It just doesn’t appeal to me.  The thought of it just doesn’t make my day.  I’m too busy.  I have no symptoms.  They just want to pad their corporate income.  I just don’t want to.  I don’t need to.

So you put it off.  You delay as long as you can, perhaps for years, not months, maybe even decades.  What in the world is so sacred about a spot on the calendar when a specific exam needs to be done?  Are we humans really all that predictable?  Not likely. 

You fill the time with other things, and the unpleasant thought of someone sticking a probe up your butt fades into distant memory.  Life is good.  Totally out of your mind except for when others are indelicate or intrusive enough to mention it.

Then the day arrives, for whatever reason, that you finally agree to have the procedure.  Maybe you’ve just had enough of your doctor, your family, your friends, some, or all, “suggesting” that you need to have it done.  Maybe you read an article with some statistics that got you to thinking.  Or maybe you just figured what the hell, you’ll get it done and be done with it at last.  No worries, it will cost you a morning and it will be all over.  Besides, you’ve put it off so long now that giving in to having the procedure is finally a price you’re willing to pay so you can get things back to normal.  Get it over with and get on with it.

Call the doc, go in, get a referral, hear the doc express satisfaction that you are finally going to have it done.  Yeah, right.

Go see the specialist who will schedule the procedure.

Go buy that foul tasting chemical kit that will clean your innards so the doctor can see what’s going on inside there.  And so if on the remote chance he finds something he can nip it in the bud, so to speak, and all will be well.  But there isn’t much chance of finding anything anyway – give him a good clear view of just how right you’ve been all this time and how wrong everyone else has been.  You’ve already proven everyone else wrong by waiting this long and still having no symptoms, so you’ve won already.

Everyone says the worst is the prep the day before, and they appear to be correct so far – it’s a stinkeroo.  Not fun at all, but not all that bad, either.  But you’ve been assured the procedure is absolutely painless because you will be out of it and will know nothing, so getting past the day of prep is the worst it can possibly be.  Right now, on the evening of the prep day, though it’s been an interesting evening, all this is soon to end, because next will come the procedure, during which you will be asleep and after which you can say “I told you so” to everyone and get on with life.  Just a few more hours to go for normalcy.  Hah!  And you’ve managed to put it off for this long, too, an added bonus in retrospect.

The morning of the procedure, a colonoscopy, is almost a relief.  The prep is finally over and though there are still rumblings down there in the innards, you know there can’t possibly be anything left in there.  The administrative process is no more than registering as a new patient with a new doctor – same information requested and similar forms to fill out.  The medical process is just as simple.  Don a fashionable medical shows-all-from-the-rear gown, have a little blood drawn, have temp and blood pressure taken, lie back, and relax.

A few minutes later you are rolled into a small room and you go to sleep.  While you are asleep the procedure is accomplished without your assistance.  Piece of cake.  In an hour you’ll be on your way home thanks to someone who will do the driving (you will still be affected by the happy juice that put you out whether you know it or not) and in a couple of hours you’ll feel totally normal.  End of story.  Done.  Fini.  Tomorrow you’ll go back to work, tell anyone who intrudes on your “I don’t need one” space that you already did it, there was nothing, as you’ve been saying all along, and you’ve wasted time doing this for no reason at all.

The procedure is done!

HOWEVER, there is a small wrinkle while you are awakening from your gentle slumber.

It seems the doctor is speaking to you.  You’ll be glad your driver is also a good listener because the doc has more procedures to do on other patients and therefore doesn’t have time to tell you everything after you are firmly in control of your thoughts.  Found something?  No problem in your foggy mind.  When they find something they take care of it during the procedure. Zzzzzzzzzz.  Hmm, what was that the doc said?  Was the doc here?  Was he talking to me?

Yes, and he says he took a few biopsy samples while he was in there.  You have a mass, a polyp, a tumor, a whatever.

Oh, OK, so he got it out and sent it to a lab.  We’re all done one way or the other.  Do we go home now?  Can I change?

Yes, you can change in a few minutes, just relax and let the medication wear off.  But no, he didn’t remove it because it is too large.  You need surgery.

Surgery?  I’m still kind of fuzzy.  What do you mean by surgery? 

Well, he’ll explain it to you when you see him next week for the biopsy results, but you will have to have abdominal surgery, what he called “external surgery” to have the mass removed.

Oh.  Cobwebs are clearing. 

Somehow this is like a cup of coffee to a morning-after drunk.  It doesn’t really make you any sharper, but it does create a small window of focus and now things seem to take on a different light, if only for a brief moment or two.

