Colonoscopies: What They Involve and Why They're Important

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by Margaret (Maggi) Cary

“I don’t want to upset my medical treatment.” My 51 year old friend, a senior executive in health care, was nervous about the getting the recommended-at-50 colonoscopy.

“It’s easy—if you’re asleep.”

“But I have to drink gallons of fluid,” she said.

“Not necessarily. There are at least three options, including pills.”

“Who says?

I had moved from caring for patients into policy work years before and knew exactly “who said.” “Standard of care,” I responded.

I put it off, as most people do. Then my younger brother called.

“My colonoscopy showed polyps—the kind that could lead to cancer. The doctor removed them so everything is OK, except that I have to have colonoscopies more often than I would like.”

“Thanks for kicking me into the increased risk group, bro.”

The next day I made my appointment.

In the gastroenterologist’s office I was the all-knowing health policy person. “How many colonoscopies have you done? I asked. “How many complications have you had? Have you perforated anyone’s colon?”

“I don’t know how many I’ve done. Lots. I don’t remember any complications.”

Reality check for Dr. Cary. I was out of rarified health policy and into day-to-day medical practice.

The day before my colonoscopy, I hosted a long-planned Sunday brunch. The colonoscopy instructions read “Clear liquids only. Anything you can see through.” Champagne qualified. I couldn’t enjoy the food, and so I enjoyed too many glasses of champagne.

First mistake. Alcohol is dehydrating so I arrived at my appointment parched.

I had a choice between being put to sleep or remaining awake. Most people prefer to be put to sleep because of the discomfort. But the inside of the colon is beautiful—bubble gum pink with wonderful hills and valleys. I elected to watch mine, awake with sedation.

Second mistake.

I was so uncomfortable I could not appreciate the beauty of the inside of my colon. I survived, the test was normal and I can hardly wait for my next. Right.

My friend still wasn’t convinced.

I remembered Fran, my mentor and friend. She introduced me to public service when she asked the Governor to appoint me to the state Board of Medical Examiners early in my career.

Fran postponed getting a colonoscopy until her colon cancer had metastasized. She quickly declined.

“Fran’s in intensive care.” A friend called me while I was on the road. “She doesn’t want any visitors other than family.”

I landed at the airport and went directly to her hospital bed. I walked into the Intensive Care Unit. “I’m Dr Cary. I’m here to see Fran.”

The nurse led me to her bed, where she slept. “Do you want to wake her?”

“No. I just want to be with her for a few minutes.”

Fran looked old and frail, lying on her right side in a hospital gown, hair undyed and without make-up. It was hard to believe she was the brilliant, vibrant woman I had known for many years.

“Fran, it’s Maggi,” I said as my eyes filled. “I know you’re sleeping. I just wanted to hold your hand. You have been an inspiration to many people, including me. Thank you for encouraging me to enter public service.”

I stroked her back and the tears rolled down my cheeks.

“Are you sure you don’t want to waken her?”

“No. She looks peaceful. I wanted to say goodbye.”

My voice broke and I wiped my face with my hand.

I stumbled out of the unit, struggling to get to my car and privacy as quickly as I could. I sat in the driver’s seat, elbows on the steering wheel and head in my hands, sobbing.

Fran died two days later.

“That’s why you need a colonoscopy,” I said to my friend. “Ask to be put asleep, don’t drink alcohol, and get your colonoscopy on time.”

The next morning my friend called me. “I want you to know I have an appointment for a colonoscopy.”

Two weeks later on our morning walk to the coffee shop she said, “You were right. It wasn’t bad. I’m not sure what I was so worried about. Everything came back all right. I’m safe for another ten years.”

I smiled.

Margaret (Maggi) Cary teaches narrative medicine and personal essay at Georgetown University School of Medicine. Her essay, “Colonoscopy — The Butt Test,” was one of eight essays accepted for publication in the inaugural issue of The Examined Life: A Literary Journal of the University of Iowa Carver College of Medicine, published in April 2011.

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