| Stuff |
[Jul. 30th, 2009|11:14 pm]
Scott
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I will never think of the phrase "trouser snake" quite the same way again.
I spent the last two days shadowing a gastroenterologist: that's a doctor who treats the digestive tract. A lot of it is colonoscopies. Today it was just one colonoscopy after another, for eight hours. Colonoscopies are not fun to watch.
Maybe you are under the age of fifty and in a low-risk category for colon cancer, and so you've never had the great fortune to experience a colonoscopy. Here is what happens. You are given forty laxative pills (or, if you prefer, a gallon jar of liquid laxative). You must take them all within four hours. The result is exactly what you would expect. The next day, when you've gotten off the toilet, there's nothing left in your digestive system and it's all sparkly clean. Or as clean as an organ that's basically a big tube full of poop can reasonably be expected to get.
Then you go to the hospital, lay down in a lab, and get anaesthetized. The doctor, nurses, and technicians undress you and lay you on the table. Then they take a long metal snake-like robotic tube and stick it up your anus. On the front of the tube are a light and a video camera. The inside of your colon gets displayed on an HDTV screen for all the surrounding medical professionals to look at.
The procedure takes about twenty minutes, during which about five feet of tubing get stuck into your anus. If at any point the doctor sees something smallish that shouldn't be there, he sticks a set of tiny mechanical scissory pincery things in the robot arm and cuts it out. If he sees something biggish that shouldn't be there, he gives the robot arm a little lasso, and the arm lassos it, tightens, and then drags it out (giving a whole new meaning to the phrase "ass cowboy").
I saw about ten of these today. Everyone over fifty or so is suppose to have them every couple of years, because at that age they're at risk for colon cancer, and the colonoscopy can detect precancerous tissue and remove it before it causes any problem. Colonoscopies are kind of like dentist visits, in that people know they really ought to have one but put it off anyway.
...don't put it off. Of the ten people I saw today, about four or five had polyps. According to the gastroenterologist I followed, pre-malignant polyps have a pretty high risk (25%) of becoming cancers if left alone. And colon cancer is pretty commonly fatal. Those ten procedures today probably saved at least one life.
There was, though, one thing that kind of bothered me (well, two things, if you count the doctor who felt perfectly comfortable eating a sandwich with one hand while threading a robo-snake into a guy's rectum with the other...well, three things if you count the anaesthesiologist who kept making Michael Jackson jokes). Anaesthetic. Now, I know that everyone who comes back from a colonoscopy says it was fine and they slept through it and it didn't hurt at all. And about three quarters of people did sleep through it.
But about a quarter of the time, the anaesthetic didn't work too well, and the patient was awake and in horrible, horrible pain. Outside of movies and TV, I've never seen someone in such pain before. And watching someone literally writhing in agony is a terrible, terrible experience.
What did the doctor say? He told me that they couldn't up the anaesthetic because an overdose could cause respiratory arrest, and that it wouldn't matter because the anaesthetic on any dose caused severe short term memory loss and whatever happened the patient would forget all about it. The second point, at least, was right on. One patient spent the entire procedure writhing in agony and screaming something incoherent to God. The doctor finished the procedure, took out the endoscope, and cut off the anaesthetic, and the patient turned his head, looked the doctor right in the eye, smiled, and said, laughing "Wow, that wasn't bad at all! Guess I slept right through it!"
It's a philosophical conundrum. When I'm fifty, and I want a colonoscopy, do I get one knowing it could be excruciatingly painful? Does pain even matter if ten minutes later you don't remember ever having it? If not, does any pain matter, seeing as we'll all forget about it at death, if not earlier?
Eh, I'll probably get the procedure. I was told most patients who the anaesthetic doesn't work well for are alcoholic, so not being a heavy drinker I'll probably end up in the lucky 75%. And it does save lives. Still.
Also, interesting fact: the inside of your colon is very, very ugly. Try not to think about it being inside your body. |
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