A week passes.  Wonder what the biopsy says.  And that surgery.  What’s THAT going be all about?  Damn.  More time out.  Hospital time.  Wonder how long that will take.  And recovery.  How long?  What will I be able to do?  This is going to be a real pain.  What an interruption!

“Your biopsy results indicate precancerous cells.”  That means you do not have active cancerous cells yet, but the odds are clearly that it is only a matter of time.  I would point out also that I am able to take biopsy samples only from the outside of the mass.  I can’t tell you the status of the cells within the inner part of the mass.  In any case, just due to its sheer size, you need surgery to have that mass removed and I suggest you do not delay the process.

Suddenly “delay” is not such a welcome strategy.  Actually it’s not really suddenly.  This past week has been distracted by many thoughts.  “Putting off” and “too much trouble,” and “interruption of things more important” are phrases that don’t roll off the tongue quite so easily anymore.  What difference does it make what the biopsy said?  That mass is sizeable and it needs to come out in any case.  What if it causes a blockage?  And then what if the inside IS cancerous?  What if the rest of it turns cancerous next week?

Make an appointment and go back to Family Doc.  Get a referral to a surgeon.  The doc is professional and sincere enough not to say anything that would rub it in, despite the right to “I told you so” is in the other corner now.  The appointment goes without incident, but it is nevertheless another interruption of life and the delay of getting in has been several more days of uncertainty.

Another week’s delay, actually closer to two weeks.  Go to the surgeon.  The appointment with the surgeon goes well.  Hmmm.  I see here you have had some heart problems.  You will need to get a cardiac clearance before we can do this surgery.

You are lucky.  Your Family Doc is sharp and had the insurance company issue a referral to your cardiologist as well as the surgeon, so getting the clearance will take only as long as it takes to see your cardiologist.  A delay, maybe a little anxiety building time again, but the clearance will come.

Go to the cardiologist’s office to deliver the request for clearance from the surgeon.

The cardiologist requires you come in for an EKG.  To perform the EKG, if you have a hairy chest the locations for the electronic sensor pads are dry shaved with a disposable razor.  Not the way you’d do it at home and probably not the way the practitioner would do it at home, either, but this is shaving in the medical industry.  The cardiologist reads the EKG strip and the same records that have been on his desk forever, listens to your heart, and signs a pre-printed clearance form.  You are again lucky.  Clearance could have depended upon a stress test and that would have meant more delay and another appointment, perhaps two. 

You go back to the surgeon’s office to deliver the cardiac clearance.  And have the surgery scheduled.

Prior to surgery you go to the hospital for preadmission and for blood work.  More interruption, and parking near that hospital is terrible!!!   

It is now surgery day, the beginning of the greatest interruption of all.  The day before was a repeat of the prep you did prior to the colonoscopy, so this is twice you’ve had to go and buy that cleanout kit and twice you’ve had to go through that prep.  And knowing what it was like only a few weeks ago didn’t do much for your anticipation as yesterday, prep day, approached.  Yecch!  The rumbling in your innards rolls on yet, despite your knowing there is nothing in there, same as last time.

You report, hoping your driver will be able to find the car in another 6 or 8 hours or so, and await your turn to be called into pre-op. 

Finally into pre-op, you change into that fashionable gown again and take your place on the bed.  You again get to provide your medical history and list of current medications.  Never mind that you were told not to bring anything into pre-op with you – all that information is supposed to be in your head.  Besides, you just gave it to the pre-admission people, right?  So despite the fact that you already gave it to them and it should be in their computer system, that’s OK because your having to repeatedly give it to everyone just makes it easier for you to remember.   

Pre-op needs to connect EKG leads and notes that your chest hair has been shaved for an earlier one.  Rules are rules, however, and a fresh shave of those locations must be done again.  You know what is coming – been there and done that – dry shave with a disposable razor.  They are actually proud that it is a “new” razor and tell you so, as if that makes the lack of lubricant somehow excusable or less painful.

A short while later the anesthesiologist drops by with the forms you filled out in his hand.  He asks you the same questions you answered on his form.  He’s another one attempting to help you remember all that information.

The pre-op nurse drops in and remarks how high your blood pressure seems to be, but says you’ll be under general anesthetic shortly, so not to worry.  You aren’t worried.  You just want to get the show begun because that is the only way to get it over with.

Shortly afterward you are wheeled into the operating room, but you don’t remember the trip because the drugs were begun before you left pre-op.

Later that day, after being held in the recovery unit for several hours because there are no rooms available, you are finally moved to your “permanent” room.  You have a painful incision midline of your abdomen, but the pain is controlled by drugs fed through an intravenous line which has been securely taped in place — very securely taped.  In fact, when it comes time to remove that tape you will realize exactly how secure it has been. 

