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The extraction will leave a sizable declivity — a crater of sorts — behind it. It is a molar, centrally placed on the lower right jaw: a large tooth of great practical and personal significance whose disappearance nonetheless will be surprisingly unnoticeable from outside. It will not, of course, grow back. The intimate world of the mouth will suffer irreversible loss. In time, if sufficient resources and effort of will can be found, a simulacrum may be fitted; until then, the other teeth will have to do the work of compensating for the absence. Different modes of eating and chewing might evolve to remove strain from the area; curiously enough, the mirroring molar on the left-hand side is also missing. This is not, then, the first such experience of loss. A major tooth has already decayed and been extracted from this mouth, a history which obviously makes things harder. The current extraction is a darker business because of it. And the question of blame, always so delicate where it is in the nature of things to break down, is altered by this new piece of evidence. It’s beginning to look like carelessness, to paraphrase Oscar Wilde. For a tooth, properly looked after, ought to be able to last a lifetime.

Outside the dentist’s windows is a sky of brilliant blue. Yesterday’s rain has been succeeded by an outpouring of confident spring sunshine, as unseasonally hot as the other was preternaturally cold and dark. The dentist’s room is balmy and bright; the sun sparkles on the steel instruments. The whole place is somewhat decrepit, the narrow building in its higgledy-piggledy street all crooked angles and canting floors, its partition walls and flimsy ceilings thickly muffled in bumpy off-white paper, its beech-patterned beige vinyl rising and falling thinly over the uneven boards. In the reception area there is a small fishtank with electric-green plastic ferns and a bubbling pirate ship sitting on a gravel bed; there are posters of diseased mouths, of infected gums, of the blackened stumps of rotted teeth. The dentist strides superbly around these improvised spaces in his patterned robe, as cheerful and dignified as his visitors are pensive and cowed. His teeth are strong and white and straight, and perhaps for this reason his smile is irrepressible. It lives on the surface, always reappearing, like something buoyant in water: it can’t be sunk. It looks, almost, unnatural. It is hard to know whether it represents good fortune — luck — or diligence and hard work. He appears to be happy, but has he always been like that? His partner in the dental practice has teeth as grey as tombstones in an overcrowded graveyard, and a canny, comprehending face; his overall is shabby and creased. From these appearances it might be deduced that one man has the knowledge of failure and the other does not. But how can one really tell? And is it better to be at the mercy of someone who understands pain or who has managed thus far to avoid it?

The dentist rummages in his tray of instruments; the nurses draw close. He leans forward, a dark shape against the bright window. The sunlit room is silent and there rises a kind of aural transparency through which a deeper background of sound emerges, intricately embroidered like an ocean bed seen through clear water: the sound of passing cars outside, of dogs barking and the distant keening of gulls, of fragments of conversation from the pavements below and music playing somewhere, of phones ringing, pots and pans clattering in a faraway restaurant kitchen, babies crying, workmen faintly hammering, of footsteps, of people breathing, and beneath it all a kind of pulse, the very heartbeat and hydraulics of the day. The dentist has a pair of pliers in his hand. Their factuality amid this impalpable veil of sound is unmistakable. They are simple and heavy and black. He wields them, drawing closer. He enters the mouth and with the arms of the pliers lays a ferocious metallic grip on the tooth. Every process has been passed through, except this one. First there was the long process of decay itself, brewing day after day in the darkness of the root; then the birth of pain, a seed that grew and branched, seeking out consciousness, awareness, like a plant seeks light and thereby blots it out; then the negotiations, consciousness negotiating with pain, trying to pacify and mollify it, to control and contain it, to dull it and hence live with it; then crisis, decision, action, a date and time decided on at which extraction would occur and the situation be brought to an end. But the contact of steel with human flesh has a reality of its own. It is happening: things are being changed, having been unable to change themselves.

The dentist wrenches and wrenches amid the soft tissues. His intervention seems allied somehow with death, yet it belongs to life, for its purpose is to liberate the sufferer from the cause of suffering. Its purpose is to separate what will not naturally separate itself. But it is cold and hard, insensate, brutal. It is called violence: people are forever trying to find alternatives to it, but they seldom work.

The dentist speaks.

‘More force is required,’ he says.

The nurse hands him a chisel. He positions it on the edge of the jaw and places the flat tip between the tooth and the gum. He pushes down, straining so hard that his smile becomes a grimace. Presently he stands to improve his leverage. He uses both hands; he stands on tiptoe, bearing down with shaking arms. The tooth resists and resists, and when at last it gives way it does so too easily, so that the chisel spends its force upwards, hitting the teeth above. They take the blow, these innocent teeth, rocking in their moorings; they loosen, but they stay where they are. The dentist holds up the bloody tooth between his trembling fingers. He is beaming again, though with less intensity. A little consternation threads his brow. Violence is so unwieldy, so difficult to control. There is collateral damage; the fine mesh of life is torn. He has caused unnecessary pain, and trauma to the other teeth. He feels bad about it. He is surprised.

‘I didn’t expect it to come out like that,’ he says. ‘I’m sorry.’

‘Please don’t worry,’ I say, with difficulty. ‘I’ll be all right.’

‘I will pack the wound with dressings,’ he says. ‘You need to change them every two hours. The bleeding should stop by tomorrow but you won’t be able to eat normally for a while. Soft things, that’s all. And cold will feel more pleasant.’ He smiles, happy again. ‘Make sure you buy yourself a big ice cream on the way home.’

Home: as a child I loved my grandmother’s house, a semi-detached Edwardian villa in a Hertfordshire suburb with mullioned windows on whose sills china shepherdesses stood, and King Charles spaniels with enamelled waterfalls of porcelain hair. In the gas-scented kitchen my grandmother served shepherd’s pie with frozen peas; I was put to bed in the little room upstairs whose window looked out on the rectangle of front garden with its laid redbrick path and gate, and beneath the faded pink candlewick bedspread and thick stiff sheets succumbed to the force of these sights and smells and textures which, though not human, seemed to define humanness. Touching the ornaments in my grandmother’s sitting room, from whose windows could be seen the long, sloping back lawn that led down to the railway line, I felt visible; the smell of the room where she and my grandfather slept in their mahogany bed, of the cold narrow lavatory, of the small pantry where the constituents of her plain English cooking dwelled, were so distinct that they made me distinct too, just as in the garden the dark foliage of the perennial shrubs made it possible to see the filigree spiders’ webs spun across their empty spaces. My mother grew up in that house: her amniotic atmosphere was there too in the potent rooms, as it was in my own consciousness, ineradicable.