ABOUT SIX OR SEVEN years ago, in an area of my mouth I only recently learned to refer to as Number 31, I developed a tiny divot. It was my tongue that first discovered the microscopic pit, and, due to the animal curiosity engendered by a hole existing where no hole should exist, the muscle returned (involuntarily, it seemed) again and again and again to this topological spot. Deep down, I knew what was happening. And, with superstitious patience, I waited. The tip and edges of my tongue were ravaged raw from all this blind-mole looking. The divot, relentlessly self-assaulted, began to widen. It opened up in protest, a mouth within a mouth.

The process of erosion was steady, eonian, and irreversible. Chewed-up foodstuff lodged snugly into Number 31's aperture, and getting my tongue into and around the blockage became as futile as trying to excise earwax with one's elbow. I converted to toothpicks: rolled from dispensers and always snapped in half to avoid piercing the roof of my mouth with barbs of wood. Carefully, I'd reach back and start poking. My eyes would tear up, and I'd sweat. It was a pretty sad dance, to be sure--a two-step pry and pop, a poor man's dreary biological waltz executed opposite some inanimate partner, an organic fleck that would eventually either dip and disappear down my throat, or jettison itself altogether from the dance floor of decay.

Then it happened. One day, in a matter of seconds, the little Pyrrhic battles I'd been waging (unearth gap-filling foodstuff, spit it out, tentative victory, idiot avoidance, etc.) erupted into a war immediately and predictably lost. I was eating at my favorite Greek diner when a spoonful of hot lentil soup suddenly became a very crunchy spoonful of hot lentil soup. I stuck my right index finger into my mouth to discover that Number 31 was half gone--as quick as that--now just a volcanic crater with a jagged stump of ruined bone rearing cheek-side. The taste inside my mouth was horrible; randy, rotten, something uncorked by time that wafted an aromatic verdict of neglect through my skull. A busted-out tooth. The single indubitable tactile monument to my very vicious personal triumvirate: stupidity, poverty, and a corrosive fear of the dentist's chair.

And still, the dentist's chair would be a long, long way off. The hunk of rotting crockery in my mouth was my secret affair, a rarefied bout of dental necrophilia that went on for years. For me, the process of decay was both fascinating and grotesque. The tooth's continual degeneracy, the granular falling away of chiseled bone along myriad fault lines, became something of a sensual obsession; my tongue made continuous, unrequited love to the remnant of Number 31.

The orts and twigs and seeds and chunks of food that continued to get wedged in there absorbed the randy taste of rot emanating from the roots. I rinsed and spat, always abetting the physics of erosion. I resigned myself to the idea that when I finally got around to visiting the dentist, I'd just have the whole set yanked. Certainly I didn't deserve any better than a set of falsies and a tube of stickum, a diet of soup and milkshakes sucked through straws.

The waxing of pain, at last, pushed me up against the wall. Big, chronic pain. My self-administered toothpick surgeries began pricking on the live wire of exposed nerves, and the wooden ends started coming up dark with blood. A bulge of gum lay swelling and throbbing like protoplasm in the crater of Number 31. I couldn't take it anymore. I made the move.

After a wary self-diagnosis, the layman's typical first step toward recovery is to go around asking nonprofessionals about treatment for a particular illness--to phone up friends, sound them out, find out what they've done in vaguely similar situations. What I needed, mostly, was advice on how to navigate the "sliding-scale" route. I was uninsured. I wanted the dirty deed done dirt cheap.

I got phone numbers. And at first, it appeared that my best bet might be to go through the UW School of Dentistry: Let some overly cautious, eager-to-please intern go at the tooth with Professor Pearly White supervising the operation. But the receptionist at the general desk, when I asked her about sliding fees, sounded appalled that I'd even picked up the phone. "Who told you that?" she snorted. She suggested that I try "Seymour Clinic" and gave me the number.

I called, was transferred to the dental desk, and explained my condition. Was this an emergency? I balked: "Well, I guess." (Can a condition that has lingered in the critical stages for years be truly considered an emergency?) And as quick as that, I was scheduled for an appointment the next afternoon. I was told to bring $15, a photo ID, and a pay stub showing that I was indeed quite poor.

