I woke up early one winter morning and felt a cold sweat break out on my palms and the soles of my feet. I had a dull aching sensation in my lower gut and a slightly nauseous feeling. Yes, today was the day of my colonoscopy. But I wasn’t your average patient, I was usually the colonoscoper having performed over 25,000 procedures; today I would be the colonscopee.
As I headed into the bathroom for one last session on the alabaster oval (better known as a toilet seat) to give one last offering to the god Uranus, I contemplated my predicament. The queasy feeling that I felt was not just from the laxatives I had taken the night before but the sense of anxiety that every patient feels prior to undergoing an invasive examination. Yes, this happy-go-lucky-this won’t hurt a bit-this you’ll be asleep for the whole thing-gastroenterologist was apprehensive about his own colonoscopy. I had no symptoms but I did have a family history of colon cancer so a negative result wasn’t completely assured. I think I had more trepidation about the simple fact that I would be asleep and not in control of the situation. So I sat there on the porcelain groover reviewing the events that had placed me in this awkward position.
I selected a colleague of mine who did not work at my center to perform the procedure. This prevented the nurses at my unit from having the pleasure of sticking me with an IV and beholding the secret parts of my anatomy. The day before I had started on my liquid diet and took home the “prep” which consisted of two liters of laxatives. I ingested the first liter in the early evening. The taste reminded me of the time I had gone swimming in the Dead Sea and had inadvertently swallowed some of the ancient brine. That horrible palatal sensation must have been avoided by mammals since the Pleistocene Age to prevent sudden expiration. After the ingestion, I experienced a faint rumbling in my gut which was a slight tremor compared to the full blown earthquake that was to follow. After a few explosive trips to the commode I just stayed there, loaded a book in my Kindle and prepared for a long siege. I gagged down the second dose later in the evening and finally climbed off my nest around midnight for a few hours of fitful sleep.
As I headed for bed, suddenly a burning question entered my mind. Why would anyone want to be a gastroenterologist and subject mankind to such an experience? My colleagues and patients have asked me this question many times, but this time I had to ask this question to myself. I mean if a heart surgeon is the Robert Redford of the medical profession, then the can’t-get-no-respect gastroguy is Rodney Dangerfield. Because of the shame of belonging to such a lowly specialty, I have always tried to camouflage my humiliation with occasionally successful attempts at humor. “I wanted to be a plumber and couldn’t get into plumbing school” was my stock answer for awhile. If I’m in a more cynical mood I’ll reply, “I finished last in my class in medical school and this was the best job I could find.” I learned never to use that one with patients. Then I tried: “It was a process of elimination.” Lately, I’ve tried a more philosophical aphorism, “Most people look ahead in life, I look behind.”
As my wife drove me to the outpatient surgery center, I reflected on my career choice. As a medical student I quickly abandoned obstetrics-gynecology (I couldn’t get up in the middle of the night); surgery (I couldn’t even tie a knot in cub scouts); and psychiatry (too scary). That left me embarking on a career in internal medicine mostly by default. During my internal medicine residency, I decided I needed to find a subspecialty. I very quickly realized that I was not cut out to be a cardiologist. People with heart disease may get sick very quickly and require urgent life or death decisions. That was not for me. I never really understood how the lungs or kidneys worked so I eschewed them as well. That left me with the liver and hollow organs: stomach, intestines and colon-Eureka!- the subspecialty of gastroenterology.
I was at first most attracted to liver diseases. We had a lot of alcoholics where I trained and thus a lot of bad livers. The liver is a stolid as well as solid organ that plods along in the body and lives in a neighborhood where nothing happens very quickly. In those days you couldn’t do much to help anybody but you also couldn’t do much harm and that was fine with me. I mostly thoughtfully looked at lab work, and made little noises and grunts in front of patients like “hmmmm,” “aha,” and “yup.”
When I first started my fellowship, colonoscopy was in its infancy as a diagnostic tool, and often viewed as just a pain in the butt. It became much more popular and accepted after Ronald Regan developed his colon cancer, and later Katy Couric had her colonoscopy televised. In 2000 it was established that regular colonoscopies could prevent colon cancer. After that I began performing 20 colonoscopies per week.
After performing about 1,000 procedures most gastroenterologists become fairly proficient. The skill level is on par with driving a car; there are occasional hazards ahead but most of the time its smooth sailing. Fortunately for me, you can only go one way and there are no forks in the road. I have a poor sense of direction which can be attested to by anyone who has ever driven with me. I am one of those talkative types so as I move through the colon the nurse, technician and anesthesiologist have to listen to my feckless prattle. How many walruses are living in captivity? How many violin concertos did Beethoven write? Contrary to popular belief we spend very little time discussing the patient’s external anatomy. For one thing, it’s dark in the room and for another most butts over fifty years of age look about the same although they come in different sizes. You never heard Darwin mentioning the buttocks of the finch, only the beaks. In my career there have only been two new variations: the completely tanned variety and the flowery tattoo above the crack. My reminisces ceased as the SUV pulled into the parking lot.
I signed in and gave my insurance card to the receptionist and filled out a myriad of forms including a consent. I didn’t spend much time reviewing the possible complications, I already knew them. It felt strange signing on the patient line as opposed to the physician signature space. My physician came in and I shook his hand. I was embarrassed that my hand was cold and sweaty belying my jovial exterior. We engaged in some small talk, and then he left the room. The nurse came in to start my IV and I showed her all the large veins in my non-dominant arm. She didn’t seem too impressed with this helpful advice. I tried not to wince when I felt the needle stick. I continued to feign that the whole thing was no big deal for me.
I was wheeled into the procedure room, experienced a little sting in my arm from the anesthetic (propofol of Michael Jackson fame) and fell asleep. I may have had a dream but I don’t remember it. The next moment it seemed I was waking up in the recovery room. My wife was there and she told me later that I was somewhat loud and obnoxious telling everyone within ear shot that “I didn’t feel a damned thing.” My doctor came in and told me everything had gone well and handed me a copy of my report. I passed lots of gas that had been put in during the procedure (I’m generally good at that), put on my clothes and headed to Denny’s. I rewarded myself with a high cholesterol dose of bacon and eggs.
The colonoscopy was over and I had experienced a successful, happy result. I felt proud that I had actually had the courage to go through the examination that I had performed on so many patients over the years. There was huge satisfaction in knowing that my own colon was healthy. The unpleasantness of the preparation liquids faded from my memory. Maybe preventing cancer and reassuring patients is not such a bad calling in life. I guess I will never know why I chose this profession. After all I could have been a plumber.
Biography
David Margolis, MD, MSMA member since 1977, practices gastroenterology in St. Louis.
Contact: davidmargo@sbcglobal.net
