Ernestine was right

Aug. 1, 2005
Comedienne Lily Tomlin amuses audiences all over the globe with her wry look at human behavior.

Comedienne Lily Tomlin amuses audiences all over the globe with her wry look at human behavior. Her wonderful comic abilities allow us to look at truth that is dressed up in exaggeration or absurdity. Through the years, Lily has created many memorable characters.

Even today, Tomlin’s characters keep a fresh perspective with commentaries relevant to today’s world. One of her earliest creations was the feisty, nosy, and preposterously polite telephone operator, Ernestine. Ernestine is known for her high-pitched, nasal delivery, with every syllable delivered in a series of rapid-fire shots.

According to Tomlin, “Ernestine was dragged, kicking and screaming, into cyberspace. It was years before she could put down her headset and give up the old plug-board ... so much easier to listen in on everybody ...of course she’s bitter about the past.”

Ernestine’s take on her career with the telephone company goes like this: “I gave the best years of my life to Ma Bell and what did it get me? When she went to pieces, so did I! I’ve got operator’s hump from plugging and unplugging. I’ve got carpal tunnel from all those years of dialing. Oh sure, everything in the workplace now is ergonomically correct. They worked out the kinks on me. Look at this hand... (”

Lily’s and Ernestine’s thoughts parallel the careers of so many in our profession. How many of us run at the mere suggestion of change or the sight of new technology? And how many hygienists have forfeited their careers or destroyed their bodies with repetitive stress injuries, all in the name of patient care? Let me share a story with you. And while you’re at it, imagine what Tomlin’s response might be to this absurd but true tale.

At noon on Wednesday, April 8, 1988, “Ernestine,” the hygienist, put down her scalers - a date and time permanently stamped in her memory. Ernestine’s 20-year career ended that moment. Her memory is just as fresh as if it had happened yesterday. She remembers everything about the last time she ever worked with a dental patient. She remembers his name, his face, his teeth, and his gums. And she remembers the nauseating pain radiating along the entire length of her arm from the tips of her fingers all the way up to her shoulder.

Six months of heavy doses of OTC medications did not touch the incessant, ever-increasing pain in her right arm. No amount of pain medication did the trick. Periodontal patients were Ernestine’s specialty. She took pride in her skills. She worked tirelessly to remove imbedded toxins from the cementum, achieving a glass-smooth surface, but her body crashed after 20 years of meticulous hand scaling, four days a week. The cumulative trauma to her body had taken an irreversible toll. Ernestine would never pick up a scaler again.

She immediately sought the opinions of neurologists and orthopedic surgeons and suffered through exhaustive and painful diagnostic tests and extensive physical therapy. But it was too late. The final diagnosis devastated Ernestine - ulnar nerve neuropathy.

Perhaps there was an early warning that Ernestine ignored. Three years before her physical meltdown, she was pregnant with her second daughter. Like many pregnant women, she was diagnosed with carpal tunnel syndrome midway through her pregnancy. By the time she lost significant motor control in her right hand, the doctors felt that it was too dangerous to let the condition go untreated. A week before delivery, Ernestine got a cortisone injection in her right wrist, leading to chronic wrist pain for the next six months. Her motor control returned to normal as soon as she stopped breast-feeding her baby. No one will ever know if her ulnar nerve neuropathy developed because of how Ernestine compensated during her bout with CTS.

Ernestine did not have her own disability coverage. She had relied on her employer’s worker’s compensation. She filed a claim immediately that was initially denied because she was receiving unemployment. The insurance company finally relented, but required their doctors to repeat every painful diagnostic examination.

It took a year for the doctors to reach a consensus. They recommended surgery that would relocate the ulnar nerve to the front part of her elbow. Ernestine agreed. Even after surgery, she still had round-the-clock severe pain. According to Ernestine, God knows where the ulnar nerve should be located, not the surgeons.

For a couple of years after surgery, Ernestine kept trying to return to the dental office. She and the dentists worked hard to create job descriptions that included nonclinical, low-trauma activities like office safety manager, new patient assessments, and reorganizing the hygiene department. Everyone hoped these changes would allow Ernestine to utilize her knowledge and expertise and continue to be profitably employed. But since she could not treat patients on an as-needed basis, the system was not economically viable.

She couldn’t practice. Bills were mounting, and her body was wracked with constant severe pain. Her clinical dental hygiene career was over. The insurance company offered Ernestine a one-time lump settlement of $6,000, even though the face value of the policy was $25,000.

