Preparation

You never forget your first time. You’re nervous, not sure what to expect. Will it hurt? Will he see my imperfections? You have had a lot to drink, but is it enough to get you through this? It takes forever to get going, and the anticipation is killing you, and you’re squirming lying naked under a sheet. And then suddenly the big moment is here, and he’s coming at you, and you’re worried that huge thing won’t fit inside you. Will I remember this tomorrow?

Yes, my friends, a colonoscopy is a life-altering event you will never forget. Sure, the drugs help you forget the actual scoping process, but the lead-up is the real struggle anyway. That, and when the nurses demand that you fart before you leave.

In my short life, I have had three or four of these procedures (you never forget your first, but then they all sort of blend together after that) because I am a special snowflake with Crohn’s Disease. Most of you, dear readers, won’t need a scope until your 50s when you start all the preventative testing that keeps you alive and kicking long after your grandparents passed on, and even then, most people put it off until they absolutely must get it done. This is common, because colonoscopies aren’t sexy, they require you to take a day off work, and to tell at least one other person that a doctor is about to stick an 8ft hose up your butt because you can’t drive yourself home. It is also a terrible mistake to put it off, because if you wait until you’re having symptoms that bother you enough to have a doctor take a look, you already have a serious problem. That problem isn’t always cancer, but sometimes it is, so if you are over whatever magic age the medical community has declared the cutoff for uninspected bowels, saddle up and ride, because it’s time for your checkup.

In college, I’d been having weird symptoms that were slowly getting worse. Mostly, I was in pain. Sure, there were some gut pyrotechnics that made me the least popular roommate on occasion, but the pain and oppressive fatigue were what brought me to see my grandmother’s doctor-neighbor. This woman had saved Grandma’s life when she insisted that a cyst be biopsied and discovered breast cancer. She’d saved my Grandpa’s life after he was released from the hospital following a major heart attack and showed signs that the blockage wasn’t cleared, at which point she told Grandma to rush him back to the ER. Dr Peggy was cautious, which I’m sure on occasion had people up in arms about nothing, but she also occasionally put herself between my family and the Grim Reaper’s scythe. Since she knew the family and was a gastroenterologist, my Mom sent me to see her.

I don’t remember what I said to Dr Peggy, but after a series of exams and blood tests, my cautious doctor suggested a colonoscopy “if I was really bothered by the symptoms”. She was feeling out my level of commitment vs college girl laziness. I told her I’d be ready tomorrow. She informed me I would not, in fact, be ready tomorrow, because there was significant preparation involved. As she went over the instructions for the night before, I didn’t understand the horror that was to come.

Dr Peggy worked in Houston, where my grandparents lived before my grandfather died in 2005. When I told my mother I needed a colonoscopy, she managed to find a hotel room with two bathrooms that would serve as Preparation Base. Apparently, she had second hand knowledge of the process. Mom drove down from Austin to take me to the appointment, and we spent an evening with my future in-laws outside Houston before the storm. When I explained to my mother-in-law that I was headed for a colonoscopy, she looked at me incredulously and said “you know that’s what Bob does for a living, right?” I did know he was a very well respected gastroenterologist, but since his son and I had only been dating a year I didn’t think now was the appropriate time to moon my future father-in-law. I didn’t want to offend anyone, but I was also under the impression that family couldn’t provide medical care, which wouldn’t have bothered me as much as my FIL seeing my ASS before I had even spent Christmas with them. I know, he’s a professional who sees butts all day, but still. Boundaries, or whatever. These boundaries became less important when I still hadn’t found a solution to my symptoms several years later and I trusted him to find out what my problem was, and he did in a matter of weeks.

Back at the hotel, Mom mixed me a cocktail and reminded me I needed to drink it quickly because there was another one right behind it, and so on, for about a gallon in a short period. My parents would be relieved to know that chugging of any kind has never been my strong suit. I did not shotgun beers or toss back shots with any sort of success, and even rushing me to slurp water makes me queasy. And did I mention I was having this test based on stomach problems? But this wasn’t beer, vodka, or water. This was water mixed with what may have been anthrax, for it poisoned me to the depth of my being.

The “prep”, which is such a cute and peppy little name of the jug of evil you’re required to drink before a scope, is thick, oily, and very salty. It comes with flavor packets which is hilarious, because if you think lemon-flavored oily seawater is better than plain ocean, you’re fooling yourself.

And so, I drank. I had been warned that if I didn’t do it correctly (not fast enough, not finishing the whole jug, etc) I would go in for my appointment and be turned away so that I could do it all over again. I put on my big-girl face and sucked that elixir down as fast as I could without throwing up, because I was unclear what that would mean for the rest of the process. Mom put on the TV in our room to distract me, all the while gently reminding me of the time limit and refilling my glass. And then it happened. My stomach was making outrageous noises that I could feel getting lower and lower until I slammed down my glass, shoved Mom out of the way and ran to the bathroom.

