I'm a David Sedaris groupie. And this
week I've had cause to be grateful for it.
Only Mr. Sedaris told me the truth about having a colonoscopy. His essay 'The Happy Place' (in Let's Explore Diabetes with Owls) describes his
own experience of the procedure. I don't understand why
no one else, those near and dear to me, bothered passing on such crucial
life information. My parents, for instance, explained sex to me in nearly
forensic detail, back when I was too young to need it. Perhaps modern parents could amend the lecture and call it 'The Birds and the Bees and
Colonoscopies'. Many of my friends and relatives in the US and Canada have
undergone the investigation, and no one, not a one, described it
as thoroughly as did David Sedaris. The only problem with his
rendition is that because it is so funny, my laughter undercut my comprehension. I
didn't actually believe much of it. I should have.
***
I got a letter in the mail notifying me that my time had come and I was
due for some bowel inspection. My family doctor referred me to a local centre
which he said was the High Temple for dealing with all aspects of the gut.
I shall call it God’s Clinic. "That's what they do there, day in and
day out," said my doctor. "That's the place to go." I agreed,
and shortly had an appointment with a Dr. Moses (not really), who
asked me when I'd last had a colonoscopy.
"I don't see it on our records," he said, flipping pages. I
confessed that the answer was never.
His glasses nearly fell from his nose. "What? And how old are
you?" He looked again, tutted, and said, "At your age! We need to see
what's going on up there."
"I once had a screening test,” I offer, knowing this will be seen
as weakness. “My family physician says there's a small but significant chance
of perforation..."
"Your doctor is wrong," said Dr. Moses. "It is not
significant. The risk is 1 in 3000. I will see you next week." And out he
marched, leaving only the whiff of burning bush behind. In the literature given
me by the clinic staff, the risk is listed as 1 in 4000. So Dr. Moses may be
wrong, too.
***
The eight pages of instructions for preparation look draconian, and indeed, when the
time comes to implement them, they are. For four days before the procedure, I
am allowed no nuts or seeds or anything that might contain them. No tomatoes,
no cucumbers, no strawberries, no blueberries. No watermelon. In summer! It's
hard to remember. And ambiguous. Is tomato sauce allowed? To be on the safe
side, I scrape it off the chicken parmigiana served at a work lunch.The salad
has cucumber in it. No, thank you.
The day before the procedure, the going gets really tough. No solid food;
clear liquids only. I learnt afterward that I could have included chicken broth
and Jell-O in my diet but instead I subsisted for forty hours on PowerAde,
ginger ale, sweet tea, other sugary liquids, and water. I am not a fan of sugary
liquids (unless they incorporate vodka or rum). Forty hours felt like forty
days. I could definitely have done with some manna. And then worst of all is
the purging, aided by the consumption of laxative tablets and four litres of a
disgusting electrolyte solution designed to clear the entire gut. Awfulness on
top of horribility. For the final two hours, not even liquids are allowed to
pass my lips. By the time I got to the clinic I resembled a limp rag, barely
able to locomote, and quite unable to be civil to anyone who mattered (ask my
husband).
"How are you today?" asked the chirpy receptionist at God’s
Clinic, when I staggered in the door, and because she didn't matter, I managed
a polite reply. Nonetheless, she understood. “I guess you've been better.”
A nurse, or at least a female in pink scrubs, escorted me to the exam
room, where Dr. Moses sat at his desk drinking coffee right in front of me. How
could he? It was fromTim Hortons, but still. I sat in the upright wooden chair
across from the desk, ignoring the vast plane of the paper-lined table across
the room, clinging to dignity until ordered to relinquish it. As I sat down,
the doctor rose in response to a summons at the door, and departed. In his
absence, one of the nurses (another had appeared) instructed me to climb upon
The Table, and I obeyed. When Dr. Moses returned, however, he scolded them.
"You can't just jump the gun like that. I have to talk to her," he
said.
"But you talked to her last week," protested the one in
pink.
"Never mind. Sit there!" he said, pointing me at the wooden
chair. Obediently, I crossed the linoleum tiles again, perching while the doctor sipped his coffee and looked at a piece of paper. In
fifteen seconds he nodded and then said, "Okay, now." And I walked
for the final time to the seat of operations. It was a lot of exercise for
someone in my condition.
"Oh, has she signed the consent?" one nurse asked the other.
"No," whispered the first.
"See!" barked the doctor, overhearing. "That's why you
can't just rush these things. Put your name here," he said, dropping a
clipboard in my lap. I paused to read the several paragraphs above the
signature line and one of the nurses huffed noisily. If there's one thing I
know, it's consent procedures, so I ignored her.
"It says here that if I don't want a colonoscopy, I can have an
X-ray instead. Would an X-ray do as good a job?" I asked.
"No," Dr. Moses said. "Not as good." I sign. I’m a
researcher; I know consent procedures, but I also know when I'm
beaten. All I can do is try to remember this experience next time I’m the one asking
for consent.
I have told the doctor, and the nurses, and written on my intake form at
the previous visit that I am worried about sedation, that in the past I've had
struggles coming out of anaesthesia, and that I think in my case, a little goes
a long way. David Sedaris describes the sedative as the best part of the
procedure, the route to the 'happy place,' so I don't want to forgo the
experience, but I do want to survive it. I suspect that in my current condition
a glass of wine would do the same trick as fancy drugs. I remind them again
about my worries.
