by Stephanie Sides
My boarding school friend ML grew up in a family that ran a funeral home in a small town in the southern tip of Illinois. I remember visiting her for a week one summer. She took me up to the casket room where several beautiful caskets, silk- or satin-lined in different colors, were laid out, as it were, with signs indicating a price and what services that bought you. I was fascinated, peeking into a world I had never visited.
While my experience in the funeral home had been brief – and safe – ML’s experience there had taken a toll on her. Recently, as she was approaching some major dental work, she told me about its affect on her feelings about that.
At the funeral home she had repeatedly seen dead bodies in the embalming room. Their mouths were open, toothless (in cases in which dentures had been removed), and their blood was being exchanged via something resembling an IV for the more rose-colored embalming fluid of formaldehyde, which turned, as she explained, the normal blue color of a dead body back to the pink color mourners expect.
As she began going to the dentist, she found that environment very much the same – and just as scary – as what she had experienced in the funeral home. Because she saw their orientation in the chair and outward aspect as similar, she related dental patients to dead bodies. I think she equated becoming a dental patient with dying.
I learned all this when she told me she needed to have 10 crowns replaced to remove the toxic metals, which she had reason to think had been contributing to some long-term health problems. She had waited too long, she said, and, because she needed so much work, it had to be done in short order, requiring sedation dentistry, involving an IV and a pill-cousin of Valium. So you’re pretty dopey but not completely out as you would be under general anesthesia.
The twist, for me, was that she planned to do it in Tijuana, Mexico, just across the border from San Diego where I lived. She had reason to think the prices there compensated for the extra anxiety she expected to experience. She asked if I could accompany her on the two-day adventure to get the work done; the idea was that, if something went wrong, I’d be there to help. She was coming from Los Angeles, just two hours north.
I had recently resigned from my job and was living the proverbial life of leisure as I contemplated next steps. I knew her well and I speak good Spanish. So I was the logical choice. I told her to count me in.
A large group of well-trained Mexican dentists (and doctors too, I hear) have smartly marketed their medical specialties in the U.S., targeting not only U.S. citizens but others from around the world that realize they can access their services easily from the U.S. side of the border.
This is how it typically works: Patients stay overnight in specific hotels in San Ysidro (through agreements with the medical offices in Tijuana), the town on the U.S. side of the western-most border crossing with Mexico, then ride a shuttle across the border in the express lane directly to the dentist’s office of choice (which takes about 15 minutes), then call for a return ride when they’re finished. The transport is reasonably priced and very efficient, though it tends to take longer returning to the U.S. because of the more rigorous immigration procedure.
As we learned later, it’s less time-consuming and probably more cost-effective to stay overnight in Tijuana until the dental work is finished. But the majority of patients seem to prefer to return to the U.S. each night, especially those that are just in it for the cost savings and who have relatively little experience, interest, or confidence in traveling to Mexico.
The most typical clients are people with long-term dental problems requiring lots of very expensive work.
Entrepreneurial types have seized on this opportunity and developed businesses that provide information and even travel arrangements to U.S.-based and other clients to enable them to secure the medical care they need and perhaps, just as importantly, a level of comfort about getting that care in Mexico. I have no idea what their markup is. Still the potential for great overall savings, the oversight they provided to nervous travelers, and the perceived sense that the dental service will be sufficiently high quality create an incredible demand for their services and direct interaction with the dental offices in question.
In ML’s case, the savings was something like 75%. Since she’d already been to Dr. Morales three times before, she had the relationship on which to negotiate the price and, I think more importantly, she knew the quality of what she’d be getting.
So, in spite of her anxiety about dental work in general, she was coming to this appointment with more confidence than some of the other patients we encountered.
Still, the previous time she’d gone to Dr. Morales, she’d witnessed a man of similar age who seemed excessively debilitated, which gave her pause about how general sedation would affect her. Could she handle it alone? More practically, could she expect to “walk across the border” back to the U.S. as was commonly done in the U.S.? These questions told her she needed a friend to accompany her to be safe.
The day of ML’s appointment, we left my house at 5:30AM to pick up the shuttle at 7:00.
Departing a half-hour late, the shuttle dropped us at the dentist’s office, about five blocks away from the main shopping area, before the office opened. That reminded us about the Mexican offset in the day: They start later, take a later lunch (around 2:00PM), and end later than the American business day.
The cleaning lady let us in, and, though ML’s appointment was at 8:00, we waited another 90 minutes.
ML had negotiated a price for the crown replacements, teeth whitening, and correction of her problematic bite with the dentist, but no paperwork was ever produced to confirm that. So, as ML put it, “the patient has to be in charge of communicating – reminding, mostly – about her dental care to the office workers and dentist himself. If that – and the typical ‘slippage in appointment time’– work for you, you’ll get a lot of work done in a short time, save a lot of money, and likely be very happy with the results.”
As we waited, I checked out the office: a world map with pins showing where past patients were from (a surprisingly large number of countries; this dentist has been doing this kind of work for a dozen years), two exhibits of what appeared to be fossilized animal teeth, and fashion magazines, some dating back to 1993. The office also had wonderful sunray grille work on the outside of the windows: I guessed the purpose of this, without being super-obvious, was to prevent people from breaking in and robbing the office of the drugs inside. My suspicion was perhaps confirmed by a noticeable bullet hole in the window.
ML’s care started with a massage on the second floor of the facility. In an anteroom, the TV was blaring with a cartoon in the face of a hand-written sign, which, in Spanish, said: “Quiet, please. Massage underway.” There, we found Fernando, the 6-year-old son of the cleaning lady, watching the TV and drawing while his mother worked.
