The Standard of Care

The germ of my idea spawned last Christmas when our Aunt Muriel, who lived in Florida and looked like a rotisserie chicken, gave my brother a set of marbles.

The Standard of Care
Photo by Diana Polekhina / Unsplash

by Justin DeCarlo

As I sit on top of the screaming girl, her twin sister unconscious on the floor, I just couldn’t wait to show her her tooth. The one I had collected not a moment ago from her own mouth. Which is why she was screaming, I’m sure. I showed her the others that I had collected from the fat heads of our fellow fifth graders over the last few days  in the hopes that she would understand that she was a part of something. Something bigger than the both of us. I told her not to be ashamed that her tooth looked positively gnarly compared to the very well cared for specimens in my hand. They all started out just like hers.  

My younger brother has been integral in this venture from the beginning. The germ of my idea spawned last Christmas when our Aunt Muriel, who lived in Florida and looked like a rotisserie chicken, gave my brother a set of marbles. And looking at the blank stare on that orange face of hers, you wouldn’t expect her to know the disappointment that my brother must have been feeling at that moment. I have always taught him to be polite to the faces of adults, so he was very nice about the whole thing. I told him I would show him how to play later. 

“The first step to playing marbles”, I said, “is to stick one up your nose. No, no, not one of the small ones. The big one. The shooter.

I should have told Mom sooner. According to her. It’s not like it’s a life threatening affliction. I found it quite beautiful actually. It was as if his nostril was giving birth to a smooth blue round baby. It was crowning. 

So, we spent the final hours of that particular Christmas in the emergency room. 

Even though, pliers in hand, I offered my services.

Mom: Why didn’t you get me right away? It’s every parent's nightmare to come home to their child with an engorged nostril.
Me: I wanted the moment to last. I just had to document it. I knew you would try to get it out, which I think was the right move on your part, by the way. I’m on your side here.
Mom: It was dangerous to wait. And it was cruel of you to take photos of your brother while he was suffering.
Me: I did not take photos!
Mom: Don’t lie to me! You just said you documented the moment!
Me: I did. Here are some pastels that I think capture the spirit of the event quite well. 

Needless to say, the drawings did not find a home on our refrigerator. 

That night, on the car ride home from the hospital I stared out the window, thinking of how irresponsible it was of my mother's sister to think that the night could have ended any other way after a gift like that. I found her lack of foresight offensive. I looked over at the coat that my brother was pretending to sleep under when his little hand poked out and waved me closer. I peeked at the little opening and he showed me his face, which currently had a marble up each nostril and we both burst out in hysterics. Mom did not join us. 

When we got home the next morning she handed me the sack of marbles and told me to dispose of them. It rattled in a way that made me smile. Like a sack of teeth. 

I had no frame of reference for this. I was not brought up in a household that had sacks of teeth lying around. It’s funny how you can feel nostalgic for a thing you have no experience with. So, like a half obedient daughter, I disposed of the marbles and kept the sack. To be filled later. To be clear, I don’t have any specific obsession with teeth or anything like that. I have no aversion to them, but I harbor no secret desire to become a dentist someday. Although, it’s a perfectly respectable vocation and one that any young person would be wise to consider pursuing. 

My first, and upon reflection, childish thought was to make a maraca for the teeth. But ultimately I decided that placing them in a dried hollowed-out gourd was too frivolous. This isn’t arts and crafts. Then I thought I wanted to create something symbolic, something to take with me wherever I went as a reminder of what I am capable of. But in the end, I just wanted the teeth. To carry them around in the little sack in their purest form. Don’t get me wrong, I don’t condone this type of behavior. I just happen to have the particular disposition to go through with this. 

I let my brother in on the plan before I read him his bedtime story that night and he was on board. In return for his allegiance, I made him my second in command. I gave him a badge-a piece of cardboard cut in the shape of a tooth-and should the unthinkable happen to me, I entrusted the teeth to him. 

There was never any question about where I would get them. I spent six hours a day, five days a week on a veritable tooth farm. It was a no-brainer. One tooth from each student. If only I had thirty-two students in my class! One whole set of teeth. Life rarely works out like that though. I would have to settle for--what was it? Twenty kids? Twenty three? This meant that I was going to have to get close to them. Make some friends. 

