The Prep

Vignettes

I celebrated my birthday with a purge. No shit left behind, I joked to friends.

The decision was prompted by a few wispy streaks of blood on a clump of toilet paper. Now, the appearance of blood anywhere sends me rushing for band aids and iodine to cleanse and seal the rent in that precious sheath between the self and the world. But blood in the feces is a whole other matter. Blood in the feces screams. The following afternoon I was in doctor’s office.

I described the color and shape and distribution of the blots, which looked a bit like an archipelago of crimson islands. Possessed of an inordinate respect for evidence, I had first thought of saving the paper in a zip-lock bag or taking a picture of it on my mobile phone, but that seemed a rather extreme measure. I never know whether my doctor sees me as the ideal patient or a crank. A bag of used toilet paper would certainly have tipped the balance to the latter.

He said the bleeding was likely due to hemorrhoids, but there was also my recent history of stubborn lower abdominal pain that had defied earlier diagnosis and that concerned him. “Am I right you haven’t had a colonoscopy?”

I shook my head.

“Well, it’s not too early for your first,” he said, and gave me a referral to a gastroenterologist.

I’d have to do it sometime, I thought. I wasn’t bothered by the thought of a probe winding its way through my intestines, much less by the idea of penetration, which seems to freak out some straight men; really, I wonder, have they so little curiosity about their own bodies that they have never explored this orifice on their own? Besides, anyone who shudders at the thought of a tube being inserted into their rectum forgets that far thicker matter descends from the same canal daily (the tube’s diameter is only about that of the little finger).

Nor was I concerned about the doctor finding something worrying. That was the whole point of the procedure, wasn’t it? Why would I not want to know, especially when the alternative of not knowing could be metastatic bowel cancer?

No, I wasn’t anxious about a tube in my rectum or the discovery of polyps. I was afraid of exploding.

My father wouldn’t have known about colonic explosion. But I had the internet.

I scheduled the procedure by phone and was emailed the instructions for the prep. It would have been nice to have had a nurse explain the  procedure to me in person, and answer my questions, of which I had a score. Instead I scoured the web for advice and tips for the prep.

And then I ran across it. A comment on a colonoscopy forum—of course there were such boards—likely from a prankster, who wrote that his intestine exploded during the procedure. Which then led me to Wikipedia and the following entry, reproduced here in its pithy entirety:

An intracolonic explosion is an explosion inside the colon of a person due to ignition of explosive gases such as methane. This can happen during colonic exploration, as a result of the electrical nature of a colonoscope. The result can be acute colonic perforation, which can be fatal.

It only takes three things: a sufficient quantity of methane and oxygen, produced by gut bacteria, and a spark. And then, bam!

Upon further research I learned that there have been only 9 such explosions reported during the tens of millions of colonoscopies performed in the US between 1952 and 2006. It was probably the same number of bear attack fatalities. Poor colon preparation was implicated as the cause.

Despite the rarity of such incidents, I was determined to be perfectly prepped. It felt a bit like wanting to ace my SATs but with a much shorter time span in which to prepare and with greater stakes than getting into Yale.

“You’ll be so much lighter,” Liz said, when she learned of the regimen I was to follow. A diet of bland, fiber-poor hospital food, broths and gelatin for a few days and then a day on which I would drink four liters of a laxative solution. “You’ll get rid of all the toxins in your body,” she said. “You’ll be ethereal, like a yogi.”

Well, maybe not all toxins, I thought. The deposits of mercury from the fish I ate, the pesticides from the fruit I’ve eaten, the unhealthy residue of my ingestion of the outside world, it couldn’t all be sitting around in the lining of my gut.

We renew our skin every four weeks, our blood every sixteen. Even our bones are regenerated. If everything is rendered anew in this never ending process of blasting and clasting, where do these poisons accumulate? Ah, yes, of course, I thought, it’s in our fat. And that never leaves, and certainly not with a bowel cleansing.

I also knew that I’d lose a good share of my gut bacteria, electrolytes and a lot of fluid, and was instructed to keep hydrated with lots of clear, read-a-newspaper-under-the-glass liquids. I didn’t want to associate any of my favorite drinks with the prep, so I stocked up on iced tea and ginger ale, neither of which I’m particularly fond of.

Salty, vanilla-y and chemical-tasting all in one, the laxative was the most vile liquid I’d ever drunk. It’s been years since the last time I had to take something into my mouth that I didn’t like. Even cough medicine these days is palatable. And when it isn’t, you only have to down a tablespoon or so of liquid, not four liters.