ML emerged 45 minutes later. She said it was the best massage she’d ever had. From my perspective, she looked like a completely different person. She indicated later the office included a massage in the purchase price because it got one’s bodily systems more fully functioning, enabling quicker recovery after the sedation. That was a fact, jack, she said later in the day.
She waited a bit, then was called in for the dental work: Four hours to remove the crowns, put the temporary ones in place, and whiten her teeth.
Most of the time I sat and read my book, suitably an arcane 900+-page novel from the 1860s by Trollope (which I came to within 10 pages of finishing by the time we left Tijuana the next day).
I heard lots of drilling but no signs of discomfort. If anything, all patients seemed to be very tolerant of the delays, very happy with their outcomes, and planning to return.
I saw and heard a slice of Mexico, I thought, as I sat there: A burro being led up the street to the main shopping area with which, on nearly every street corner, tourists can have their photos taken as a memento of their visit to Tijuana; electioneering cars pass by with speakers on the roof advertising the election August 5; complementing these cars, precinct workers, in red T-shirts supporting their candidates of choice, working the streets with clipboards. But I realized it could have been any place in “main street America” were it not for the Spanish being spoken.
Throughout the day, the dentist and his associate would come and go – to the bathroom, outside to make a cell phone call, and talk with those of us in the waiting room in English or Spanish. They were all more relaxed, even casual and funny, compared with the American standards I’m used to. I’m guessing that, since their foreign clientele pays cash, they may not have the pressure of serving a higher number of HMO-funded clients as in the U.S.
I talked with several patients while they waited for their appointments. In our two-day adventure alone, I met people from Oceanside in northern San Diego County, Las Vegas, and from as far away as Maryland, including one whose business was to promote interest in these kinds of services.
I also was an unwitting “reference” for the dental practice with a local woman casing the place to see if she wanted to avail herself of its services. Her English sounded native and she came with a native Mexican mother and an English-speaking daughter, which brought home to me how truly mixed the border area is.
Some 50% of the office’s clientele seemed to be locals. One was a typical Latina – the type that always makes me feel insecure about my “femininity” as I dress in blue jeans and clogs. She was wearing a snug but well-fitting dress showing the usual amount of décolletage and high-heeled sandals. When she entered, the dentist commented approvingly in her direction so that she could hear: “Qué milagro!” [What a miracle! Or, taking more liberty in translation: How fabulous you look!]
That phrase became the mantra for our adventure as ML’s dental work turned out likewise to be a miracle in terms of how much easier it was than she anticipated.
About halfway through my wait the first day, I went out for lunch. The place ML had suggested, two blocks up the street, was now graffiti-covered and out of business, so I continued on to a place called Café Suiza. It seemed clean, had some business so probably had good food. The sign in the window advertised, suitably, enchiladas suizas. I sat down and, looked at the menu, and requested enchiladas suizas. The waitress said they didn’t have them. So I ordered chicken enchiladas with green sauce (the exact same thing), which they did have. Go figure.
While I ate, I watched a telenovela, the likes of which ML had worked on for several months in Dallas. I had seen them occasionally before but now, in context, I wanted to pay attention. But they talked so fast that it was hard to understand. So I focused on the blue cosmetic masque one of the characters wore for the entire show. I found that both funny and surprising, as Mexican women tend to have a sexier, saucier presentation than most American women I know and would never show publicly how hard they work at looking good. Go figure again.
In general, I was continually surprised at how much more prosperous and clean Tijuana was and how happy the residents were than I had remembered from my last visit several years before. ML’s dentist was quite funny – in Spanish and English. The hawkers on the main shopping strip – La Avenida Revolución – were similarly relaxed and funny, inviting us to come in and “buy things we clearly don’t need.” They didn’t seem to resent Americans as I had remembered. This was reinforced by others who came into the dentist’s office – they seemed like vendors or salespeople of some sort – who struck up conversations in nearly native English with a gringa. And, except for the hotel we stayed at on the doorstep of the border, people seemed happy enough to speak with us in Spanish when we indicated we wanted to do so.
…
I was wondering how to end this story when I arranged a phone call with ML for her to comment on an earlier draft. As a writer, I unfailingly anticipate that this kind of interaction will amount to the other person commenting at either a macro (the general ideas or structure need tuning) or a micro (copyediting) level.
But ML had a completely different idea. The title that I suggested for this article, which she had seen in the first draft and which we kept, got her thinking more about what had really happened to her.
She told me that “a minor miracle” had occurred to her as a result of this experience. She, like many in our generation, had undergone years of therapy to address the demons in her life. But, given the time and expense involved, she had gained relatively little insight into her anxiety about dental work.
In the past a friend had advised her: “Just act like a normal person and take drugs to get through it.” So, when ML had to get crowns the first time in 1991, her friend took her out for drinks to meet the dentist and develop a plan for the work. Because the friend had recast the encounter as a more personalized, social experience, it worked. (The dentist’s recommendation: Take a cab and rely on Valium at his office.)
That worked then but, luckily as it turned out, couldn’t apply this time. For the Tijuana experience, she had a trusted friend to accompany her and not be judgmental, the process at the dentist’s office was “brilliantly relaxing,” and she and I were collaborating on something creative – this article – about the adventure. This combination of factors had led her to a completely new outlook that a lifelong challenge can be resolved. Significantly, because she was able to talk about the experience while she was moving through it – in fact, it was ML who set the tone by being the one to stamp it an “adventure” – made it more transformational than talk therapy.
“For a long time, I’ve been thinking about and filming pieces of what I hope will become a movie about growing up in a funeral home,” ML said. “But I need a collaborative partner who doesn’t have this experience. Since I don’t have one, I tend to get stuck. I guess I just needed a collaborative partner with respect to my dental work to help me get un-stuck about that too.”
A few days after our phone call, ML returned to Tijuana to get the permanent crowns put in. This time she walked across the border, no problem.