I wasn’t exactly, and I say this with no bitterness, the most popular girl in school. I received excellent grades, so I’m sure I was quietly respected for that. I would just have to socialize. Try to relate to my classmates a little. It’s healthy for young people to learn social skills. Maybe take part in some sleepovers. More time to steal those precious little mouth bones from my victims. 

No. Not victims. Unwitting participants. 

And even though I felt that once they got to know me, they would like me--maybe even look up to me--I knew that I couldn’t just ask them for their teeth. Or purchase them. No, I would be too considerate to let any monetary awkwardness get in the way of our budding friendships. I wouldn’t hear of it. They would have to be burgled.    

I could have, I suppose, campaigned for a project in science class in which collecting one tooth from each kid was integral. Not until it was their time to fall out, of course. An experiment proving something about tooth decay or calcium deficiency. Then, after they were all collected and accounted for, stage a heist. One big score. I could get some rope and glass cutters and sneak in there in the dead of night. 

But that would be too much waiting. I wanted to be active in the collecting process. Not just sit back while they came to me--I wanted to get my hands dirty. And although I may not have admitted as much to myself outright, in the back of my mind I knew that I wasn’t going to just be stealing the teeth that fell from the mouths of these cretins. “Accidents” happen on the playground all of the time. A kickball to the face isn’t unheard of. I may even have to get in a fight or two. A sudden argument about an umpire’s call that leads to a violent melee on the field...

My second in command fell out of line only once before the plan was underway. “Why do you want to steal from your friends?”, he asked one night as I was tucking him into bed--his exhaustion no doubt clouding his judgment. I usually told him bedtime stories of Medieval kings and tyrants and the like, so I decided Richard III would rekindle his enthusiasm for the plan. Richard ascended to power by dethroning Edward and imprisoning him and his brother in the Tower of London. When he gets a loose tooth, I told him, it too will be forced out and replaced with an usurper. He would eventually have a mouth full of Richard III’s. Everyone does. We were just doing our part in helping the Richards. 

“Don’t you want to help Richard III?” 

“I do! I do!” he shouted in one last burst of an attempt to stay awake. “I can’t wait to have a mouth full of them,” he said as his eyelids grew heavier and heavier. “My teeth will all be named Richard. Who is my nose?” he asked. He was a demon, but he could be quite adorable at times. “Your nose is...your nose is Attila the Hun,” I said and gave him a loving squish on his nose. He smiled and I started to tell of the exploits of Attila. He was barely awake when I told him that he failed to take over Constantinople. I tucked him into bed, tooth badge paper-clipped to his pajama pocket, to dream of prisoners of war and blitzkriegs and such. 

Maybe it was his questioning me or maybe I was just tired, but sitting on the edge of his bed, I had a moment of introspection. Why was I doing this? Why, in fact, did I want them so badly? I went to the window and looked out at that red moon, hanging low in the night sky and it just felt like my heritage. Some distant ancestors must have looked at a moon just like that and thought similar thoughts. Felt what I felt. And somehow these tiny citizens of the oral cavities of my classmates would bring me closer to them. The whole of my body was an echo chamber and my insides reverberated with the thought. 

Any small inkling of reluctance I may have had before I started this project was shattered after I got my first tooth. Ah, the first tooth. An eyetooth. Straight from the filthy mouth of Lydia Hargraves. Every other word out of her mouth was a four-letter one. She had such a staccato way of talking--like the words were being pushed down the stairs from her brain and tumbling out of her mouth. She must have felt those harsh words pushing up against the back of her teeth on the way out. The opportunity presented itself to me in the hallway after school. I had not planned on Lydia being my first. I had a sleepover planned for the weekend with Laura and Beth, the twins, that I had been slowly befriending for the last week. I figured starting off with twin teeth would be good for morale, for all involved in the project. 

But the gods were smiling on me that Friday as Lydia walked past me and said, “So, I hear you're having a sleepover with the freaks this weekend.” Oh, Lydia, whose tooth I couldn’t help notice had become loose about two days prior and who couldn’t help playing with it with her acid tongue all day long. I was planning a playground accident for you on Monday. 

I responded by questioning her upbringing. Not the most sophisticated thing for me to do. But I was on a mission. A destination to which the high road did not lead. She then suggested that my brother was a less than reputable character and it was no surprise that we were related. 

