Home » For Lawyers » Links & Resources » Alaska Bar Rag (Quarterly Newspaper) » Featured Bar Rag Articles--2000 to 2007 » 03-06 November - December 2003 Featured Articles » Why a colonoscopy is a rite of passage: A light-hearted but sobering tale.

Rites of Passage: A lighthearted, albeit sobering, tale of colonoscopy

By William Satterberg

A friend of mine recently was advised by the family physician to have a colonoscopy, as part of the ritual of turning 50 years old. So much for rituals. More like a ritualistic practice. Prior to discussing the procedure with my friend, I could not even pronounce the word, let alone differentiate between a colonoscopy and a sigmoidoscopy. To me, both words seem to mean the same in the end.

As suggested, my friend wisely submitted to the procedure and soon learned that a large, cancerous tumor had developed in the colon. Fortunately, the tumor was removed prior to extending into the main bowel and causing further, very serious complications. According to the surgeon, my friend was quite "fortuitous" in having caught the tumor in time. It was a slow-growing tumor, which apparently had been developing for approximately one and one-half years, but was ready to invade the main section of the large bowel area, where it would have spread rapidly. Colon cancer, known as the "silent killer," had almost claimed another victim.

Other friends have not been so lucky. Several years ago, another very good friend of mine and accomplished Fairbanks trial attorney, Charlie Silvey, succumbed to colon cancer at a young age. I still remember Charlie tearfully telling those who had shown up at an anniversary party for him and his wife that he truly appreciated their friendship. It was a depressing event. We all subjectively knew that Charlie was saying his good-byes as he bravely wished us all the best. We lost a good friend shortly afterwards. A few years later, another friend and a client was claimed by the same disease at a young age.

Despite these tragic losses, I still did not fully appreciate the incipient, developing threat of colon cancer until my close friend had that unpredicted bout with the large, cancerous polyp.

Submitting to gross indignity

After successful surgery, my friend soon insisted that I, too, submit to the gross indignity of a rectal examination. After all, I was told, "you, too, likely have polyps." Until then, I thought that polyps were only something that were formed in people's noses, and caused obnoxious roommates to snore.

It was not the first time that the concept of a rectal examination had been probed. My personal physician had been suggesting for over two years that I have the rueful rectal reconnoiter. I did my best to ignore his entreaties about my entrails. I figured that his regular attempts to confirm or deny prostrate cancer were enough of such indignity, and I consciously resisted any efforts of taking our relationship to any greater depths. Everyone seemed to be lining up behind me. Even my wife insisted that I have the humiliating examination.

"After all, Bill," she stated. "What have you got to lose?" she asked.

Eventually, reason and common sense unfortunately won out. I reluctantly scheduled myself for an examination. Although some alleged friends had suggested to me that I have the "flexible sig", which is a probe approximately one and one-half feet long which simply takes a look at the discharge end of the alimentary canal, my kindly physician told me that it would be just as wise to "go all the way with a full bore colonoscopy."

The terms "all the way" and "full bore" struck immediate terror into my soul. Nevertheless, my doctor indicated that it was much wiser to have the full examination. Besides, I would be given a "memory drug" at the time. I was assured that I would have little, if any, recollection of the event. If so, I asked, "why do they call it a 'memory drug'?" In reply I was told that, the "flexible sig" ordinarily was given without anesthesia and actually was considered to be more painful by those who had to endure the process. Although the colonoscopy actually went much deeper, the memory drug removed any memories of the procedure.

The "memory drug" was obviously another oxymoron - some sick doctor's idea of humor. Finally, although price was a factor, I checked out the competitive values to both, consulted with my insurance company, and ironically elected to take the more expensive colonoscopy. This costly decision added a whole new meaning to the concept of being hosed. I made a mental note of that. Lawyers no longer had a lock on the concept.

I scheduled the appointment. This short phone call took me approximately three months to place. After all, some phone calls are difficult to make at times, especially when one has an aversion to the instruments. To my surprise, the local internist was more than delighted to arrange an early appointment for me. I suspected my wife's input may have had something to do with the prompt response.

The intake

The day that I went to my internist's office for the intake visit, I thoughtfully showered, shaved, and arrived as late as possible, hoping that my appointment would be canceled. I was unlucky. The internist was also running late, apparently alerted in advance about my nefarious scheme. Apparently, everyone has the same thought in mind about late arrivals.

Following the preliminary obligatory questions regarding insurance and charge cards, I was taken to a room where I watched an X-rated movie telling me just how painless and enjoyable a colonoscopy actually was. I tried to remember that the movie featured trained professional actors, and that I should not try the depicted stunts at home.

