By the time I climbed onto the hospital bed, I could feel the first goofy nudges of the Demerol.
Following orders of the nurses, I rolled onto my left side. Through the gauzy narcotic shroud, my brain told me to brace myself for certain pain. I gripped the rail of the bed and waited.
Colonoscopy. The word provokes fear, as much for the nasty forethought of a medical device going in the “out” door as for the deadly diagnosis of colon cancer that can follow. Still, with almost no textbook cancer symptoms, I had volunteered for this.
Why? I was (at the time) a healthy, active 34-year-old with no weird pains and only occasional — and I like to think endearing — episodes of unusual bowel activity. I have never qualified as a hypochondriac, take pride in my strong constitution and certainly have other things to do than submit my body to medical scrutiny for pure sport.
I had 2 reasons: One, my mom had recently had emergency surgery to remove a large, cancerous tumor from her colon, earning me valuable “family history” points in the Game of Colon Cancer Risk.
Two — and to me the more important motivator — was the litany of stories I’d heard and read about people my age and younger who, in the midst of relatively asymptomatic lives, suddenly learn that they had mere months to live because their cancer was detected too late.
Not me, buddy. As a thrill-seeking and adrenaline-addicted extreme skier, white-water rider, mountaineer, windsurfer and mountain biker, I’d long ago decided that if I was going to die stupid, it would be for a good reason like wiping out on a 40-foot wave or skiing off the wrong cliff.
Dying as a result of inaction driven by ignorance and fear was out of the question. Within weeks of my mother’s surgery, I had an appointment.
Go Lytely – not!
Unfortunately (and you knew that word was coming), there is more to a colonoscopy than the actual scoping. A successful procedure requires an evacuated digestive tract — clean, empty, pristine as a glacial ice melt.
So, 24 hours before going in, patients must quit eating. At some point around 15 hours before showtime, they must take a drug — one of a variety of gastrointestinal cleaners I like to call nuclear laxatives — to forcefully usher all transient matter out of the digestive tract.
My doc prescribed that I drink 1 gallon of a diuretic called Go Lytely. (There are others on the market; at the time of my test, this was still considered the gold-standard product).
Some say Go Lytely tastes foul beyond description, but I’ll give it a try: “Soapy water mixed with sour milk.” It is misnamed so extravagantly that I’m surprised the maker hasn’t been sued for false advertising or malicious wounding.
The liquid provokes 5 hours of activity that can only be properly described as Go Hard and Often. This misery is necessary because some foods, left to the whims of nature, dally for up to 36 hours in the digestive tract. The colonoscopist understandably does not want to encounter them.
So I spent a Sunday afternoon learning visual nuances of my bathroom that I’d never noticed before and swearing that if I ever have another colonoscopy, I’ll opt to fast for a week — like Gandhi protesting medical human rights violations — and skip the Go Lytely altogether.
All of that said — and I add this cautiously, with the necessary disclaimer that each patient is different — Go Lytely is about the worst of it. Not that I enjoyed my colonoscopy. But for sustained discomfort, the Day Before easily topped the Day Of.
Without pants, it’s a different world
I arrived at the hospital cleansed utterly and absolutely (I will leave it to the reader’s imagination to figure out how I knew that) and not at all worried about the procedure.
Once I was led to a changing room and told to trade my clothing for a hospital gown. However, this insouciance inevitably turned to jitters — which is to say, when my pants were still on, the threat of invasion remained abstract.
But as soon as I tied on that rice-paper miniskirt and felt cool hospital air where my underwear used to be, my vulnerability became real. Fear finally set in.
Two nurses, all smiles and good humor, whisked me into a private room where they explained colonoscopy with the practiced cadence of flight attendants going over safety procedures (“routine procedure” … “mild discomfort” … “you will be lightly sedated” … “in the unlikely event of a water landing …”).
They patiently answered my questions while sliding an IV needle into the skin on my right hand. Ten minutes later, the Demerol had me as loose as Gumby in a hot tub.