As truthful as her observation may have been, I proceeded to punch her right in her fucking face. And though I don’t believe words like that should be uttered in polite society, I will have to admit that it felt good to think it. I have never punched anyone before either, but I knew that I did the right thing. It was exhilarating to feel that I had the courage to take the first step on my mission.      

During the mishegas of crying and blood-gushing, I quickly scooped up the lone canine I had freed from the prison of her mouth. Go big or go home as they say. 

I went big. 

Then I went home.

Not just for the weekend, but for three days of suspension after that. 

I wasn’t happy about the black mark on my permanent record, but being home for a few days to better plan without the distractions of the classroom was a welcome benefit.

The plan had begun beautifully. And the twins’ parents were so happy that my kerfuffle was in defense of their friendless progeny they let them attend the sleepover as planned. My mother took a little convincing though.

Mom: What were you thinking?!
Me: I was thinking of family honor!
Mom: I've never heard such nonsense! And that poor girl!
Me: That “poor girl” besmirched our good name! I have too much esteem for you and your parenting skills to stand for that kind of disrespect. Not to mention my own embarrassment of being a part of such a gruesome situation. I know you're mad, and frankly so am I. This is no way for young people to behave. I was thrown into this situation and I admit that I reacted emotionally. But it was in defense of family and friends.
Mom: Well, I am proud of you for defending those poor handicapped girls.
Me: They're not handicapped, Mother, they’re twins. 
Mom: That must be hard though, having to do everything together…
Me: I’m not quite sure they have to. They are in fact two complete and separate people, I think-well, we are getting off-topic here. Can I still have the sleepover?
Mom: And that poor girl you struck couldn’t find her tooth…
Me: I’ll just call the handicapped girls’ mother and tell them to come over at 7…

As fate would have it, one of the twins was sick. I’m pretty sure it was Beth. The one that always walked on the left. We would have to postpone the sleepover until next weekend, but I was too excited at having gotten my first tooth--I wanted to keep the momentum going. I decided to make the most of my two-day school week. I gave myself the impossible task of obtaining a tooth a day. I admit it was somewhat conceited of me to think I could do this, and even my brother, though loyal to the cause, seemed to harbor some disbelief in my abilities. But, if you don’t dream big, big things won’t happen. And two teeth in two days would have been one for the books. 

The first day, I got lucky. I overheard the nurse say that Philip Bergen lost a tooth that day. I have been going to school with him since the third grade and I don’t think we have spoken more than three words to each other the entire time. He had long thin hair and a large forehead that gave him an unfortunate Ben Franklin look. You could have fit a whole other face on that forehead. Just a vast wasteland from the top of his eyebrows to the bottom of his hairline. Between that and the giant gap in his two front teeth, the kid was just working with so much negative space. He couldn’t afford to lose a tooth. Part of me wanted to glue it back in while he was sleeping. But I couldn’t let my generous nature get the better of me. Only a fool would not take advantage of this fortunate turn of events. I decided to take the easy way out. I walked past him as he was opening his locker and memorized his combination. Later, after class, I lingered behind and took the chance that he stored it in there. Sure enough, there was a dixie cup from the water cooler in the nurse's office with the tooth wrapped up in a tissue, like a pirate’s sack of coins. Not exactly a daring caper but every tooth can’t be an adventure. I wrote that down as a reminder to keep things simple: “Every tooth can’t be an adventure.” This is not an “It’s the journey, not the destination” type of situation for me. I want those teeth. In retrospect, I did start to have the feeling that they did in fact belong to me, and I was just taking what was rightfully mine.

The next day I did not enjoy. The next day was work. For the first time in my life, I participated in gym class of my own volition. There was a kickball game and I volunteered to play. I was planning on kicking a ball straight down the line and right smack in the face of the pitcher. But I wanted firsthand knowledge of that experience before I did it to someone else. 

First, because I figured it would be a good alibi that it happened to me too. It’s a violent sport. We are all casualties of the game here. The second reason is that I really wanted to know what it would feel like. 

