“The worst part is the preparation.” “The worst part is the day and night before.” “The worst part sitting on the toilet all night.” This is what I heard about a colonoscopy from everyone I knew who had already experienced one. No one said anything about the procedure itself, other than there was “nothing to it,” “no pain at all,” or “it was the best 15 minutes sleep of my whole life.” Still, I had my suspicions, and the worst part for me turned out to be something completely different and unexpected.
As if there weren’t already a host of bountiful blessings that go along with turning 50, the screening colonoscopy floats to the top of your doctor’s “To Do” list for you. I chose the physician who had done my partner Mitchell’s colonoscopy the year before. He was closer to us in age, and therefore a little more experienced, unlike most doctors these days who look like high school students. He impressed me when he discussed Mitchell’s results with me after the procedure, as well as with the follow up care he provided.
After my initial consultation with the doctor, he sent me to the scheduler to set up the procedure. She explained all of the prep that was necessary, and told me they had already called in a prescription to my pharmacy.
With a new, jacked up laxative, I prepared to join the chorus of “this is the worst part,” but that would have been premature. The main difference with the new prep was drinking two 8 oz. premixed liquids, which didn’t taste nearly as bad. Less fluid, better taste—almost like a beer commercial. The rest of the prep flowed along as it had before, no better, no worse.
After checking in at the surgery center, somebody with an official nametag that I could not read without my glasses took me back to an area where I took off all my clothes and put on my hospital gown. After I was changed and lying on the bed, she placed a warm blanket over me. Instead of a bedtime story, she told me the surgery would be done on that bed, that someone else would wheel me to the OR when it was time, and a nurse would be in momentarily to start the IV.
That nurse was Kay—the nurse of my dreams. I looked at her and could tell immediately that she had been around the block, in a good way. She was seasoned and experienced, had probably seen everything in her career, and could no longer be shocked by anything. Having worked with nurses most of my adult life, I imagined Kay as my perfect choice for a Happy Hour partner, her stories becoming more colorful with each passing drink. I made a mental note to keep my mouth shut, or at least watch what I said and did. I preferred not to be a story she told someone else over cocktails.
Dee, the surgical nurse, came in after Kay made her exit. Dee was young, pretty, and bubbly. We chatted for a few minutes before she got the call that the OR was ready for me. She pulled up the side guard rails on the hospital bed and wheeled me down the hall. I stared at the ceiling lights and panels and thought, “this is it. Showtime!”
In the OR, I met Julie, the anesthesiologist, and while she was pleasant enough, compared to Kay and Dee she was a stick in the mud as far as personality was concerned. This was a good thing—I wanted the person putting me under to be focused and serious.
I looked around the room as Dee went from machine to machine, connecting this cable to that one, getting everything set and ready. A large computer monitor was mounted on the side of the wall a little bit to the right of where I lay on my back. Initially, I thought it was displaying an unusual screen saver, but after a minute I realized I was very, very wrong. The screen actually had four different views separated in perfect squares, each one a different picture of the colon of the patient who had the privilege of going before me.
HIPAA regulations are very strict these days about protecting patient privacy, and I had signed some paperwork earlier concerning them. Lying there looking at the monitor, I felt confident that I must be violating at least 67 different privacy provisions. Is there a way to invade anyone’s privacy more intimately than staring at pictures of the inside of their ass? Yet, I couldn’t look away. I stared with fascination at the clarity of the image, the curves of the tissue, the color and texture. Everything looked good to me, and if I was the doctor, I would proclaim the person to have the healthiest colon in town.
The doctor came in and apologized for the delay. “Mounds of paperwork,” he said as he headed to the table behind my line of vision, where he proceeded to shuffle and sign various papers, based on the sounds he made. He said his name, the names of the assistants, my name, procedure name, time, that “conscious sedation” would be used, etc.