That evening, in a panic, I began rooting through the "Dental" section of the Yellow Pages, looking for Seymour Clinic (or was it Semore Clinic, or C-Moore Clinic, or See More Clinic?), hoping to find a half-page ad touting their indubitable professionalism, their nationally certified approval by the ADA, AMA, FBI, and USDA--anything that would hold my latent prejudices at bay. Nothing. Apparently, the place didn't exist. Or if it did, the bitchy receptionist at the UW was sending me to some fly-by-night Burroughsian tooth-yanker, where I would be put through excruciating agony sans anesthesia, subjected to medieval tortures with rusty, hand-cranked drills, get infected by a noxious and fatal blood-borne virus, and finally limp away with tread marks on my lower jaw.

The inertia of resolve--or vice versa--was the only thing that got me into the car on the day of my appointment. I ramped onto I-5 South, took the Corson exit, and hit Georgetown's East Marginal Way, keeping an eye on the passenger seat, where I'd wedged the directions the receptionist had given me. "Right over bridge. 14th Ave S. Across from BP station." And there it was. My lexical question was immediately answered: Sea Mar Clinic.

At the front desk, I was handed a stack of papers attached to a clipboard that I was to fill out, the Sea Mar "Eligibility Screening Form." I sat down and started penning in the info: name, address, social security number, income level, allergies, previous medical conditions, etc. The penultimate page stapled into the stack was titled "Rights and Responsibilities of the Patient," which numbered no less than 14. Chief among these were the rights "to be treated with dignity and respect," "to be provided with information concerning your diagnosis, treatment and prognosis," and "the right to continuity of care." And with my signature I vowed to uphold, in turn, seven responsibilities; I promised to return the dignity and respect conferred upon me, be on time, not lie about stuff, and fulfill all financial obligations.

I turned in the forms, along with four pay stubs and my driver's license, all of which were copied, assessed, and filed. I paid the $15 minimum entrance fee. (There's a fantastic, albeit disconcerting, typo in Sea Mar's welcome packet: "For uninsured patients, there is a $10 minimum charge for medical visits if pain in full at the time of visit.") After hitting the drinking fountain across the room, I seated myself beside the door and pretended to read the novel I'd brought along. A couple of older men seated adjacent spoke softly to each other in Spanish; the woman directly across from me kept an eye on her roving children; some guy next to her was rubbing his thigh in obvious pain.

My bones jittered.

The door to my right was nudged open, and a young woman poked her head out--white-clad, chart in hand--and called my name. I closed the book and stood as nonchalantly as possible, as though I'd forgotten why I was there. We went through the doors together. So, finally, at long last, the time had come. A decade of denial was condensed into seconds of panicked self-confrontation, and my perception became acute. Lights seemed brighter. Noises louder.

She led me through a maze of open cubicles, where I witnessed supine folks in various helpless stages of dental subjugation. All around were the familiar stereophonic sounds of wetness flying through suction straws and the high-pitched blackboard-and-fingernail whine of drills hitting bad enamel. In a room near the end of a long hall, I was motioned to sit down in a reclined, plastic-covered chair surrounded by the arcane tools of dentistry. The assistant asked me a few specific questions about the pain. Sharp? Dull? Achy? Hot or cold? She scribbled my timid answers onto a notepad and left the room.

Next came the heavy bib--the anti-carcinogenic armor--laid across my chest. I bit down softly, as instructed, on the L-shaped photographic paper. She revolved the large telescopic lens until it pressed against my jaw, and left the room. I heard the whir and click of the X-ray machine, and thought about cancer. The assistant returned, and I spat the scientific evidence, drool and all, into her hand.

More waiting. What is it doctors and dentists do while you're prostrate on their daunting examination tables, strapped down by infantile fears, suspiciously eyeballing an arsenal of shiny surgical instruments wrapped up and banded down in clear plastic?

The Dentist entered without a word and sat in a chair at the very edge of my periphery. After looking over some notes, she put on a pair of latex gloves and spoke, asking me a few more basic questions about the condition of Number 31. The assistant had me don a set of huge, yellow-lensed goggles (these turned out to be superfluous, as I kept my eyes shut during the entire procedure), and some strange, rather intimate poking ensued. As The Dentist roamed the contours of my bad tooth with what appeared to be a cotton swab, I was advised to squeeze her finger with my finger whenever I felt a stab of pain. I obliged.