Ernestine said no! Her career was worth more than $6,000. Even though she was not totally disabled, her clinical dental hygiene career was gone forever. Ernestine fought back. She hired a lawyer to appeal the decision. Four years passed before Ernestine and the insurance company faced each other in court. It took the judge less than four minutes to make a ruling. Ernestine recalls the judge’s succinct ruling verbatim. “This is a legitimate case. You have to pay it. Don’t waste my court time.”

The judge ordered the insurance company to pay the full value of the policy, but Ernestine did not end up with all the money. The lawyer received $5,000 and she signed a $5,000 waiver to continue coverage on any injury related to the ulnar nerve in her right arm.

After all of the negotiations, Ernestine stood to pocket $15,000. Rather than pay one lump sum, the insurance company chose to pay $200 every two weeks, hardly a living wage. Ernestine desperately needed income to start her new consulting career. It took four years to collect the entire judgment. So far, Ernestine’s story is pretty typical, but the next series of events reveal an even darker story.

The final settlement contained two additional conditions. Ernestine had to agree to go to career rehabilitation. She considered trying to learn to do dental hygiene with her nondominant hand, and determined it was impossible for her to scale with that hand.

Ernestine was also required to provide the insurance company with her entire employment history. She was asked to reveal every dental office she had worked in since 1973. In retrospect, she now says, “What did I know?”

The insurance company now possessed a very powerful tool. Without her knowledge or consent, the insurance company filed suit, in Ernestine’s name, against every doctor she worked with since graduation. The company was attempting to recover the litigation fees and money paid out on Ernestine’s claim. The damage to Ernestine’s personal and professional relationships was devastating.

Ironically, many of the doctors who got served with papers had workman’s compensation coverage with this company. During all of the legal wrangling, the insurance company made it very clear that they were attempting to prevent a judicial precedent. The company did not want claims made by dental hygienists for cumulative trauma injuries paid.

When Ernestine was in school in the early 1970s, no one ever talked about cumulative trauma disorders or workplace-related repetitive stress injuries. A few years after she graduated, she started teaching part time. She heard rumors that a few key educators had a history of CTDs, but the students were never told of potential risks. The wall of silence was never breached.

It took nearly eight and a half years for the chronic pain to subside after surgery. Over that period of time, she gradually gained the ability to do more, but Ernestine’s right arm will never be the same. The ulnar nerve is very close to the surface of the skin. Even today, the slightest irritation, from a seemingly innocuous source, will send shooting pains up and down the muscles in her right arm. She can’t wear wrist or finger jewelry any more. The pressure of a tight cuff on a blouse or poorly fitting procedural glove can initiate pain so severe that it brings Ernestine to her knees.

Ernestine’s life goes on, but to this day she can’t sew, can’t play racquet sports, can’t garden, and can’t vacuum her own house. Before her injury, she spent years excelling in sports that strengthened her upper body musculature. She was faithful about stretching. According to the medical experts, this training delayed the eventual nightmare by at least a decade.

Ernestine, the dental hygienist, has closed this chapter of her life, but like Tomlin’s beloved character, our Ernestine gets misty eyed every time she sees a scaler at a dental meeting. “I miss touching patients. That was a huge part of my life. All of my knowledge came out in my fingertips. This was my identity, and I was good at it.”

Is she bitter? No. She is still mourning the loss of her clinical career. Ernestine is mature enough to know that bad things happen to good people. And she is also smart enough to go on with her life, and hopes that her story will make each of you examine your situation and take the necessary steps to protect your career.

Your dental hygiene career is precious. Can we learn from these two feisty women who are not afraid to speak up about how repetitive stress injuries devastate lives? Your clinical days will be over if you do not respect your body’s limitations or its signals.

Do you want to end up bitter and broken like Tomlin’s Ernestine, or are you ready and willing to be responsible for creating your own professional comfort zone?

Anne Nugent Guignon, RDH, MPH, is an international speaker, has published numerous articles, and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540 and her Web site is

Ernestine’s Recommendations

* Remember that health is a priceless commodity.
* Get a good disability policy immediately.
* Don’t rely on others to protect your career.
* No one can ever pay you enough dollars to get hurt.
* Purchase and use good ergonomic equipment.
* Recognize CTD symptoms early.
* Exercise, stretch, and strengthen your body.
* Act at the first sign of pain or unusual symptoms.
* Pain is your body’s signal that something is drastically wrong.
* Nurture and protect your body.