Colonoscopy story, at a salubrious level of abstraction. Can be read by the squeamish! ≈2.8K words, © ยต 2019.
"What's the procedure?" my son Sam asked. We were speaking confidentially in the doorway of his kids' home, where we had met up to take them out to a restaurant. He was referring to the upcoming medical appointment he'd agreed to drive me to.
I launched into words prepared to ease him gently toward the truth. "The prestige the body parts are accorded varies greatly. Most esteemed is the brain of course, then the heart …".
"Is it a colonoscopy?", he said, cutting me short, but softening the brusqueness with an eye roll mixing affection with impatience.
"Well, yes … but there's only a 5% chance of cancer." He gave me a hug and a clap on the back.
… … …
Kaiser boasts of reducing colon cancer-related deaths by 58%. The main reason is early detection, accomplished by a test for tell-tale blood cells. Securing the test sample is a five-step process: 1. Take a sheet of paper the same color and texture of a toilet seat cover, and lay it on the toilet water; 3. Secure the sample by probing the floating mass with the bulbous, textured end of a plastic stick the shape of a toothpick; 4. The other end of the plastic stick is a stopper for a test tube; put the stick inside the tube sample end first, and seal it in place; 5. Mail the tube to Kaiser inside a padded envelope.
I received my first test kit last year for my 68th birthday. Ignored it at first, defying increasingly urgent nagging from my Kaiser primary, Dr. Siacha (pronounced seeACHuh in her native Ethiopia) . My "rationale" was disgust; toilet training inculcates us with the notion that some things are best flushed and forgotten. But doesn't disgust decay quickly when a newborn enters your home, or when someone you love gets very sick? And abnormal gastrointestinal (GI) cells multiplying like crazy — what would THAT do for civilized toileting! Reality gained traction over the ensuing months, and eventually I did the five-step. Then a few anxious days. Then Kaiser told me the results were negative.
This year, 2019, I taught summer session Computer Science intensives at two colleges, CCSF and SFSU. This meant standing in front of classrooms sixteen hours per week. Days slid by in a sleep-starved blur, but I was not unaware that Dr. Siacha was nagging me again. "Later." A guy only has so much bandwidth. "Later" happened after my CCSF class ended mid-July, and then there came a Saturday that didn't feel like a desperate lunge toward the finish line. But at step 2, the paper sank under the weight of the mass that was supposed to float on top of it. Decided just to collect the sample from the TP: paper is paper, s. is s. This time Kaiser said the results were positive; schedule a colonoscopy ASAP.
… … …
Only one out of twenty positives actually have cancer, according to the reassuring test results fine print. My odds are even better, not being rotund, sedentary, or a smoker; and a carnivore only if the occasion insists. But one risk factor does apply: Eastern European Jews have the highest colon cancer rate of any ethnic group. I took Kaiser's first available Monday appointment, for September 9th at 1:30.
My three fall semester classes would be in full swing, and I'd need to comply with a detailed set of instructions. Six days before, stop using ibuprofen. Three days before, stop eating high-fiber foods such as salads. On the morning of the day before, stop eating solid food, and drink only clear liquids. On procedure eve, drink half a gallon of Gavilyte; expect to spend a lot of time on the toilet. On September 9, finish the Gavilyte by 11:30. At 1:30 present myself to Gastroenterology, escorted by an adult who would commit to driving me back home; no, Uber would not do.
Everyone said the escort requirement was Kaiser going the extra mile to protect themselves from lawsuits. A requirement nonetheless. A close friend volunteered, one who I'd helped care for after his kidney stones operation. Then it struck me that I wanted family close by. On alternate weekends, Sam drives from Keyes, near Turlock, to Richmond to spend the afternoon with his kids. And he works full-time, and goes to several AA meetings every week — but would he be willing to pile an Alameda-Oakland round trip onto his schedule? Yes, although it meant sleeping over at my place after seeing his kids.
Nobody said much about the Gavilyte experience; one expressive friend told me it was "unpleasant," and flashed me a confiding look. But that unspoken unpleasantness could adversely impact my teaching career. Tuesday's my big classroom day, and Mondays mean frantic preparation tinged by panic. So, go online and figure out how much prof work could be done pre-procedure, between gagging on Gavilyte and racing for the bathroom? Not the computer nerd approach. Instead, I went online and armed myself with abstract knowledge.
… … …
The GI tract is a feature homo sapiens share with all other bilateria: that is, it's been in the family tree since we split off from the sponges, 555 million years ago, and acquired left and right sides.
