Due to to a couple of very serious surgeries in my childhood and a traumatic general anesthesia episode in my early twenties, I have developed a pronounced phobia of surgery. Of course, everyone dreads going under the knife but in my case, the fear far exceeds just “nerves” or apprehension. My mind equates the thought of being put under with dying: I have a pronounced terror of not waking up from anesthesia. No amount of reassurance assuages this phobia - it’s in the very nature of phobias not to be amenable to intellectual reasoning. Naturally, if I ever needed open heart surgery - God forbid - I would have no choice. But when it comes to more minor surgeries, I’d rather take the pain and discomfort than an IV drip that might send me from Morpheus to Thanatos. I’ve had a gastroscopy without sedation (no big deal - just don’t forget to breathe) and a few root canals with just a healthy dose of Novocain but no nitrous oxide in case the dentist were to overdose me. In short, I cling to a measure of control as far as possible. For this reason I have been avoiding a colonoscopy or years, despite my peers having had two or three at this stage of life.
Some years ago, a product called Cologuard came on the market. Now you could do a fairly simple at-home test that was advertised to be fairly accurate for cancer detection. I jumped at the chance and took the test three years ago. It was fully covered by insurance and would give me the the peace of mind I wanted without the dreaded deep sedation used for colonoscopies. The test came back negative. Then, last November, three years having passed since my last Cologuard and on the advice of my doctor, I took it the second time. Oops! I got a positive result this time, meaning there was either a) a pre-cancerous polyp b) bleeding or c) cancer present. Needless to say, I freaked out. Not only was I sure it would be the worst possible outcome but now I HAD to undergo a colonoscopy, which meant anesthesia. I was consulting Dr. Google day and night. I even paid for a second Cologuard test out of pocket (a cool $600), certain that the first result was a false positive. It was not. The second test came back positive too. Covered in cold sweat and barely able to eat, I now began experiencing actual abdominal symptoms that further cemented my conviction something was terribly wrong. I made an appointment for a colonoscopy - then promptly canceled it. I started shopping for GI doctors - in Orlando, Lakeland, Tampa and elsewhere to see if they could help soothe my fears but they all said the same thing: a colonoscopy is unavoidable. When I tried to explain the sheer panic I felt at the thought of being anesthetized, they mostly shrugged. Surgeons are are good with scalpels and scopes but their understanding of basic psychiatry is zero. I told them all that I doubted neither their skill nor their wonderful drug Propofol (though given Michael Jackson’s fate perhaps some doubts about Propofol would have been warranted). I simply was not going to do it if it could not be done while fully awake or with some kind of minimal sedation.
Fortunately, Dr. Google - as well as an anesthesiologist friend - told me about an older method of sedation, now almost never used: a combination of a strong benzodiazepine and Fentanyl. This amazing brew allows the patient to be conscious while experiencing very little discomfort and subsequently not remembering much of the procedure. Then, some more luck came my neurotic way when I found a wonderful doctor who had no problem using any combo of drugs I preferred - assuming his anesthesiologist signed off on it - and did not insist on Propofol. “We have every kind of drug you may desire,” he said, “just please don’t cancel again and show up for your procedure!” I told him that by that point I had canceled three colonoscopies with three different doctors. None of them would work with me and recognize that a powerful phobia is not something I can joke myself out of.
Dr. K, my wonderful GI doc, lives and operates in Bradenton, almost two hours from my house. But 100 miles is a small price to pay for a physician who understands your fears and is willing to work with you.
Most people know that the “prep” is usually the worst part of a colonoscopy procedure. It’s 24 hours of a completely liquid diet, punctuated by never ending trips to the bathroom where the contents of your bowels are emptied, aided by consuming half a gallon of magnesium citrate. Not a fun day, but not as horrible as some will have you believe.
Early this morning Diane and I headed out to Bradenton. Thankfully, only one bathroom stop had to be made - at this point there was nothing left. I felt slightly headache-y from hunger and dehydration but otherwise fairly calm, knowing I was in good hands. The surgical center was clean and tidy, the intake procedure smooth. Once I found myself in the pre-op room, it finally hit me: after having dreaded and avoided the procedure for decades, after having had nightmares about it for six months, I was finally here, lying on a gurney, ready to be wheeled in to the operating room. The first dose of Versed hit me as they wheeled me in, followed by the second dose and then the Fentanyl. I remember the Dr. K saying “here we go” but felt nothing, except perhaps a small amount of cramping. I watched the scope snake through my large intestine and even though I know the procedure took about 20 minutes, under the influence of the fabulous drugs it felt like a minute. The drugs have the effect of contracting time and making reality seem dreamy. In fact, I remember the nurse saying, as she started the Fentanyl, “let’s put some dreams on top of that floating”. And just like that - it was all over. Month and years of fears for nothing. But then, that is the normal course of events for a neurotic wimp. Fear the worst, spend months worrying about it, then get through the event and wonder what the psychic pain was all for.
The best part was the hour or two after the procedure. We went to a nice local café for lunch and never did an ordinary cup of coffee and a plate of scrambled eggs taste SO good. The world was a wonderful place. I loved the town. I loved the waitresses. I loved the people (and I NEVER love people) It was easy to understand the roots of the opioid crisis. Everybody would want to feel that good. All the time.
They found a small polyp which was removed and sent for analysis but I was told it did not look dangerous. But given the finding, I have to be back in three years instead of the customary five. This time, instead of dreading it, I’m looking forward to those good meds!
Great story! I’m sure you’ve convinced some readers to get the test, you might have even saved some lives! Thank you!
There's nothing worse than "waiting for results" (which I am now...) but glad to see that everything worked out OK!