The Porch: A Dental Fable

By Barry Polansky and Deborah Bush

"The Porch" is a business-spiritual fable. It is a masterful work of fiction that serves as an allegory for today's young dentist, as it imparts wisdom to inspire fortitude, purpose, and actions that lead to career satisfaction and a life well lived. This is a Hero's Journey about a dentist whose life goes from hopelessness and despair to growth and prosperity with the help of his philosopher mentor.

Follow along in this journey as Tom, the young protagonist, learns new ways to view his world from Henry who is a dental philosopher. Tom is motivated to determine what he really wants out of life. He also seeks to view new approaches, practice new positive attitudes, and commit to a higher purpose. On his journey, he masters behavioral skills that fuel a passion for his work and lasting happiness in his life. Ultimately, Tom gives back to other young dentists by guiding them like his mentor Henry guided him. Many of the lessons Tom learns and implements in his life are based on the perennial philosophy of the Stoics and today's field of Positive Psychology.

• Language: English
• Publisher: BookBaby
• Release date: Mar 30, 2021
• ISBN: 9781098357108

Book preview

D.M.D.

Part One:

Departure of the Hero

Chapter 1

The Ordinary World

Someone lowered the air conditioning to 65 degrees, and it was most appreciated on this stifling July afternoon. Today was almost over and the end of the workweek. With just one hygiene check to go, Dr. Tom Parker greeted Ann, his last patient. How are you today?

I’m fine, Dr. Parker.

With many things on his mind, he smiled at Ann, looked at Gwen’s notes, and did his examination. Ushering Ann out, he said, Your mouth looks good. See you in six months.

Ah, the day is over, he thought. On the way to his private office, he was blocked by Sally, his receptionist. She appeared alarmed, but that was normal for her. Under stress, she became agitated by the smallest things and routinely passed her anxiety on to him.

I need to talk with you.

He ushered her into his office.

Doctor, I have some bad news.

Out with it, Sally. Cut to the chase.

Your friend Dr. Simon...she killed herself this morning.

Tom fell into his leather recliner. Sally noticed the tears welling around his eyes and thought it best to leave him alone.

Tom stopped her, Tell me more. I need the details.

All I was told was that her husband found her in their garage with the motor running. He called the police, and they determined she had been dead for over two hours.

Where was the baby?

I think she dropped her baby off at daycare at the usual time. Her funeral is being arranged, and they will let us know.

Who will let us know?

The family. Apparently, you were close enough to be on a list of her closest friends...I'm so sorry, Dr. Parker.

Tom's throat felt like it was in a vise. Dr. Monica Simon was one of his closest friends. They had met on the first day of dental school. They had spent many hours together going over notes for exams and many late nights in the lab...pouring and mounting models...waxing teeth. What great hands she had, and what a great dentist she would have made. Talented in every way... intelligent, personable, and so artistic. Monica would have been the class's most likely to succeed. And now she was gone.

###

Tom shut the door to his private space. Once alone, the primal urge overcame him to collapse inward on his gut and cry out in pain. Oh God, why, why, why? he could be heard softly wailing through the closed door.

They had just had lunch the week before at their favorite pizza place. It was a good location to have private conversations about how the world was treating them. In other words, it was a good place to complain. Monica had confided that she hated dentistry the way she had to practice it. Things had taken a turn for the worse after the baby was born and she went back to work at the newly opened corporate dental location in town.

Tom did not like corporate dentistry and had advised her not to take the job. The corporates were competing for his patients and winning by lowering their prices and accepting every dental plan. And they shamelessly advertised...not only about their fees but their quality of work and their superior services, which by his standards were not. Monica knew that, but she still turned to Tom for emotional support.