The Dentist gave her prognosis: It didn't look good. This bit of expected non-news was rapidly followed by an education regarding the fiscal disparity between my two options. I could tell by her tone of voice that she knew a priori which I would choose. Root canal, my ass. Pull it out. She nodded, and, again, I was left alone in the room.

Wait! Suddenly, everything happening was too sudden. A hot panic flushed my veins. "Do I get gas?" I asked when she returned. The Dentist informed me that if I desired nitrous oxide, it could be arranged, but I would have to reschedule for tomorrow. The thought of waiting out a Sartre-ian eternity of 24 hours didn't appeal to me. I'd come to get it done. I wanted it over with. No more stalling.

The Dentist swabbed a Q-Tip full of topical numb-juice into the regions she was preparing to inject, and without further ado, hauled out the hypo. I told her, as the needle stood poised in her hand, that my nervous system was made of jerky: It usually took three times the normal dosage to dope me up proper. Per my request, she went at it. In a matter of minutes, the lower right side of my jaw, all the way back through my tongue, was heavy and insensate.

After some initial digging around and loosening of the gum wall, The Dentist called for the "elevator." I attest that there is no more appropriate name for any known surgical instrument--though this particular elevator only went in one direction along the vertical axis: up. My tooth, of course, didn't desire to go up; nor did my head. Rotten tooth, interlocked vertebrae, and good old gravity thus commenced a lengthy grudge match pitted against the one-way elevator that was winched up skyward with the halting, calibrated movement of a hand-cranked car jack. This was indeed a slow elevator, a mean machine with crude mechanics and a tendency to stall between floors. The kind of elevator that might, given the choice, compel you to take the stairs instead.

Up. And stop. Suction. Pause. And... up. Stop. Pause. Suction. Pause. Heave. Ho. And up. Stop.

About halfway through the surgery, I was informed--with an exasperated chuckle--that I possessed some extremely long roots. Translation: This was turning into a bloodbath. The Dentist asked three or four times if I wanted to take a break. I would grunt no, and then wonder if this solicitation wasn't so much an offer as a vicarious request on behalf of the beleaguered team. And how many silently gawking dental assistants were surrounding me, anyway? I sensed--or perhaps only imagined--that people were perpetually leaving and entering the room as the hydraulic action of the suction tube echoed in my skull. Was I losing blood? Nobody was talking. On ER and St. Elsewhere, this lack of banter always indicates bad news. Was something going wrong? My fingers clawed at the ends of the armrests, and the toes of my shoes tapped together like a metronome. At regular intervals, my flooded throat let out small, stilted, involuntary moans.

This one, I soon understood, was going into extra innings. The Dentist was working too hard, obviously under duress; she kept up a panting, Hemingway-esque monologue--making sure I was as comfortable as possible, asking if I needed a breather, and letting me in, albeit vaguely, on the progress of Number 31's evacuation. (In all matters medical, "vague" equals "reassuring," and "blunt" just means you're dying). With every leveraged, slow-motion jerk and pull of the elevator, I could feel the isolated tooth being tugged reluctantly upward against the mooring of bone in my jaw, could feel it slipping micro-metrically away from strata upon strata of blighted gum. The square-poundage of pressure being exerted upon it must have been phenomenal. I'm still amazed the thing didn't burst apart.

After a while, everything begins to recede: You drift off. All the atmospheric trappings of pain are immediately present and graphically accounted for--aura, sound, pressure, effort, blood, spit, breath--and yet there is no pain. Somehow, this absence makes the proceedings all the more difficult to bear, and gruesome, like a horror film where you never actually see the monster. Your mind collects the unattached definitions of the one thing you've been anesthetized against, and your imagination just runs away. Sounds are at once amplified and distorted due to their obscene proximity. I thought, at times, that I could actually hear the tooth creak like a rusty hinge as it was being pulled out of its socket. Other times, I decided everyone had permanently left the room. The phenomenological monotony of the operation eventually escorted me into a borderline state, somewhere between mild shock and static anxiety. And finally, the unbelievable totality of the situation being staged within my mouth exhausted me in a weird, restless sort of way--like, if you're tired enough, you can sleep with a jackhammer pounding beside your head. You just won't sleep very well.