In homo sapiens, the terms colon and bowel refer to the small and large intestines (herein SI & LI). Picture a rectangle of coiling alleyways, with a broad road on three and a half sides. Digestive matter enters the narrow SI from the stomach. The SI ducks behind the LI, then twists, turns, and loops around itself, before becoming the wider LI near the southwest corner. The LI meanders north, east, then south, jots west, and then the last segment, the rectum (from Latin rectum, straight), heads due south. Feces exits the rectum at the discretion of the ring muscle called the anus (from Latin anulus, ring).
A colonoscopy entails exploring only the LI, with an instrument resembling a plumbers snake equipped with a headlight. The official reason for the clear liquids diet, for the cleansing with Gavilyte, is to avoid spoiling the view. If the instrument encounters any of the small growths called polyps, it snips them off and retains them for biopsies.
The "movement" in "bowel movement" does not mean excretion or secretion, as I'd assumed; in which case doctors might speak of bladder movements, or consider crying to be a tear duct movement. Although crying as movement isn't far off.
Because "bowel movement" is not a medical coinage. It derives from "bowel" in the metaphoric sense of guts, as in "gut feeling;" and "movement" in the sense of emotionally engaging, as in "they were moved by the ceremony." So the meaning of "bowel movement" was originally something like "deeply moving," and changed to defecation over time, perhaps at first as deflating humor.
I wrote my stray facts in a notebook. The heft of the paper was reassuring, like the warmth of a security blanket; I wanted it with me on the 9th. Maybe it would let me counter any medical arrogance with countervailing writer status. Maybe doctors would be willing to share insights into the cosmic significance of the colons they scoped, or at least some irreverent jokes. When they asked me if I had any questions, they might be amused by my asking if it was merely a coincidence that two practices crucial for civilization, toilet discipline and speech, both relying on controlled constriction of orifices, take hold at about the same age, on opposite ends of the GI tract.
… … …
That ominous silence around colonoscopy preparation foretold nothing whatsoever.
Giving up fiber 3 days before was a bit like the doctor saying your weight and blood pressure are too low, you must eat more sugar, fat, and salt. Enjoyed the junk food interlude, but strange to say, suspending solid food intake the day before was no biggie either. I eat prodigious amounts to fuel my bicycle commute, utilitarian fare, such as protein bars; meals with all the charm of filling a tank at a gas station. Lounging around drinking tea and apple juice, consuming and expending little energy, was a vacation.
The part that had me worried was Gavilyte, drinking it, processing it. I have a strong gag reflex, and a vivid memory of the stomach flu. The Kaiser pharmacy dispensed packets containing medication and citrus flavoring, along with an empty plastic jug. To improve the taste, they recommended letting the brew chill in the fridge for 12 hours.
Did so, and my first swig procedure eve reminded me of lemon-lime Gatorade: mildly sweet, distinctly chemical. The worse part was the slightly gelatinous texture. Not the most repulsive beverage I've ever tasted, by a long shot. I sat on the toilet 5 - 10 times, but it was on then off, not writhing in agony. And without having to eat, my GI tract didn't take up much more of my precious prof time than usual.
Nor did Sam; he's developed a warm sense of social occasion since he's been in recovery. He brought fast food takeout, and said that there was no need to serve him anything, or play host; that he was just there to hang out with me. We "clinked" plastic, my Gavilyte, his Dr. Pepper, and talked about the Raiders. Then I left him to his James Patterson novel.
… … …
Gavilyte has completed its work when both toilet functions sound the same hitting the water, and look about the same in the bowl. Passed that landmark 10 am Monday morning, with a liter of Gavilyte to spare. Plenty of time to chug the rest, and then take a shower before leaving. It seemed important to smell thoroughly presentable for the medical professionals.
The drive to Oakland took 15 minutes. We talked real-estate. Sam's getting married next year, and is saving for a house; four years ago, he was homeless. I tell him that homes are much cheaper near Turlock than in the pricey Bay Area. I tell him that somehow it will all work out; my bland reassurance whenever our conversations turn, as they tend to do, toward navigating the obstacle course of middle-class existence.
Sam helped me navigate an obstacle course too, the one called the physical world. The appointment was for the Specialty Medical Office Building (SMOB), 3600 Broadway in Oakland. Apple Maps knew about a Kaiser Medical Center at that address, but not an SMOB. I imagined a secretive annex, a maze of ill-marked corridors stretching for blocks, panic, missing the appointment. Told Sam what Apple Maps didn't know, and he said just ask at the help kiosk.
Of course. The SMOB is the west side of the Medical Center, whatever's to your left when you enter the building from the parking garage; the hospital's on the right. The help guy told us to walk past the glass-walled arboretum to the elevator lobby, and go up one floor. A dozen people sat stonily in the Ambulatory Surgery waiting room while a cheery receptionist named Shawn checked us in. Shawn told Sam how to find the cafeteria, and that he would text him when it was all over. I sat down among the quiet ones and pulled out my notebook.