She needed to vent. She told Tom she used to love dentistry, but at the new place, they made her do dentistry that was below her ethical standards by hurrying along, which meant she sometimes missed steps. They made her insert restorations made in laboratories thousands of miles away, and the restorations were not the quality she was used to. Patients were coming in the front door and going out the back door. She wondered if their dentistry had failed. Would there be a lawsuit? It had even crossed her mind that God would punish her for doing that kind of work.

At first, Tom used to say, There are alternative places to work. Maybe, you should set up your own practice, but she always shook her head no. She felt she couldn’t risk losing the income she was making. Her husband Paul was a salesman who brought in less than half of what she made. And having the new baby seemed to have made things worse. Lately, she seemed glum or numb, easily lost her train of thought in conversations, and only picked at the pizza they ordered for lunch. Tom wondered if she suffered from postpartum depression on top of the stress of dental practice. Surely, she would have sought medical help for that…but would she have? Doctors are notorious for not seeking help as it might injure their reputations.

Remembering their conversations saddened Tom. Monica had turned from the most popular and prettiest of his classmates into a heartbreaking and miserable soul.

Tom stood up straight out of his reclining chair, realizing so have I. Tom had started his practice six years ago, directly out of dental school. Classmates told him that was risky. He needed to learn more dentistry, so he took continuing education courses. He learned the more popular procedures like cosmetic procedures, bonding and veneers, and the newer endodontic practices. He had attended some limited implant courses and the new Invisalign courses that were becoming popular. Lately he had started taking sleep dentistry courses. He enjoyed the education, but it rarely translated to making more money.

The new techniques just became more drudgery as his days felt longer and longer. Something was missing. His way of practice was just like Monica's. The only difference was he didn't work for a corporate. He worked for an idiot, and he was the idiot.

There was a knock on the door. Sally called out, I'm leaving, so sorry again. They called and said the funeral would be on Tuesday at Johnson's Funeral Home at noon. Oh, and by the way, I left a chart on your desk. It's Lillian's, your last patient. She left you a note.

###

Tom’s 20-minute commute through the city and into the suburbs was relatively easy. Linda and Tom had chosen to live in Bountiful, a suburb of Columbus, because of that easy commute. He usually took a shortcut through the wooded groves. He felt prosperous on most drives, appreciating the beauty of the landscape and architecture. Six years ago, he hadn’t dreamed of living in such an upscale community.

On tonight's commute, his mind drifted toward his mortgage and how overextended he was. The financial pressure of trying to run a private dental practice was taking its toll. With his office overhead, his home expenses, and just keeping up with the Jones's, he didn't know how long he could sustain the pace. He was under pressure to produce more and more dentistry, and yet it seemed like there was less and less predictability and consistency in his income.

Tom was seriously considering leaving dentistry. It was becoming too stressful. He always made enough to get by, but this wasn't the job he signed up for when he entered dental school. The four years of dental school and six years of private practice had taken its toll.

Like many of his colleagues, Tom had hoped for a less stressful and more lucrative job. Now, it would be difficult for him to close his practice. This was due to his student loans, his family depending on him, and the disappointment that his parents would suffer after saving for years to send him to school. The cost of quitting was way too high. He would just have to plod on.

Tom wondered how this had come about. He lived an idyllic life—a yellow brick road where one success always led to another. Just get good grades and take the next step. Paths were laid out for him to follow...at home, in school. He followed all the cultural norms.

He had been a good student and a high school athlete. Tom met Linda in high school, and they stayed together through college. When he entered dental school, he was one of a few students who was married. The other students envied him for his stability. His life followed an ascending trajectory, but today, it felt like something had gone terribly wrong. Monica's death was challenging him to put everything into perspective.

His BMW turned into his driveway. Linda was home and he would have to tell her the bad news. Linda and Monica had been friends since dental school. Linda had been a dental hygienist in Tom's practice, but she had stopped working when their son was born.

I'm home.

Dinner is on the table. You’re late.

As soon as he came into the kitchen and she saw his face, Linda realized something bad had affected him. She sat down and fixed her eyes on his. What happened?