Prepping for a colonoscopy is basically hooking a firehose to your mouth; it cleans you out completely so your doctor can see the walls of your intestines and check for any abnormalities. You can’t see the writing on the wall in a muddy tunnel (forgive the visual), so that bubblegum you swallowed in seventh grade has got to go. The problem with this, is that you’re not finished drinking the prep and you’re still on a very tight schedule, so you must drink fast in between bathroom breaks and, when there are no breaks to be had and you’re clutching the toilet seat like your life depends on it, you must now drink while in the bathroom. At this point things are happening so fast and furious that you feel like you are literally taking a sip and then taking a shi…well, there are a few twists and turns in between, but you get the idea. It seems like no matter what time I’m told to start the prep, the aftermath lasts all night. I have, on more than one occasion, fallen asleep sitting on the toilet. Long after the cocktail sprint is finished, the digestive marathon carries on into the early morning. If that is also when your scope appointment is scheduled, be advised that the drive to the endoscopy center can be dicey, and once you’re hooked to the IV and on the gurney, there are no bathroom breaks. It is what it is. Please, remind yourself that doctors do several of these procedures every hour and they have seen it all. So, when instructed to lay on your side and lift your hospital gown, don’t obsess like I did about the view your doctor has, because they don’t see misshapen cellulite or a Kardashian stunner, they see anatomy and the task at hand. They aren’t looking for Brazilian waxes, they are looking for polyps, ulcers, appropriate coloring, spasms, swelling, and other more serious concerns.

As I lay there, anxious about the possible pain or what Dr Peggy might discover, I tried to relax and block out the embarrassing fit I had thrown about getting an IV placed. In those bygone days before my waltz with clinical trials and their incessant blood-letting, I was terrified of needles. I would flinch or push the nurse’s hand away without my brain’s permission like a terrified child. I was 20, sadly.

Then we rolled into the procedure room with all the buttons and lights and switches and hoses, my God, the hoses! They looked enormous, and there was some discussion about whether they should use a hose for a petite woman or an overweight man, the difference I’m sure was several feet. I’m glad I don’t remember what they settled on.

And then came the drugs. Having an obsessive fear of needles, I hadn’t had much interest in heroin, but the 30 seconds before I blacked out gave me a tiny hint as to why people bother with such a risky intoxicant. The nurse pushed the meds into my IV and asked me my birthday, which I got wrong, and thought was hilarious. After that the drugged haze was unsettling, because I woke up in pain and couldn’t articulate that to the nurse, but did spend several terrifying seconds watching the video feed of the scope examining my insides. Never tell someone that is high as a kite that you’re pushing past their uterus. I could hear myself moaning but couldn’t stop, and the doctor quickly requested an additional dose of meds.

When I woke up on my side in a curtained stall, I could hear my mother talking to Dr Peggy about how everything looked good, intestine-wise, but that I woke up in pain when she was near my uterus, so just to be cautious I should get checked for endometriosis. Later testing revealed I did not have endometriosis, I just don’t take kindly to being jabbed in the baby-maker. Thankfully, I didn’t have ulcerative colitis, Crohn’s Disease, cancer, or whatever else the doctor suspected, but I did have a couple ulcers and should have a follow-up scope in 6 months to make sure nothing had changed. Lovely.

The prep is still the worst part of a colonoscopy, pants hands down. But the second worst part is coming away from that whole experience and still not knowing what was wrong. Dr Peggy found some spasming, so she prescribed an anti-spasmodic and reiterated that I needed to do his whole carnival over again in six months to make sure I didn’t have more ulcers.

About eight months later (hello, lazy college girl) I had a scope at Georgetown, which was largely the same process. The doctor came in and excitedly told me to relax, because “I can tell you for sure you don’t have Crohn’s Disease which would be so horrible and you’d never be able to get insurance!” What a relief!

Two years later I was dropping weight, throwing up, writhing in pain, and bleeding from a tear in my colon. My FIL thought the Lazy College Girl was making a return and told me that people with Irritable Bowel Syndrome (my initial, half-hearted, we’re-not-sure diagnosis) should be able to keep a job so I had better walk it off. I decided to break down the invisible wall between family and medical professional and told him how my symptoms had evolved. Immediately his demeaner changed and he was muttering to himself about different tests that should have been done and exams I should have. His practice took me in and gave me an endoscopy (tube down the throat to the stomach, no prep!) and then sent me home to drink prep (dammit) so that the following day I could swallow a pill the size of a multi-vitamin that contained a camera, equipped with flash. This was the coolest thing I had ever heard of, and it is used to get pictures of the small bowel, which otherwise remains a mystery between the reach of the endoscopy and colonoscopy.

After reviewing 8 hours of footage from the camera pill, and a quick game of “guess what kind of seed is lodged in your gut in photo 3467!” (tomato seed) it was determined I had Crohn’s Disease. I processed this information with my new family watching my face for clues about whether I knew the extent of my diagnosis. I didn’t know anything about Crohn’s, only what the doctor at Georgetown had said: “it’s horrible and you’ll never be able to get insurance!” I suppose that’s an OK thing to say to someone who doesn’t have that disease, like telling a woman that getting kicked in the manberries is horrifically painful, but I DID have Crohn’s Disease, and I was starting out with the knowledge that a medical professional familiar with the affliction wouldn’t wish it on his worst enemy. Even my FIL seemed to be eyeing me with curiosity, or maybe concern.

But I felt relief. After countless tests, exams, and blood draws, I finally knew what was wrong. Fighting a battle with an unknown enemy had been unsuccessful at best. At least my problems had a name, and an avenue to treat my symptoms.

And so, my story isn’t a sad one. I finally found out what had been bothering me for years, I have since been treating my disease somewhat successfully, and against the odds I have had two healthy pregnancies that yielded two healthy babies. So please, everyone who is of that magical preventative-exam age, go get scoped! Your formative years of booze-guzzling will finally come in handy.

Forgive me for not including photos with this entry, for though I have alums aplenty, I don’t want to be banned from the internet.

Love,

Gutsy Gal