Nursing 210.

Angel is a chubby, cherubic girl who lives up to her name. Her hair is bright red and frizzied out like a medieval halo. We were paired for the clinical portion of the course at a local hospital in our new, perfectly white uniforms. On our first clinical day in our first clinical course, Angel and I were assigned an elderly lady on the Medical-Surgical floor.

Mrs. J was white-haired, dehydrated, aphasiac and suffering from a host of terminal conditions. "Oh, how sad," sighed Angel. The woman's middle-aged son and the physician had conferred about her condition earlier in the morning. They spoke over the unresponsive person stretched out in the bed, her eyes open but unseeing, or so it seemed. They agreed that only palliative measures were to continue. Then they left.

Angel and I stood around the room unsure what to do. We certainly didn't want to touch anything without permission. Something might break or the woman might scream out in pain and accusation. Finally our RN came in to see how we're doing. Pat was thirtyish, thin, soft-spoken and very efficient. "Did you check the Daily Patient Care Form?"

We shook our collective heads. In fact, we hadn't the least notion what Pat was talking about. It must have been as obvious as Angel's heaving bosom. "Find her chart at the nurse's station. Look in the Daily Patient Care Form and find out what needs to be done: bath, range of motion, teeth, whatever. Do what you can and then find me. OK?"

On the form we found a note to do dental-denture care. That we could manage. Back in the room we opened her mouth and looked in. She did not react to our presence. Perfectly neat, pearly-white dentures stared back out us. The gums and mucosa were dirty with brown particles and crud. Did not look as if they had been cleaned for the whole week she had been in the hospital.

"First we need to remove the dentures and scrub them," I said. Sounded like a good nursing plan that we could manage.

We followed basic procedure and put on latex gloves. "Well, let me try," I said. I reached into her mouth and grabbed her front teeth. As I recalled, the right procedure is to pull down and out to break the denture-glue seal. At least that’s what I remembered from a television commercial. I pulled. And pulled. Mrs. J groaned. That old jelly feeling in my legs returned. The denture seal wouldn't break.

Angel stepped in and tried. Pull, tug, groan.

"Got a problem?" asked Sarah, the nurse's aidwho had just walked in, her arms full of clean linen. We showed her the denture sheet and described our efforts. "No problem. I've done this a thousand times. You pull and twist. Watch." She went in without gloves and pulled hard. Mrs J's eyes popped open with a huge moan. Nothing in her mouth moved.

Sarah went out in the hall and called in a loud voice: "Clara!" An elderly nurse's aid entered the room.

"What's the problem?" she asked in a clipped voice.

"We can't get the dentures out," said Sarah.

"You sure she has dentures?"

"Says so in the chart. And her mouth is pretty cruddy."

"Well, let me try." Clara reached into her apron pocket and pulled out a pair of latex gloves. She snapped them on. An old pro at this. She pulled hard. Mrs J groaned and bit down. "Yikes! She bit me!" Pat the RN walked in. "What's going on? Am I missing a party?"

Sarah explained the situation. Pat said: "Did you pull and twist?" We nodded. "Well, let me give it a try." Pat checked the chart, put on gloves and grabbed the upper teeth.

"Watch out, Miss Pat, she bites," said Sarah.

"She won't bite me."

"Whatever. Don't say I didn't warn you."

Pat does it by the book: Tug. Pull. Groan.

Clara was massaging her finger. "Are we sure she has dentures? Doesn't feel like dentures. Has anyone checked the gum line?"

Pat pulled the upper lip back. No line. The chart was wrong. She didn't have dentures. These were her real teeth.