The words came tumbling, They found Monica unconscious in her garage with the car running... He could say no more.

At first unable to speak, Linda absorbed the shock.

I saw the signs, Tom. Monica had a difficult time getting up and going to work. The joy she used to feel about doing dentistry disappeared. She was beginning to hate her life and I sensed she might be hiding some deep depression, trying to carry on. God, I wonder what I should have said or done. About work…I just told her to hang in there. I hoped things would improve…but we rarely know what is going on inside another person. I mean we glimpse it but don’t really know.

Tears started flowing, and then Monica let it out in great moaning sobs. Tom leaned over, put his arms around her, and held her tight. She managed to ask through the gasps how the family was holding up.

I don't know. I heard the funeral will be Tuesday at noon, at Johnson’s Funeral Home.

I guess we’ll know more soon. You know, don’t you, that the gossip will come nonstop? Everyone will have their own version...creative storytelling. Rumors about a bad marriage, someone cheating on someone, she was sick, they were broke. You know how the stories start. But we may never know why she did it.

She told me she hated her work, and I could tell she was unhappy. I think you were the only person she trusted, and if you don’t know why….

Tom, she was lonely and exhausted. She felt more isolated after having the baby. She was so scheduled with work and daycare transport and then spending time with the baby at night…and Paul had to be on the road a lot with his job. We stopped seeing each other and rarely talked on the phone. I should have done more. I didn’t realize things were escalating to her feeling hopeless, but there could be more to this. She could barely discuss her loneliness even with me. She felt Paul didn’t understand what she was going through.

And from my perspective, said Tom, People don't believe the old-wives’ tale about dentists having the highest suicide rate. Most people think it's absurd. They think we have a charmed life. Little do they realize how much stress we feel every day. That had to be a part of it.

I know, Hon, I was a hygienist, remember?

Linda, this is really affecting me. I think I need some time off, but I can't take time right now.

Linda searched a pile of professional journals and came to an article she was saving for Tom. I realize the article is a couple of years old, but I’ve been reading about Vivek Murthy’s call for change for three years now, said Linda. The public media and talk shows keep referring to the problem.

The headline screamed at him:

SURGEON GENERAL CLAIMS THE NUMBER ONE PROBLEM WITH HEALTHCARE IS THE WELL-BEING OF OUR PROVIDERS

Tom looked over the article. The former Surgeon General was calling for greater attention on physicians’ well-being and evidence-based action. Murthy said it was long overdue to create a culture where healthcare providers could seek help without being stigmatized as weak.

Linda handed him another related article. This one, written by a physician, reported that close to 50% of physicians had suffered from some form of burnout, and the World Health Organization recently classified burnout as a legitimate medical diagnosis.

Tom recalled listening to an ADA podcast one morning a while back. It had been about burnout among dentists. He could not remember all of it, but a couple of 2018 statistics had stuck with him. He remembered that over 60% of physicians were not optimistic about the future and close to 80% said they were experiencing burnout. Burnout isn’t just happening in medicine, he thought.

Tom was aware that, year after year, both dentists and doctors were reported to be among the professions with the highest suicide rates. He had read about suicides occurring in dental schools. He believed depression was real. He had his personal bouts with it. Other than Monica, he only knew of one other suicide among his associations, and that was one of his classmates while in dental school.

It's becoming a worldwide epidemic, Tom blurted out. I know of many dentists, young and old, who are suffering from mental health issues from anxiety and depression to overworking and marriage problems.

He began to read out loud for Linda's sake, Listen to these symptoms. First, feelings of mental and physical exhaustion. Next, increasing mental distance from the job, feelings of negativism and cynicism, and finally reduced professional efficacy. Linda, I think I have burnout.

Tom was worried. He knew he was feeling a little depressed lately. He thought the waves of hopelessness were just part of running a business, but apparently, he had a new disorder. He felt an urgency to get some treatment. I don't want to end up like Monica, or worse yet, to practice in a living hell.

