clontzville.com

Due, then overdue

I turned 50 last October which meant that not only was I due for a colonoscopy, but I am now overdue, according to contemporary medical practice. When I had my last physical when I was about 48, my doctor recommended that I get one and… I didn’t. After much prodding by my loved ones, I called him up and had him renew the order and made my appointment. It took a couple of months to get on the schedule, but I didn’t have any urgency aside from my advancing age and the latent concomitant risks.

My time finally arrived. I got a call from a friendly intake nurse at the endoscopy clinic with very specific instructions about what I could eat, when I could eat, when I couldn’t and what to expect. Some advice: Take notes on what they tell you. Like, written notes. There’s a lot of specifics around when you drink, how much, what you can have and when, and if you do the wrong thing, they’ll send you home.

My appointment was for 11 a.m. on a Monday, which meant that I needed to stop all solid food on Saturday night. Sunday was to be a broth and Jell-O day with “prep” starting at 5 p.m. on Sunday evening. I had to drink ¾ of a gallon of the prep that evening and the remaining quart the following morning prior to 7 a.m.

And, she advised me, I shouldn’t make any plans for Sunday.

A fellow pentagenarian friend of mine advised me to get the prep as cold as possible, as the four hours that the nurse had recommended was unlikely to get a full gallon of fluid from lukewarm to chilled in the four hours recommended. Good advice.

So, after my Last Supper on Saturday night, the fast began.

The Day Before

I don’t usually eat a lot in the morning, so the early part of Sunday was easy. My wife made some Jell-O for me. Finding an acceptable flavor was more difficult than you might think – purples, blues and reds are excluded, presumably because they could look like blood in the colon. That left three options at my local Publix: lemon, lime and, my choice, island pineapple.

I don’t eat a lot of Jell-O as an adult person, but I have to say that I dug the island pineapple. It doesn’t exactly taste like actual pineapple, which I love, but the experience was roughly analogous to the way a banana-flavored Runt captures some of the fundamental character of actual banana without tasting similar. Regardless, it was more than palatable, and by midday I was happy to have something semisolid to eat.

Next step was to make the prep. I’d picked it up from the Publix pharmacy two days before, and the pharmacist had advised me to “have a nice weekend” in a way that suggested that she knew that I would not. I had a brand called Gavilyte-G, which makes one wonder what deficiencies the first six iterations had suffered from to warrant a seventh. Or maybe the G just stands for “Go to the bathroom urgently.” Not sure.

After filling up the bleach-like plastic container with an alarming amount of water, I poured in the “lemon flavor packet.” Frankly, I’m not convinced that the hint of lemon flavor represented an improvement, but I was all-in on the full experience. I capped the bottle and shook it as hard as I could, making sure to de-clot the actual medicine powder that had been delivered at the bottom of the bottle.

I’m not averse to drinking unpleasant tastes – the distance running world is rife with electrolyte and salt drinks designed to rehydrate more than to please the palate. To that end, and to get the drinks as cold as possible, I decided I might hijack my brain by pouring the prep into empty BodyArmor drink bottles and throwing them in the freezer for fifteen minutes or so. So I decanted 8-ounce portions into three bottles and loaded them into the freezer about 20 minutes before Zero Hour so they wouldn’t freeze entirely.

The time had come. I was hungry, but not ravenous, and I drank the stuff with a little trepidation. I’d been warned that it was unpleasant, so I was pleased to find that it… wasn’t terrible. It wasn’t good, but I could hork down the full eight ounce portion in four gulps. The hint of lemon really added nothing, maybe even made it a little worse.

For the next hour I drank my eight ounces about every ten minutes. And then the bathroom experience started. I’ll spare the details, but it was what you’d expect from mainlining lemony laxative on an empty stomach.

I had a five-hour window, from 5 p.m. until 10, to get through the Sunday portion, and I was done by about 8:30. Frankly, by the time I’d had my 11^th portion, I was pretty sick of the stuff. I was able to fight it down, but I was very relieved when I didn’t have to drink anymore, and I went to bed early in anticipation of the following day. More advice: write it down. You drink so much for so long that it’s easy to lose track.

The Day Of

I woke up at 6 and immediately had one of the few pleasures I was allowed, a cup of black coffee. I drink black coffee as a matter of daily function, though I noticed that the flavor seemed particularly intense to my hungry palate.

Back to the chilled saltwater. I had another quart to put down, and was supposed to have it done by 7 a.m. In truth, morning two was more of a fight than the evening had been. Maybe it was just hunger or bloating or maybe I was just sick of the stuff (I was definitely sick of the stuff), but l was basically pushing it down in gulps to meet the deadline. I finished my last swig at 7:07 a.m., celebrated briefly, then ran for the bathroom.

Properly emptied, it was time to go. My wife drove me to the clinic and we checked in. I was a little nervous, mostly because of the IV. I don’t like needles. Never have. I’m prone to vagal nerve response that I’m not always able to rope in, and it’s pretty embarrassing: tunnel vision, sweats, the works. Sometimes I can overcome it, and sometimes I can’t. I’d never had an IV before, and the idea frankly gave me the creeps.

