THE COLONOSCOPY

For those of you who have been on the receiving end of a colonoscopy, you can appreciate the process – as long as it is happening to someone else. For those of you who have yet to experience the process, I highly recommend you stop reading now; knowing full well you won't. It's not something that many people write about. At least I've not seen any documentaries on it from a non-medical viewpoint.

My colonoscopy began with a visit to my urologist. I know; they don't get involved much with the colon, other than sticking their finger up it to check the prostrate. Before checking my prostrate, my urologist asked me if I would like him to use two fingers. Why? I asked, with some concern in my voice.

To get a second opinion, he replied, and then laughed heartily while using only one finger. After retrieving his finger from where the sun doesn't shine, he asked, Have you ever had a colonoscopy?

Why, is something wrong? I asked. I hate it when doctors ask leading questions while examining some part of you. Questions like, How long have you had... or expressions like Hmmm... are easily misinterpreted.  We patients hear, It looks like you have cancer, or It's not fatal, but...

After reassuring me that all felt normal, which was more than I could say, I told him that I had a colonoscopy about five years ago. He then told me that I was old. He didn't say it in that exact way. Instead, he said, You are at the age where you should have one every five years. I'm not sure what age that is, but we are never old enough to want to hear the dreaded words, You are at that age...

And thus began the process of seeing my primary care physician, who agreed with the urologist, and gave me a referral to the local endoscopy center. I now know why they call it endoscopy. They use an endoscope, which is a scope to look up your end. Good ones cost upwards of $14,000, but you can get a reasonable priced one for around $3,800 if you are a do-it-yourselfer. Actually the ones that they used for endoscopy are called colonoscopes, but they also have bronchoscopes, gastroscopes, duodenoscopes, enteroscopes, sigmoidoscopes, and a few others, depending on which part you wish to look up, down, or in. I have no idea what type of scope they use for an esophogogastroduodenoscopy, and I don't want to know.

The day before you get your colonoscopy, you are required to clean out your intestines by drinking obscene amounts of a laxative liquid. This might be Colyte, Golytely, TriLyte or Nulytely. I can understand this from the perspective of the people using the endoscope, because they don't want a crappy video. However, from the perspective of the patient, this may be the worst experience a healthy person can inflict upon his or her self. Basically it involves giving yourself the worst case of diarrhea you have ever had.

My doctor made me drink four liters of TriLyte. The first thing I did was to read the directions, which said, Do not use TriLyte if you are allergic to any ingredient in TriLyte Solution. Unfortunately it didn't tell me what those ingredients were. Then there were the warnings of possible side effects, which consisted of: Bloating; nausea; rectal irritation; stomach fullness or cramps; vomiting; rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; chest pain; hoarseness; muscle weakness; persistent or severe nausea and vomiting; severe bloating or abdominal swelling; severe stomach pain; slow or irregular heartbeat; vomiting of blood.

I can guarantee that you will experience the first five of these side effects: bloating, nausea, rectal irritation, stomach fullness, and cramps. At least I did. The rectal irritation is self-inflected, so purchase some flushable wet ones at the store before you begin.

The instructions said to drink an 8 oz glass of this stuff every 20 minutes until it is gone. If you do the calculations, that is 17 glasses of disgustingly awful-tasting stuff, which will take you 340 minutes (5.6 hours) to finish. The instructions went on to tell me what to do if an overdose is suspected. It did not tell me what symptoms were indicative of an overdose, but it seemed to me that just following their directions guaranteed an overdose. I don't care what you are drinking; beer, soda, or water, 17 glasses anything is an overdose.

To add insult to injury, eight hours after you start drinking 17 glasses of laxative, you have to take four super-strength laxative pills and then go to bed. I recommend sleeping on a towel or wearing a diaper, because your sphincter is not equipped to retain liquids under pressure. You would think that 17 glasses of any liquid would overload your bladder, but evidently TriLyte has built-in directions to bypass the bladder and go straight through your intestines – regardless of where you happen to be.

