Visions of death in the dentist's chair

The author went in for a routine appointment. She left on a stretcher.

By Karla P. Montague-Brown, MD
Family Physician/Clarksville, TN

The scariest experience of my life happened on a sunny afternoon in July 1998. After a full day of caring for patients, I walked to my dentist's office, located a few doors from my own. I'd scheduled a 4:30 appointment, figuring I'd zip in after work, get my fillings done, pick up my son from day care, then breeze back home.

Like most people, I've never looked forward to going to the dentist. But I reminded myself that the worst part would be the initial needlestick in my gums, then the familiar fat-lipped numb feeling that would wear off after a couple of hours. I could handle it.

I guess I didn't look comfortable, though, because the dentist teased me good-naturedly, asking whether I was okay. "I'll be fine after that needlestick," I assured him.

The assistant asked the appropriate questions, including whether I had any allergies. "Sulfa is the only thing I'm allergic to, as far as I know," I told her. Then I added, "I generally avoid penicillin, because everyone in my immediate family is allergic to it."

As I lay back in the chair, I relaxed and mentally prepared myself for the injection. "I'm giving you a local anesthetic called Carbocaine," the dentist said. "It doesn't have any epinephrine in it, so it should have fewer side effects than some other local anesthetics."

"That's fine," I replied. I'd received Novocain and other local anesthetics in the past, so I wasn't worried. The injection went smoothly. Okay, I thought to myself, my mouth should start to feel numb soon, and the rest of this should be a piece of cake.

The dentist told me he was going to step out of the room for a few minutes and give the anesthetic a chance to take effect. I nodded. A moment or so later, the left side of my mouth started to grow numb, as expected. But then my face felt flushed and warm, and I became mildly uncomfortable. My expression must have reflected my discomfort, because the assistant, who'd remained in the room with me, asked how I was doing.

"I'm feeling kind of warm," I replied, a little unnerved.

Right then, I began to get drowsy, and the left side of my body started to tingle. That, too, seemed odd; a local anesthetic should make my mouth feel funny, but not the rest of me. Am I imagining this, I wondered, or is something bad actually happening?

"Is this stuff supposed to make me sleepy?" I asked the assistant. By this time, the dentist had returned, and seeing my expression, asked whether I was okay. "I'm not sure," I told him, and tried to explain what I was feeling.

"You might be having a vasovagal episode," he replied. "Let's lie you back a little more, with your head down."

He and the assistant adjusted the dental chair to Trendelenburg's position. A simple vasovagal reaction—yeah, that must be it, I thought to myself. I'll be fine in a few minutes.

Wrong. Trendelenburg's position just made me feel worse. Pressure built in my head; it felt like an overinflated balloon, ready to explode. "This isn't working," I told him, my anxiety growing. "My head hurts and feels big." He raised the chair to its original reclining position.

Suddenly, my sensorium shifted. I felt as if I wasn't all there—off balance, and in a mental fog. Even more frightening, I started having trouble breathing.

"Help me!" I cried out, grabbing the dentist's knee, my composure slipping away. "Something's wrong!"

It didn't seem like a typical allergic reaction. I didn't wheeze, itch, or break out in hives. My throat wasn't swelling, nor did my chest feel tight. Breathing just felt extraordinarily difficult. I had to force myself to inhale and exhale.

"Do you need to get up and walk around?" the dentist asked.

"Yes, let me try that," I answered, trying to calm myself. If I could just relax and try not to struggle, I'd probably be okay, I told myself. My mouth felt dry, and I asked for some water.

Then I began to feel as if I was going to black out, and my mind seemed indescribably strange. I passed a mirror and found it odd to see my reflection. That's when it hit me: If I pass out, I won't wake up again. I've got to stay alert and keep breathing, or I'm going to die, right here in the dentist's office.

Full-blown panic struck. How could this be happening? I'm not even sick, I thought. I'm young, healthy, and have no major problems with my teeth. How could I just come to the dentist's office for routine dental work and leave dead?

Stay calm, I reminded myself. I'm not dead yet; there's still time. Maybe this isn't really a reaction to the medication. Could my mind have picked now to have its first panic attack? No, that didn't seem likely. I'd never suffered from a panic disorder; I'm the cool, calm, don't-let-them-see-you-sweat type. Something must be horribly wrong.