They took me back quickly and had me get dressed in a hospital gown and trampoline-park-style grippy socks. My admin nurse, Diane, reminded me “not to bother tying it in the back,” as I suppose that’s where access was to be required. I bagged up my stuff and got in bad. Diane brought a warm blanket, which was nice because the admit area was chilly.

She asked the usual battery of questions. I told her that I tend to have a fairly low resting heart rate so not to worry that I was in bradycardia if it was a little on the low side. I was clearly anxious, as my heart rate was a little higher than usual, but it settled in to my usual high-50s as I settled in.

Then came the IV. Another nurse named Benita started unpacking the kit, and I warned her that I had some “needle anxiety.” She said that I had nice veins, which I chose to take as a compliment, and she sprayed the back of my hand with lidocaine. I kept my eyes averted, but I can’t say I liked the experience much. It didn’t hurt as much as it just felt foreign having something poking into my skin and staying that way. She taped it down and the nurses left for a while until my designated time.

Then the vagal response kicked in. I started to sweat and feel lightheaded. I was regretting the warm blanket as my whole body got damp. I heard the heart machine beeping, annoyed, and glanced over. My heart rate had dropped to about 45 bpm, but no one seemed particularly concerned. After a few minutes of deep breaths the world started to come back together, and I felt okay again.

The anesthesiologist popped through the curtain and said hello. She assured me that she’s be present throughout the procedure and told me about propofol. I tried not to make any jokes, as I was sure she’d heard them all before. I told her that I’d never been generally anesthetized before and she clarified that this wasn’t a general anesthetic, but was rather considered “heavy sedation.” Potato, po-tah-to, but I appreciate the clarity.

The doctor came by to introduce himself and let me know that it was a really safe procedure but, you know, no guarantees in life. He asked if I had any worries, and I told him the truth: that I wasn’t entirely confident that I was 100 percent empty. He waved me off and said they’d “suction me out,” which made me feel like a car going in for detail. These are humbling conversations.

After a half-hour or so, they came to get me, wheeling the bed into the darkened procedure room. A nurse passing by en route told me to “enjoy my nap.” Once my bed was docked, they had me turn on my side – needed easy access, I guess – and verified who I am for the umpteenth time. A nurse told me that she had gone to high school with a “Clontz boy” in Orangeburg, SC. Probably a relative somewhere up the line, but no one I know. The kind of small talk that people make before they going to knock you unconscious and spelunk your behind.

The nurse sitting by my head told me that she was about to give me the “good stuff” as she attached a syringe to a hose that presumably led into my arm. She told me that I might feel funny in my arm but I didn’t feel anything. Like an old Looney Tunes cartoon, the world irised-in to dark, and I was out within a couple of seconds.

Recovery

We iris out, and I’m back in the first room as if I never left. I’m aware that I’ve been talking, which isn’t a great sign. My wife is walking in the room, or maybe she’d been there for a while. I wasn’t exactly groggy as much as I was aware that I had lost time.

One of the anxieties I’d had about the procedure, aside from the aforementioned needle situation, was that I would say something gross or incriminating while coming out of sedation. What if I’m a worse person than I realize, and my recovery nurse is the only one who knows? It occurs to me that recovery nurses must genuinely hear some of the most deranged human monologues imaginable. Despite that, I didn’t want to open any new doors, though it’s clear to me in retrospect that what happens in recovery stays in recovery. Or hopefully does.

The doctor came in with a small stack of printouts: an annotated photo map of the inside of my colon, which was, ultimately, the star of the show. All good news, no polyps, no nothing. I don’t have to do this again until I’m 60, which will come faster than I anticipate. My prep, he noted, was “excellent.” I was quite proud.

With some significant help from my wife, I got dressed and got to the car. Honestly, that part of my memory is still fairly patchy. I remember being hungry, though not ravenous.

The rest of the afternoon was kind of a snoozy blur. I felt fine, no discomfort and very few lingering effects from the laxative (in fairness, it took a while before there was anything sufficient in my system to have an effect). I napped on the couch for a couple of hours and was back to normal by the next day.

Now What?

People treat you weird when you’re my age and you talk about having a colonoscopy. There’s a specific kind of moral approval that you receive, I suppose because lots of people avoid them and come to regret it. It reminded me a bit of the vibe around the COVID vaccine, where people would ask you what brand you received as a kind of a cultural synecdoche: oh, nice, a fellow Pfizer or Moderna, how bold! Or J&J, they must have been out of the other two.

Anyway, all that is to say that people treat you nice when you say you’re having a colonoscopy or that you’ve recently had one. It’s a weirdly personal thing that you can share in mixed company and the vibes are reflexively supportive. Probably because it’s an experience that, for most of us, connotes something universal and humbling: that we’re all getting older, that we’re all flawed and failing biological beings and that nothing beats a great nap.