So when the ball came screaming my way, I feigned trying to catch it and ever so subtly leaned my face into it, leaving the children to suspect it was my ineptitude in athletics. At first, it was just the sound. Taught rubber smacking against my face. It echoed in my head and the sound enveloped my brain. Then came the pain. Along with the taste of grass and dirt. I’d be lying if I didn’t acknowledge my tears. 

Anyway, I didn’t feel as bad when I tried to administer the same thing to any and every member of the opposite team after that. I did not, however, take into account the fact that I was not yet experienced enough at the sport and couldn’t seem to get the ball to go the way I intended it to, much less with enough force to liberate a tooth. At one point Christine Fowler fell while trying to catch the ball and I ran over to see if she happened to land on her face. I asked if she was ok while claiming the ball that she missed. The team's perception of me as a poor athlete allowed me to hit her in the face with the ball while she was getting up and have it appear to be accidental. I, of course, wildly apologized for my miscalculation. She's a good sport and it seemed like she forgave me. “Poor thing”, I said as I gave her my hand and got her to her feet. “I know exactly how you feel”. She was rubbing her jaw and I asked her if she was ok. Sadly, no teeth were loose and I got a glimpse of the most exquisite example of a lateral incisor that I have ever seen. 

I learned a valuable lesson that day: A vigorous physical regiment has its unforeseen advantages. If only I had participated more in gym class, honing my hand-eye coordination and toning my muscles, I could have been at home polishing that beauty that very night. That was the one that got away. 

I decided not to dwell on the negative and go into the weekend with gusto, although I knew it was going to be difficult to perform my little amateur surgery on the twins that night. First of all, I had no idea if any of their teeth were loose. I had literally never seen either of them smile. I had never even seen them eat. At lunch, they both drink these weird green shakes through straws. I don’t even get to see them chew. And when they do actually speak, they hardly move their mouths! It’s like they're practicing ventriloquism. Say what you will about them, that's an act you would pay to see: Adolescent twin ventriloquists. 

Second of all, I couldn't exactly pull both of their teeth at the same time so I would have to do it twice. I expected the first extraction to be a learning experience, but by the second I hoped to be, while not exactly a seasoned professional, cultivated enough that maybe the next time I’m at the dentist we can talk a little “shop” as they say. Perhaps we would bond over unruly patients and share our battle scars in the form of bite marks. Again, I have little to no interest in pursuing dentistry, but I would have to admit I felt a rattle of satisfaction at the thought of discussing the splendors and pitfalls of tooth care with one of my peers. 

In school, we learned that sharks have to keep moving or they will die. This seems misleading to me. It makes it seem like they have a choice. Do they ever just stop and give up? I don’t know if I’ll die if I don’t do this but the question is irrelevant as I don’t have a choice. Giving up isn’t an option. It’s written in my bones. 

My plan for the night didn’t hinge on one of them having a loose tooth. It would just make my night a lot easier. I was sure that having them in such close quarters for the whole night would give me the chance to at least find out if any of their identical teeth were loose before bedtime. I catered the event myself. The food was perfect. Not in quality, mind you, unless you find gummy worms to be a particularly delectable cuisine. I am not one for the sweets, but the efficacy of the candy should be two-fold: first, they would have to chew. If nothing else, I will know if they even have the ability to masticate something rather than suck it down with a straw. Second, if one of them does have a loose tooth, the gumminess should help to dislodge it. 

I decided that our viewing entertainment for tonight would be a comedy. I would catch a glimpse inside those elusive portals as they inevitably let the laughter take over. Any information I could glean could only help, as I planned to be knuckle deep in both of their mouths in just a few hours and I was getting a little nervous at my lack of preparation for this. I would like to point out now that I find mouths disgusting. Moist caves that carry more bacteria than the doorknob on a gas station's bathroom. It’s unfortunate that the thirty-two most perfect parts of our body have to call it their home. And unfortunate that to get to those little jewels, my hands have to enter them. I heard that tickle fights have been known to erupt at these sorts of gatherings, but I had no intention of engaging in such pedestrian behavior. No, I will not be the one “losing my shit” as Lydia would say. I felt her tooth that I kept in my pocket as I thought these words and felt a little affection for the jerk. As if there was an inside joke between us. 

