I was going to post this on my substack. But nothing is on it, and now this is not even on it, because I decided to post here, for better or worse. For those of you who have accidentally clicked on posts of mine before and recoiled, note that this is more of the same, and you’d best go ahead and scroll elsewhere now. There is no conclusion or point, and I certainly do not talk about Hamas or Jared Kushner or trans- (insert noun). No. The journey is the destination. Or however it goes. The destination is the journey. Whatever. This is the story of a colonoscopy. That should tell you enough.
I should play you some of that relaxing music that was in my head as I lay sideways on an examination table wearing my black nylon tear-away pants with the fly in the rear, gazing blankly at the video screen which was tilted down toward me as if to play the opening credits of Fantastic Voyage. I think I was humming in my head Billie Holiday's Embraceable You.
In order to not bury the lede, let me tell you what the doctor said at the end (there are many unintentional puns in this), so that you are not gripped by too much suspense and worry for my wellbeing. He said—and I felt he did not want to say this, that he would have preferred to say almost anything else—he said in what I imagined was a quieter voice than he normally used: “You’re fine.” Or that equivalent in Japanese. Actually what he said, clicking on his computer, the monitor of which now revealed neat squares of color slides depicting the interior of my colon: “綺麗.” That’s kirei, which means beautiful. It’s what you say about exceptionally attractive women, or sunsets, or flowers. It can also contextually mean clean, which in my case meant “There is no problem here with your colon.”
Two years ago, I went to my urologist because I had felt a pain in my lower abdomen that seemed wrong. It was not like any pain I had felt before. Probably. The urology clinic I go to is run by two older Japanese doctors who are there on alternating days, but my カルテ or file is the same for each, so they both have the same data on my PSA and creatinine and whatever else is measured in a urinalysis. The one doctor I seemed to keep getting on my appointment days is the more doubtful, less friendly one, and also the one who has the distinction of having done DRE on me more than any other doctor. DRE for those not aware means digital rectal examination. It is exactly what it sounds like, if you aren’t the type of person who assumes digital means something that might be shown on the readout of a G-Shock timepiece. No, digital means, in its barest sense here, finger.
He was stumped. Wherefore this pain? He asked me many questions in Japanese, and I tried to answer all of them as well as I could. It hurts here, yes. No I don’t have trouble urinating, no more than the usual with a prostate such as mine, at my age. On my insistence that I did in fact feel pain in the area I had indicated, he referred me to a research hospital up the road, writing a letter, enclosing a CD. He gave all this to me in a sealed envelope and sent me on my way. To the department of psychosomatic disorders.
The research hospital concerned is about ten years old, at least in its current incarnation in this set of buildings, and is still clean, has the requisite coffee shop on the second floor where one hears the reassuring and soothing clink of saucers and china cups, old people murmuring to one another as they take their morning repast of a “morning set”. Perceived as a whole the hospital as an institution would probably engender confidence even in the cynical. Clean carpets, working bright lights, purposeful movement, even the sick and probably dying blanketed and wheeled about on quiet gurneys seem to be in the best possible shape, considering. Like the Holidays Inn of my youth, before they became camp and moldy: All seems well-planned and expertly run. The nurses are more often attractive than not, at least from the bridge of the nose up (everyone is in masks in hospitals in Japan, all the time). The greeters and information desk personnel are female, lithe, and efficient, and give one a sense of being in the right hands.
The psychosomatic intake involved an interview of many minutes conducted by a nurse who seemed too young to be charged with adult crimes, should she commit any. I remember her as very pleasant and patient, and after about a half hour of interview as we were wrapping up I discovered via random throwaway phatic question that she spoke English rather well (the entire interview had been in Japanese, including my stumbling bumbling Japanese answers.) There was a time when this would have annoyed me. That time passed years ago. Now I just roll with it. People don’t like speaking English.
When I was finally allowed to sit in the presence of the doctor, who wheeled his chair the meter or so in and out from his desk expertly, and had the practiced look of a man who cares, and probably cares even about you, he told me, after a minute or two of speaking Japanese, to just say my whole spiel in English, to just get it out. Which I did, and briefly: I have pains here, and here, and I don’t know what is causing them and I would like to know. He then asked, in Japanese again: “What would be your ideal outcome here? What would you like us to say?”
