Saturday, October 22, 2011

My first (and last) colonoscopy running journal

Every year, Father Time chases me with just a little more alacrity, emboldened by my slowing physical growth, deteriorating brain cells, and lackluster youthful spirit. He must have been pleased to know that, about two months ago, I almost -- repeat, almost -- got a colonoscopy. At 22 years old. Here's my running diary of what could have, should have, might have oh my god been.

Pretext: At the beginning of January, I got my eyes checked up my a Yale ophthalmologist who told me I was at risk of having Gardner's disease, because of the appearance of what might have looked like a little freckle in my eye. (Note: as bad as that sounds, the medical terminology makes it seem much worse than it is.) Gardner's means that I have an increased risk of having polyps in my intestines, so she recommended that I get a preliminary colonoscopy. So, back at home in August, my parents scheduled an "exploratory" visit for me against my (obvious) wishes against it.

Tuesday, August 16th, 2011. 

10:30 a.m.

Reading New Yorker on way to the doctor's office. Can’t wait to get the appointment done with. I walk in and immediately, the receptionist says, “The 4 pages I’ve creased are the ones that you need to sign.” The first page is normal: SSN, address, insurance information. The next three pages are colored. Uh-oh. Sign here to acknowledge that there is a 400 in 1 risk of having internal bleeding. Sign here to waive your right to sue because there is also a chance that your bowel walls will be pierced, which requires immediate follow-up surgery. There are many other bullet points of harm, but I don't think I can handle it if I read them. So I sign it all. It's ok. I'm not actually going to have one. The doctor is going to look at how healthy I am and realize it is absurd that I am here. 

I sit on the big comfortable chairs they have and read Oprah Magazine. It’s pretty good: how to defeat emotional robbers, Dr. Phil advice on abusive friends, stylish watches you can wear underwater.

10:40 a.m.

White man, fat. Bulging middle. Standing over the desk. Looking at his file. Yelling at the receptionist. "I’m 70 years old. I’ve had bleeding once! You can’t put that down.” He's furious about his record.

10:45 a.m.

The doctor walks in: genial, skinny, Hawaain shirt, and salt-and-pepper beard. Looks like Mr. Clarke, my high school English teacher. I move from his stool to a seat. He asks me questions: do you have any allergies; are you on any medications; have you had former problems – I answer them all easily. I tell him I’m going to the Philippines; he says he worked in Micronesia for 3 years, and remembers the mountains being cold. Also says he came back from Ecuador, and tells me I’ve been living an exciting life. Can’t help but smile; I really like this guy. If he’s going to poke around my anus, that’s probably the best worst-case scenario.

11 a.m.

He's looking over my paperwork from the eye doctor. “Yes, we’re going to want to do it," he tells me. "You always want to check this.” He's going to look for polyps. It’s a all or nothing deal. If I don’t have polyps, I’ll never have polyps. If I do...well....

He tells me that I should come in Friday to do it. I ask him what the procedure is like, and my fear is unconsciously reflected in my eyes. He says it takes 15 minutes, and I don’t feel anything because I’ll be heavily sedated. “What? I’m heavily sedated through the entire thing?” I ask.

“Yup. You don’t feel a thing. Though…I can do less sedation. That way, you can see what’s going on. It’s actually pretty interesting…”

11:05 a.m.

The receptionist gives me a box with containers of laxative and a sheet, and tells me I can’t eat solid food all Thursday. I lean against the counter while she’s handing me the materials. I look to the right, and on the wall I see something I missed before: a wooden sign that says, “Thou Shalt Not Whine.” It’s so fitting that I start chuckling to myself.

11:09 a.m.

I'm out of the office, and I let out a half strangulated scream. I can’t believe this is happening. Colonoscopies happen when you’re 40. Not when you’re 22. I shuffle back to the car, and I’m stuck between three thoughts: I can’t believe this is actually going to happen; it’s not happening for 2 days so I don’t need to think about it; how much sedation should I ask for? See, I have a choice: go through ignorant bliss and wake up 20 minutes later with a little soreness, or, I can satiate my intellectual curiosity and watch the doctor from start to finish, see the insertion, the plucking, gain some experience, develop some knowledge, but have it  hurt, mentally and physically. I already know that I'm going to choose the less sedated route. It's now about just getting over my fear.

11:15 a.m.

Driving back home, my dad relates his experience 5 years ago. Apparently, when you start the fast, you drink only water, so basically, by the time the operation begins, all you’re expelling is water. I think of how I’m going to survive not eating solid food for a day. Then I stop thinking: I’m numb to what’s going to happen. Well, I guess I can’t meet up with those guys for fro-yo anymore.

One of the most hotly debated scientific papers I debated in psychology class revolved around "experienced utility" and "remembered utility." The former is your moment-to-moment happiness, and the latter is your happiness in a particular moment upon reflection afterwards. Which one is more important? And how do we represent pain and happiness after the fact? Well, probably the coolest psychologist of this era, Daniel Kahneman, did a study asking patients undergoing colonoscopies how happy they were before, during, and after the procedure. The finding was pretty formative for modern psychology: while the total pain of the participants (graphed out like an integral) varied tremendously, their remembered pain was a function of the peak pain and the pain endured during the last 3 minutes of the operation. This had a striking implication: to make more men come back to do followups, colonoscopies should actually last 5 minutes longer than necessary, with those 5 last minutes in a "slow, low burn" as to give patients a better recollection of the experience. Total pain would be higher, but remembered pain would be lower. 

I wondered if, during my colonoscopy, I was going to have the probe in me 3 minutes longer than necessary, and if I would ask him to remove it sooner.