"Yes, yes," says Dr. Moses. “You can tell the
anaestheiologist.” Meanwhile he inserts a needle into the back of my hand.
"Roll onto your left side." I do so while the nurses work to ensure
that my (still clothed) body remains covered by large paper sheets. My back is
to the door so I can’t see anyone going through it, but a moment later a man leans over my
shoulder and starts pushing an ampoule into the needle in my hand. I never even see
the whites of his eyes. I never see anything of him, in fact, but his fingers.
I say, as quickly as I can, slightly desperate, "I have concerns about the
amount of sedation. I've had experiences before..."
"Why are you waiting until now to say something?" says the
bogeyman behind me, irritably.
"I didn't!" I protest. "I'm not! I told them, I told them all,
many times..." I feel myself fading, and I contemplate death. Then I decide
this might not be a good last thought, and instead, conjure up David
Sedaris. Happy place, happy place. And I'm out.
***
I'm vaguely aware of being prodded into a wheelchair, but don't really
come round until I'm lying in a La-Z-Boy in another room. There’s a line of
them, in black vinyl, each slightly torn or scuffed, each with a vital-signs
monitor beeping next to it. Without the monitors, it could have been a beauty
parlor. I have a cuff on my right arm and a clip on my middle finger, and my
machine is beeping too. I feel fine, pleasantly sleepy, and cold. A nurse reads
my mind and puts a blanket over me. Is this the happy place?
Dr. Moses comes in holding a battered leather briefcase and wiggles my
stockinged toes. “All good!” he says, cheerily. “See you in 10 years. Bye.”
He disappears out the door, down the corridor. I drift off.
***
As I gradually awake, I have questions. Can I eat now? Drink? Yes. The
nurse helpfully fishes out the travel mug I brought with hot sweet milky tea. Why
is my blood pressure varying? The nurse says she is not sure, but is not too
worried; for the next few days, she suggests, I should go to Shoppers, a local
drugstore chain, and check it again. I heard her give the same advice to the
woman next to me and was not impressed.
I ask the nurse whether I can consult with a doctor about my blood
pressure. Moses has gone but I know there is a doctor about the place, a thin
man with white hair, white skin, and pale eyes. He made me think of skim milk. Earlier, I had watched him speak to a patient in another La-Z-Boy, a
woman looking smarter than most of us, in a print wrap skirt, high-heeled
sandals, and a neat chin-length bob. The milky doctor had rested both his hands on
her bare shins and said “I bet you do a lot of
walking.”
The nurse fetches him. I see from stitching on his white coat that he
is, in fact, Dr. God, the head honcho. In response to my query he says “Oh,
it’s just nerves. You're a woman. You see, I'm married so I know all about you
girls.” I tell him he is lucky he didn't say so at
a conference in South Korea, but apparently he has not followed the
#TimHunt news. I ask when I can resume exercise.
“Two days,” says Dr. God.
“So I can play soccer the day after tomorrow?” I ask.
“Sure. Well, it depends. Do you know how to play soccer?” Cute.
“Yeah, yeah. And doctor will I be able to play piano afterward,” I
respond.
He takes this as humour. Fine, let him. “She's sharp, this one,” he says
to the nurse. Annoyed would be closer.
Husband is in the waiting room, ready to escort me home. I’m a little
slow, a little fuzzy, nowhere near as happy as David S. promised. (I knew I
shouldn’t believe everything he said.) What I am mainly is starving, so we stop
in the deli downstairs for a sandwich, which goes a long way toward waking me up.
Within an hour, I’m feeling fine, and we head off to collect daughter from her
friend’s house. “Don’t turn left here. Take the next street,” I
instruct. “Watch the pedestrian!” I’ve signed an agreement that I won’t
drive for the next 24 hours.
“You’ve recovered,” sighs my husband, resigned.
***
David Sedaris lives in England but had his colonoscopy while he was
visiting the US. According to the NHS, bowel cancer screening is recommended to
people between the ages of 60 and 74, and by ‘screening’, they mean sending off
a stool sample to a lab. If the sample is abnormal, only then does the NHS
offer a colonoscopy-- eventually. Meanwhile, in Ontario, it seems, everyone over
50 gets a colonoscopy right off the bat (although the webpage for the Cancer
Society of Canada says that ideally, the lab test should be offered first).
Does it make a difference, this widespread deployment of invasive
investigation? I sure don’t know. There are lies, damned lies, and statistics,
and the interweb has all of them ready for me. Five-year colon cancer survival
rates are ever so slightly higher in Canada than they are in England, by about
two percentage points. I don’t know the data and have no information about how
the calculations were done or on what population. I do know that googling ‘bowel cancer
survival rates UK’ led me, at very first go, to an immaculate, easy-to-read
table1. Doing the same for Canada took me to pages within pages of
text before I located a cautiously-worded rendition of (possibly) comparable
information2.
About the behind, Canada seems less up-front.
***
The ever-ready net tells me that, in fact, it’s perfectly okay to
exercise the day after an uncomplicated colonoscopy, so I allow myself an easy
bike ride and a Pilates session. I find myself looking at other people in the class,
and wondering. Has she had one? Has he? We need a secret sign. “Arms out, and
squat,” says the instructor.
That could be it.
my compliments! I had to have a polyp removed. wow - hard to describe the experience - you've done a fantastic job.
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