Take it easy, Tommy. Let's look into it a bit more. Can we see a doctor?

A shrink? I can do this myself. We can fix this, even if I have to leave this flawed profession. I'm going to start with that first sign, the exhaustion thing. I'm going out for a run.

###

The July sun was setting, but the humidity was still high. Tom changed into his gym shorts and running shoes. They barely fit anymore. Tom hadn't exercised in years. He always found excuses. Mostly he was too busy. He had gained 25 pounds over the past five years. Occasionally, Linda would let him know with little, good-natured pokes, but today's events were the nudge he needed. Mental illness scared him. The thought of suicide was not as foreign as it seemed. There were moments... just short instances...but they were there.

He took off into the twilight. This was hard work. His stamina was low, and the heat was causing uncontrollable perspiration. He became winded after one block and decided to walk. Yes, I'll walk until I can do better. He was proud of himself for taking a first step. The fight has begun, he thought.

After 20 minutes, he returned home, exhausted.

Home so soon? Linda hollered from the laundry room and came down the hall to ask, How did it feel? You didn’t overdo it the first time out, did you?

I'm going to beat this or get out of dentistry. I know of a guy who hated dentistry and left to become a farmer. I'll bet he's a lot happier now, growing tomatoes.

"Yeah, that's the ticket. Become a farmer. I don't quite see that as your calling. By the way, I saved your dinner for you. I’ll heat it up."

Tom sat down at the kitchen table and noticed the chart he had brought home, Lillian's chart. There was a sealed envelope with an attached labeled: Confidential. For Dr. Parker. He opened the letter and read it out loud.

Dear Dr. Parker, I have been your patient since the time you opened your practice. My entire family comes to you, and we considered you a close friend and even a member of our family, so close that we invited you and your lovely wife to our daughter's wedding. You completed a lot of dental work in my mouth. I must say it looks good...but I am very dissatisfied.

I have been complaining of pain ever since you finished. Your response has only been that I will get used to it. You are implying that it is all in my head. You sent me to a specialist, and after two root canals, I still have the pain.

When I came in today and repeated my woes, you basically ignored me. I have no choice but to change dentists. On Monday, I will call and give Sally the name of the dentist to send our records. I am sorry it had to end like this. I thought you were my friend.

Linda became defensive, Who does she think she is, after all we’ve done for her and her family?

Tom was silent. He kept rereading, I thought you were my friend. Almost comatose, he began to think she might be right. Not only was she disappointed in the work, but she was disappointed in him. She was right. Tom had stopped caring about his patients. Oh sure, he cared from a transactional perspective, but he was beginning to depersonalize. They were just procedures and profit, not people. He reflected again on the symptoms of burnout. He was emotionally exhausted. He was failing to see his patients as people, and the rewards just didn't seem worth it.

It hit hard. I’m a burnout, he said.

Chapter 2

The Call to Adventure

On Monday morning, Tom called Sally and told her to expect Lillian's call to send the records to her new dentist. He also told her that he would not be in today. He would see her tomorrow at the funeral. Tom dreaded the idea of going. This would be the worst funeral of his charmed life.

The rest of Monday seemed like a fog. He tried to run again. He pushed himself to go one more block and congratulated himself for making progress.

After dinner while staring aimlessly at the Evening News, the phone rang and broke him out of his trance. It was Monica's husband, Paul. Tom answered the phone with, Paul, I'm so upset that I couldn't work today. I feel like cancelling the week.

Tom really felt like canceling his career. He wasn’t sure what to say. He wasn’t very familiar with the inner workings of Monica’s marriage and didn’t know if Paul knew the depth of his wife's unhappiness with work.

