The Downside of Sweden, Part I: Dentists
Here in the Frozen Tundra, Pain is Considered More of a “You” Problem
This is an occasional series about things I don’t like about Sweden. Usually in this space, I argue that America is bad and Sweden is good and to be clear, I have never regretted my decision to leave the former for the latter. By my calculus, the tradeoff has had very little in the con column. But I have to be honest with you: There are a few areas in which I think Sweden sucks. In this fair and balanced series, I detail them for your benefit.
Healthcare here doesn’t cost much, but it pretty much sucks. I understand what an unimaginable luxury it would be to have healthcare at these prices — a $25 copay for a CT scan, for instance — for the many Americans who are struggling right now with the sadistic U.S. healthcare system. But still, Swedish healthcare sucks. I think of the words of my journalism school professor: “If it’s free, it must be worth nothing.”
Most of my work contains some element of analysis, but this one doesn’t. It’s only a story.
When I got here in 2019, I was normal. I didn’t love the dentist, but it was no big deal. Before I left the U.S., I knew I needed a cap on a tooth that had been bothering me for a while. “Don’t wait too long,” my American dentist warned. But I did. With this and that, I never got around to it. Then, one Friday morning about two years into my time in Sweden, I woke up in pain.
My Swedish dentist took a look. I was shocked when she said I needed a root canal. I was even more shocked when she said that we were going to do it right then and there. Everyone masked up. The suction device roared, the drill whined and the sickle probe tapped in a frenzy of activity. And then, like blowing out a candle, all activity ceased. The dentist turned off the overhead light, took off her mask, and said I needed a specialist.
She didn’t say why and I was then still new enough in Sweden to ask a doctor a question, sweet summer child that I was. “Why do I need a specialist?” I asked. In silence, she squeezed my elbow, passed me a card, and then disappeared like mist.
Some tortures are physical,
Some are mental.
But the ones that are worst
Are the ones that are dental.
― Ogden Nash, “This Is Going To Hurt Just a Little Bit”
Doctors here don’t explain things to patients, because the doctor is the government, in the same way that a Department of Motor Vehicles clerk is the government. Do DMV clerks explain things to you, patiently, with eyes full of tender concern? They do not. At best, you bore them with your stupid problems and your cloying face and, at worst, you irritate them, because you are a human worm. Do you know why this situation exists? Because you can’t sue them, that’s why.
Congratulations! You now understand Swedish healthcare.
I went home. In a matter of hours, the tooth had gone from irritated to infected. My husband called the specialist and he prescribed a course of antibiotics ahead of the root canal. Since the pain was intense and growing by the minute, he prescribed opioids, as well, which is unusual here. The joke, which isn’t really very funny, is that no matter how dire your medical crisis, all you’ll get is ibuprofen. My friend had brain surgery and that’s all she got. So I was thrilled, until I noticed the painkillers weren’t working at all. I was high as a kite and struggling with executive function, but still in terrible pain. Something wasn’t right. By Sunday morning, I was unable to speak and living from breath to breath. When it became unbearable, my husband took me to the hospital.
But I didn’t make the cut. The ER nurse came out from her station to observe me with great clinical interest, as I rocked and muttered in agony. Her coolness was kind of insulting. After a few minutes, she nodded, as if something had been decided.
“You’re not a priority for us,” she said, with the customary Swedish bluntness.
“What?” I asked, panting.
“Pain isn’t an emergency. Your life is not at risk.”
My husband looked homicidal, but she remained unruffled. This is par for the course in Swedish hospitals. To see a doctor, you need to appear to be at death’s door and you also need luck. She explained that I had two choices: Wait an estimated eleven hours for a doctor, who would probably just send me home to wait for Monday morning, when the specialist would come in. Or I could just go home now.
I showed her my box of painkillers and pleaded for something better. “That doesn’t work for dental pain,” she said breezily. “Just alternate acetaminophen and ibuprofen.” She brought me two ibuprofen tablets to get me started and we went home in a daze. Were we victims or victors? On the phone later that day, as I iced my face with a bag of frozen edamame, my friend chided me. “You’re not much of a drug seeker, are you, trading your heroin for ibuprofen?”
The following Tuesday, still in considerable pain, I was due at the specialists. I went to the address on the business card, as one does. It was a big, stately building right on Vasa Park, but it was clearly residential. Something wasn’t right, so I called the number on the card. The friendly man who answered said I was at the wrong place.
“That’s actually our home address,” he said, chuckling. “It’s a misprint.”
“Oh,” I said. “I must have gotten an old card.”
“No,” he said. “We never fixed it. Why waste money?”
His use of the possessive pronoun — our home address — threw me. It seemed odd, because Swedes aren’t folksy. And how would it be wasting money to correct an error that defeats the purpose of the entire exercise? I tamped down these thoughts, though, and got back on the bus, because my tooth really hurt.
When I arrived the right place, the same man who had answered the phone greeted me in the reception room. He was enormous, almost seven feet tall and beefy. His vast shadow danced behind him on the wall. “I’m the endodontist,” he said, after we had switched from Swedish to English. “I’m actually Canadian.” As we were chatting, his exact copy entered the room from the opposite direction. A second shadow merged with the first and seemed to rise and twist heavenward, like the Matterhorn. The new guy said he was also the endodontist. My specialist turned out be a pair of giant, identical twin brother endodontists from Winnipeg. And, yes, they lived together in the stately building.