The dentist and his staff didn't seem to know what else to do for me. The physician in me took control, and I started giving orders. "Please call 911," I told the receptionist as I continued walking around the office. I wanted paramedics there, ready to intubate and resuscitate me if I stopped breathing. I also asked the receptionist to call my husband, Terrence, and my office to let them know what was going on.

Then I remembered that I didn't have a regular internist or family physician; I just saw my ob/gyn for regular exams. Who would take care of me? My mind raced briefly, then I remembered Fritz Lemoine, a colleague I respected and felt comfortable with. I asked the receptionist to call him.

My thoughts quickly turned to Terrence and my 4-year-old son, Justin. I didn't want to die and leave them.

"You've got to help me!" I told my dentist again. "Please tell the paramedics to hurry. I don't know how much longer I can make myself breathe."

Inhale, exhale, inhale, exhale—I was growing tired from the effort. "Don't let me die, Lord, please don't let me die," I prayed out loud, fear overwhelming me. Then I caught the look on the dentist's face and the slight quiver in his voice. He was scared, too. I tried to reassure him that I'd be okay, though I wasn't sure I would.

The minutes dragged on, and I started feeling worse. My thoughts again turned bleak. Suppose I didn't make it. What would happen to my husband and son? The rest of my family, and my friends? What would I want them to know?

"Please, you've got to tell my husband and son that I love them, and let them know how much they've meant to me. Promise me you will," I pleaded. The dentist assured me he would, then tried to calm me.

After what seemed like forever but was probably just a few minutes, I heard the ambulance. Before the paramedics reached the dentist's office, the nurse from my medical office burst in. I was so grateful to see her friendly, familiar face. At that moment, I realized how important it is for people who are dying—or even who just think they are—to be around those they know and love. I felt like a scared little girl, and I wanted my mama, my husband, and my son. Later, my nurse told me she knew something was dreadfully wrong when she saw the look of sheer panic on my face. She'd never seen me that way, even in our office's most hectic times.

By the time I got into the ambulance, breathing seemed a bit easier, though I still had to make a conscious effort to do it. But I had begun to shake uncontrollably as though I were cold, even though I didn't really feel cold. I listened as the paramedics relayed my vital signs to the emergency room personnel: My blood pressure was 160/90 (for me, normal is 100/60), and my respirations were 32 per minute. I realized I was probably hyperventilating, and I tried again to calm myself.

When we reached the emergency room and saw Fritz, the physician I'd asked the dental receptionist to call, I breathed a small sigh of relief. "I thought I was going to die," I told him. Then Terrence arrived and kissed me. I was so glad to see him, to tell him how much I loved him. He said he had arranged for a friend of ours to pick up Justin from day care, so I wouldn't worry about that.

I was admitted to the emergency room. Based on the symptoms I was having, Fritz determined that the Carbocaine must have been introduced into my bloodstream inadvertently, causing a variety of reactions, including respiratory depression. That explained the anxiety and sense of impending doom I felt. I was given fluids intravenously and observed for a couple of hours. Gradually, my breathing improved, but I remained out of sorts for the rest of the day, and awake much of the night. By morning, I felt much better, but humbled by the experience.

These days, I'm especially thankful for the blessing of life. And though I've always tried to let my family and friends know that I love them, I'm even more careful to express those feelings every chance I get. I've learned not to take anything for granted.

My sensitivity to the needs, feelings, and fears of my patients has also increased. And I've developed a healthier respect for the medications we prescribe and the side effects and adverse reactions associated with them. As a physician and a patient, I now know all too well what can go wrong. In fact, I'm a bit afraid of taking any medication I haven't taken previously.

In one respect, though, I feel reassured: Two of my own patients have since listed Carbocaine among the medications that cause them problems. At least I know I didn't just have a panic attack.

Almost three years have passed since my "near death experience," but I still haven't gotten those fillings done. I haven't yet found the courage to make another dental appointment—not even for a cleaning. So I floss and brush diligently, hoping this will be good enough for a while. For now, at least, it will have to do.

Karla Montague-Brown. Visions of death in the dentist’s chair. Medical Economics 2001;10:136.