I understand, Tom. I am calling to ask you for a favor. Monica spoke so highly of you and so looked forward to your talks. She considered you one of her best friends. I think she would love to have you say a few words at her service tomorrow. I know this is short notice, and I know how uncomfortable this may be for you...but you really meant a lot to her, and she didn't have many friends in dentistry since graduation...

Without thinking Tom replied, Of course, I’d be honored.

Thank you, Tom. It will just be the rabbi, you, and I. No other family members can bring themselves to this moment. I’m just devastated. It’s all I can do to breathe. And I can't answer all of the questions she left behind. Paul started to cry but managed to say, I thought we had a good marriage. We never fought. She must have been keeping a lot of things bottled up.

Paul, I know she loved you and the baby. I didn’t see this coming.

Tom felt strong anxiety in the pit of his stomach. Of course, he had to help with the service, but what could he say? All she had spoken about at their last lunch was how she wanted out of dentistry, how no one understood, and how she had a responsibility to continue. He knew she had been unhappy...but not like this.

They hung up. Tom spent the rest of the night composing his few words. In less than fifteen hours, he would have to speak. He always shied away from public speaking. He froze whenever a teacher called on him in class. He even disliked addressing his team at the annual Christmas party. Now he was committed.

With the same determination that promoted his new exercise regime he sat down to write his few words. But what should he say? Should he take this moment to tell what he thought was her truth...the flawed profession? Is that what took her life? He was sure the attendees would include family, friends, professional acquaintances from the local dental society, and maybe some of her professors.

He thought no one would want to hear that old story about dentists and suicide. The appropriate thing would be to celebrate her short life, explain their close relationship, and remark on how much she loved her family and how giving she had been to others. If he could bring Monica back and speak directly to her today, his few words to her would be to just keep going. Never give up. Never quit.

###

Tom woke up early on Tuesday morning to practice his speech. It wasn't much, but his anxiety was getting the best of him. He hated himself for this inadequacy. Linda made him a breakfast of oatmeal and berries. He looked at the bowl skeptically. Is this my new diet? What happened to my bagel and cream cheese?

Well, if you're going to lose weight, why not start today?

She was right. Why not start today?

Johnson's Funeral Home was located just outside of the city. It was a family business, and Mr. Johnson's wife had once been a patient. She was a nice elderly lady, who didn't hold high value for her teeth. Like most dentists, he felt judgmental about that. Maybe, he wouldn’t run into her there. At least, he hoped so.

They pulled into the parking lot. Even though they were early, there wasn't a spot to be found. He dropped Linda off and looked for a place down the block. He found one next to another a car that looked familiar—a brand-new Porsche 911 with tags that read SMILE4EVR. Does everything have to be about smiles these days? Tom thought sarcastically.

Tom knew the car belonged to Monica's boss, Stan Edwards. Monica had hated her boss and everything he stood for, including that car. In a strange way, Tom felt Edwards might have contributed somehow to her death. Tom often wondered about the examples business owners set and how their leadership styles affect the customs and habits of the people who work for them. Edwards would have created the climate and the ethos that everyone worked under...what people these days call the culture.

Most of Tom’s conversations with Monica had centered on the toxic culture that Edwards had created, yet he appeared so successful...his car...his designer clothes and sunglasses...and of course, the de rigueur smile of today's cosmetic dentist. He thought, Is every dentist a cosmetic dentist today? Just make up a smiley name and buy a big sign.

Morning, he offered to Edwards, nice wheels.

Thank you, do I know you?

Tom extended his hand and replied, I'm Tom Parker, a dentist in town and a good friend of Monica's. You were her boss, right?

Yeah, what a tragedy. She was such a good person and one of my best dentists. She'll be missed.

Tom thought, Sure, she will. You’ll miss her production. They walked together to the visitor's waiting room. It seemed like a long walk. Despite Stan’s trappings of success, Tom knew Stan wasn't a happy guy. According to Monica, Stan was angry most of the time. No one could please him. It was all about one thing for Stan Edwards—production.

Stan was already on his third wife,