The End Justifies The Means

(An experience from 2009) 
    It all started with my most recent interview with my melanoma doctor at M.D. Anderson Cancer Clinic. Since I had undergone surgery to remove a melanoma (skin cancer) on my right arm about a year ago, I have been checking in with him about every three months. Everything has been going well, and he was about to cut me loose from him and allow me to just visit a dermatologist occasionally. This time, just in passing, he asked me when I had last undergone a colonoscopy. When I replied that I had never had a colonoscopy, he stopped and gave me that look that only wives and doctors can give and said, “You’re 66 years old and you’ve NEVER had a colonoscopy??” After casting my eyes down in a repentant manner and shuffling my feet a bit, I regretfully answered that I had not. That response, of course, gave him the opportunity to launch into a lecture about the need for regular checkups, including colonoscopies, for anyone as ancient as myself and how all sorts of bad things can happen if regular checkups aren’t scheduled. The upshot of all this was that a colonoscopy was scheduled for me two weeks later. I was to go in on a Thursday for “anesthesia assessment” and the main event would start the next day promptly at 8:00 a.m. I was due to visit the clinic that Friday anyway for my six month checkup in the Leukemia Center, so this way I could kill two birds with one stone, so to speak. You have to understand that at M. D. Anderson Cancer Clinic, every floor of the hospital is like a separate hospital. For melanomas, it’s the ninth floor; for leukemia, it’s the eight floor, for GI endoscopy, it’s the fifth floor, for lymphoma, it’s the sixth floor, for lab work, it’s the second floor. I have been on all these floors; I’m trying to avoid the other levels. Each floor is an entity unto itself having different registration procedures and totally concerned with only its mission…to treat whatever form of cancer is its specialty. They are incredibly competent, organized, and caring. I am convinced I am still here on earth because of God’s hand and their skills.
     Now, if you’re under the age of fifty, it is possible that you do not know what a colonoscopy is. For those of you who are teachers, it has nothing to do with English grammar and counting, adding, or subtracting colons in an essay. Rather it is an up close and personal (REAL personal) examination of your intestinal tract. Your colon (or intestinal tract,) doing the critical job that it does for you, is fertile grounds for all sorts of bad bacteria, germs, and diseases, and therefore close monitoring of this very critical function within your body is a prerequisite to disease prevention. The actual examination is an exercise in state of the art technology and medical creativity. Doctors are able to insert a little video camera into the colon and visually inspect every inch of this tunnel of digestion. When it’s over, they’ll even give you photos, for crying out loud, of the inside of your colon! Seeing any abnormality, they are able with tiny scissors to snip away any bad stuff and remove it for closer analysis. “How do they do this?” you may be nervously asking. Well, the camera and any other tool is inserted through the….is inserted through the….through the…the…well, I’m sorry, I can’t say it. I was raised in a very sheltered environment, and there were just some words we did not say in public conversation, and that included the crude words used by uneducated folks and educated words describing the same things used by doctors and proper people. Let’s just say that the word describing the place of entrance rhymes with the word for the seventh planet from the sun, and let it go at that. If you’re not an astronomer, there are only a couple of areas of entrances into the human body…from the top down or the bottom up. And it’s not the top down. I think I’ve made it clear. It’s really better not to think about the process, anyway, just the results. Fortunately, when all this probing and photography is going on, you will be in dreamland thinking about candy canes. They will say, "This will relax you,” the lights will go off, and the next instant they will be saying, “Wake up, Sir! It’s over!” Piece of cake.
     So, on Thursday, Shirley and I made the trek to M.D. Anderson for my “anesthetic assessment,” which is basically a question and answer activity to make sure I had no hidden allergies, previous bad anesthesia experiences, or potential problems. Each time you visit MDA, a blood draw will be taken along with “vital signs” which are weight and blood pressure. This data is then analyzed and compared to previous records for any changes. All was well with me, and we left MDA to head home via the drug store, where a prescription had been sent for me. The prescription was for the “prep” that would get me ready for the main event tomorrow. When I walked out of the drug store, I was carrying a jug that was bigger than a gallon milk container. In fact, at four liters, it was about a gallon and a pint.
