On the way from last Monday to this one, I passed my 71st birthday. I also spent time in the dermatologist’s and dentist’s offices. My face is still healing from little spritzes of liquid nitrogen, but my smile is less ragged than it had been after a September incident with an olive pit that had made it, undocumented, into an evening martini.

When the dermatologist’s assistant was updating my chart, she asked, “Are you currently in any pain?”

“Existentially?” I asked.

“Wrong office,” she said.

 

My dentist has put me on notice that he’s retiring. His retirement project is to build a Japanese garden to honor the Japanese farmers who settled into southwest Idaho and eastern Oregon after the internment camps closed after WWII. They and their communities prospered, due to their hard work and the farming skills they brought from the coastal properties they had been forced from by Roosevelt’s internment order.

A Japanese garden strikes me as a superior legacy for a dentist or anyone else. It represents a relationship with the land that is mostly absent in American industrial agriculture, which has become yet another extractive industry. American farms are mining topsoil, mining water, mining the capacity of rivers and lakes to remain potable, mining petroleum for diesel and natural gas for fertilizer, mining the health of the people who harvest their fields and the health of the people who eat the food that is harvested.

Just as shoemakers’ kids once went without shoes, potato farmers’ kids don’t eat French fries. The difference is that the shoemakers would have given their kids shoes if they could have afforded not to sell them, but the potato farmers won’t let their kids eat potatoes because they’ve read warning labels on the chemicals they spray on their potato fields.

A Japanese garden treats the land as a person, one with whom you can have a dialog. To paraphrase Martin Buber, you can have an I-Thou relationship with the land rather than an I-It relationship.

Being in any I-Thou relationship focuses your attention on the dialog-filled space between you and another, rather than on the empty space inside you.

I’m happy my dentist is building a Japanese garden. I hope it tempts its visitors to start seeing the land as living and aware, and to start seeing human relationships with the land as living and aware, too.

 

Dentist chairs: the best locations on the planet to experience existential pain. Plain old physical pain isn’t what dentists do best anymore. Now, you’re alone in the chair, your gums and teeth are numb, your mouth is propped open with a bite block, and any clenched fists or curled toes are just muscle memory from your first tear-scented mercury amalgam session as a kid.

You’re unable to move or talk, facing the slow tick-tick-tick of time, alone with your thoughts. You used to have an I-Thou relationship with your teeth, but they have all become treacherous Its, parts of you that have gone over to the material world, subject to decay and, if necessary, extraction.

What do you think about, besides the It-ness of your teeth? You think about being old and toothless, and you remember that Americans over 65 have, on average, 18.9 teeth left in their mouths, and 27.7 percent of Americans over 65 have no teeth left. That seems high, you think, but Google has a couple of pages on tooth loss and old age that confirm those numbers, at least to the extent that Google can confirm anything.

You wonder about sharks, who continually replace their teeth with new ones for as long as they live. You wonder at the box of stuffed animals, rubber balls and balsa-wood gliders that lies in the corner of your vision. You think they didn’t give out balsa-wood gliders when you were a kid. Even now, when you’ve aged out of eligibility, you want one. You mourn all the times you walked out of the dentist’s office without a glider.

You think that if you live long enough, you won’t have any teeth. Then you think about the symptoms of Long Covid, one of which is tooth loss, and then you think of the people who refuse vaccines, and you remember one Covid victim who said Jesus was his vaccine as they prepped him for a ventilator.

You wonder if Jesus also serves as a dentist and if the Covid victim had any teeth left when they disconnected the ventilator. You remember once, a long time ago, when a dental technician, in the middle of cleaning your teeth, asked you if you had accepted Jesus Christ as your Lord and Savior, and once she took her fingers out of your mouth, you told her that you deeply respected her religion, but, no, Jesus was busy enough these days without having to take on a new portfolio. She didn’t give you a balsa-wood airplane. Neither did Jesus, but you weren’t asking him to.

Then, of course, you start wondering if the purpose of religion is to provide a balsa-wood airplane to hold while you’re sitting in the Dentist’s Chair of Life. It’s a promise that you’re not going to die there, that eventually your appointment will end, that the whole of existence isn’t holding your mouth open while someone works on your teeth. You get to think about throwing the glider in a big loop-de-loop and having your spirit soar with it, even as your ass is stuck in the chair.

You wonder if the Cosmic Dentist is Jesus or his evil brother, the Great Illusionist. Suffering is involved in either case.

You wonder what the purpose of suffering is, and if it’s good for you. You think that suffering better be good for you since there’s so much of it in this world. You remember reading Viktor Frankl’s Man’s Search for Meaning, and you wonder how he was able to show so clearly how consciousness can come from even the worst suffering, and how he came to value consciousness enough to make consciousness, not suffering, the most important thing.

