Lady behind the curtain

My wife and I had just completed tandem colonoscopies in a brutal two-day ordeal, and were relieved to be walking out of the Physician’s Ambulatory Surgery Center (PASC) in Ormond Beach with a small assortment of papers.  After arriving at home and relaxing following the trauma, I looked at the papers.  One was a three by five postcard asking for an evaluation of the services and staff.  The last question in particular caught my eye, and provoked substantial curiosity.  It asked, –

Was there any one person that “made your day” during your visit to PASC?

It was a peculiar, yet fascinating notion that one’s day could be made at an outpatient surgery center!  Then I considered my answer. Sure enough, my day had been made at the center at precisely the right moment.

My wife of 50+ years had been through so many procedures by this time it was just another day at the office for her.  By contrast, I had serious reservations about my first colonoscopy, an invasive procedure recommended for all folks at fifty years of age.  I had managed to put it off for 21 more years, and was seriously seeking alternatives to it, like drinking arsenic or ingesting barbed wire, either of which might be an improvement over the torture I anticipated.

In my quest for alternatives, we scheduled the procedure 90 days into the future.  It was my hope that something would intervene making the process unnecessary.  It didn’t happen, so for 88 days I looked forward to the affair with dread and anxiety, knowing that  the last two days before admission was the beginning of the torture.  During that 90-day period I discovered that a slug of pinot noir does wonders to soothe the nerves.

The anxiety was not all misplaced, as many ominous cautions and detailed instructions were required to prepare for that final, fateful day when my end would become the focus of so much attention.  Indeed I knew that my end was coming, but I was reluctant to make an appointment for its actual arrival.  I wanted to get the whole ordeal behind me, – but alas, that was precisely the plan!!!

First, we were required to have a pre-procedure office visit.  On that occasion, our physician instructed us to be sure to put on our surgical garments with the opening to the rear.  We understood this to be standard hospital fare, providing the staff with unobstructed rear-access, and instant recognition of the patients.   It also reduces the chance of inserting random pieces of garment where they don’t belong.

Next, we were advised that we could not have the procedure on the same day, as one of us had to drive the other home afterward.  This caution raised a red flag that the process would leave one incapacitated for driving, – or even sitting without distraction.  Procedures on separate days would double the painful preparation time, as one of us would be the survivor and the other would be the designated driver and caretaker through the ordeal.  Instead of two days of preparation, it would be four days of preparation or painful watching.  To avoid this extended cruelty, we imported a driver so we could suffer simultaneously.

Finally we were handed two pages of detailed instructions that described in step-by-step fashion exactly what-all was to be done for the final two full days before admission.  It left out most of the more colorful details.  To add insult to the already frightening preparation, there were two pills attached to the instruction sheets with dates and times listed for their ingestion.

Lest anyone is uncertain what the appointed process includes, I will explain.  We are seeking a thorough look-see inside the lower end of the bowel, the same one that has performed for us so regularly for these many years.  Actually looking and seeing is a simplified description of what will really happen.  They not only want to look and see, they also want color videotape to be available for subsequent analysis.  To achieve this result boggles the imagination, but I will attempt a lay description of the process so that all may understand.

Once the patient is fully evacuated and comatose, the attending surgeon inserts an air-hose into the anal sphincter, the valve which normally squeezes and retains contents of the bowel safely within.  These contents, hopefully, have all been removed, leaving an unobstructed view of the anus, rectum, descending, transverse, and ascending colon, all known as the large intestine.  After assuring an airtight fit, the pump is energized which inflates the entire large intestine like the Goodyear blimp.  With things nicely expanded, the air hose is removed, and replaced with a camcorder and a flashlight.  The flashlight is required as this is one of those places where the sun don’t shine.

Slowly the camcorder and flashlight scan the entire area, 360 degrees, taking videotape as it moves.  When an object of unusual character is seen, a small instrument is extended from the VCR and a snippet of flesh is removed from the object for later analysis.  At the finale of the process, the camcorder, flashlight, and snippets of flesh are removed from your end, your intestine is deflated, much like it performs quite naturally, and you begin your recovery following removal of the equipment.

This is the process you look forward to. The most obvious person to make your day should be the one who publicly removes the equipment and the compressed air from your private end, and turns the camera off.  You just hope the tape is not shown on 60-Minutes.

The final two days of preparation are where the rubber meets the road.  It is called evacuating the large intestine, and restoring it to a pristine condition, which it has never experienced since birth.  Following birth, the usual outlook from the anus is quite badly obstructed.  This condition must be corrected, as only pristine large intestines are admitted into the PASC.

