Life in dentistry with autism

autism conceptAutism is a lifelong developmental disability that affects how people perceive the world and interact with others, according to the National Autistic Society. Here Dominic O’Hooley opens up about how autism affects the way he thinks and acts in and out of dentistry.

‘I just don’t know what to say about Dominic. He is such an odd boy… He seems to listen to what I say to him and then float away to do exactly the opposite.’ So grumbled Mrs Wood, my teacher and apparent nemesis speaking candidly to my mum at parents’ evening in primary school.

This place I inhabited in body, where I occasionally visited in mind, but where for the most part, I viewed the internal geography of corridors and rooms through the lens of the self-focused trance-like-state that defined me. That defines me.

This preamble sets the tone for what follows; an attempted treatise exploring how someone with autism, ‘the autist’, has ended up within a profession known for the sophisticated nature of human interactions that define its day to day. The almost artistic nature of the balancing act as we take our patients on journeys when their fear closes down their ears. Where they hear only a semblance of our complex explanations, relying on our sensitivity and emotional intelligence to guide them and keep them on the road with us. To that end point when we both smile, perhaps, and the job is done.

Growing up with autism

As a child, I knew very little and I certainly didn’t understand that I was different. The fear was with me though. ‘Hello, dear friend, I am with you now. I am in you: in your stomach and behind your eyes. I see what you see and I refuse to tell you what it all means.’

My fear taunts me, this lost boy who wanders alone as his school mates play on the field. As their screams of joy startle, bringing me momentarily from my tear-filled musings.

Don’t worry, this isn’t going to be the self-indulgent whining of the misunderstood middle-aged man. The ruing of days gone by when, if only I knew what I know now, it would have been different, it would have been so much better. No, if it was going to be that, I would feel compelled to warn you now. I hope instead, this serves a small purpose to give some insight into how I am and what I have had to do to try to function more seamlessly within this world of ours. Within this job of ours.

‘We are all on the spectrum you know’

Are we? I tend not to think so. Then again, who knows what complicated machinations whirr away behind the eyes of the most seemingly straightforward of people?

It has always intrigued me, how everybody else thinks. Do you think like I do?

Constant word streams like rapidly flicking books of facts and figures. Diagrammatic blocks of words and letters and numbers and back to centre… back to centre and off again. Excitement flooding as ‘old faithful’ specialist interests capture me for a moment, spun out to internal hours of deep joy as kind friendly topics take me from the fear and to the comfort of knowing that I have found peace. And back to centre, milliseconds past in the reality outside my mind, disappointment flooding in that it is time for me to start the act again.

Acting normal

Hating myself for lying to you all, all the time, every day of my life. This actor in his comfortable clothes, with his specialist topics and ready jokes; laughing with the horror that he has gotten away with it again. I have fooled you all again and acted my way into the normal that I desperately want to understand. You may well have inklings that all is not quite as it seems with me. It is when I interrupt the Zoom call, social graces all asunder, as I articulate what I need to say, right now.

It is when I lie on the bed at home refusing to go for that meal with our friends, despite seeming so excited about it half an hour before. Tears in my eyes as I completely fail to explain what the hell is going on. As my wife leaves the room, perhaps wondering how she could possibly have ended up with this odd attempt of a functioning human. As I feel so sad that I have failed to be a husband, but also elated that I don’t have to go now.

The song I sway to

Those Zoom calls… Lots of these during the ‘Covidian Age’ that we now inhabit. Those who have been on them with me will notice that I touch my face all the time. That I look down when I am speaking and that I don’t seem to get the taking-turns bit very well.

I can barely stand it. A moment of it is too much. I know what you are going to say next; I know what is going to happen 10 minutes from now; who is going to say what, when, and how.

The Zoom calls for me bring thoughts of our limited little interactions and the scuffling of the mini beasts within their nest. All wrapped up in the importance of the infinitesimally trivial things that enrapture us. This then brings on my obsession with the finality of death. The pure ending of it all that will be like going to sleep for good.

This isn’t suicidal ideation, published within a future digital-chip paper floating on the internet breeze. No, this is just my neutral reality.

I have many obsessions, eg tribology and solid lubrication. Seeing ‘truth tells’ within the involuntary micro-gestures of the liars within us all, gaining notoriety so that when I am over, my name is uttered once or twice.  This is the fact of my autism. This is the song that I sway to; looking past you, towards that thing only I can see.

I want to share it with you. I also want it to interest you and to understand why it is important to me, this thing that I see. And I want you to help me see what you see and for us to connect before our time is over.

But dentistry?

It seems almost like the worst job in the world for someone like me. Well, in some ways it is up there within the upper echelons of professions that expose my limitations mercilessly, cruelly and consistently. The trouble is, that is exactly what I want to happen.

The daily dance gives me a dose of the reality pill that I crave; the medicine that takes my ruminations away for a while, replacing them with the semi-hidden panic of appearing normal and not being ashamed. Not embarrassing you all so you don’t know what to say, where to look. I will think your case through, and I will somehow give you the best that I can do, and I will not take you too far into my world.

No, I don’t want to somehow beat my autism. To do that would be almost as trite as ‘welcoming my gift’. After all, I don’t know what it is like not to be the autist. As the lifelong blind person cannot grasp sight, the limits of my intelligence tell me that I will not suddenly grasp what it feels like to be you. I may toy with the idea of macro dosing psilocybin, licking the cane toad’s nobbled back or necking Ayahuasca, handing me that neurotypical trip, allowing me to journey the roads you walk daily. I may well do this sometime.

Being Dominic

In the meantime, I will embrace the technicalities of this profession of ours. I will engage my patients in the way I know how and often they might smile back at me, perhaps wondering exactly what I was going on about. I will continue to lose myself in scientific papers, enchanted by the attempts to overcome our human limitations through the scientific method. And I will share exciting papers with you all. You will grin indulgently and turn back towards the real stuff that confuses me.

You may well think twice before our next Zoom call. Don’t. It isn’t a big deal. I’m just being Dominic.

I will try hard not to be the social media persona that I always hid behind. This special unique viral time has given me pause to think about being hurt. About hurting, winning and really losing. About not overcoming but accepting. And about facing that little lost boy and holding out my hand to his.

‘Come on son, let’s go and speak with Mrs Wood. I can help you explain it all to her if you like?’

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