You wonder if sharks think about the fact that they’ll never be toothless. You wonder if sharks are going extinct as the world’s oceans turn to purple acid, and if they know it, and if that knowledge is causing them to suffer, and if that suffering is improving their consciousness or just forcing them into angry, bubbling denial.

You wonder what else to think about while you’re waiting for your teeth to be fixed. Somewhere toward the end of those thoughts, you realize you can just as easily start thinking about a good rare rib steak, and having the teeth to chew it. You lose a bunch of points on the consciousness scale.

You’re going to tell all this to the dermatologist’s assistant the next time she asks you if you’re experiencing any pain. Maybe this time she’ll give you instructions to the right office.

 

Since before the pandemic began, my relationship with the medical profession has been difficult. Upon my ascension to Medicare six years ago, my primary physician announced that the only Medicare patients he took were patients he already had been seeing, and I qualified. But I thought it was a bad sign, and I began seeing small signs that our I-Thou relationship was becoming an I-It relationship, the It being the Medicare patient that he used to treat as a functioning, thinking person. As someone who believes that all medical care in this country should be socialized, I began to see him as a certain kind of right-wing doctor, which meant he also stopped being a Thou to me.

About that time I read Ezekiel Emmanuel’s essay in The Atlantic, “Why I Hope to Die at 75,” which is a well-reasoned and informed recommendation to consciously avoid the horrific treatment of the very old by the American medical system. If suffering improves consciousness, our oldest citizens ought to be active, informed, aware, profoundly stoical, and determined not to waste limited medical resources in a futile effort to avoid death.

Instead, they’re shuttled from incurable disease to incurable disease. They’re hit with dementias, grief after grief, a cascade of personality-altering drugs, and a system that rewards procedures rather than health. They enter a vast medical machine as raw materials and are refined, over time, into the functionally dead. In the meantime, their suffering has been prolonged, their dignity has been destroyed, their consciousness obliterated. Death comes as a relief to everyone but the hospital billing department.

Emmanuel recommends stopping life-saving medical intervention once you’re seventy-five. In my case, that’s four years from now, which seems rather too close, as potentially fatal life decisions go.

But the simple existential truth is that we get old and fall apart. At some point the repair work interferes with making peace with your own mortality. You can decide, quite sensibly, to proceed on a disease-by-disease basis, but at some point, the system won’t be your friend, and you’d better know where that point is.

I now rely on the Salmon River Clinic for health care. I respect the PA who runs it, and she takes seriously my questions and thoughts about my own health. Her knowledge, in my opinion, is better than any M.D.’s, because she’s smart, well-educated, and she knows when to look stuff up.

She knows that I believe in basic health maintenance and common sense when it comes to exercise, diet, and going to the dermatologist when the actinic keratoses come back and to the dentist when the teeth shatter on olive pits.

 

My dermatologist looks about twelve. But he knows a bunch about skin cancer, and his youth makes me think he’ll be there when I retire from medicine, rather than the other way around.

As for my dentist, I’m sending him a book, Gardens of Japan, by Tetsuro Yoshida. It was a gift to me from a dean of the faculty at the College of Idaho. At the time I was struggling with staying at the College (a paying job) or going back to Sawtooth Valley and becoming a writer (a non-paying job). The book is full of hard-to-read diagrams and puzzling building plans and mostly black-and-white photographs, but to the extent a Japanese garden is thought made flesh, the book showed me better ways of thinking about the world than the ways I’d learned so far.

I think my dean was trying to show me I could relate differently, and better, to the College, and become less frustrated with the incompetence, malice, and sloth that afflicted many of my tenured colleagues.

But I saw, in those dim photographs, a way out of my life as an angry professor. I took it. In my new, poverty-stricken profession, I could wander through a world where the paths were more journey than destination, and all the odd and fractured shapes of the world could be brought together in harmony, and there were no English Department meetings.

Not that it turned out that perfectly. But it turned out well enough that I never wanted to go back, even though I missed teaching terribly.

I don’t think my dentist will miss dentistry. He’s been working long hours for three or four decades and the work he does involves that old no-win proposition, fighting entropy.

The book I’m sending him as a retirement gift is a doorway into a world where a gentle decay, coupled with the slow growth of moss and the lap-lap of barely-rippled water, provide for moments of peaceful non-expectation. I hope his garden will add to that world. I hope it will be a place where entropy hasn’t insisted on unconditional surrender, and as such, it will be a place where we old folks can hang out for a little while longer.