I then was examined by a physician's assistant. His first question was whether or not I had experienced an unexplained weight gain or loss within the last month. I was honest with him. To his surprise, I quickly pointed out that I had just recently experienced a weight gain of well over 10 pounds in less than two days. Obviously alarmed, he asked how the event occurred. I explained that the scale at his office was reading a good 10 pounds higher than the scale at my house, and that I could not explain the difference.

The doctor's scale was obviously defective, just like the state's Datamaster units. We argued about it a bit. In the end, I attributed the difference to my inability to have something to hang from in the doctor's office, such as a convenient shower curtain rod. Curtain rods have always proven handy at home when I weigh myself. In addition, the physician's assistant would not let me step on the scale gently, as I am also used to doing at home. I also had to be weighed wearing clothing. Even that could have helped. Had I been allowed to be clad in T-shirt and shorts, I reasoned that I could have easily shed over 10 pounds of body weight. However, I remembered that this doctor's office was the last place that anyone wanted to parade around in while wearing shorts. Carhartt coveralls were a far better choice--weight gain or not.

The physician's assistant next commented that my blood pressure was somewhat high. I pointed out that, given the circumstances, it seemed only natural that a person's blood pressure reading would spike when talking about such personal details as a six-foot-long telescoping, articulated camera being inserted into areas which had never seen the light of day. He compassionately assured me that he had also endured the same examination. In response, I asked him if he would be willing to substitute as a double for me. I promised I would not tell anyone, and would even maybe pay him. Again, my tearful pleading was unpersuasive. The test would go on as scheduled, once I notified the doctor of a convenient time.

Preparing for the big event

My first appointment completed, I left the office. Within just three weeks, the office called my wife, Brenda, to remind her that I failed to schedule my actual examination. I pointed out to Brenda that it was simply a minor oversight on my part. It certainly was not intentional. The fact that I failed to schedule the appointment on at least four other occasions, I admit, gave rise to a certain air of suspicion. Eventually, based upon continuous gentle and not so gentle prodding from Brenda and others at my office, I scheduled my appointment. As a precaution, I scheduled it far enough off into the future to hope that a major calamity such as a world war, earthquake or hurricane might strike Fairbanks and thereby necessitate an unfortunate cancellation. Again, I was not to be so lucky.

For the next several weeks, I conducted an informal survey of individuals who had endured the examination. Results ran the gamut from "not so bad" to "totally terrible", and "you have to drink real icky stuff." Almost everyone was unanimous in their one piece of sage advice: "Take the drugs, Bill!"

I deliberately made special inquiry of court system personnel. I learned that more than one judge had submitted to the examination process. Moreover, some judges even were repeat customers. In retrospect, this fact helped to explain their sometimes drab outlook on life. Others I questioned stated that they chose to undergo the process only once. Others avoided the topic in its entirety.

As the dreaded day approached, I had second thoughts for the 10th time. There was the nagging fear that the doctor would find something which would necessitate an even greater, more personal examination. I have long been a believer in the concept of "what I don't know won't hurt me." I had always reasoned that physical check-ups are simply inviting disaster. It is, in that regard, a neurosis which I prefer to live without, being a dedicated hypochondriac.

I have another phobia. I am a control freak. Most attorneys are. One thing that has always bothered me has been the concept of inadvertently losing consciousness. Obviously, I have chosen to lose consciousness many times on a voluntary basis. In fact, I do so on a daily basis when it is time to go to bed. I have also done so at parties, and once in a fight. Yet, even in the fight, I voluntarily let the other guy hit me several times. At least, that is how I rationalized the event as I watched the stars go by.

Being injected with drugs, on the other hand, is an entirely different matter. It is not that I have a phobia for needles. In fact, I used to be an IV technician in an ambulance. However, it is when the needle is stuck into myself that I begin to have second thoughts--just before my head hits the floor. This "loss of consciousness" thing clearly was going to be an issue.

Fasting on liquids and Jell-O

One of my biggest concerns was that I would not get to eat for a full 24-hour period. The manual of instructions given to me to prepare for examination clearly ordered that I was to go on a 24-hour fast, consuming only clear liquids and Jell-O. To add insult to impending injury, the evening before the test, I was ordered to drink a full half gallon of a diabolic concoction known as "Go Litely". "Go Litely" was some pharmacist's sick idea of humor. Another medical joke. "Go Litely," as it turned out, was a supercharged form of grandma's unflavored Metamucil laxative on steroids. I had been told about the brew from numerous sources, including even my own kindly physician. All well-wishers warned me that the "Go Litely" phase of the examination process was, by far, the most difficult and demanding.

The day before my scheduled examination, I awoke. This was clearly an involuntary act on my part. I next had a last breakfast of eggs, bacon, and toast. I timed the breakfast to be exactly 24 and one-half hours before the scheduled examination, thereby meeting the actual "24-hour" rule. I viewed the meager meal as a last supper of sorts. Following breakfast, it was to be clear liquids and Jell-O for the balance of the day. I was even deprived of my ability to drink my beloved coffee.

