Even if had the aptitude and dexterity, dentistry would rank near the top of jobs I’d least like to do. The thought of sticking my hands into the mouths of every person who showed up at my office has no appeal, which is why I cheerily pay my dental bills on demand. As I’ve previously written, I’m in awe (pardon the pun) of my dental providers and all they do for me.
At the very top of jobs I’d least want to do is gastroenterology. The specialty spans what’s between the mouth and the anus, which means that in addition to sticking one’s hands in patients’ mouths it also requires sticking fingers up their rectums. It’s very challenging and honorable work, and those who pursue the life-saving specialty are deserving of a shoutout.
I imagine you’re wondering how I even think about stuff like this, let alone take the time to write about it. My appreciation for gastroenterologists struck me on Thursday as I was waiting to be wheeled into a surgical suite for yet another colonoscopy, a procedure I’ve endured with more frequency than most people. Colon cancer runs rampant in my family, as does Crohn’s disease. I’ll spare you the details, but I’ve sometimes been required to endure colonoscopies in successive years. Admittedly, one of those instances was because of poorly written instructions that resulted in limited visualization of my colon. If someone says two cans of Ensure are permissible a day before a colonoscopy, they should make clear that the chocolate flavor can’t be one of them!
Waiting to undergo my colonoscopy — my second within the space of 15 months – I got to thinking how fortunate I was for the procedure. My grandfather was younger than me when he died of colon cancer, and although I was quite young when I’d visit him in Pittsburgh, I still vividly remember his screams of agony during the night. My grandmother refused to admit my grandfather into a nursing home, and in the early 60s pain management was considerably less advanced than today. My grandfather suffered a very painful death.
The modern-day colonoscopy was developed in the 60s by Drs. William Wolff and Hiromi Shinya at Beth Israel Hospital in New York City. As reported by the New York Times, Wolff and Shinya, in partnership with the Olympus Optical Company, pioneered a device called the colonoscope, a snakelike instrument that allows physicians to navigate the entire length of the colon and zap all the polyps they encounter along the way.
According to the Times in its obituary of Dr. Wolff, the colonoscope led to a radical shift in medical thinking. Prior to the instrument’s development, doctors believed that bowel polyps rarely, if ever, turned into cancer. Prevailing medical wisdom today is that most, if not all, cancers of the colon arise from polyps.
Colon cancer is the third leading cause of cancer-related deaths in men and women, and the second most common cause of cancer deaths when men and women are combined. The American Cancer Society (ACS) projects that 52,580 Americans will die of colon cancer in 2022.
The mortalities would be considerably higher if Wolff and Shinya hadn’t pioneered the colonoscopy. The ACS estimates that more than 19 million colonoscopies are performed in the U.S. every year, so it stands to reason that many of the people who undergo the procedures avoid cancer down the road. Colonoscopies can reduce colon cancer occurrence by 40 percent and mortality by 60 percent, according to the ACS.
Despite the intricate skill required to perform a colonoscopy, the procedure has a remarkable safety profile. The American Society of Gastrointestinal Endoscopy estimates that only three in 1,000 colonoscopies leads to serious complications, most of which aren’t life threatening. A patient dying undergoing a colonoscopy is considered a “never” event, which means it’s so exceedingly rare the expectation is it should never happen. A patient died from intubation complications undergoing a colonoscopy at Beaumont Royal Oak Hospital in Michigan last year, but the circumstances were unique to that hospital.
One likely reason for the impressive safety profile is that becoming a gastroenterologist is no mean feat. According to Med School Insiders, the physician must complete four years of medical school, three years of internal medicine residency, and then three years of gastroenterology fellowship. Many gastroenterologists pursue an additional one- or two-year fellowship to further subspecialize. Gastroenterology competes with cardiology for being among the most competitive internal medicine fellowships (I know which one I’d pick.)
My colonoscopy this week was performed by Dr. Jeffrey Sherman, about whom I can’t rave enough. Cousin Rob turned me on to Sherman, and we both appreciate how he personally comes out to the waiting room to greet his patients. My renowned physician in New York City, the late Harry Lodge who was the doctor of choice for the top docs at Columbia Presbyterian, also personally greeted his patients. It’s a gesture that signals respect for the patient, one that all doctors should consider emulating.
Sherman, whose father also is a gastroenterologist, instilled confidence from the get-go. I knew I was in good hands even before I looked up his background. Sherman previously served on the board of the Crohn’s and Colitis Foundation and is still active in the organization. He’s also active in the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy.
For his prep, Sherman prescribes two small bottles of tolerable tasting Clenpiq to be taken a few hours apart. To my chagrin, my insurance wouldn’t cover the prescription and I had to fork out $162 and change. I’d like to see Congress pass a law requiring top executives at all health insurance companies to drink daily a bottle of over-the-counter MiraLax, which is commonly used for colonoscopy prep but in my experience didn’t work nearly as well as Clenpiq. The required daily cleanse would give health insurance company executives time to sit and reflect about their insufferable business practices.
Sherman does his procedures at the Specialty Surgical Center in Beverly Hills, which also is deserving of a shoutout. The quality of the medical staff is first rate, and they employ physician anesthesiologists, not lesser trained nurse anesthetists. The nurse who started my IV was so gentle I didn’t even wince. My post-operative nurse formerly worked in the ICU at Cedars-Sinai. Everyone was compassionate and caring.
My longtime gastroenterologist in New York was Dr. Lewis Schneider, whose praises I’ve previously sung.
As I awaited my colonoscopy procedure another thought passed through my head. Why can’t the folks at Dyson invent a high-powered poop vacuum that would instantly prepare you for a colonoscopy? I’ll bet Elon Musk could come up with something if he put his mind to it.
The other thought that crossed my mind as I awoke from my colonoscopy was why can’t the makers of propofol, the anesthesia drug used for colonoscopies, come up with a pill formula that’s safe for daily use? The one pleasure of a colonoscopy is that when you awake you feel incredibly rested and refreshed. I felt so good after one procedure that I went to the gym and worked out, something I’d never do again, and I strongly discourage you from trying.
I do strongly encourage regular colonoscopy screenings. While the prep is most unpleasant, it sure beats dying from colon cancer.