Dr. Romi's Biggest Challenge

Because I’ve gotten a few remarks about this, although I understand it was unintentional, I thought it would be best to share a bit about myself. I really think by knowing more of my story, that you’ll come to realize where my source of empathy arises from. Not only to current patients but to prospective patients looking for someone who will listen, because I will. Let me start by sharing my biggest challenge.

This past month has been more challenging than ever with this ‘condition’ I have. I was asked when I would actually drive by several people when I have already decided in my life that I would not actually drive. I even had an extended family member who ridiculed me of choosing not to drive.

For those who have had a meal (or even a coffee with me), you have already experienced this with me where I appear as though I am going to throw up and ask for a moment to myself. This has to do with what I am about to describe.

My biggest challenge(s) on a daily basis, especially in this past while, are putting a toothbrush in my mouth in the morning and putting on a mask. But why, one may ask?

I was born with a very sensitive gag reflex. What this means is that my threshold of wanting to throw up is much lower than most people. That sudden reflex occurs when I put something in my mouth, and is worse when I’m sleep deprived, doing physical activity, talking too much or too fast, in anxious situations (I still remember those horrific Objective Structured Clinical Exams where I’m standing right in front of the clinic door waiting for the bell to ring so that I can enter the clinic room and conduct a consultation and physical exam on a standardized patient, and I’m almost to my knees gagging the life out of me!), and when I’m eating too fast or too much. In fact, growing up I had a very hard time putting many solids in my mouth. I was told I couldn’t even stomach breastmilk and had to be fed soy milk. The thought of putting anything in my mouth before would elicit a response that made me just want to throw up (even if it was air).

This prevented me from eating much, even as of right now. My gag reflex (as I will refer to it right now, due to a lack of a better description) tends to get to me before my satiety cues come. That’s why after every meal, I tend to be almost paralyzed by this response. What makes it worse is having the mask on me, which has felt to increase the intensity of this by severalfold. Just a couple of weeks before Christmas, I was out on my own having lunch at the food court mall. I thought I took a good enough break after eating, but the moment I put the mask back on and took a few steps away from the table I was sitting at, the response was just paramount. I couldn’t get back to my seat as it was already taken, and I felt if I took any unnecessary move, that would make me want to throw up on the spot. It’s a very uncomfortable response, and I found myself having to find some area that is not crowded for me to temporarily take my mask off and be able to breathe. In this event, I slowly approached the tray return stations and told the worker there I needed a moment. It’s really hard to let anyone know how I’m feeling in this state without looking like I’m about to vomit or that I am in need of emergent care because I can’t make any swift moves.

Luckily, these situations that are intense as above are few and scarce at this time. I’ve found acupuncture to have really helped me which developed my love for Traditional Chinese Medicine. And as I grew healthier by having a more positive mindset and increase in fitness, that I felt I wasn’t gagging as much (albeit I do gag during my workouts between sets). But I feel the overall gag intensity and quantity have decreased as a result of having a healthier self.

This is why my biggest challenge on a daily basis is having to brush my teeth. The response will vary, but I realized that on days I do not sleep well the night prior, that it would elicit a very immediate response upon inserting the toothbrush in my mouth. This is something I have to endure and continue to endure.

Of course, that being said, and maybe you are thinking about this as you read this, what about dentists? Well, they were my worst nightmare. I have been to a good half a dozen dentists already, and the majority of them have been nothing but disastrous. The dentist I had been recommended by a family friend in Granville, Vancouver was nothing but condescending. The state of my teeth is apparently a result of my negligence for not brushing or flossing, and I find myself hearing the same lecture over and over. Of course, this is while they’re trying to work on my teeth with extreme difficulty because I’m finding myself gagging like crazy. I could barely handle having a toothbrush in my mouth, what makes them think having 2 or more tools in my mouth would be any less challenging? How would they feel if they gagged so easily on anything that comes into your mouth? How would they feel if they were just being negligent of your dental health? I don’t need to be reminded several dozen times that my teeth are going to rot, and this is just coming from the dentist. No considerations, no thoughts of alternatives or ways that could make it better, nothing.

I’ve had dentists that attempt to puncture my tongue just to get it away while I was gagging. I’ve had dentists that lost their temper on me and lash out that I need to do something about this gag reflex. I even had a dentist decided to take a personal call while working on me just because no work was being done. Over the years, I have always wondered if I should ever report these dentists. Now that I’m a physician myself, I realized these were probably examples of what not to follow as a health care practitioner. But this is all in the past, and I’ve grown stronger. I’ve come to let go of my past and focus on the present in which I am appreciative and grateful for what I have.

This is also why if they have met me pre-pandemic, or have seen in my pictures, that they recognize that I do not have straight teeth and have chosen not to get braces. To tell you the truth, I have attempted to get braces. But there were a few things that stood in my way. One was the mold that you must insert in your mouth to see the state of the teeth. I remember having that placed in my mouth, and barely halfway in, I was in tears, gagging and actually throwing up my lunch. That was a memory I’ll never forget.

Despite all the negativity, I have found a dentist that has been nothing but empathic, so empathic that it makes me feel I have more work to do between me and my patients. I’m nothing but grateful for this current dentist and have regained some confidence in working on my dental hygiene.

This is also the reason why I chose not to drive. Had I started feeling as though I am going to throw up, the last thing I want to be doing is driving. I feel it’s not for my safety, but also the safety of my surroundings. I can put up with public transportation (in fact, I find it quite therapeutic to be staring out of the window). However, I do have my novice license in case I have to drive someone in an emergency. (I did gag during my driver's test, and had to briefly explain it to the evaluator).

I thought that this gag reflex took away a lot of what I could have done earlier in life. I could barely present, let alone talk. Look at me doing over 150 talks in the past 3 years to large audiences!

I thought that this gag reflex took away my capability of doing any intense physical activity as I would be intensely gagging upon initiating any activity. I was able to do some sports growing up such as dragon boating and ultimate frisbee. And even right now, I found the perfect balance with resistance training. I feel I can lift pretty heavy and have moments where I can gag in between sets and get back to it just fine. And the more I’m able to lift and perform, the healthier I get, that these events lessen. I find myself teaching to a class of 30+ as an instructor now, having to project my voice. I never thought I’d be doing these things.

Even at the start of the pandemic, while we were in complete lockdown in March 2020, I could barely put on a mask. The moment I had the mask on, I’m gagging the life out of me. And now, although it still happens, it is something I am able to handle. I can keep my mask on and be able to teach and see patients, something I was concerned about at that time.

I feel my gag reflex, although it can be a nuisance, is something that has developed me to become the resilient person that I am today. I know there are people out there that are living with life-threatening illnesses, or situations more challenging. I witness events where people are saying ‘they wish they had this or something. As much as I wonder what it would be like to not have this gag reflex, I can’t imagine how resilient I’d be compared to now.

So the next time if someone is with me, whether that be coffee (hopefully in the near future when restrictions lessen) or a hike, or even just a simple chat, that if I start coughing to rid of this sensation, to just give me a moment? I would greatly appreciate that! Cover Photo: Images from Wix