Because the colonoscopy would evaluate numerous attributes of my lower working unit, I was also precluded from drinking anything which was either red or orange in color. I therefore stuck to a rather gruesome color of florescent green in almost everything I consumed that day. I had green Jell-O for lunch, green Jell-O for a snack, and green Jell-O for dinner.

Fortunately, my compassionate doctor friend did me a small favor. Breaking sacred medical science, he disclosed one of the sneaky tricks of making "Go Litely" more tolerable. The solution was to mix a bag of Crystal Light Lemonade into the ghastly goo. As such, when it came time to quaff the half gallon of "Go Litely" that evening, I spiced up the potion as instructed. I was also somewhat inclined to add a cup or two of vodka to the mix, as well, in order to make the entire process even more palatable. My wife quickly vetoed the idea.

To my surprise, I actually found the "Go Litely" to be rather enjoyable when spiced up by Crystal Light. It was sort of like drinking a thick, lemony gruel which, if properly chilled, turned out to be not only tolerable, but actually rather tasty. To this very day, nobody believes my assessment, but I will stick by my words. Just try a gallon and see!

I had also been warned about the intended effects of "Go Litely". I should not regard its potency lightly. The remainder of the evening should be spent in very close proximity to the family restroom. In hindsight, this was one time that I should have listened more closely to my doctor's advice.

For 30 minutes, nothing happened. I was just becoming proud of myself and my longstanding ability to consume anything, when the "Go Litely" decided to make its purpose acutely known. Although I tolerated the input of "Go Litely" well, the "Go Litely", in turn, did not tolerate me. Eventually, we rapidly parted company over the next several hours. As a reputed devotee of colonic therapy, Princess Diana would have been proud of me.

I was finally able to retire that evening at approximately midnight, relatively confident that the "Go Litely" phase of my forthcoming experiment was hopefully gone.

The end game begins

I awoke the next morning at 6:45 a.m. My wife insisted that it was now time to go to the outpatient clinic for the finale or, as some people prefer to call it, the End Game. Because anesthesia would be administered, I was told that I would not be able to drive to or from the facility. I had to have a designated driver, or the examination would be rescheduled. I took the threat of cancellation most seriously. Although I repeatedly offered to drive myself, Brenda was firm. The appointment would go on as scheduled. To reward Brenda's willingness, I thought about slipping her a quart or two of leftover "Go Litely," just for fun, but wisely decided otherwise. After all, Brenda is the family cook with untold opportunities for future retaliation.

As we left for the clinic, I contacted my office to determine the status of any potential hearings scheduled for that day. The office had already obtained coverage for one arraignment scheduled for the afternoon. As a precaution, I had also asked my office at the last minute to cancel an evidentiary hearing scheduled before Judge Funk later in the day. I figured Judge Funk would have no problem with the change. Instead, when I called to check in, I was shocked to learn that the court would not allow a unilateral cancellation of a month-long scheduled evidentiary hearing with numerous subpoenaed witnesses. I was told quite clearly that Judge Funk had ordered that I was to be in court that afternoon, either telephonically or in person. To my surprise, last minute cancellations were not the norm. It was then that I decided that I would forego the anesthesia and take the colonoscopy "like a man." My options were quite limited.

When I arrived at the clinic, I courageously announced that I would not be taking any anesthesia. Gasps were heard throughout the premises. Numerous well wishers advised me that this was definitely not a wise course of action. Not only was the procedure most uncomfortable, but I would likely be begging for anesthesia before it was concluded.

Despite the warnings, I had no fear. My reputation in town is that I am rather large in that particular area of anatomy. As such, I saw no reason why I should not be able to tolerate the examination, if not actually welcome it. Eventually, I was able to convince the doctor not to give me anesthesia. Still, we compromised on just a "minor dose" of anesthesia to "cut the edge." We furthermore agreed that, if I found the procedure agonizing, I could scream at any time for additional drugs to be administered. The crisis over, I left for the examination room.

While awaiting the doctor's entry into the examination room, I toyed a bit with the colonoscopy unit. It was an extremely long, black flexible hose. It had a camera on one end and a television monitor on the other. For several minutes, I had great fun taking pictures of my wife in the room and swirling the camera around to get a different viewpoint of life. It was then that I realized that this unique camera had a different journey in mind. From that perspective, the tube no longer appeared to be a thin, flexible tube, but a device cleverly designed to inflict the most hideous forms of torture upon the hapless recipient. Moreover, I was not its first victim. This thought, alone, held certain distasteful implications. Finally, the fact that my examination was to be televised also caused anxiety. I wondered what would show up on the local news that evening.

