Sunday, March 28, 2010

Inside and Out

I've discovered that I'm as pink, healthy, and beautiful inside as I am on the outside.

I'm not sure it was worth having a 5-foot probe stuck up my butt in order to find this out, however.

I'm at the age, however, where colonoscopy is a regular part of medical care.

“Have it done this year,” advised my doctor, “That way, you won't have to have another one for ten years.”

Um, yeah, okay. I made an appointment back in January and pretty much forgot about it.

The prep was not a lot of fun, although I admired the way the drugs brought on a mild bout of dysentery that cleaned me out without much discomfort. Drinking the cleaning solution chilled me clear through, as if I were drinking a refrigerant.

I don't like pain meds. I don't like the way they make me feel, not just during the time when they're supposed to work, but also for the next several days. I don't like the feeling of being numbed. I don't like feeling woozy and disconnected.

Pain meds, I learned during my first pregnancy, can interfere with labor. They take weeks to clear out of the newborn's system. As a breastfeeding counselor, the difference between drugged and undrugged babies is striking. A normal newborn, whose mother received no pain meds during labor, is active and alert. A baby whose mom had pain meds is in infant la-la land, not quite in her body, not really paying attention to the hard work a newborn needs to do.

After giving birth naturally, I looked at drugs with a different eye. What do these medications do? Are they actually fixing something or are they merely masking symptoms? If they're masking symptoms, what else are they doing? Are they making things better or worse?

In a lot of cases, I decided, the drugs actually make things worse. Suppressing fever, for example, can lead to a longer bout of illness and more secondary infections. Antihistamines and decongestants can also lead to secondary infections. It's better, I think, to use such drugs sparingly and to focus on supporting the body so it can do its healing.

While breastfeeding, I started having my teeth drilled without being numbed. To my amazement, I discovered that having cavities filled isn't all that painful. (My dentist deserves a lot of credit for this; she's slow and gentle and careful.) In many cases, it's a toss-up whether the pain from the injection is worse than the pain from the drilling. Even when the fillings are a little deeper, the pain is often manageable and is a clear win over being numb for several hours.

When I told the gastroenterologist that I didn't want pain meds, he was skeptical. I told him I'd given birth four times without pain meds, and that a colonoscopy couldn't possibly be worse than transition. He wasn't convinced until I told him I had my teeth drilled without meds, and even then he wanted to be sure I had an IV in so they could drug me if I changed my mind.

I knew then that I'd have to stay focused to keep from having drugs slipped to me. I told everyone that I wanted no pain meds and I wrote the refusal on my consent form. Everyone asked me why I didn't want the pain meds. I tried to explain, but I don't think they understood.

I don't think pain is all that important. There are other things, like having a clear mind, that matter more to me.

My body, my science experiment.

Okay, so they have me in there, on my side, with an IV in my right arm, a blood pressure cuff on my left arm, a pulse monitor on my finger, and a saturation monitor on my chest. I felt like a real patient then. All the gadgets seemed like overkill to me. I'd had my babies without them; the midwives had looked at me to see how I was doing, not at a bunch of monitors.

I flashed on my eldest when she was hospitalized as a newborn, how the nurses spent all their time focused on the monitors instead of on the babies. I remembered my dad's repeated hospitalizations during his long bout with cancer, how often it seemed like he was lost in the machines and monitors, held under by the sea of drugs they kept feeding him.

I am so not ready for being a patient. I have spent my entire adult life avoiding anything resembling this.

The gastroenterologist and his two nurses (both men) are so not ready for an undrugged patient whose experience of medical care is primarily with homebirth midwives.

The gastroenterologist switches on the video monitor in front of me, giving me a fetching view of my curvy, creamy ass. I'm startled by this at first, at the same time interested to see my body at an angle ordinarily reserved for my husband. I'm irrelevantly grateful for all the dancing I do. If my ass is going to be featured on a video monitor, I'm glad that it looks good. I briefly imagine what it would be like to see a flabby or pimply ass on that screen and know it was yours.

The probe goes in the first bit painlessly. I'm startled again, seeing that the inside of the rectum is not what I imagined.

“Oh, it looks like a mucus membrane.”

The doctor gives me a friendly enough “duh” response, remarking that mucus membranes are pretty much of a muchness. He points out the liver as we go by, and I ask about a couple of other internal organs that he can't identify.