Once in the surgery, I lay supine in the chair while the brothers loomed over me. For some reason, I need a lot of anesthesia. If it’s not enough to knock a bull flat, it won’t work. This runs in my family. And even if I do get a big dose right off the bat, it still may not work, as in the case of my two failed epidurals. I explained all this and they gave me a jumbo dose, but something wasn’t right. I could feel every foray of the probe. I have a pretty high tolerance for pain, but this was bad. I whimpered and flinched but they kept going. But then the twin who didn’t seem to do much besides hand implements to his brother rose to the occasion. He began narrating the scene in a formal baritone, describing me as if I couldn’t hear him.
“Laura may be experiencing touch as pain,” he said.
“No, she is not!” I hissed. “Stop!”
When they finally gave me more anaesthesia, it was alarming. I began to shake violently. “Nothing to worry about,” said the twin who did all the work and all the talking. He chuckled as I thrashed around in my reclined chair like a blue-fin tuna on the deck of a trawler. Rolling around, my spine arching and contracting, I wondered why everything was always so fucked up.
The shaking subsided and we waited for the new dose to fully kick in. The boys were good enough to fill me in on their recent monograph on the complexities of dental practices in Uruguay, where the locals’ teeth have up to seven roots. Very few endodentists in the world had the knowledge, skills and experience ― let’s just say it, the balls ― to handle something like that, they assured me, but they did. The twin who did all the work leaned back in his chair, taking a moment to reflect on his professional achievements from this, the pinnacle of his career.
“Where do you go when you’re at the top?” he mused, arms crossed against his chest.
Bliss and numbness took me. Nothing hurt anywhere for the first time in days! It was like drifting inside a dewy, misty bubble. It lasted a good while, too, until we were almost finished, when the probe was circling the pulpy tangle of nerves at the bottom of the root, which God reserves for the true pain. Then the probe landed and I saw a blinding flash of white light. There was nothing like this that I have ever known. The world tore open and time stopped. I couldn’t scream because I had several implements and a large man’s hand in my mouth. In shock, my animal self took over. I began batting away the nearer twin and kicking toward the other one, ready to fight to the death. As they dodged my blows and shut it all down, they looked sad. This is not supposed to happen, not even in Sweden, where pain is unimportant. This was beyond pain: It was torture. They cleaned up in silence. They did not charge me for the work.*
I went home with a sore jaw and a shaken sense of trust in my new Swedish brethren. I slept for 13 hours and woke up in pain again. It did not subside. It got worse. After five days, I went back, because I didn’t know where else to go. The x-rays showed that the root canal had been flawless, the twins declared triumphantly. They exchanged congratulatory nods. It had been perfect work. The only problem was that I was in agony.
“I guess it just isn’t working,” said the brother who didn’t do anything.
That was that. They gave me enough pain killer for a sperm whale and extracted the tooth. It didn’t take long and we didn’t talk much. They didn’t charge me again for the perfect work and after they cautioned me against eating peanuts or popcorn, I went home.
It’s just a story. A nasty tooth and some bad luck. I’m still not sure if it meant anything. But I can’t help thinking about the Swedish concept of lagom: Not too much, not too little, but just enough. This concept is part of why Scandinavian countries are so relaxed (just enough) and why there is zero sense of urgency in the air (too much), even when there should be. I credit the lagom philosophy with my children’s academic success here. When we arrived, the school just met them where they were and took it from there, beautifully, without all the American ranking and measuring and assessing and stressing. The Swedes were like, “whatever.”
But that’s also what my dentists seemed to be saying, and they shouldn’t have. I’m old enough to know that we’re all making it up as we go along, no matter how accomplished. And I quit believing in experts a long time ago. But that was a bad week for me and it didn’t have to be (too little) and my new dentist has tissues on hand when I come in, because now I always cry.
* Dental and ophthalmology care are billed for Swedes over age 20, but they are subsidized by the state and cost much less than in the U.S.
I cringed and contorted myself through this story, Laura. It reminded me of too many dental experiences (I think there are parts of the US that can compete with Sweden for inflicting of dental pain).
In Ireland the Health Services Executive doesn't contribute to dental care and private dental insurance is obscenely expensive, but I was able to find an excellent dentist in South Dublin. The first time I visited him and he examined my teeth he pronounced that the "interventions" I had had in the US were shameful ... even though some had been done by professors at Harvard Dental School. The work from the US was better, though, than much of what he'd witnessed by itinerant dentists who come to Dublin for a week and set up a black-market dental practice in a hotel room. He was not at all keen on these dentists, nor about the dentistry practiced in Hungary and Romania where Irish people often went to save money on dental procedures. At one point while carrying on about this, he paused his work to show me images of some of the nasty tooth disasters he had dealt with.
Dental care is covered partially by the *Assurance Maladie* in France, and dentists can function within different cost tiers. My approach is to always find the dentist who lives in the area where rich people live, and the strategy has worked well here, my dentist is excellent--though he doesn't work cheaply. More here if you're interested: https://www.service-public.fr/particuliers/vosdroits/F33956?lang=en
Laura, I lived in Sweden for 18 years and so much of this rang true for me; I am so sorry for what you went through, all that agony, but you are an amazing funny storyteller, and there’s nothing lagom about that. I moved to Spain (I’m American) three months ago as my older daughter lives here in Barcelona (the younger in Paris), (while their Swedish dad, my ex, remains happily in Florida, go figure) and so we’ll see how the Spanish public health care system is, but so far I give it an A+ having had to make use of it for emergency back pain and more minor issues. Excellent fast professional care at the local ER on three occasions, before I had my public health card, never charged a euro. We will see about the dental care here however…I am dreading that because…well you know why 😀 I may well run into the same issue as you. Public health care systems not able to prioritize ‘non-emergencies.’ Which is why I’ll probably get myself the very affordable private health insurance available here as a supplement; 25% of Spanish citizens do the same, I’ve read. Thanks for your insights into my second home. It’s the Swedish passport I have that made moving to Spain a breeze.