I felt he must have learned these phrases in the elementary level courses that one takes in dealing with neurotic patients, the same courses that cause one to end up practicing in the psychosomatic disorder department. I did not say this. I did say: “I want someone to say ‘Oh, we’ve seen these symptoms before; this is probably what you have, let’s do a test.’” I do not know how I expected him to react to this, but it seemed as if I had given exactly the right response. If he had looked down and checked off a box on a clipboard, he could not have given off a more reassuring vibe. At last, it seemed some kind of examination would begin, rather than the type of qualifying session I felt I had been subjected to.
Please lie on an examination table. Okay. He palpated me deeply in the lower abdomen asking repeatedly “Itai? Kore wa?” “Does it hurt? How about here?” I realized during this examination that one can actually push fairly deep down into the abdomen presumably without causing damage, but when I finally did say “Yes, that hurts” it seemed such an obvious statement (as in: Why wouldn’t it hurt when you push basically all the way through my body?”) that I couldn’t imagine how anyone could learn anything from it, any more than if he had jammed a knife into my leg and asked the same question.
He nodded. He seemed to be thinking very carefully. He typed a bit on his computer, mumbling that I could get up from the table and put my shoes back on. I sat up and waited. This was how I was scheduled to get my first colonoscopy two years ago.
Fast forward in time to last week. Now we are at colonoscopy Number Two, which has been ordered for me by my local doctor, who has written the referral letter, again with a CD, though this time I am sent to the gastroenterology department. The pains have returned, though the first colonoscopy (and endoscopy, which was another day and involved a tube down my nose) showed nothing out of the ordinary. One polyp (not a word one wants to imagine, though apparently polyps after a point are normal) but it was removed, and found to be benign.
This time, I have been scheduled to have the procedure on a Thursday, and have cleared my schedule and bowels for this purpose. The way one prepares for a colonoscopy may be well-known to some of you, but I will iterate it here for the uninformed. According to the internet one is supposed to consume only a liquid diet the day prior, and cease all medication such as aspirin which would increase the chance of bleeding. There are various dangers if the colon has not been completely voided and a colonoscopy is conducted, among them a term I recently learned: intracolonic explosion. I do not even want to know how this term was coined or in what circumstances. (That is not an image link.)
In Japan, however, there are little boxes they let you buy for about 10 bucks that contain what are called レトルトパウチ or retort pouches that contain MRE-like substances, and these are supposed to get you all set. Each box has five pouches, three meals and two that contain watery rice. You are supposed to pour the contents into a pot or bowl and either briefly boil or microwave them.
The box has on its cover the various meals you will be eating on the day before. It looks like this. You can see each “meal” such as it is on the box, plus some little pills are there that I was supposed to take. The first meal, the breakfast, is here in its pouch, and then looked like this when I poured it in the bowl. It looked better in the pouch. Rice and stewed chicken and some egg. The lunch was daikon radish, more chicken but minced this time, and, according to my youngest son, some potatoes. It looked like this.
There were also two packets of the watery rice I mentioned, similar to what is known here as お粥 or okayu, which is the Japanese equivalent to the traditional chicken soup, i.e. it’s what you eat when sick, but without the egg that is usually a part of that dish. I dumped one of these on the dinner, which, in a contest, would have to be called the best of all the meals, but so Spartan as to be disappointing, though by the time you get to eating dinner you are so hungry that you are imagining if maybe you can just forgo the procedure altogether and just go grab a goddam cheeseburger. I was too hungry to take a photo at that point but here is what the box claims the dinner looks like.
Anyway over the course of the day I warmed all these up and ate them and drank a bunch of water and took the two little pills at 9 pm. The instructions said to then drink a cup of water at 10 pm but by then I just wanted to lose consciousness, so I drank the water with the pills. I went to sleep early as my family ate stewed yellowtail, white rice, garlic scapes with sesame, and miso soup.
