Sep 17

We have reached that part of the project where I am finally posting what most people would consider to be the actual book part of the book, by which they would mean: The Introduction. Chapters. Etc.

We’re done with the packaging, the excusing, the thanking, the congratulating, the greeting, the Buy-Me-Take-Me-Home part of the ordeal. We are back where I was in mid 2005. I had signed a contract in January of that year to write a book about traveling abroad for plastic surgery and dentistry and medical care; but I did not really start working on it for a few months, because it took that long for my publisher to actually write me a check for the first half of my advance and I was otherwise sort of broke, or at least broke enough that I couldn’t afford to do the travel I needed to do for research until I saw some money.

I finally sat down to start the actual writing of BFA in June of 2005. I wrote an introduction. Then I wrote another introduction.

I hated them both, and I started panicking. What had ever made me think I could write a book?

Finally, I retraced my steps. I reread the original proposal I had written for the book, which I had liked, and which my agent had liked enough to represent me, and which my publisher had liked enough to give me an advance.

And I found the right tone, and the third try at an introduction was … well, you know. It was fine.

Introduction: How I Got My Smile Back

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Sep 17

Introduction Page 1 | Seeking Beauty from Afar: How I Got My Smile Back

Stumbling upon an open secret

I became a “medical tourist” in the early spring of 2004, when I traveled to Costa Rica for major dental work I could not afford in the United States. I use the term medical tourism, with the benefit of hindsight, as a catch phrase for the unusual business of traveling a long way for health care. It did not gain currency in the media until later the same year. At the time, I considered myself … as what? Not a tourist. More of an exile, perhaps. Though there are certainly terrific dentists in
the United States, I couldn’t afford them. I was on the outside of the health-care system looking in.

My teeth and gums had deteriorated prematurely in my forties to the point where smiling was no longer an instrument of charm. I needed what dentists call full-mouth reconstruction. Insurance companies generally call it unnecessary and would rather wait a few years before contributing to the cost of what by then would be an entirely necessary full set of dentures. In any case, there was not an insurance plan in the world that would cover the $18,000 to $30,000 that a United States dentist would have charged for my full-mouth reconstruction — not unless I’d lost my teeth in a horrible accident, as opposed to simply having them wear away over time. I know. I shopped around.

All this I knew in 2001. By 2004, I had mostly resigned myself to having bad teeth. A quirky grin had become my all-purpose expression of approval. If my misshapen teeth appeared in a photograph, I touched them up with a bit of virtual dentistry. I hoped that what was left of my teeth would last me, functionally, until I was eligible for Medicare. I admit that the molars were still fine for chewing, that the ragged fronts could still tear food. “Let vanity go, you’re 48 years old,” said a voice in my head. I avoided looking at my teeth even when brushing them and tried not to be bitter.

On the evening of February 16, 2004, I was reading the latest messages on the Interesting People (IP) e-mailing list, an influential Internet forum hosted by Professor David Farber, often called, without much exaggeration, the Father of the Internet. The topic was the outsourcing of technology jobs overseas. Jim Warren, a computer professional and long-time online activist, went off on a mild tangent about how it is not just technology jobs that are leaving the country:

“… Many Americans fly to Bangkok to get needed (or simply desired) medical and dental procedures … everything from crucial transplants and sex reassignments to cosmetic surgery and liposuction. The surgery, hospital, and drug costs are almost nothing by comparison to U.S. medical, surgical, and hospital charges.”

Warren told of a good friend who had a laparoscopic adrenalectomy — an operation to remove a benign tumor of the adrenal gland — that would have cost $30,000 or more in the United States. In Thailand, she paid 100,000 baht — a little less than $2,600. The quality of care, he said, was outstanding.

Immediately, I was thinking about my teeth again. It had never occurred to me to shop outside of the United States for dental care. Thailand! It sounded a little crazy.

Nevertheless, 3 months later, after a lot of reading, correspondence, and consideration, I was reclining in a dental chair; not in Thailand but in San Jose, Costa Rica. The cost of my full-mouth reconstruction fit inside my credit card limit.  Six root canals, 14 crowns, and 10 days later, I was heading for home with perfect teeth and a dazzling smile for less than half of what it would have cost me at home.

I chronicled my journey for Northeast, the Sunday news magazine of Connecticut’s Hartford Courant. The article over time provoked more gratitude than anything I had written in 20 years of journalism. It also got a chilly reception from dentists in Connecticut. “Hey, maybe the Courant could get a cheaper reporter from Botswana,” was one of the more memorable gibes.

“You were very brave,” a friend told me. She meant, “I wouldn’t have done it. You always were a little crazy.” But I knew that I wasn’t crazy, and I also knew I wasn’t alone. While in Costa Rica, I’d met dozens of people who were in the country for health care — mostly cosmetic surgery and dentistry — and learned that San Jose had, for years, cultivated a reputation as the “Beverly Hills of Central America.” It was an open secret, decades old, spread first solely by word of mouth and later via the Internet.

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