To achieve this result requires a visit to the grocery store, where you purchase two baskets of things you didn’t know the stores had.  For two of us, one cart is filled with clear liquid foods, which, when held up to the light, you can see through.  It is not possible to actually chew on any food in this cart.

The other grocery cart is full of flushing agents guaranteed to give you a complete cleanout, very much like power washing your driveway without a hose.  One item is a gallon container with a powdery substance in the bottom.  To it you add clear water to the top.  The instructions say you are to drink the entire gallon by yourself between 9:00 and 12:00am on the designated morning.  The idea of drinking a gallon of anything in three hours turns into a real challenge when the substance looks and tastes like dirty bathwater.

To make sure your preparation is adequate, the final straw is a fleets enema administered two hours before your admission.  It finishes the job on your large intestine, with the caution that if the result is not pristine, the enema should be refilled with plain water and repeated until the effluence is perfectly clear.  I had a little problem here, as nowhere in the instructions was I told to turn off my liver and gallbladder.  Those little bile ducts continue to dump yellow stuff into the system.

Having done the best I could do, I presented myself to the staff of the PASC, who prefer not to encounter any surprises while videotaping.  After the usual wait at the front desk, we were admitted to a large pre-op preparation area. It had the look of a large co-ed dormitory with 20 elevated hospital beds, and individual curtains that could be drawn around each bed, the only privacy provided.

After 90 days of waiting, the moment of truth was clearly approaching at breakneck speed.  When my curtain was closed, I was instructed to remove all my clothes, except socks, and install the rear-opening gown.  After a moment of privacy, one of the lovely attending nurses returned to check my chart and any vital signs that remained.

The nurse carefully reviewed the chart, and asked questions relevant to my  scheduled procedure.  How is your blood pressure?   Do you have any loose teeth?

“I really thought you were working on the other end,” I replied.

Do you have headaches?  When was your last headache?  How did your fleets enema come out?

“Almost pristine!” I answered.  “except for a little bit of yellow bile. Sorry about that, but I just couldn’t get my liver to shut down.”

I was not initially aware that my bed was attended by two ladies, one nurse and one nurse-trainee.  After the questions they both left. Then the trainee returned to insert a long needle into the back of my right hand.  She dangled my right arm down from the bed, tied a tight band around it, and started thumping on the back of my hand to encourage the pooling of blood.  After dozens of thumps she believed she had seen a workable vein.  She straightened out my hand and wrist, and inserted the needle about an inch into my flesh.  She missed, and then carefully proceeded to insert and withdraw the needle in a futile attempt to catch the vein just right.  Each insertion felt like a razor blade slicing the back of my hand wide open.

The more she tried, the more anxious I became.  I was on the verge of jerking the needle from my arm, jumping down from the bed, and bidding the facility goodbye as I ran screaming out of the front door.  But, I gritted my teeth and waited.

At that moment she called for help.  She was immediately rescued by her supervisor who stretched the hand, stabilized the rolling little vein, and inserted the needle into it perfectly.  I was greatly relieved, and hoped to experience a period of solitude.

It was at that moment that I became aware of the lady in the enclosure next to me.  She had just been surrounded by the curtain, and instructed to remove everything, except for her socks, but she had questions about these instructions.

“Do I need to remove my brassiere?” she asked.

“Oh yes!” the nurse replied.

“Must I take off my pants?”

“Yes, certainly!” was the reply.

Then the two ladies lapsed into a conversational tone like you might hear between any two best female friends.  The nurse managed to work in her pertinent questions almost as an afterthought.

Is your intestine in pristine condition?  Did you take your fleets enema, and how did everything come out?

Finally the nurse asked “Do you have headaches?”

Her response was clear and immediate.  “Yes, of course.  I am married you know.”

They did not laugh, but I could not restrain myself from the other side of the curtain.  What a priceless response to a question about headaches.  She not only reported headaches, but just as casually revealed their origin as well.

That little bit of laughter completely replaced the anxiety I had just experienced over the needle in my right hand.

Within seconds I was wheeled out of the room and down the hall to the chamber of horrors where my end would become the center of attention.  A small substance was injected through the needle in the back of my hand, and in seconds I was perfectly comatose.

Then just as suddenly, I dreamed of the lady on the other side of the curtain, and the way her candid statement about headaches provided exactly the relief I needed at a critical moment.  The laughter, and the injection, converted this brutal procedure into a piece of cake.

Nothing to it!

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