… … …
A worried-looking nurse carrying a clipboard called my name. By way of hello, she asked if I needed to use the restroom (OK). She was standing outside when I emerged and asked for the results (negative). She asked if she could go back in with me and watch me try (no way). She asked for the last time the results were positive (noonish). She shook her head skeptically, and said "Most people need to go every 15 minutes."
"Then how do they come in for their colonoscopies without, you know, risking social disaster?"
"Good question," she allowed.
She led me to a pre-procedure room, then left me to change into hospital garb. She returned with two nurses, one with "BSN" after her name (Bachelor of Science in Nursing, she explained), the other an RN, who graduated from the two-year program at CCC in San Pablo. "West Contra Costa's another world" I said, and by a smile and a glance she agreed that it was a gritty side of our gilded metropolis.
They took my vital signs, said to eat light tomorrow, and not to drive. They had me put my street clothes in a net mesh bag, allowing me to keep my notebook. But from the quizzical looks they gave me, the notebook wasn't intimidating, it was just odd, as if I'd brought along my Teddy bear. They released the breaks on the hospital bed to wheel me toward the procedure room, and that moment was easily the worst part of the entire experience. Not bad physically, but the sensation of my lightness brought the inconsequential little old man into focus; easily wheeled about and deposited wheresoever the busy world wants.
… … …
There were three large medical monitor screens in the procedure room, and a whiteboard with my name, DOB, and Kaiser number. Two new nurses introduced themselves, Nancy from New Hampshire, and Elisha. Nancy asked me to confirm that the whiteboard information was correct (yes); and asked if she could hold onto my notebook during the procedure (it stays under my pillow). Asked her what it was like to work in Gastroenterology, and she said sincerely "great, great people." So much for my childish notion that it was a punishment assignment, like latrine duty in the army.
Enter a jovial thirtysomething thin bearded man, and an attractive young woman with a practiced smile. Benjamin was the doctor in charge of the scoping, Camry a med tech representative on assignment; in a movie they'd have been supplied by central casting. Turned over on my left side, as commanded. The oxygen tube smelled like plastic wrap. They hooked up the IV and told me I'd be getting two different relaxants, fentanyl and midazolam, brand name Versed. Fentanyl is known as synthetic heroin; the intended side-effect of midazolam is memory loss.
The midazolam must have worked. The next thing I remember after "We're going to start the sedation now" is "It's over." Looked around, different room, no fancy equipment, and the only person I saw was Nancy. No biopsy needed she told me, you didn't even have any polyps. My mesh bag was by the bed, along with a tray of crackers, cheese, and apple juice. After dressing and snacking, they gave me a wheel chair ride, room to curb. Sam was parked a couple of cars down, and jumped out and waved.
… … …
"No cancer," I told him. Feeling smug, as if the test results were a testament to some hitherto undisclosed virtue on my part; as if my number wouldn't come up in due course.
"I know, I was there when they told you."
How had I missed that? He must be hungry if he skipped lunch. Suddenly, I was famished too. "There's a burrito place near my house," I said, not intending to eat light.
"OK, but the Raiders are playing in the Coliseum."
"So you want to watch the game."
"So I don't want to get caught in football traffic."
So we returned to the island on a mission, eat fast food fast. We parked near a Hawaiian BBQ place. They had table service, but we would be the only customers. Sam has a thing for shrimp, and there was this amazing seafood platter picture in the window.
More middle-class survival talk while we waited to be served. "You still for Biden?" I asked.
He shrugged. "I'm for anyone who can beat Trump."
We hadn't discussed politics since July, since the Gilroy massacre. On Facebook he'd reacted by saying angry white guys were our biggest terrorist threat, and then one of his recovery friends called him an Islam lover. Then El Paso happened, then Dayton, and Sam deleted the conversation. He told me in the future he would avoid politics, because it distracted from his sobriety message. But he seemed shaken, as if anticipating many more random victims.
Our food came. BBQ is irresistible, the tangy sweetness, the seared surfaces yielding up the juices sealed inside. I savored the tastes, and despite his traffic anxiety, Sam didn't rush me. How lucky to stay on in the generous world, enjoying an unhurried meal with my adult child; a sublime pleasure not every parent will have. World, thanks for the reprieve. Please consider America for the next one.
Sam dropped me off at home afterwards. Then as usual on Mondays, I went into my study and worked for hours, at what, after all, is my dream job.
© ยต 2019