I am lucky in being a rather catholic eater; most of my challenges are with things that are too salty or sweet or cloyingly rich. Birthday cakes were always a problem, because, unlike other foods that I could decline feigning an allergy or a traumatic childhood experience, cakes are offered not as food but as an act of celebrating the birthday boy or girl. There was no excuse that I could reasonably offer for not eating it. Who doesn’t like butter cream? (Me, I want to shout).

I’ve eaten and drunk unpleasant things, of course, when there was no choice: an unripened Camembert served at a dinner party that was all ammonia, a cocktail overtaken by Fernet Branca, a bitter liqueur that resembles the cough medicine of old if you mixed it with toothpaste. And there was a veal stew that Matthew’s cousin made for us one evening with an obscenely large amount of heavy cream that she had added to make it, as she said, more special for company. But the last time I gagged on food was eating a mayonnaise-laden tuna fish sandwich I had at the pool club when I was eight.

I gagged on this solution with the first glass.

I had read the tips. The less contact with the taste buds, the better, so drink it through a straw. Have it as cold as possible. (Apparently the receptors in our taste buds react more intensely and send stronger signals to the brain when they are stimulated by food or fluid at warmer temperatures.) Hold your nose when drinking. Suck on a lemon—being careful not to swallow a pip—right after drinking.

I followed all the tips, and it was still disgusting. And I had to drink a liter of it an hour for four hours. Unwisely, I first thought it would be less unpalatable if I sipped it. It turns out the trick is to drink it as quickly as possible and then concentrate fully on not throwing up.

Liz was wrong. There was nothing spiritual about the purge. I spent too much time on the toilet shitting. No, that’s the wrong word, with its connotations of slow deliberateness and time for crosswords and cogitation, as Auden once wrote. This was no good omen. It was a violent expulsion.

Imagine needing to go to the bathroom. No, desperately and suddenly needing to go. Multiply the need and the volume and force threefold. Color the liquid brown and rocket it out the rear exit. And do this again and again and again, until the liquid turns the color of pale straw.

Good student that I am, I drank it all as prescribed. After finishing my rations, I collapsed in bed from exhaustion almost certain that I’d need to wake again in an hour to repeat the action. But I woke up only once in the early morning, naturally, to shit.

I was disappointed to see that my prized straw-colored stream of effluent had yellowed. I didn’t ace my SATs after all. Bile. I’d been purged but was already gathering slime. Apparently even yogis can’t stay clean for long.

I arrived next morning at the hospital “We’re a little stressed today,” the nurse taking my vital signs said.

Uh, yeah, I’m lying here on a surgery table in a flimsy hospital gown with my ass exposed. This may be a pornographic trope and the guy was cute, but I felt more like a specimen than a man. After all, I was waiting for my colon to be photographed. I was a procedure about to begin, which I suppose is precisely what you want your gastroenterologist to see you as.

The drugs were nice and I didn’t feel anything. I had the sense as I came to that the probe was still in me turning corners. But it was probably just my imagination or the remnants of impulses sent by the gut’s second brain. The doctor didn’t find a single polyp. I wasn’t lighter for the procedure but I was clean.

In the end, it wasn’t all that awful. Granted, I had spent the previous afternoon doing nothing more than ingesting and expelling liquids.  For the span of eight hours I’d been reduced to a channel of inputs and outputs, but there was no pain other than a sore ass. (Luckily I had followed the forum tips and stocked up on baby wipes and Vaseline). When I wasn’t drinking in order to shit or shitting what I had drunk or waiting to shit, I was in the shower soothing my ass. These inconveniences and an occasional wave of nausea during the prep were all there was. It was nothing like spending a day with the obliterating pain of a toothache or the chills and aches of a bad case of the flu.

It was an intensely focused and humbling meditation on the act of excretion, and of its contribution to keeping me alive and well. I emerged with a new found respect for my bowels and an intense craving for a fish curry (I had yoghurt and a plum instead). It turns out there was something yogic to the whole experience after all.

-/-

Nothing in this post is meant to be medical advice. There are reliable sources of information on colonoscopies available on the internet (this post is not one of them), such as the  American Cancer Society and the Harvard Medical School Family Health Guide, though arguably none of these can or should substitute for your physician’s guidance and instructions.

Featured image: Gustave Caillebotte, “Man Drying His Leg,” 1884.  I doubt if there is an appealing image to accompany a post on a colonoscopy. This intimate portrait by Caillebotte of a man drying himself after a bath is hardly congruent with the discomfort of the prep but considering how much time I spent in the shower during it and the relief bathing provided me, it seems apt enough.

Tags: colonoscopy, WPLongform