Stop right there! What do you mean “conscious sedation?” You’d better be knocking me out. Mitchell woke up before they finished his procedure and he watched the final moments on the monitor. Fine for him, but NOT for me. Surely this must be a mistake. No one had ever relayed the experience to me and been awake for the whole thing. I struggled to remember the definition of “conscious sedation,” knowing it was buried somewhere in my memory. I convinced myself that my panic was an overreaction, and that the term must be equivalent to “anesthesia lite.”
Dee had me turn onto my side to allow the doctor access to, well, you know where. Julie came over with two hypodermic needles in her hand. As she inserted the first one into the IV, she said, “this one is Demerol.” OK, Demerol I know—this is good. With the second needle she said, “this is somethingelseatol.” I had no idea what that was, but I knew it was not Propofol, the most commonly used anesthetic for this procedure and best known as Michael Jackson’s sleepy milk. OMG! They really are going to keep me awake. Is my health plan so cheap they won’t spring for full sedation?
“Within about 30 seconds, you will start to feel a little lightheaded or dizzy, and then you will feel sleepy,” Julie told me. Feeling sleepy and being asleep are two very different things. I expected the injections to begin working immediately, and I tried to force myself to relax. I tried, and failed. Panic had caused my adrenaline to kick in, and I lay there with my mind in overdrive, talking to myself.
“It has already been what, 15 seconds, and I still don’t feel anything. For my appendectomy they asked me to count back from 10 and I got as far as 9 before falling asleep. What if I’m immune to this anesthetic? It took extra shots of Novocaine to numb my mouth for wisdom teeth removal. Still not feeling anything. I’m not light headed. I’m not dizzy. I’m more alert than I’ve ever been in my life. I could read War and Peace or Ulysses right now, that’s how awake I am. Thirty seconds has to have passed. Why don’t I feel anything? You’re going to have to tell them it’s not working. You absolutely cannot let them get started if you don’t feel anything different. Accept the fact that you might not be asleep, but if the doctor touches your butt and you can feel it you better say something. Don’t wimp out like you usually do. Like you did by not asking these questions earlier. Don’t wait for a break in their conversation, just shout it out if you need to. This will definitely go down in history as the worst part. Oh wait, I feel something. I’m not dizzy or light headed, but something is different. Maybe this is it. I do feel a little sleepy. I’ll just close my eyes for…”
Blackness.
When I regained true consciousness, I was sitting up on the bed, fully dressed in my own clothes. Mitchell was sitting next to me and one of the nurses was sending for an orderly to wheel me out. How much time had passed since I closed my eyes? But more important, how long had I been “awake” and what had I said and done between then and now? I had to have been awake in recovery, passed some gas, dressed myself. But I don’t remember any of that. Is this what they really mean by “conscious sedation?”
This, finally and truly, was the worst part. I had been awake and functioning, but was reason intact? Or was I operating without any filters, allowing anyone access to the deepest, darkest parts of my soul? Moments of true nakedness, from surgical gown to street clothes, and from unconscious to conscious. It was like waking up after a long night of partying and not knowing where you were or what you did, but then you could take comfort in the fact that anyone around you was probably in the same condition. This time, everyone was sober, leaving me the lone loose cannon in the room. My inner demons were naked and exposed without any self-control, and I struggled to hide the worst panic I had ever felt.
Mitchell told me that I had mentioned at least twice during my post procedure conversation with Dee about the breakfast that waited for me when I got home. OK, that’s not too bad. I also told her that my hair used to be red, and green, and blue. This was not entirely true, although I was the guinea pig for Mitchell when he was in cosmetology school. Accidental green hair, check. Blue—never. At least I could confidently deny anything I might have said with “it was the anesthesia talking, because I was saying crazy things you know weren’t true.”
I am sure I was overreacting, making more out of it than it was. Hopefully subconscious filters were still in play, providing extra barriers to keep the demons suppressed. At the very least, only a relatively short amount of time could have passed, and how much damage could I have done? Mitchell asked later if I wanted to know everything I said and did during that time. “No. No I don’t,” I told him emphatically.