On the Day Of, you wake and unsurprisingly you’re hungry. You are not supposed to eat or drink coffee, so I did not. I did drink some water. I put on sweatpants, wore the kind of sandals that slip right off, got all my stuff, and took the bus in. The instructions also say not to drive, as you will be woozy from the drugs they give. I remember the first time I had one of these, the drugs were very effective. This time they would not be, but I did not know that going in.
I won’t bore you with the details of checking in and finding my way to the right department, but all went efficiently. Eventually I was cordoned off with a group of two men and three women who were also scheduled for the procedure. I am not young, but everyone looked much older than I feel I look or am. But who knows. Everyone was wearing a mask, including me. They sat us all down at tables and put in front of us these big jugs of fluid, which had our names written on them in black ink. That jug looks like this.(My name is on the side that is turned around.)
If you are thinking to yourself “That’s a lot of fluid” you are thinking the same thing I thought. And it is. It’s two liters.
The nurse at this point is going on and on in Japanese about what to do. She is very animated and friendly and you can tell she has done this lecture many times. It is like a performance, a routine, she hits certain points like punchlines, and we all breathe in a laughing-like way accordingly at these moments. Drink 250 ml in the first 15 minutes. Then another 250 ml in the next 15. By then you should have gone to the toilet at least once. If we have not, we are informed, we shall be given an enema. This seems a foreboding prospect, despite what awaits us. Somehow an enema seems worse than a colonoscopy. We are also given more little pills to take. This is the blister pack of mine. I had greedily swallowed them before I thought to take a photo for posterity.
The next photo you might not want to click on. It is a little laminated paper with six five photos that we are told are the stages of what our voiding will look like. The first is dark, then they get progressively lighter. Like a little picture book of defecation. Here is what that looks like. You will note the cute little bear in the top right, because everything in Japan must have a cute mascot associated with it, even the act of crapping.
If you did not click it’s fine, but the last pic of the stages is clearish, like very weak tea. At this stage, if this is what you are producing out your rear end, you are a Go for the colonoscopy and you are supposed to call the nurse into the john and have her inspect it to be sure.
I begin drinking. After 20 minutes I have had about 300 ml of the stuff, which tastes like poor quality Gatorade with no sugar and too much salt. I excuse myself and sure enough I will not be one of the enemized, which is good news. Time passes and the nurse has switched on the television. She has said we should not just sit there and watch it, but that is what everyone does—all except one old guy who prefers to stare at the corner in the opposite direction, as if mourning all the mistakes in his life that led him to this little squalid room. Instead of sitting there and watching TV the nurse encourages us to walk around, and even to push in on our abdomen to get the process rolling. I take a stroll, come back, and watch the TV again. On the television there is a show called ラビット which reads like “Rabbit” but I realize is supposed to be “Love It.” On the show three extremely homely guys who are probably comedians are visiting a racetrack and oohing and ahhing over it. With these guys is one extremely attractive woman, but before I can try and follow what it is they are all doing at the track I have to excuse myself again.
Eventually I’m ready, after about six trips to the restroom. The bowl looks so clear it is as if I haven’t even sat on it. I push the chime and the nurse very excitedly runs up, much in the same was if I were an elementary school child who just announced that he finished making some bit of artwork and she, my teacher, has come to admire it. “Ooh that’s perfect,” she says, gazing into the toilet bowl. “You’re ready,” she says.
She escorts me to another small locker room. I have left behind my cohorts, who are all quietly drinking and sitting and contemplating the television, except the one sad man. Two of the women have struck up a conversation. Their voices dim as I walk down the hall to the locker room. The nurse says to take off all my clothes and put on a little pair of black nylon pants, and then put on what looks like a blue pajama top thing, something like Luke Skywalker might wear on Tatooine. Then put my stuff in the locker. A beat or two passes and I am wondering if she is going to watch me do all this, but she leaves and closes the door behind her. There is no lock on the door, so I make haste. The fly, she has noted, is in the rear of the nylon trousers, for obvious reasons.