My playing with the camera was soon interrupted by two nurses who entered the examination room. Giggling happily about various things that they had done the previous day, they expertly coached me on what positions to take, having no consideration whatsoever for my male modesty. Their introductions completed, as if on cue, my internist arrived. It was time to begin the examination. I felt like Gary Gilmore. "Let's do it." My wife said she would wait outside. The drama unfolded, as did my green gown.

Fond memories of the exam

Ironically, I did remember the examination. As promised, the nurse gave me only a very small mixture of drugs consisting of a Valium-like substance and a pain reliever. It was simply enough to lightly dull my senses. I remember joking with my doctor with respect to the quick journey that he took clear up into my small intestine, pointing out various landmarks along the way. In less than eight minutes, the entire experiment was over. To my relief, I was given a clean bill of health. I was considered normal, if one overlooked the psychological trauma. I had nothing to worry about. I was told to come back in no less than five years and no more than 10 years. (Then, again, maybe he said no less than 10 years. Or was it 20? Or 30? By then, I won't need a memory drug.)

In short order, I was able to dress and leave the doctor's office. I knowingly winked and remarked to him on my way out that we had certainly entered a new and much deeper relationship. After all, he had gone places where no one had ever ventured before. In response, he complimented me that it had been one of his easiest and fastest examinations, stating that he had lots of extra room for maneuvering. Only later did I appreciate the subtle implications of his professional opinion. As a memento of the historic visit, my doctor gave me an 8x10 glossy photograph of the incredible journey, complete with diagrams, and a dated, time-stamped legend. Little did I realize how important that photograph would be later that day, when I had to establish a viable alibi.

Brenda drove me home. I stayed relatively inactive for about one hour. I then decided that, despite the instructions that I should not drive, I was good to go. I drove to work. Much to everyone's surprise, after being reminded several times, I was even able to button my shirt and zip up my fly, both of which have proven to be somewhat problematic in prior court hearings.

Returning to duty...and a sympathetic judge

My first hearing was with Judge Savell. It consisted of simply a felony admit/deny hearing, which went relatively well. I was able to enter a one-sentence denial for my client without mistakes.

My second hearing before Judge Funk, however, was far more complex. Initially scheduled as an evidentiary hearing, my client and I had discussed the very real probabilities of an adverse decision. At the last minute, he elected to enter into a Rule 11 agreement with the State to resolve the case with a stipulated sentence. It was a good decision.

Prior to accepting my client's plea, Judge Funk lectured me that my office should not be unilaterally canceling court-ordered hearings in the future. Although, admittedly, I saw a certain merit in the judge's position regarding court system time management procedures being usurped by me, I also figured that my age and wisdom should be given at least some credit, especially recognizing that I had now entered my senior years, as evidenced by my newfound internist/doctor/friend.

Following my session with Judge Funk, my client's plea was entered. At one point, Judge Funk asked the obligatory question regarding whether or not my client was under alcohol or drugs, adding to my client that the inquiry is being made directly of him, and not through his attorney. I wisely chose to sit and continue to giggle. My client's plea accepted, my client next left the courtroom. I finally could talk "off the record."

When I explained to Judge Funk that the reason that I wanted to cancel the hearing was because of the colonoscopy which I had suffered earlier in the day, and that I had taken the examination without anesthesia in order to be relatively competent in his courtroom, Judge Funk immediately became most understanding. He graciously pointed out that, if he had known that a full colonoscopy had been involved, he would have been most willing to cancel the hearing. Something told me that the good jurist may have once endured his own experiences of a similar nature. Maybe it was the subtle, involuntary grimace that gave him away.

It was then that I proudly displayed my newest 8x10 colored glossy photograph, complete with a date stamp. My alibi was airtight. In response, Judge Funk's court clerk, Karen, was clearly less than amused. The following day, I was reminded that I should not be bringing my family photographs to the courtroom anymore.

Have you had yours lately?

In the end, my worst fears of colon cancer were not realized. Setting aside the fact that I had to engage in conduct reminiscent from one of the more memorable scenes from the award winning movie "Dumb and Dumber", and that various strangers now have certain private insights into my life, the examination, itself, was well tolerated. Undoubtedly, there are other medical procedures which are likely more enjoyable, such as a first childbirth or battlefield limb amputations.

Still, colonoscopies are one of those rites of passage which we must endure, even if most of us would rather put them well behind us. On the side, a colonoscopy is one of those experiences that those of us who have reached the golden age of 50 can share in common, along with our complimentary AARP subscription, estrogen pills, and Viagra. Regardless of what our aversion may be to such examinations, we must also keep in mind that the alternatives are simply unacceptable, especially when colon cancer is so avoidable.

As such, the next time you see somebody who looks like they are over 50 years old, smile warmly at them and ask innocently, "Have you had your colonoscopy lately?"


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