You also have a nasogastric (NG) tube in one nostril and that tube extends from your stomach, up your esophagus, out your nose, and into a combination pump/collection unit.  It keeps your stomach empty for as long as it is in place.  Insertion of the tube was less than smooth and you are bleeding from both nostrils.  You are unable to cough due to the pain of the incision, but your throat fills gradually with blood, source unknown.  In the next few days, as you are able to gradually exert slight upward breathing pressure, almost the point of coughing, you attempt to bring up phlegm and it always contains fresh blood.  Nobody you ask about it, or anyone to whom you comment about it, has anything to say regarding it.  There seems to be either a conspiracy of silence or a case of widespread ignorance.

Between the prep day and the NG tube, you are guaranteed that your intestines are now and will remain empty until your surgeon decides otherwise.  Your urinary tract is kept empty via a catheter.

At some point a central line is installed.  It is taped securely in place.  Again, very securely, and there is a sizeable dressing taped around that area, too.  More tape.

There is no need for you move much and there is little desire to do so.  Well, except to bring up that blood-filled phlegm.  The only way to get rid of it is to do as deep a clearing of your throat as you can and spit the results into a tissue.  A fresh box of tissue becomes as necessary to you as the NG tube, the catheter, and the central line.

As time passes you are allowed to “eat” ice chips.  Not exactly tasty or nutritious, but you don’t care about eating anyway.  It is just an instinct all animals have, including humans, and besides, you do it more to keep your lips from turning into a dry lake bed than for any other reason.

The NG tube is finally taken out and full blown nosebleed begins.  Nobody seems to notice and those who do see the pile of blood-filled tissues simply move them to the medical waste container.  Eventually the nosebleed moderates and you realize that the effort in “coughing” up the bloody phlegm is also the effort that brings on more nosebleed.  You do what you can to remain calm, as you notice your breathing become more and more difficult and your throat more and more clogged.  At one point you comment about what you really feel, and that is the growing concern that you are not going to be able to breathe that night.  You begin to worry that surgery may not be the direct cause of your demise.  Rather, blood clogging your breathing system seems more likely.  You are the only one concerned about it, however.

At some point you get a modified liquid diet, as opposed to a full liquid diet.  When you figure out the difference, please let me know.  You may note that both are on the same menu and the tray contents of each seems identical despite the fact that title of each is circled differently for different “meals.”

Along the way the dressing over the incision is changed and the central line dressing is changed.  Tape is removed each time, along with hair and skin, but those are the breaks.  Welcome to hospitalization.  Vital signs are taken periodically around the clock, preventing you from sleeping, and by the time day 5, discharge day, rolls around you are a wreck.

You finally go home and 9 days later you realize that it is the first day you have not coughed up blood.  On the sixteenth day you realize that your throat is still painful and swallowing is still inhibited.  The staples are finally removed and you are told that full recovery is between four and six weeks, so you have a way to go yet.

The good news is that the biopsy of the surgically removed mass is benign.  You are a little lighter due to parts of both the lower and upper intestines having been removed, along with the valve between the two, and a lot lighter due to poor appetite, sore throat, difficulty swallowing, and several days beginning with prep day when you had no intake by mouth at all.  Well, with the exception of those yummy ice chips, that is.

All in all, you are not really concerned with the biopsy results because everything was removed anyway – the mass itself as well as the surrounding lengths of intestines.

You begin to wonder, however, if it was all worth it. 

That is, might it have been less painful, less intrusive, less an interruption?  Weeks before you are back to normal, before your appetite returns, before you are allowed to do the things you used to do, before your digestive system is ready to handle all the things you like to eat, before a shirt doesn’t irritate the area of your incision, before any cloth, be it T-shirt, dress shirt, or bed sheet, stops grabbing at the re-growth of hair, well before all those symbols of normalcy, you wonder what you could have been done differently to have made life better.

The answer?

With added pain, this time purely mental pain, you realize the answer is that you could have stopped the vast majority of it from having to happen.  You could have had a colonoscopy when the mass was but a polyp, when if it existed it could have been removed effortlessly during the colonoscopy procedure.  If you had had the procedure when it was recommended based on historical data and probabilities, you could have avoided, well, how much would you have avoided?

The answer to that one is equally simple.

Scroll on back up to “The procedure is done!”  EVERYTHING below that point was preventable.

It really would have been that simple.

Perhaps you can help someone else to get a colonoscopy and keep it simple.  Perhaps they won’t have to go through all of what you did because of your ignorance, bluster, pride, busy schedule, or whatever it was that made you choose to do it the hard way.

Perhaps you can make it worth typing all this with two fingers and remembering the results of being foolhardy all along the way.