The skin of the colon is thin and translucent, showing a delicate tracery of veins. Rather beautiful in its own way. Sometimes it's ribbed and arched, but mostly it's amazingly smooth and pink and pulsing and alive.

The switchbacks are wicked, though.

I would have been better able to focus if my body hadn't been having this visceral reaction to the probe.

“Just kick that guy,” my gut urged me, “and get that thing OUT OF HERE.”

Judging from the cramping in my abdomen, that was good advice. The colonoscopy wasn't too bad, for the most part, although it was definitely painful going around the bends. The hard part was controlling the visceral reaction, willing myself not to fight the probe, trying to keep my abdominal muscles from clamping down on the thing, trying not to give the biggest push I've ever given in my life to GET THAT FOREIGN OBJECT OUT OF ME.

After the first few bends, I wished I'd brought a doula. I asked the nurse who was monitoring my monitors to let me grab his hand during the worst bend. He said okay, but told me not to squeeze too hard or I'd interfere with the blood pressure cuff. I wondered briefly what drugs he was on, but remembered he was used to drugged patients and had no clue how to support a person through this.

I really appreciated how very much emotional support had helped during labor. It's wonderful to be told how well you're doing, how much progress you're making, that you can do this.

I didn't get that with the colonoscopy. The gastroenterologist repeatedly offered me drugs to ease his discomfort. (I was moaning low to try to control the urge to push the probe out. The nurse kept telling me to breathe and I controlled myself long enough not to tell him to stuff it. Really, I was admirable throughout the whole thing. I didn't kick anyone, threaten to stuff the probe up their butts, or snap at anyone. I didn't even make the scatological jokes that kept popping into my head.)

These guys were nice enough and they were trying, but they clearly had no clue about how to support someone through a colonoscopy without drugs. I didn't get any encouragement for hanging in there for a little longer. I didn't get any of the atta-girls that make it so much easier to bear the pain. They clearly thought I was foolish and stubborn to refuse the drugs, and I could tell that the gastroenterologist didn't like causing pain.

The gastroenterologist remarked that I had an especially twisty colon. It was at that point that I thought I ought to devote the next ten years of my life developing a robotic probe that could navigate the twists and turns by remote control instead of by almost-blind ramming against the obstacle of my body. I started imagining the little vehicle fondly, how it could take the hairpin turns slowly and easily and without causing the least bit of discomfort.

I imagined hanging out my shingle as a colonoscopy doula, someone who would help people through medical procedures like this without drugs. Someone who would do the work of supporting the patient emotionally.

No one offered me drugs during labor. When the colonoscopy probe was almost all the way in me, the doctor offered me drugs again. He seemed almost desperate to have me accept. I felt a wave of pure hatred at that moment. We were almost done; there was no point in doing drugs now. It was a tough bend, but surely we could get around it.

It was a painful bend. A short while later, I was moaning and writhing and trying to get myself together.

“Okay,” I said, meaning “Okay, I've got to get myself together here.”

It was the kind of “okay” that midwives and my husband understand as meaning “I'm just getting my focus back here, and then I'll be good for the next section.”

The gastroenterologist, however, seemed a little unhinged by it.

“Okay, WHAT?” he demanded a little wildly, “Okay you want drugs?”

I don't remember what I said, but I managed to communicate that no, I didn't want drugs, and let's just get this over with, shall we? I am quite certain I didn't call him any mean names, either, although I was plenty annoyed with him right then. Why did he keep offering me drugs when he knew I didn't want them? That struck me as disrespectful, and the last thing you need when some guy has a 5-foot probe up your butt is for him to treat you disrespectfully.

A short while later, we were at the cecum. The gastroenterologist told me it would be easier on the way out (and my gut informed me that we could make the trip out really fast if I just gave the word). I had kind of figured that, and was able to relax and enjoy the view on the monitor.

All along, I felt kind of bad for the gastroenterologist and his nurses. They were doing their job, and they were doing their best, and here I was, an intractable patient refusing the drugs they were offering me for my own comfort. Instead, I was choosing the pain, and inflicting it on them, and for what?

So I could be clear-headed for the rest of the day, and the following weekend. So I could spend the afternoon and evening working on my open-source project, totally focused on coding and debugging. So I could be in my body during the colonoscopy. So I could feel what was happening. So I wouldn't be cut off or disconnected from my own experience.

1 comment:

Jennifer said...

I was just reading an article about GI resistance, and thought of you with a smile.