     Just for your future references, if you see any kind of medication with the work “lyte” in it, I would suggest that you make yourself scarce at the earliest possible moment. Medications such as Gavilyte, Colyte, Nulytely, and Golytely (someone had a sick sense of humor there) have an effect that, well, you just have to experience it to believe it. My medication was the tried and true Gavilyte, and all I had to do was drink the entire gallon and a pint of Gavilyte at the rate of 8 ounces every ten minutes. Needless to say, since the makers of these drinks have a sort of captive audience, they have no concern for taste or “drinkability” to quote a beer advertisement. In fact, one could come to the conclusion that the drinks had been designed as some sort of evil revenge for our past sins. Anyway, the taste was not too good. But it wasn’t too bad, either, and I downed the first two or three glasses with no effects. I began to think that this whole process may be pretty easy. A few minutes later, however, the inevitable took place. Without being too graphic, let me just say that in the next few hours I had plenty of opportunity to study my bathroom and make a list of trim to touch up, paintwork to do, and doors to adjust. I was able to determine that my new toilet, which I installed only three weeks ago, worked very well even under extreme conditions. By 4:00 a.m., I was able to find the bathroom in pitch darkness, do my job, and get back in bed without even opening my eyes. At 6:30 a.m. Shirley and I rose up to prepare for the MDA big day.
     Friday morning the weather was muggy, warm, cloudy, and rainy…a bad day for someone like Shirley who is still recovering from a knee replacement a couple of months ago. People who have joint problems like arthritis or joint replacements are better weather forecasters than the best meteorologist on TV. When the weather changes for the worse, they feel it in their joints. And Shirley was feeling it this Friday morning. To make matters worse, she forgot her cane as we left home, and so she had to wander all around MDA without much help. Plus, she had to push me in a wheelchair for a short time. Her day was as hard as mine. The plan on Friday was for me to have my colonoscopy from about 10.00 to 12:00, and then visit with my leukemia doctor about 1:00. I had to get another blood test for him, so since we got to the hospital about 7:30, we went to the leukemia laboratory (8th floor) first. I weighed in, got my “vitals” taken, and blood drawn and headed to the GI Endoscopy Department (5th floor). Check in time was 8:00 for the 10:00 procedure.
     Another thing to consider when entering a hospital is that you check your modesty at the door when you go in. Endoscopy is a prime example. We were cheerily lead back to a large room divided into maybe 16 individual cubicles with curtain walls. The sweet young lady said, “Remove all your clothing, put the hospital gown on, open in the back, lie on the bed, and cover with the sheet. When you have finished, open the curtain so we’ll know you’re ready.” I did so, and lie back to listen to the voices around me. You put sixteen patients with spouses and friends plus nurses in a big room, and cloth walls don’t mean much. The nurse visited the old guy across from me with the intent of giving him an IV, and he told her (as we listened) all the horrible experiences he had endured in hospitals. When she jabbed him with the IV needle, he yelled like his leg was being amputated. I can say truthfully that in the last two years I have probably been stuck with a needle a hundred times, and there have been times I did not know I had been stuck until I looked. The nurses at MDA are incredibly skilled. But maybe he got a bad one…I think it was in his head.
     Think also, there were sixteen patients in the room and all still feeling the effects of their “prep,” and there was ONE unisex bathroom. The traffic was heavy. The Oriental lady next to me headed to the bathroom thinking she was holding her gown closed in back…but she wasn’t. Oh, well, we’re all in this together. Another husband and wife (patient) came in and was assigned to a bed. As soon as the nurse left, the guy said, “Well, there’s not much I can do here. I think I’ll go down to the first floor and have lunch. I’m sure they’ll call me when they’re finished.” And he left. I do not predict a long and happy marriage for that couple.
