Undergoing a colonoscopy demands the abandonment of one’s pride and dignity. The prep turns you into a lean, mean, defecating machine. The following day you don a flimsy gown and expose yourself to a medical team who regards you as just another workplace asshole. It’s the price one must pay to avoid becoming one of the 53,000 in the U.S. who die of colorectal cancer every year.
I long fancied myself as an authority on enduring colonoscopies because my medical history demanded that I undergo them with greater frequency than generally recommended, sometimes on a yearly basis. Last week I learned that colonoscopy experiences can vary widely based on how and where you have them performed. Let’s just say that for the first time since relocating to California from New York City some eight years ago, I was pinning for the Big Apple while being prohibited from eating one.
The ColumbiaDoctors Way
My longtime NYC gastroenterologist was Lewis P. Schneider, part of the Columbia hospital system and consistently ranked among the best medical roto rooters in the country. Admittedly, my face-to-face encounters with Schneider were fleeting, but he always struck me as a really nice guy.
More importantly, I had become so accustomed to Schneider’s way of doing things that I no longer dreaded surrendering to his camera-enabled scope. I always left Schneider’s treatment room feeling blissfully rested and ready to eat like there was no tomorrow. Some of my best times with my good friend Bart, who over the years graciously retrieved me after my colonoscopy exams, were going to breakfast afterwards.
Schneider’s prep, at least when I saw him, allowed me to eat until 10 am the day before my procedure. To ensure I’d have a hearty appetite, I’d get up early and do an intense workout, and then gorge myself until the appointed hour. At noon, I’d take two Dulcolax pills, and then around four, I’d start downing this horribly tasting prescription fluid and wait for the fireworks to begin. I couldn’t eat, even if I wanted to. For nearly six hours straight, the toilet was my throne. A caring woman from Schneider’s office always called me in the early evening to see how I was faring. The calls gave me comfort.
I’d make certain I was Schneider’s first appointment, which was 7 a.m. His office in Columbia’s midtown medical building was deserted at that hour, but someone instantly appeared from the back and told me to change into a gown and then go into the procedure room. Schneider likely remembers me from the initial time I made a fuss and refused anesthesia; he subsequently made clear that was no longer an option. Within minutes an IV was inserted into my arm and the anesthesiologist would tell me to count backwards from 10. The best I can recall doing was making it to 7. The wonders of Propofol.
Next thing I knew I was awake feeling like a slept for more than 24 blissful hours. Someone helped me onto my feet and escorted me into a recovery room where I was treated to some orange juice and crackers. On one occasion I had to see Schneider in his office to discuss a medical concern, but most times I’d just get dressed and meet Bart in the waiting room. Once, I felt so well rested that I went to the gym later, which I quickly learned wasn’t too smart.
The Cedars-Sinai Way
Last week I had a colonoscopy the Cedars Sinai way. Cedars is the hospital of choice for Hollywood celebrities, so it stands to reason that dealing with assholes is among the facility’s advanced capabilities. Cedars has a special wing for A-listers, and I imagine that if and when the Kardashian sisters undergo colonoscopies, their experiences would differ from mine.
Cedars is a soulless medical facility akin to a visit to Motor Vehicles. The administrative staff has uniformly mastered the art of indifference; I’m almost in awe of their ability to ask for ID and proof of insurance without even a passing glimpse of eye contact. That said, you have to be exceptionally good to practice medicine there. My Cedars gastroenterologist was of Schneider’s caliber. I’m not naming him for fear of pissing him off (or should I say crapping him off?).
The Cedars prep prohibits eating all solids the day before the procedure. The instructions, at least as I understood them, said I could only drink fluids, including Ensure and other meal replacement drinks. The only caveat was that I couldn’t drink any red colored fluids.
The Ensure sold at my local CVS came in two flavors: Vanilla and Chocolate – none of which are red colored or clear. The pharmacist assured me I could have any flavor as part of my preparation. Being the chocoholic that I am, you know what I went with.
Cedars prep required that I take two Dulcolax tablets at 2 pm. Then between 5 and 8 pm, I was to take half a bottle of nonprescription MiraLax mixed with a 32-oz. bottle of Gatorade. Six hours before my procedure (12:15 am) I was to mix the remaining MiraLax with another 32-oz bottle of Gatorade. As I’m diligent about limiting my sugar intake, the 64 ounces of Gatorade likely exceeded my sugar intake for a week. The poison made me feel sick.
During the day, I had three chocolate Ensures – at 10, noon, and 5.
The fireworks never arrived. I watched a couple of movies with nary a nature disruption. When I awoke at 5:30 am, I didn’t have that cleaned out feeling I had with Dr. Schneider’s prep. I mentioned to the nurse who rustled me from the waiting room that I thought there was still some chocolate Ensure inside me. My gastroenterologist quickly appeared.
“Did you really have chocolate Ensure yesterday?” he asked with a look of disbelief. I admitted that instinctively it didn’t feel right, but the pharmacist assured me it was okay.
“If something doesn’t feel right you should go with your instincts,” my gastroenterologist said. “We’ll do the procedure, but we might have to repeat it.” He wasn’t a happy camper.
There was a silver lining dealing with my gastro’s disgust. It distracted me from the fact that a nurse had surreptitiously inserted an IV into my arm.
Things are hopping at Cedars’ endoscopy center even at the crack of dawn. When I arrived, a nurse took my temperature at the door. An administrative person took down all my info. One nurse ushered me into the changing area, while another asked me a bunch of questions. Yet another inserted the IV line. The anesthesiologist swung by to ask a few quick questions. I could tell that she knew I was the chocolate Ensure guy.
Suddenly, the IV nurse pushed my gurney through the door and made a quick right. My gastroenterologist was at a computer and there were four people in the room, including the anesthesiologist, who instantly slipped an oxygen mask on my face. Someone yelled: patient verification check. I heard my doctor shout my name and then it was lights out.
Next thing I remember is yet another nurse hovering over me telling me it was time to go home. My cousin Rob was supposed to pick me up at 8:45, and it was only 8:15. The nurse had already called Cousin Rob to fetch me earlier, and was annoyed she got his voicemail. Cedars clearly wanted their gurney. My gastroenterologist had more than a dozen colonoscopies scheduled that day.
I managed to get Cousin Rob on the phone. Unlike at Schneider’s office, I wasn’t allowed or required to savor some crackers and orange juice. I was given a plastic bag filled with a mini bottle of water and snacks I’d never eat. I was also given a card signed by all the folks involved in my procedure. There were more than a dozen signatures. Nice touch, but I didn’t feel like a million bucks like when Schneider finished with me.
My gastroenterologist did a heroic job under very cloudy circumstances, removing more than a half dozen polyps, including one of considerable size. Fortunately, none of them were cancerous. As a precaution, he wants me to undergo another colonoscopy next year.
It goes without saying that I will never again drink a can of chocolate Ensure.