And did I mention that you are not allowed to eat any solid foods the day before your procedure, nor drink anything after midnight. After 17 glasses of liquid, I thought this would be a welcome respite, but eight hours into the no-liquids period, I started craving a drink of something normal. Taking a mouth full of Pepsi, gargling, and spitting it out helped.

I had a good friend drive me to the procedure (Thanks Harvey!) and then pick me up after it was over. When I checked in, the receptionist would not even process me for the procedure until I gave her the name and phone number of the person who was driving me home. I also had to sign several forms that warned me of everything that might possibly go wrong – including my death. It gives one pause when signing something that says you might die. I didn't even have to do that when I went to Vietnam.

Once I was processed and waited what seems to be the standard 30-minutes in the waiting room, my name was called. Meanwhile I got to observe nervous patients being led in for their procedures, and unsteady patients being released to their designated drivers. There wasn't the usual chitchat that most waiting rooms have, in spite of the fact that there were at least 20 people waiting. It's hard to strike up a conversation in a room full of people with diarrhea.

A nurse led me back to the inter-sanctum where there were lines of gurneys containing bodies, much like a morgue, except that most of these bodies looked relatively alive. All had curtains that could be drawn for privacy, but that only happened when you had to undress or dress. I commented to the nurse that colonoscopies appear to be a booming business. She said that they were doing about 36 of them that day, but they had three doctors. My doctor was doing six before lunch and six after lunch, if one can actually eat lunch after doing such things.

When I was lying naked, except for a green gown that made me look like a barefooted doctor, the nurse asked me dozens of questions about my medical history. I'm not sure why it was relevant that I had tonsillectomy when I was six years old, but she insisted it was. I asked her if my vasectomy was important. She said, It is to me. I decided not to pursue that line of reasoning.

She started me on an I.V. drip, which wasn't exactly quenching my thirst, but it was nice to see liquids once again entering my body instead of just leaving it. After about 15 minutes the anesthesiologist nurse came and wheeled me into one of the rooms where the procedures are done. The doctor, anesthesiologist, and assisting nurse introduced themselves to me and asked polite questions like, what did I do for a living. Then the anesthesiologist injected the drug into my I.V. line and told me I would be entering a drug-induced sleep. I recall saying that it had been a long time since I had a drug-induced sleep, and then I awoke in the recovery area.

I heard someone say, He's awake, and I wondered if that was a normal response, or if they have patients who don't wake up. The attending nurse walked past me, and I asked her if it was as good for her as it was for me. She replied, I had a different perspective.

Another nurse came over and explained that the doctor had pump air into my colon, inflating it to get a better view, and that I would have gas, so don't hold it in. Then she said, Let it rip. I'm use to hearing it, and I actually like the sound. It wasn't the kind of thing I have ever heard a woman say, and I had no retort – other than what she was expecting to hear. I've had plenty of doctors tell me to say Ahhhh, but never one to say Let it rip.

When I looked reasonably awake, I was told to get dressed, and then I was led to a small waiting room where I had to sit until Harvey arrived. As we exited through the main waiting room, looking at all of the people waiting for their colonoscopy, I wanted to tell them that the worst was over. Or better yet, tell them, "DON'T GO IN THERE." But I didn't want to get a room full of diarrhea cases excited, so we quietly exited the building.

Harvey took me to IHop, where I discovered that there was more than air coming out of my colon, but I managed to stuff myself with eggs, pancakes, bacon, sausage, ham, and toast. I washed it down with two large glasses of orange juice and once again felt bloated, but this time the process was pleasant.

I now have a five-year reprieve before my next colonoscopy, but it gives me a new perspective. It adds one more thing to my list of things that I don't particularly want to live for – along with root canals, tooth extractions, old age, taxes, work, and bad relationships. And that makes dying seem not quite as undesirable as it once did. It's all in one's perspective. With the right perspective, you can see the bright side of just about anything – except perhaps a colonoscopy.

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