     In a few minutes, a different cheerful nurse came in and placed an IV in my right hand, and said the big event would commence shortly after 10:00. Since it was still before 9:00 the interminable waiting had begun. In this regard, MDA is like every hospital; time is relative, and there’s no need to rush. But around 10:25, sure enough, in came the serious looking medics who, after telling Shirley to wait in the waiting room, wheeled me down a couple of halls to a large refrigerator. Well, it really wasn’t a refrigerator, but it was cold enough for one. I guess that’s just the characteristic of an operating room. I then had about a dozen wires attached with suction cups to my chest and arms and told to roll onto my left side (open back gown.) With nary a modest thought, I dutifully rolled, and then the nurse said something about relax…and that’s all I remember.
     I awoke to someone yelling in my ear, “Mr. Downing, wake up!” and to the worst sore throat I have ever experienced. My chest was hurting and I was having a little difficulty breathing because I was so congested. I tried to speak, but I had no voice, and I felt I had swallowed a box of razor blades. I lie there for a few minutes until they determined I was back amongst the living and could respond to questions, at least with a head nod, anyway. I asked for a drink of water, but they said, “Not yet.” So I asked for a tissue and was able to blow some of the cobwebs out of my head and breathe easier. They begin to explain that the procedure had gone well, but midway I had begun to choke and managed to get some of my stomach acid down into my lungs. They could not explain why my stomach still had liquid in it while my colon was clean except to say, “Sometime that happens.” They had been forced to aspirate (suction) the liquid from my lungs using the gadget they force down your throat into your lungs. Hence the sore throat. I would assume in an emergency situation like that they’re not too concerned about the effects on your throat and vocal cords.
     I was wheeled back to the recovery area where my faithful wife was waiting. I couldn’t say much to her since I could barely talk, and when I coughed, I sounded like a lifelong chain smoker. In a few minutes, the doctor came by, and said I still had some fluid in my lungs and to be very careful the next couple of days and watch for fever and difficulty of breathing. Pneumonia was a definite possibility because stomach acid can damage the lungs. However, I was able to see for the first time full color photos of my colon which I will not post here in the interest of delicacy and decorum. The colon report was very good and there were no problems. In a few more minutes, we were released from the Endoscopy department…just in time for lunch.
     I was in a wheelchair by this time, and Shirley wheeled me to the first floor and the cafeteria. Although I had not eaten for two days, I wasn’t too hungry, and after a half of a sandwich, I was done. Shirley’s knee was bothering her enough that I couldn’t bring myself to have her push me, so we left the wheelchair in the foyer and headed to the eighth floor and my visit with my leukemia doctor. By this time, neither of us was feeling too well. I was moving slow because the procedure medications had not yet worn off and Shirley was limping badly. But we checked in right on time at 1:00. We were called back to Doctor Farhad Ravandi-Kashani’s (NOT a native Texan) office about 1:30 and waited….and waited…and waited. Finally the nurse came in and gave me my lab reports from the morning…and that was the bright spot of the day. My blood condition is the best it has been in probably twenty years. One funny note: since I had blood work and vital signs taken on Thursday and on Friday, she noticed that my weight on Friday was six pounds less than it was on Thursday. “How could that be?” she asked. When I said, “I had a colonoscopy this morning,” she smiled slightly and replied, “Oh.” Finally, over two hours after our 1:00 appointment, my doctor makes his appearance, checks me over and declares me sound. He asked when I wanted to come back, and I think if I had said in a year he would have said OK, but he said, “Why don’t we keep it at six months; that way I can keep an eye on you.” I agreed; a lot can happen in a year.
     We pulled out of MDA shortly thereafter and drove home and collapsed. As I walked in our home, I began to have chills and a little fever with a still-awful cough. It began to assuage in an hour or so, and, other that just feeling worn out, I began to feel better. Both of us did very little besides recline in our sofas before bedtime. Saturday morning I awoke with a throat not nearly as sore and feeling much better, but not perfect. As I write this, I still have a hacky cough, but my prognosis is in a couple of days I’ll be back to my normal, cheerful self.
     To you readers who are over a certain age, consider a colonoscopy. I think I had a rougher time of it than the usual patient, but truthfully, it is a vital part of your maintaining health vigilance. Remember, you have to go into it with the proper positive attitude and consider it an adventure. Plus, you’ll have photos that are guaranteed to break up any party whenever you feel the need!