And then--maybe an hour into it? More? I had no means of telling time--with me nearing the point of hallucination, there was an indefinable movement, an indescribable sound, an impalpable hypothesis of release. I haven't a clue how high my rotten tooth flew spiraling and looping quietly through the air, but the arc of its trajectory shot it directly into my navel. Plop--I felt the bloody stump land against a shirt button. And there it sat.

Still, I kept my eyes pinched shut. My mumble--"was that it?"--was answered curtly in the affirmative. Someone picked the exiled tooth out of my belly button. Then The Dentist asked, politely, and a little excitedly, if I wanted to see it. Holy Jesus! I shook my head no, as adamantly as possible. And now, in order to make sure no surgical instruments or fragments of tooth or root were left behind to fester in my head, The Dentist went back in and probed the site. This post-op maneuver deeply nauseated me; for some reason, after the concrete act of extraction, the soft-focus metallic brutality of digging into the muck of Number 31's void was so terrifying it made my nipples hard.

Satisfied at last, The Dentist called for gauze, set it in my mouth, and asked me to bite down gently. Someone wiped my tingling chin, and finally, I opened my eyes.

According to the cover letter on the information pamphlet I received, written by Sea Mar CEO Rogelio Riojas, the clinic where Number 31 met its fantastic end is part of "a private, non-profit community health organization" founded in 1978, "committed to providing affordable and quality care for all you [another funny typo] medical, dental, mental health and social service needs." Sea Mar claims over 40,000 patients as a service provider, "operating 13 facilities in five Western Washington counties"--the second largest such nonprofit medical provider in the state. In the fourth paragraph of his all-embracing introduction, Riojas lays it on the line: "Health care is available at Sea Mar Community Health Center, regardless of income."

I assume that, like me, most chronically poor people are self-brainwashed into putting their own health on the fiscal back burner; that it's only the well-to-do who don't feel systematically conned out of options by the monopolistic grip of profiteering insurance corporations operating in an unprincipled laissez-faire economy run grievously amok. Poverty and illness have always been in vicious lock step, but these are especially bad times--an era of upper-crust triage and bottom-line directives that leave you, your body, and your pocketbook unattractive free agents in an increasingly mean-spirited medical playing field. The twin engines of personal neglect and systematized lack of opportunity propel the poor down a cyclic path, bouncing between the narrowing byways of denial and Band-Aids, until a condition gone critical lands you coughing and groaning at the door of mortal urgency.

Though my condition wasn't quite life-threatening, I knocked, and, thankfully, that door opened.

In the aftermath of surgery, The Dentist looked tired. She told me not to smoke for at least 48 hours. She warned me that after such a difficult extraction, I might be in for a long, achy week. Though exhausted, her professional manner was both casually efficient and warmly reassuring. I made a dumb joke about how, after such protracted intimacies, it seemed strange that I would never see her again. She smiled.

But I would see her again--and again and yet again--because once I got out of the parking lot, and against all good reason, I immediately popped two prescription painkillers and lit up a cigarette. For a moment, I considered smoking it through my nose, but that seemed too hardcore. I drove home, lay down on the living room floor, turned on the new Flaming Lips CD, and waited as the Vicodin and the pain battled it out.

I got partial dry socket, which is just as hollowly painful as it sounds. Back to The Dentist I went, expecting to be strongly admonished; but when she saw me she didn't appear mad so much as resigned--an attitude I attribute to the Zen acceptance of an overburdened social worker acclimated to dealing with fucked-up poor people and their stupid bad habits. She repacked the wound with some kind of chemical sealant, told me not to smoke for 24 hours this time (a logical compromise with my proven idiocy), and prescribed more drugs.

The hurting continued. It wasn't just the open wound in my mouth that smarted; my entire jaw throbbed as though I'd received a massive cranial bastinado by a southpawed maniac with a croquet mallet. I scheduled one last trip to Sea Mar--a place with which I was now becoming, to my surprise, quite comfortable.

