he greets my dad after his three-year absence, "how's it goin' with you?"

My dad beams. He loves it when people call him Doc. Eleven years from now, my dad will go head-to-head with the incumbent town mayor and use the name "Doc" while campaigning. He will go on to lose the election, then proceed to wave his middle finger at the state of Connecticut and become a Florida resident, but that's beside the point. "Reni, long time no see. How've you been?"

Reni responds with a hacking cough. My dad turns white.

"Hey there, K-K-K-Katey," Reni looks over at me. He's gripping a cane. He's pale and his face is bony, his cheeks hollow. He's lost a lot of weight since the last time we saw him. He's got to be down about fifty, sixty pounds. He's also missing the pack of cigarettes from his shirt pocket. "Sweetheart, you look spectacular. How old are you now?"

"Eighteen. In my first year of college."

"Son of a bitch." He hacks again, wiping the errant spit off his chin with his sleeve. "I'm old. What college are you going to?"

With all the ease of someone who's been working in this office for three years, I joke with him, "C'mon, Reni, you should know that my old man would only send me to the one all-girls college in Connecticut."

He smiles with me as he eases his body into the chair. He looks so frail and old. Just like he said. My dad and I wash our hands, glove up, put our masks on, and sit down in our respective chairs. Him on his dental stool, me in my assistant chair. "So Reni, why are you here today?" he asks. The look on his face is grim. I cut through its false cheerfulness to the grimness beneath.

Reni exhales sadly. "Well, Doc, a funny thing happened to me after I quit smoking. I got the cancer of the lungs."

My dad shakes his head in disgust. "No kidding. Well, that's always the way it happens, huh. You quit smoking, and then you get cancer."

"Yeah, I'll say. So, in any case, I got this letter from my radiologist saying that I need to have any of my tooth problems taken care of before I go in for treatment." With great effort, he fishes a copy of the folded-up letter out of his back pocket and hands it to my dad. His breathing sounds labored. "My first treatment's in four days."

Looking over the paper, my dad whistles grittily through his teeth. "Shit," he mutters, almost imperceptibly, under his breath. I don't think Reni hears, not over the music coming from the little stereo in the operatory. Then, more loudly, pleasantly, he asks, "So what exactly brings you in here today?"

"Remember my lower front tooth?" Reni asks. Of course we do. Reni suffers from periodontal disease, a chronic infection of the bone and gums. Three years ago, when Reni was healthier, his lower front teeth were fairly loose and my dad splinted them together to keep them immobile. When Dad breaks out his mouth mirror to inspect what's left, that splinting is fractured. Most of those teeth are okay - not great, but not terrible, either - but one tooth is hopeless. It's literally flapping around in his mouth like his tongue and his lip are playing keep-away with it. "It hurts. And it's loose."

"I can see that."

"So what are we gonna do about it?"

"I've got to take it out," my dad tells him.

Reni grimaces. "But Doc, it's a front tooth."

Dad nods, a solemn expression painted on his face. "I know, and I'm sorry I have to do it. But there's this condition called osteoradionecrosis. Once you start radiation therapy, this condition kicks in. If you have a tooth that's really mobile, or if I extract a tooth after you begin your treatment, this condition can cause your jaw bone to die." He shakes his head. "I'm sorry, Reni, but I'd rather see you lose a tooth than lose your lower jaw."

"Can't you splint it again?"

He shakes his head. "No. The tooth is so loose that the splinting will just break again, and when it does, you'll be in treatment, and the the osteoradionecrosis will kick in."

Reni understands, and nods a reluctant, sorrowful nod. "OK, Doc. I trust you. Do what you gotta do."

My dad swabs some benzocaine on his gums, and injects him with a little lidocaine with epinephrine. I use my surgical suction tip and clear the area of all the blood, pus and saliva in the way before handing him the lower forceps. Technically, the tooth is so loose that I could probably pull it out with my fingers, but we're professionals here.

"No, Kath. Hold onto the forceps for a second."

Curious, I put the forceps back on the bracket table and watch my dad as he stretches Reni's mouth wide and pushes his tongue aside with the mouth mirror. Shit. I can see the tumor at the base of his throat, towards the right side of his mouth. It's large, bigger than a golf ball but with the same stippled texture, in a color reminiscent of chicken fat. God. It horrifyingly dawns on me that Reni's lung cancer isn't just in his lungs anymore. It's spread. And if it's here in his mouth, it's probably situated in other places in his body as well. I swallow with terror. Reni begins to hack again.

"You okay, Reni?" my dad asks him.

"Sure. As good as the day I came off the press."

"Okay. Kath, the forceps." I hand him the forceps. It takes him all of three seconds to extract the tooth. Before I can blink, the tooth is out, the gauze is in, and Reni's jaws are locked together to stop the bleeding. Not that there's much bleeding.

