To set the scene: There is no patient in the world more frightened than myself. I am approaching a half-century in age, and until Friday April 21, 2023, I had never had an IV line inserted, never been under anesthesia or deep sedation, never had any procedure that I’d have to hear about afterwards, rather than participate in. The far stretch of my tolerance for medical interventions was that – with considerable preparation – I could just about handle the 10 seconds of a needle required to do a blood draw, with much hyperventilating.
Around the end of 2022, I set myself some health goals – in a nutshell (and as I phrased it to my doctor): “Put me on the factory maintenance schedule”. My doctor is great, by the way. We were talking about prostate cancer and PSA tests and so on, and he a) talked about the controversial nature of PSA tests, and b) said that he could do a digital exam, but it would be just for fun if I wanted it. Great guy, exactly the kind of doctor I need. But the important thing is, part of that factory maintenance schedule is a colonoscopy. The cutoff date used to be 50 years old, but it was recently reduced to 45. He signed me up for it, and it turned out to be several months out, so I kind of lost sight of it… until it was week of, and I had to start preparing.
So, you’re headed for a colonoscopy? DO NOT GOOGLE ANYTHING. That’s my advice to you. You will read a litany of problems, pain, unpleasant reactions, etc. And almost certainly, none of that will apply to you. One of the things you’ll definitely read (and nurses repeated it to me) is that “the prep is the worst part”. Well… that might be true for some, but for me the worst part was fear of an IV. Remember, I’d never had one.
There are different prep regimens, but the current preferred option in my neck of the woods is Sutab. This is a regimen of two bottles of 12 tablets – one bottle taken the night before your procedure, the other taken early morning of. I’d read about the older magnesium citrate prep where you have to guzzle pints of horrible liquid, and honestly – that’s BS 🙂 You really want the tablets. They’re easy to take, you take them with water, they work quickly and efficiently. OK, diarrhea isn’t a thing you want to seek out, but – at least for me – there’s nothing scary about it. There is a lot of Internet talk about vomiting, bloating, pain, etc…. Yeah, no. I didn’t get any of that, you probably won’t. My worst complaint about the prep period is … so much hunger. You’re on a low-fiber diet for a week and if you like salads, cereals, etc – that hurts. Also seeing your significant other cooking delicious meals … so pain, very meow.
So you finish prep, you arrive at hospital.
Here I need to say – they make you undress in the hospital, and some people have a problem with that. OK. 🙂 I only state this here because I read (while I was foolishly googling my experience) that a lot of people are worried about what their doctors/nurses might see. Serious talk, people. Every doctor and nurse in that hospital has seen all the body parts, many hundreds of times. If you were in hospital for a nose thing, they’d be looking at your nose. If you were there for an elbow thing, everyone would be looking at elbows. Nobody, and I mean NOBODY, cares about any clinically irrelevant detail of your rear end; it’s just the part we’re working on today. In my particular case, every time I rotated and had to get re-covered, the staff told me “you’re covered now” – but really, there’s no reason for you to care.
Scary to me was IV. I don’t even think I was mostly frightened of being knocked out – I was mostly terrified of the IV needle. Of course, my nurse was very experienced and sensitive to scared patients. It was probably her 1,000,000th IV insertion but it was my first, and she talked me through it. Actually, if I’m going to be honest – it wasn’t even painful. Much like a blood draw, the sensation is really just a “poking feeling” – right on the edge of pain, but not actually painful. Something between a pinch and a poke by a cat’s whisker. Once she had it in, I felt a bit of stinging, and we talked about that (I wasn’t sure if it was just an expected sensation from the saline) but it turned out to be a sticky tape issue.
After the IV, I was wheeled into the procedure room. That is probably the first time in 40+ years I’ve been wheeled anywhere 🙂 When I arrived, the first thing I saw was a nurse or tech holding part of the endoscopy apparatus, and I have to admit my thought there was “wow!!! look at all those gold plated contacts – gee, that looks like 20+ pins, I wonder what they all do?”
Anyway. There’s a technical distinction between deep sedation and anesthesia, but you won’t care. What matters to you is, the procedure happens to your body – not to you. You’re out to lunch at the time.
I had my eyes closed while the nurse-anesthesiologist and doctor were exchanging protocol statements (I do remember what they said in full detail, but that conversation isn’t important here). At some point during that exchange, I felt the IV go cold. This may have been lidocaine, which I’ve read is provided before propofol. The nurse then said “think of something pleasant, you may feel something warm”. Right around then, my vision went dark. Remember, I had my eyes closed, but I was still seeing OR illumination through my eyelids. I was wondering, “did they turn out the lights so they can see the monitors more clearly?” … and then I realized “Oh… I guess I’m getting switched off here”. There was a bit of scintillation of optical effects, I heard a few more statements and then it was really lights out for me.
I woke up in a recovery area, and my most pressing feelings were hunger and thirst from NPO early that morning. Luckily my wife was there and ready to share a Diet Coke (seriously all the hospitals in my town seem to be on a Pepsi contract, and that’s just… wrong). Then my doctor arrived and gave us a summary of the results. Biopsy of the things he snipped takes some time, but the short version of what we do with colon polyps is: Kill ’em all.
Afraid of a colonoscopy? “Do not be afraid, I am with you. I have called you by your name, you are mine”.