I sat the twins on the couch, both clad in matching beige pajamas, a color that complimented their personalities to a tee. Luckily, they seemed genuinely excited about the mindless romantic comedy that I chose for the evening’s entertainment. As they laughed at the inanities on the screen and I got a look at those pristine teeth--no doubt from lack of wear and tear--I sent my brother upstairs to make sure that the homemade chloroform we made earlier was well hidden. 

It was a fun Saturday afternoon project for us. A little bleach, a little acetone, a lot of ice, and we had a recipe that would help anesthetize and keep the lame look-alikes asleep whilst I removed two little tokens of their anatomy.  

As luck would have it, Beth, the more gregarious sister, told me without prompting that she did in fact, have a loose tooth. And as luck would also have it, Laura did not. A conundrum for sure. Do I work on Beth’s loose tooth first because it will certainly be easier and I can learn from it, and then move onto Laura’s more stubborn tooth a little more experienced? Or do I get the hard work out of the way first, then dive into Beth's mouth, which will then be a relative cakewalk? 

I chose the former. It was my brother’s job to clean up and stuff the mouths with cotton as we went. I couldn’t exactly have them sleeping on old newspapers so I would just have to be careful not to spill blood on my bedsheets. The one glaring oversight came to me moments before bedtime. I had no explanation for what was about to happen. When they woke up they would both be missing something and I had no way to explain it. I contemplated pulling one of my own teeth and pretend that we were all victims of the same mystery so I wouldn't be a suspect, but I was afraid of my mother being charged with the hideous crime. I can see the headlines now: 


That wouldn’t do. I wracked my brain over this and came up with exactly nothing. So, the point of no return getting ever so near, I decided I would wing it when the sun came up. There are few things as good for clearing the mind as a good night's sleep. I was confident that when the sun came up, inspiration would not be far behind. 

Even though I made a misjudgment about how much chloroform to use, I took pride in having the foresight to purchase three large bags of cotton balls. No plan goes exactly as expected, and indeed a great plan is one that anticipates this fact. The amount of blood was certainly not unexpected. 

Although Beth woke up during my operation, and she was clearly not enjoying it, the poor creature was finding a place in my heart. And my brother was the perfect little helper throughout the whole thing. He needed a break, which is to be expected of one so young, but he was a trooper. His cardboard tooth badge, saturated with blood, now a deep brownish red, stuffing cotton balls into the mouths of one screaming girl and her sleeping mirror image. 

“She doesn't need cotton yet,” I told him but decided to let it go. Let him have some fun on the job. I seemed to give her sister plenty of chloroform though, as she hasn’t even woken up from the noise. I may have been a tad overzealous in administering her dosage. I hope that means that her operation will go much smoother than this one. 

I’m sure I’m going to have to do some explaining tomorrow and I think I started to feel a little giddy about it. Working on something you’re passionate about in secret has its pleasures for sure, but at some point you want to share your work with society at large. My mind wandered to some periodicals, like Modern Dentist or Incisors Aficionado. I don’t expect anything to happen overnight. I’m not saying I’ll be on the cover, but one can assume an interview or a two page spread. I can imagine Modern Dentist asking “where do I get my ideas?”  Or “Where do you see the future of dentistry going?” Incisors Aficionado would probably want a more provocative interview. 

IA: Do you feel conflicted about the way you have gone about this project at all? I’m thinking of the incident with the twins…
Me: Are you familiar with King Richard the III?

But I’m getting ahead of myself. Right now, I have a job to do. It’s not about the accolades. It’s about the teeth. 

As Beth passes out from all of the screaming, I give the pliers one last twist, walk over to the bedroom window, and admire the bloody incisor glistening in the moonlight. I think again of my ancestors. Laura still doesn’t seem to be moving. I feel such gratitude for her and Beth, Lydia, and even Philip. And for all the teeth that would join theirs. The life I would live to make that happen. I don’t see anything that can happen tomorrow as an obstacle. Everything the universe throws at me is in service of me getting the teeth. My heart swells. I will admit that I start to tear up a little. I have never felt as present in the moment as I do right now. It doesn’t matter that I have no excuse for what happened with the twins. Nothing matters but the teeth. Tomorrow is going to be a great day.

Justin DeCarlo grew up in New Jersey. He now lives in New York. His work has appeared in the Brooklyn Review, Entropy Magazine, and Sundog Lit.