The colon is a 6-foot tube lined with muscle and ribbed in a pattern resembling a centipede. It begins at the rectum, about 8 inches from daylight and, traveling in a path that makes an approximate rectangle, encircles the small intestine before joining it near the appendix.
A colonoscope is invariably described as a “thin, lighted, flexible tube,” “approximately the thickness of a finger,” with a monocular eyepiece on the business end to give the doctor a view of conditions inside the colon — a view that I was invited to watch live via a TV monitor propped 2 feet from where I lie. It wasn’t exactly like watching the Final Four, but it wasn’t nearly as predictable as most television.
As I lie there, googly but scared and awaiting my encounter with the silverhead snake, I considered requesting more Demerol. But the words never reached my mouth. Right at that moment as my doctor was saying that I might feel “some initial discomf–,” I felt the first push.
Recalling the benign description of the scope, my first thought was “thin my [bad word]!” I instinctively clenched the offended muscle. I later learned that the inward pressure I felt was caused not entirely by the instrument itself but by the air it was blowing — yes, blowing — into the colon to inflate the space for better viewing.
At this point, I instantly abandoned hope of abiding by my well-established home training in good manners that prohibits certain propulsive acts “when someone else is in the room.” Hey, when your innards are inflated like a Moon Bounce, you gotta let it rip.
The scope wandered through my system like a spelunking armadillo, pausing periodically to check blemishes on the colon wall — hieroglyphics etched by meals long past.
Though I was located squarely in downtown Demerolville, I do recall the strange sensation of simultaneously feeling and watching on the screen the scope’s progress as it pointed up, down, left, right, checking blood spots and other blotches, before inching onward. The doc controlled its progress via a small square box like a kid uses to operate a remote control car.
This was indeed “virtually painless,” much as advertised. Though my discomfort — which is to say, a sense of pressure — flared when the armadillo maneuvered around the corners, trapping air deeper into the cavern and leaving scant room for escape. I lie in this pleasantly drugged, unpleasantly inflated state waiting for things to get worse.
But they didn’t. The scope wove on, revealing a fairly homogenous, mucus-lined passageway evocative of the movie “Alien” but — I think I can report, despite the Demerol — without a trace of food or even Sigourney Weaver.
When it came time to exit, the armadillo retreated methodically, stopping only briefly to reexamine a couple of sites. If I’d had polyps, the doctor would have used the device to remove them. If a tumor had been discovered, the colonoscope would have been used to take a biopsy sample for diagnosis. (Full removal of a tumor requires surgery.)
The next thing I remember is a nurse bringing me my clothes and making sure that I had a ride home. (Patients are legally barred from driving themselves — or taking cabs — due to the hospital’s liability for administering narcotics.) The whole process had taken under an hour.
Oddly, I have absolutely no recollection of a 5-minute post-op conversation I had with my fiancée, Anne, during which (I am told) I sent myself into peals of laughter with adolescent jokes about all the air that finally had a chance to escape my body. I assume I will hear about this for some time, though ideally not during any wedding toasts.
It’s a journey, not a diagnosis
As for the test results, it turns out I have rare diverticula (a straining of the colon wall) probably the result of a poor diet. In advanced stages, this becomes diverticulosis or diverticulitis, conditions common in Americans age 60 to 80 due to our country’s generally low fiber consumption.
But I may be able to forestall those conditions by adding fiber to my diet and drinking A LOT more water (which softens waste, easing pressure on the colon).
For now, I am relieved to know that I am very unlikely to be among the estimated 153,760 cases of colorectal cancer that will be diagnosed this year in the United States — or, worse, among the 52,180 likely to die from it this year.
My doctor wants me back for another scope every 5 years, and I say fine. I know some colonoscopy patients who pray that medical science develops easier and less invasive procedures in time for their next scoping. But I don’t mind doing it again and again if I know it increases my chances of living a long and chemotherapy-free life.
But I certainly wouldn’t complain if, in the next 5 years, Go Lytely goes gently into the dark night of retired pharmaceuticals.