Clad in this getup, I step out. I am still wearing my athlete’s sandals. The nurse takes me past my cohort again, and they are all still drinking or sitting waiting to drink. Their Japanese politeness prevents them from acknowledging me, though my American friendliness feels somehow hurt by this, as if they might cheer me on. I go first, wish me luck sort of thing. Maybe they just don’t care at all. I go into a room where another nurse is busy with something. This room seems less clean than the rest of the hospital. Scuff marks, signs of wear. She wheels over a rolling upright pole with an IV bag on it and wipes my arm with alcohol. As she is inserting the needle I can’t think of anything to say so I say: “Your watch is nice.” It is, though my eyes are so bad at focusing on close things I cannot tell if it is a Jaeger-leCoultre or just some offbrand. Probably the latter if she’s a nurse in a research hospital, but you never know. She says thank you in a polite way but I imagine she thinks I am an idiot. Which, I think, I am at this moment.
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I am told to stand and wheel the little pole with the needle now taped in my arm and go into the room with the doctor. This doctor is young and I’ve never seen him before and he seems emotionless and businesslike, which is pretty much what I want. I am instructed to lie on a table, and this is where I left off in paragraph two of this. As I lie there the nurse says she is giving me medicine to make me sleepy, which she does with a needle injected into the tube that is also giving me presumably saline for rehydration. The walls in this room are not clean. I almost ask “is that blood” about a splat on the wall right at my eye level behind the video monitor, but I don’t want to know the answer so I just leave it. I begin to wonder how violent colonoscopies can be. The medicine calms me a bit, but not enough that I do not realize that the doctor is now ramming what feels like an exceptionally large finger up my bunghole. Presumably he has applied some sort of lubricating jelly and put a goddam glove on, but I am not a good enough contortionist to turn around and verify this. It feels as if he is rawdogging me with his thumb. An involuntary sound between a moan of pain and a grunt escapes my soul. No one seems to hear it. The nurse and the doctor are chatting, perhaps to escape the awkwardness. Or probably they don’t feel the awkwardness any more, maybe this is all just routine for them and they’re just talking about what looks good in the cafeteria this week. I feel like the last time I had this procedure I remembered very little from this point onward, but this time I remember and feel everything. Maybe they gave me the wrong drug, or a weaker version. The only effect it has had is to have made me slightly woozy. But the pain is all there—the pain of the tube being inserted, then what feels like inflation, like those crazy man balloon things beside car dealerships once the air goes inside. In it goes, and it takes all my willpower to not go into a willful sideroll off the table and just take flight.
The video monitor has come to life. I am suddenly watching the Empire Strikes Back when Han flies down into the asteroid—a tan cavern, lit dimly, and in we go. I feel it snaking up into my abdomen and yes, let’s just let the rest be something you imagine and let me not describe it. The rest is less of a blur than I would like it to be. I was on the table maybe twenty minutes. Eventually I feel the tube—which has felt not like a gentle rubber coil but more like a soft plastic ramrod—being pulled out, and at least he is slow about it. When I feel like it’s mercifully all the way out the only thought that crosses my mind is that it could have been worse. I consider “You should get that wall wiped down,” as a parting shot but instead just say “Thank you,” in Japanese and I am escorted to a bed-table-type thing with curtains and told to lie on it. I do. The nurse puts a soft, thin blanket over me and disappears.
This is the post-roofie coming down, when I am supposed to sleep it off and awaken refreshed. Normally in 2023 this is where you’d swipe open your phone and begin browsing TheMotte or whatever, or in the old days leaf through a copy of Boy’s Life. I am without resources, however, so I just close my eyes, listening to various timer alarms and paging chimes going off, and nurses scuffling about. When I open my eyes again about 20 minutes have passed. The nurse turns up and sees I am awake and whips off the blanket, takes my blood pressure, and declares me fit to go sit in the lobby again and wait to be called. I do. And when I am, my intestines are declared綺麗.