"So Reni, these precautions are for today only," my dad instructs him, running through the rote spiel that he always has to tell patients post-extraction. Soft diet, quiet activities, no aspirin. I notice that Reni's not paying attention to any of it. He's staring off into space like he wants to ignore everyone, ignore everything, including the fact that he just lost his lower front tooth. I feel sorry for him. Sorry and scared.

After a few minutes, once my dad's done with giving him post-op instructions and removes the gauze from his mouth, Reni sits up and asks for a mirror. Dad hands him the hand mirror, into which Reni looks at himself and smiles broadly. The socket which only a few moments ago held that missing front tooth is clotting well, and Reni stares at the crimson-brown spot incredulously. Like he can't believe how shitty his luck is. One minute he's healthy, the next he's got lung cancer. One minute he's got a full complement of teeth, the next he's missing one in the front. Staring at his reflection, he begins to laugh bitterly, like someone high on drugs. He puts the mirror down and rubs his hands together.

"Looks good, don't it, Doc?" he cracks sarcastically. I can hear his heart breaking in his voice.

"I just need you to be well, Reni," my dad answers quietly, shaking his head.

Reni shrugs. "Yeah, whatever." He locks eyes with me, and his eyes almost frighten me with the emotions swimming around in them. "K-K-K-Katey, my beautiful Katey...good luck in school. You're gonna be a star, I know it." Then he looks at my dad. "Thanks, Doc. It's better to laugh than cry, right?"

Dad nods. "Yeah, Reni. It's better to laugh than cry."

Before walking out the main office door, Reni looks over the front desk to Constance, the receptionist. "Hey Con," he shoots out, disbelief thick in his voice, "take care of yourself, will ya?" Then he closes the door behind him and walks out of the practice without any further good-byes. We can hear him muttering to himself out in the hallway, "Christ. Now this looks real good."

The rest of my semester passes unremarkably. I get through my final exams and pull two As and two Bs. Not bad for my first semester of college, especially considering that my courses consisted of Intro Biology, Inorganic Chemistry, Calculus and this Art of Effective Writing course that was a pre-requisite I couldn't get out of it. I choose my courses for next semester and I return home for the holiday break, gearing myself up to work six days a week in the office. That will be some good money. I'm thinking about investing the money in a vacation with my new boyfriend Daniel this summer. That will give me something to look forward to.

The new year comes and goes, and on the last day of work before I go back to school, Gary comes in for an appointment. Gary is a very polished and well-dressed guy, a professional salesman at the top of his game. He works in the same department as Reni. The hygienist seats him for a cleaning.

"Yeah, it just wasn't the same at the annual holiday part this year," Gary tells us with a heavy quiet in his voice. He carefully lowers himself onto the dental chair. He's very into his appearance and tries to avoid wrinkling his pants and shirt whenever he comes into the office. "Reni's chair was empty. The lack of his presence was palpable."

"What do you mean?" the hygienist asks him incredulously. She knows - we all know - what's coming, but until we hear confirmation, we're in denial.

"Oh, you know, Reni lost his battle with cancer," Gary offers nonchalantly, answering rhetorically like it's plain fact to him, no emotion involved at all. He eases his head back into the headrest. "We left his usual chair empty. It didn't seem right otherwise."

"Oh my God," I murmur with an overwhelming sadness. "Reni's dead." I look over at my dad and Constance, who are both situated in their usual positions at the front desk. They heard Gary. They know. My dad shakes his head and mutters, "That's too bad." Constance drops her head and closes her eyes, as though in a silent momentary prayer. I feel like I'm going to freak out, and I just barely manage to hold myself together. I am a professional. Well, sort of a professional. But I still need to hold myself together. I excuse myself to use the ladies' room.

I walk down the retro wood-paneled hallway and into the ladies' room, where I lock myself into one of the stalls. I don't actually need to use it, though. I came in here to collect my thoughts, collect myself, before going back in to the office. The news about Reni rattled me hard. It rattled me so much that I think now I actually have to pee. Damn it. So I use the facilities and exit the stall to wash my hands.

There's a mirror over the sink, and I look into it as I soap my hands up and scrub thoroughly. I may not be a doctor yet, I still have a long way to go, but I'm getting the extensive hand-washing thing down. I study my hair, my face, my eyes, my teeth in the mirror. I look into my eyes, dark and chocolate-brown, drowning in sadness for the passing of a man who used to sing and smoke and call me K-K-K-Katey.

My lips begin to move. They begin to form the stutter. "K-K-K-Katey..."

The tears fall down my face, quietly and without shame. I continue to wash my hands and let the fat tears roll over my cheekbones on their steady course. He's just a patient, I think. He was just a patient. But I liked him. He was a good man, a pleasant man, and this practice won't be the same without him. I dry my hands and my eyes with the same paper towel, then I return to the office space, thinking there will never be another person who calls me K-K-K-Katey ever again.