My comfort, however, was quickly inverted by the bored note of familiarity in the receptionist's manner as she checked me in over the counter. What was this? Did they all think I was some sort of Woody Allenish hypochondriac now? Hence was the purity of my pain metamorphosed, through social osmosis, into a sudden and strong feeling of otherness: It became, in my mind, the unseemly burden of pain's proof. This overly sensitive uncertainty was in turn ratified by the The Dentist. Seeing me in her chair for yet a third time since the extraction, her demeanor appeared at once amused and annoyed, and her eyes seemed to telegraph some unpleasant suspicions about me. She wasn't rude, but she was icily expedient. She peeked into my mouth and claimed that everything was fine, that I was healing normally. After this, she gave me a plastic syringe with which to "irrigate" the hole. Then she actually patted me on the knee. The implication of that sporty gesture was clear: Buck up, buddy, and quit yer bellyachin'! Get out and don't come back!

Over the next several weeks, I again learned to cope with the pain, to accept it as part of my physiological makeup. As I'd been told, it had been an unusually difficult extraction; it only stood to reason that the recovery period might be abnormally protracted and unpleasant. So, barring a lethal hemorrhage or suppurating infection, I vowed to suck it up. I consigned Number 31 to the trash heap of oral history.

But, to paraphrase Marx, history repeats: the first time as tragedy, the second as farce. In this instance, the farce reared its head in what I thought was a sharp piece of organic matter that had somehow planted itself into the not-healing hole. Try as I might, I couldn't irrigate it out. Neither would I break my solemn vow; I would not return to Sea Mar. It was the old waiting game again.

Almost a month to the day of the initial extraction, the object in question became noticeably loosened by repetitive backhoe movements of my tongue. I reached in with wet fingers and dislodged it. Holding it to my eyes, I wondered: What is it? What could it be? A sliver of petrified cracker? An uncooked noodle? A piece of brain? It looked similar to the chunks of beachcombed coral I'd brought back from a trip to southern Mexico: eroded, porous, and colored a whitish gray. Whatever it was, I put it into a black plastic film canister and stowed it in a kitchen drawer.

When a second, sharper object started poking up through my gums a few days later, I knew something was seriously wonky-doodle. What else could it be but that my body was furiously rejecting the leftover shrapnel of Number 31? My God! Somehow, somewhere, I had slipped through the cracks of the sliding scale. I realized, reluctantly, that there was only one thing to do: circle back, get in line one last time, and finish the ride. I wasn't happy about it, but I had no choice. I was a ward of the state.

The Dentist who had first worked on me was booked solid through July, so I was forced to see a Different Dentist who was handling urgent care. The Different Dentist, God bless him, was very eager to see what I'd recently dredged up from my gums. I popped the top off the canister and dropped the mouth-trophy into his hand with a slight feeling of vindication. My last three visits had been obscure failures, but now I had hard evidence: Exhibit A. Different Dentist said, matter-of-factly, that Exhibit A was a piece of jawbone. He seemed slightly perturbed that, after three visits, I had never received a post-operative X-ray. Oops!

The procedure, this time around, was as short as the other was long. Different Dentist held up an X-ray negative of my inner mouth, pointing to the white slash within the gum wall that indicated either a tooth shard or bone matter. He shot me up with Novocain, and, after reminding me to breathe ("My God, you're making me nervous!"), he pulled the stubborn remainder of Number 31 from my head. In the end, it took all of two minutes.

When, at his stern request, I opened my eyes, Different Dentist was waving tweezers in my face. It was an ambush! "See," he said. Suspended at the end of the tweezers was an irregular blob of crimson-coated bone. It looked like a piece of half-popped albino popcorn dipped in neon-red nail polish. I was grossed out. This sort of physical confrontation, I gather, must be intended to serve approximately the same psychological function as an open-casket funeral: to show you that what's done is surely done, and can never be undone--ashes to dust, and so on.

"Huh," I said weakly, acknowledging that I'd intellectually beheld the blob, had thought about it some as it hung there pinioned in the tweezer's grip. Then, unceremoniously, Different Dentist stuffed me with gauze and left the room. I looked up at his assistant, who was looking down at me and smiling. "Is that it?" I asked. "Yep," he replied. "Okay," I said. Was it over, at last? I got up out of the chair and made my way, a bit shakily, toward the exit, through the maze, past the sounds of suction and drills, skirting open cubicles where new patients, just getting under way, lay yawning and gurgling and spitting.

I realized that, rather than being over, this could just be the beginning. I still have 27 teeth left--or, perhaps better stated, 27 to go. All in a row. Like a xylophone.