9:50 p.m. 

Wake up from 4 hour nap. First thought: I've having a colonoscopy.

Wednesday, August 17th.

8 a.m. 

Wake up. Drink a little red bean soup. Today, I have an opthamologist follow-up appointment. My schedule has been packed with doctors visits, because I'm leaving in two weeks and because I haven't been back home in a year. 

In the office, I get my eyes dilated and can't see straight. The doctor – the name's Gauche – comes in and is unyieldingly gregarious. She's chipper because I'm the first patient of the day. She glances over my file, checks my eyes, and says, "There’s nothing to be worried about." I tell her that because of the freckle, I’m getting a colonoscopy. She looks at me carefully, pauses, and drops a 4-letter curse word – almost. Then she says, “I’m the closest I’ve ever been to dropping a 4-letter word with a patient. You’re a healthy, 22-year old male. What are you doing this for? You know colonoscopy is not a benign procedure. If it was a haircut sample, I’d say, go ahead, get a haircut. But this is different. I read this Newsweek article yesterday night -- you have to read it -- about how medical procedures that are uneccesary cause more complications than they help. I wouldn’t have diagnosed this in you. This. Is. Absurd.” 

The best part about all this: the only light was the lamp at the desk in a closed room. It lit her face from underneath; it looked as if we were telling scary stories in the dark. Mom asks a few questions, still concerned. The doctor says, “If I were you, I’d strongly consider cancelling the colonoscopy.” (Then she says many, many things to make me feel better about my eyes: white without pressure is not threatening. Only .01% of the population ever has a tear. The treatments today are great at dealing with this. I have perfectly healthy eyes. Lattice degeneration happens at birth, and it doesn’t get bigger. You can only tear something once. And – this is cool – if I see a flash in both eyes, it is not a retinal tear. Which makes complete sense.)

I walk back to the car, and I'm thinking: the key to life is staying positive. I’m a normal, healthy, 22-year-old. That's the mindset. Sweet.

9 a.m.

Dad calls the clinic and tells them, “My son really doesn’t want to do it – he’s scared. So we’ll do it next year.”

4:30 p.m. 

It's all over -- not. It's another call from the clinic. It's the doctor. He understands, he doesn't want to persuade me to do the exam, but -- just in case -- I should do x-rays on my colon, just in case. It won't be as effective, but it's a necessary precaution. Let's meet in the middle here. I agree. X-rays I can do. So they get penciled in.

Friday, August 19th, 2011.

9 a.m.

The hospital is expansive. I sit down in front of the cashier's table and whip out my credit card to pay for the $2,500 examination. With insurance, that number comes down to $200. Ridiculous.

9:10 a.m.

The waiting room is all old people, at least 90 years old, and one baby who has a heartbreaking problem -- he can't wait, and can't talk outside of meaningless babbles. The mother, though, is eager, happy. She puts on a great face.

9:25 a.m.

I walk in. Take off my clothes and put on a one-sided robe at the front and at the back. Then I do battle with the fluoroscope. It's literally the biggest machine I've ever seen. I never watched the X-men movies, but I imagine it would fit perfectly as a set piece there. The machine his built in with the table for the patient to lie down on; it can rotate 90 degrees (basically, from lying down to standing position), has a trellis system to move, a huge telescopic x-ray that is bigger than my midsection. Ah -- not X-men. Transformers. It feels like a Transformer, like it could whir and start walking away destroying the hospital.

I’m doing the stomach and the esophagous first.

The coolest part by far is the barium I have to drink, so that its progress can tracked through my digestive tract. Yea, barium, like the periodic table element. Just when you thought science would have no relevance to your life...what I'm drinking is a water-soluble barium (it's native form is a rock-like) salt that might be barium sulfate. Barium absorbs x-rays and thus creates a contrast that makes it possible to image soft tissue. 

It's also flavored. The nurse gives me a thick white shake, so thick it looks heavy. I pour it into my mouth and taste the hint of coconut and chalk; it mainly tastes like a weak latex glove. The next step involves a  plastic shot glass. There are white crystals at the bottom, and when he pours water on top, it fizzes and rises to the top like a Mentos-and-Coke reaction. Boom! I gulp it down before it drizzles out of the cup and over the front of my gown. "Here, here, you have Barium lips," he says, giving me a towel to wipe it off. "Try not to burp." The shot I took was literally all carbonation; it's to give my stomach air so X-rays can work better. It is very hard not to burp.

I lie down on my side and am instructed to roll over two revolutions to shake myself up. While I am rolling around and around, the X-rays are taken. I feel like I’m performing a circus trick. Then the entire machine tilts up and I’m standing. The doctor (who's in by now) gives me a straw and watches me drink the milkshake, watching it fall through my system on the monitor. It's kind of cool, except I can't see it. I drink one more shake – at this point I’ve done almost an entire quart -- lie back down, my stomach a little queasy, and wait for an hour for the Barium do descend into my bowels. It typically takes one to two hours to make its way through my system, but during a preliminary X-ray, the nurse realized it was already in my small intestine. Score one for a youthful plumbing system! I’m the first patient in a while that's been this fast.

11:30 a.m.

My mom is shocked that there were 20 X-rays taken. Those are dangerous! So, when we get back home, we cancel the 2nd set of X-rays for my large intestine. Done and done. 

5 days later, while I'm walking to the Giants game, I get a call from the doctor, who says that the X-rays checked out perfectly. I thank him for calling, and then hang up. The future is bright, fierce, lovely. No colonoscopy in my future. At least not for 18 more years.

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