The doctor had no explanation for my pain, which comes and goes and has gone, anyway. “Maybe just gas,” he offers. “Or stool passing through your bowels.” This seems a flimsy bit of guesswork, but I just leave it and say thanks. The instructions also said not to eat anything the Night Of except rice and maybe broth, to ease the intestines back into their role as the major player in the digestive tract. I have a dinner of heavy pasta, a bag of ruffled potato chips and a beer.
“It’s not the destination; it’s the journey.” There, I remembered it, finally, for those of you who were gritting your teeth in frustration earlier. No problems with my colon; that was the journey. And here we are at the end of it.
Ahh, I sympathize, I had a colonoscopy last month in the US. Though there I had to stop eating Sunday night, clear liquids only on Monday, though that did include hard candies and jello as long as it didn't include red or purple coloring. I had to drink a large bottle of gatorade with half a tub of Miralax mixed in at 6pm the day prior, then get up 8 hours before the procedure (so 5AM) and drink another large bottle of Gatorade with the rest of the tub. That eventually left me with the clear results they asked for. Though for a while, I was thinking, that nothing appeared to be happening, until all of a sudden it did. They put me under (kind of, as the nurse explained it wasn't general anesthetic, but I have no memory of the procedure itself, once they asked me to roll onto my side and injected the drugs into my IV) for the procedure itself mind you, but the whole process of getting into a gown getting an IV with a bunch of other people was similar. As well as a kind of bustling competence from the nurses. I was out for about 30 minutes all told. Then biscuits and apple juice, which I consumed as if they were the Ambrosia of the gods. Two polyps removed and negative for cancer, but positive for Crohn's which is what I thought it was likely to be going in, from Dr Google. Mild to Moderate, so it could be worse.
In the US system, I was lucky enough that my doctor was willing to code it as routine/preventative which given my age meant it was entirely covered by insurance. If they coded it as diagnostic I apparently would have been on the hook for 20% so maybe 2,000 dollars. Though whether that would have been reduced via arrangement with the insurance company I don't know. A steroid pill every day, made a huge difference to my symptoms after just a few days and I have to go back for another in 3 years rather than 10. But that is a problem for future SSCReader..
The prep was definitely the worst part for me, I was hungry, thirsty, had a headache and was in the bathroom for way too long spread over both doses of the laxative. But it is certainly tolerable, and bowel cancer is a hell of a way to go, so at the appointed time it is worthwhile.
Sorry to hear about the Crohn's though. That must be rough. Apparently Crohn's can manifest throughout the GI tract. Glad it's not severe.
I appreciate that! It's not been too bad honestly, For me at least it's mostly manifests in the morning and once I get past that, the rest of my day is mostly unaffected. And the medication they have me on seems to have done a good job in reducing the severity of this flare up. The future question is how often will I get flare ups and how bad will they be.
And whether at my age it's worth adjusting all the diet tips which may or may not actually help prevent a flare up, on which the research seems decidedly mixed.
Hopefully you are able to get to the bottom (hah!) of your issue!
The cyclical pattern is common, and some people with Crohn's modify their schedule to work around it.
Unfortunately, beyond that, Crohn's seems to be one of those things where people have drastically different responses. I've heard reports of people who consistently have flareups not just to specific foods, but certain types of perfume, temperature swings, alcohol, which are not common even to relatives with Crohn's/IBD.
The typical recommendation is to set up a food diary with a rating system, but I don't know how productive that is.
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Beautiful story. My favorite part is the abrupt and anticlimactic ending.
Ha. Well you'd really love my story about
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An incredibly shitty story, but I enjoyed reading it ;)
Japanese hospitals are pretty much what I'd expect, it's a bit more bustling where I'm from, the few times I had to escort my mom for the same procedure. Polyps, ah, you can have quite a few before it's a real concern, but given that my grandma died of colon cancer, an occasional minor pain in the ass is worth preventing a far bigger one.
They seem to have a different protocol for pre-colonoscopy bowel prep, here the enema is standard, as well as as plenty of indigestible goop for taste.
They can be done under full sedation, but most often, it's just a mild sedative to keep you from feeling the worst of it. Faster, and you're back home earlier too, but eh, doesn't sound particularly comfortable.
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