Susan Tarnofsky is leaning over a patient, dental mirror in one hand, glinting silver drill in the other. She wears a regulation plastic mask over her mouth, and her assistant, holding yet another instrument, glances at her, wondering why she hasn't begun the procedure. But, before continuing, she pauses briefly, turning her gaze to the patient. "Wow, what a pretty shirt you have on! I like the pink flowers," she marvels, wrinkle-lines creasing into a smile under her regulation mouth mask.
You'd probably think Dr. Tarnofsky's speaking to a nervous-looking child—maybe a five or six year old girl on the verge of tears in the dental chair. But that isn't the case. In fact, the patient is thirty years old, and a victim of cerebral palsy, a disease that severely impairs one's mental abilities and makes day-to day life and interactions difficult. Doctor Tarnofsky, who works for the National Foundation of Dentistry for the Handicapped, deals with mentally and physically impaired patients every day.
The National Foundation of Dentistry for the Handicapped, a foundation Tarnofsky's been involved with for over ten years, offers oral care to needy patients--the elderly, mentally handicapped, and generally disabled population. The care is especially important to this needy segment of the population, whose medical expenses usually aren't covered by Medicare or Medicaid. The organization, which is a charitable affiliate of the American Dental Association, includes about 15,000 dentists across the country. One reason the organization's so convenient is because it flexible—it travels directly to its patients. Tarnofsky and her assistant, by way of van that houses dental materials, trek wherever patients are located—mainly in old age homes and institutions for the handicapped. Once there, Tarnofsky faces unique challenges with each new patient she treats.
In order to complete her procedures successfully, Tarnofsky must develop unique ways of communicating with patients and making them feel comfortable . Because none of the patients are medicated for dental procedures, Tarnofsky explains, she must find individualized ways of relating to them. For instance, in order to connect to a mentally handicapped patient, "you might say something that you might ordinarily say to a five year old—something to distract them from feeling nervous." (Hence, clothing-related compliments work well). Though these conversations are, many times, one-sided, it's important to engage patients in conversation and distract them—especially during lengthy procedures. If they get nervous, Doctor Tarnofsky notes, people oftentimes want to get up in the middle of the procedure—something that's obviously impossible if she's trying to complete a filling and a patient has a nail-sized hole drilled into their tooth! Tarnofsky also faces major roadblocks when treating autistic patients, she explains. Because autistics have difficulty communicating, and even dislike eye contact, Tarnofsky's friendly approach isn't as effective.
Given the plethora of challenges they bring, then, what inspires Tarnofsky to treat handicapped patients? Tarnofsky, who decided to go into dentistry because of the combination of medicine and artistry it involves, was spurred to help handicapped at a young age. She recalls a particular moment during one a summer as a camp counselor, as she was about to meet her group of children. She'd been informed a handicapped child was part of her group, but vividly remembers the first moment she met the child—and the first sensations of nervousness she experienced. "I remember watching [the child] approach with the crutches that strapped onto her forearms, and saw her kind of jolting towards me, because she walked with an uneven gait. I remember being scared because I never met anyone before who had used crutches , and I was nervous because I didn't quite know what to do or how to react--I remember being quite intimidated by the situation." Eventually, though, the camper's cheerful demeanor stripped away Tarnfosky's nervousness, and she became specially attached to the idea of helping the handicapped.
She's progressed a long way from the one day as a nervous middle-school camp counselor. And though she's learned to weave past the layers of mental and physical disease in order to communicate with patients, she still encounters fresh challenges every day. For instance, one day a man grabbed her wrist and wouldn't let go, and her assistant had to wrench him free. In the middle of procedures, patients can burst into unpredictable fits or emotional outbursts. One mentally impaired woman even threatened to call the police in the middle of an extensive procedure.