Medicine in the Ninth Decade
Last week I had a colonoscopy. Anyone squeamish about discussing matters related to the gastrointestinal tract should probably stop reading now, although I don’t intend a medically-explicit dive into the gritty details of the subject. Rather, the experience led to reflecting upon the medical establishment’s looming importance here in the ninth decade and possibly beyond. I’m wary of anecdotal evidence, but when I look around the corridors and waiting rooms of my HMO and see so many who look like me I don’t really feel the need for statistical confirmation.
First, though, the colonoscopy. In simple terms, an examination of the colon, or large intestine, for the purpose of finding any anomalies, in particular polyps that can sometimes be cancerous. In my case, a routine examination, not a response to any symptoms. Performed under general anesthetic, the procedure was painless—I walked into the building shortly after eight a.m. and walked out shortly before noon, just a bit tired and groggy enough that the nurse who had taken charge of me made sure I stayed put until my wife arrived to drive me home.
A painless procedure, yes, but “painless” wasn’t how I’d describe the preceding 48 hours, a time devoted to a vaguely-termed and possibly euphemistic process called preparation. First, a day of eating bland, easily-digestible food—regular elements of my diet like nuts, whole grain bread, various kinds of roughage, were off limits. Then, on the day before the appointment, an all-liquid diet that allowed coffee (thank god), and drinks like Sprite and Gatorade as long as they were clear. I opted for coconut water and fat-free chicken broth. For those who haven’t slurped down the latter without any amendments, I can report that it’s pretty much tasteless and does little to pacify internal growls of hunger. Whenever I cracked open the refrigerator door, I found myself staring like a hungry dog at the bagels and ice cream. Likewise, I was unmercifully taunted by the boxes of crackers and cookies I knew were behind the cupboard door.
All that was delightful, though, compared to the moment the clock turned to six p.m., when I had to begin imbibing a suspicious-tasting liquid from a large jug earlier procured from the pharmacy. An eight-ounce glassful, every fifteen minutes. The first glass was bearable, if lacking in any delights for the palate; the final glass required an extreme act of will, my over-saturated body threatening to rebel against another ounce of the forced infusion. If any readers are curious about what happened next, I invite them to enter “colonoscopy” into their internet search box and choose from a myriad of sites with as much detail as anyone might care to know.
Earlier this year, I wrote of having spent a day in the OR. There, I pondered the terror that seized me when my baby sister had to be rushed to the hospital after taking a swig from an open jar of kerosene (talk about unpalatable liquids!) It wasn’t so much the fear that she would die, because she had only been part of the family for a year and I hadn’t developed strong feelings about her, but fear of the place itself, the antiseptic smell, the green institutional walls, the motionless figures beneath sheets on the beds, the inexplicable movements of women in white dresses and men in white coats. Subsequent visits to that hospital and others, for both social and medical reasons, may have muffled that early claw of fear but never erased it. A hospital was a place I never wanted to be, for any reason.
On last week’s visit, I was put into the hands of a congenial nurse—a male, something unheard of in that childhood hospital—who asked me a series of routine questions about my “preparation” and stuck an IV needle into the back of my wrist. There is something about wearing one of those open-backed hospital gowns that confers upon oneself an aura of meekness and submission, and thoughts of everything that could go wrong were suitably muffled, although not entirely vanquished. While he efficiently moved about my gurney, I told him that the first thing I was going to do when I got home was brew a cup of coffee and have a large scoop of the double chocolate ice cream lurking in the refrigerator. A brief conversation ensued about chocolate-flavored coffee, which I only like in the form of mocha, with a substantial dollop of whipped cream, but which he liked as a regular flavoring. I was then wheeled from the curtained enclosure and down a corridor to a brightly-lighted room where the gastroenterologist in a green coat introduced himself and quizzed me about pausing the blood thinner I take for cardiac reasons. Another man introduced himself as the anesthesiologist and hooked something to the IV. Within moments I began to feel sleepy and everything in the room faded from sight. When I woke up I was back where I started, but this time with a female nurse holding the plastic bag stuffed with my clothes. She smiled cheerfully, told me to get dressed as soon as I felt able, and drew the curtain.
When I was dressed she led me to a small room with a table and several chairs. I sat for awhile daydreaming about coffee and ice cream and maybe even a bagel with lox and cream cheese. I assumed that the enforced fast and liquid diet meant at least a minor reduction in adiposity, but would I suddenly discover a long-lost or never-developed discipline and keep it off? The gastroenterologist, a stocky man with thick dark hair, appeared and told me that he hadn’t found any polyps in my colon, just a few hemorrhoids and what he called diverticula. Nothing of serious concern, he said, his business-like tone and manner deterring me from making any stabs at badinage. Finally he said that because of my age and the lack of issues, I wouldn’t have to undertake this procedure again.
As the nurse led me to an elevator that would take us down to the patient pick-up area where my wife awaited, I remarked on the bustle we had just left behind—nurses, doctors, patients, others of indistinct provenance, all busy, seemingly focused on their activities. She told me she had just transferred from the emergency department, and found things in gastroenterology remarkably calm by contrast. My HMO is the largest in California, and I knew that a few years earlier the nurses in several facilities went on strike for higher wages and improved working conditions. As the elevator drifted downward I told the nurse that I hoped that she and her colleagues were adequately paid, and she murmured something I didn’t catch. I knew that I’d get a link to a patient review form as I do every time I visit one of the departments, and I told her I’d be sure to give the nursing staff a good rating. She thanked me with what seemed sincere gratitude.
This week I’m going for a Covid booster and flu shot, and two weeks later I’m scheduled to see the ophthalmologist for a follow-up to a laser procedure I had on one of my eyes. The nurses there are usually cheerful, amenable to a little banter, but the ophthalmologist who has been peering into my eyes for the past dozen years has no obvious sense of humor, and sometimes seems on the verge of being harried. No small talk, just the business of eyes. I guess I should be grateful for his steady focus (pardon the pun) on my rods and cones and optic nerve and the other doodads that project the images onto my brain.
I trust him, along with the family medicine doctor, the ENT guy, the urologist, the dermatologist, all of whom have peered and poked and performed tests and procedures and advised attacks on various physical problems. I trust them, because what would it mean if I didn’t? I made my living in the construction industry for thirty years, so when a roofer or electrician or plumber comes to address an issue involving our house, I have some grounds to evaluate the advice I’m given. As for bodily malfunctions, I’ve consulted online sources like the Mayo Clinic and WebMD, but in the end I have to assume that the man or woman in medical garb is properly educated and trained and won’t make stupid mistakes when I put my body in their hands.
At first, I was relieved when the gastroenterologist said I wouldn’t have to have another colonoscopy. But then I considered the fact he’d qualified that as a matter of age. Did he assume I’d be dead before any of the insidious polyps appeared in my digestive tract? At some point, will the ophthalmologist tell me that I’m so old that any further eye exams would be a waste of time. Will the urologist tell me...what?
My baby sister survived the pneumonia brought on by inhaling the kerosene fumes and a later bout of rheumatic fever and is now an active, healthy woman, probably the healthiest of the three siblings. But I’ll never forget the unpleasant atmosphere of that hospital, and the feeling that such a place doesn’t represent health and healing but the grim shadows of disease and death. I’ll go to the shiny, modern spaces of the HMO because I have to, and hope for the best.