Colonoscopies As A Metaphor For Obamacare

A friend recently forwarded a piece written by Dave Barry regarding his first encounter with a colonoscopy that has been widely circulated on the Internet. In it, Dave describes the experience in typical Dave Barry fashion, heavy on intimate details, many of them fantastical, others mundane, but collectively a bit much; and while I was amused, I couldn’t help but wonder if there wasn’t a better way to educate those who were candidates for a colonoscopy and similar procedures; you know, kind of like a public service. And thus, this Riff was born.

For your edification, here’s a link to Barry’s article: http://www.miamiherald.com/dave_barry/story/427603.html

Some background is in order, since a Colonoscopy is by no means the be-all and end-all of humiliating medical procedures that men must endure. Just as women must surrender their dignity for a gynecological exam when embraced by the stirrups (not to mention the doctor’s artificially chilled fingers), men are subject to a plethora of similar humiliations starting at a very early age. These include a hernia exam administered in Elementary School for any who endeavor to play sports in school and the infamous instruction to “turn your head and cough”, straight through through to the mandatory prostate exams and colonoscopies of men's later years.

Let me start by saying that my qualifications to speak on this subject are greater than Dave's. I had my first colonoscopy when I was 36 at the recommendation of my doctor, who thought I needed this procedure when I went in complaining of chronic heartburn and diarrhea. I know what you're thinking: what could heartburn possibly have to do with the need for a colonoscopy? Nothing, as it turns out, but it was a medical procedure that my doctor could refer to a Specialist, and nothing greases the wheels of Commerce in the medical profession like a referral, as I was to learn repeatedly throughout my life.

I arrived for my appointment and was directed to a change room, where I donned the universal garment of humiliation. You know the one I’m talking about: The drafty, uncomfortable, one-size-fits-all, ties-in-the-back, ass-hanging-out slab of table cloth required for every medical or diagnostic procedure more complicated than a prostate exam. Speaking of prostate exams by the way, I’m convinced that the only reason men are not required to don this garment for said procedure is that it would deprive the Urologist of the opportunity to say “drop your drawers”, as he pulled the plastic glove onto his hand, releasing the bottom with a resounding “SNAP” and sitting down in a chair behind you.

I always wondered if the “SNAP” was absolutely necessary, by the way, or if the good doctor did it because the procedure – at the end of the day – involved one guy sticking his finger up another guy’s butt? And besides, what exactly would your urologist say if you were wearing a hospital gown? “Part the curtains”? Too frivolous, and it just doesn’t leave any room to segue into the Guy Code humor the situation demands. Since most urologists are men, it is not lost on them or their male patients that they are the only people on the face of the planet for whom the command to "drop your drawers" would be honored - the "SNAP" being the flourish that pulls the whole thing together - with the possible exception of folks inclined to explore the recreational possibilities therein, and the alternative lifestyles such choices imply.

But I digress.

Whether you’re subjected to a hernia exam, prostate exam or colonoscopy, all of them have the virtue of reducing even the most powerful and important of us to a figure of abject humiliation. Presidents get fingers and devices stuck up their behinds in exactly the same manner as Joe Six-pack, as do Captains of Industry, Congressional leaders, Talk Show hosts and Hollywood Moguls. Barack Obama, Mahmoud Ahmadinejad, Bill O’Reilly, Dr. Phil or Governor Arnold Schwarzenegger, it makes no difference. In our modern health care system, all stand (or stoop) before the man and do exactly as they are told; all of them take the Turbo-laxative the night before; all of them confine their movements to within six feet of the toilet for the next four hours; and in the case of a prostate exam, all of them are handed a tissue by the doctor after the examination and encouraged to remove the micrograms of residual lubricant he so thoughtfully applied to his gloved finger before working your butthole like Mad Max scooping the last bit of the dog food out of the can before giving the near-empty container to his pet dingo. For more on this cultural reference, check out the 1981 Mel Gibson classic "The Road Warrior".

The universality of these procedures is the thing that makes them bearable, whatever your opinion of their efficacy, so the next time you're subjected to one, simply imagine the Celebrity of your choice being subjected to the same thing. My personal Surrogate: The Pope. "This is the laxative required to cleanse your bowel, Holiness; I have taken the liberty of cancelling your appointments for the evening". "Please hike up your gown, Holiness; you will feel some pressure". "Offer up the suffering as penance, Holiness; no, I believe God will forgive a little profanity under these circumstances". "That will be 3,000 Euros, Excellency. What is your preferred method of payment"?

When one compares the various intrusive procedures that bedevil men, it's clear that a colonoscopy is a far bigger deal than a prostate or hernia exam, wherein your doctor divines your state of health by the mere poking and prodding of your privates. They are positively 19th century in their sophistication. Colonoscopies, by comparison, are lent a legitimacy born of technology: all gleaming metal, shiny plastic and complex machinery, tended by serious professionals under conditions of extreme antisepsis, and thus to be greeted with a suspicion reserved for the people who took the time to invent such technology in the first place, considering its purpose.

After donning my gown, I was escorted down a public hallway and past at least a half dozen waiting rooms full of people, wondering – not for the first time – if it was truly necessary for me to have disrobed 400 feet from the examination room. Guided into what appeared to be an operating room, I was directed to lie on an incredibly narrow table by a surly young nurse. You know the kind I'm talking about: not wide enough to comfortably lie on, not quite narrow enough to actually cleave you in two by virtue of your own body weight. I’m referring to the table, of course.

Lying on my back, the surly young nurse approached me with a Rube Goldberg-ish device consisting of an impossible maze of tubing, metal protrusions and superfluous plastic devices. It looked for all the world like a gigantic Swiss Army knife suspended from a hot water bottle, minus the sharp edges. "What's that?” I asked. "This", she said, "is the colonoscope". Even though it was almost twenty years ago and my cynicism as to the motives of the Health Care industry was not near as defined as it is now, I asked her: "in what particular part of hell did they come up with this design?"

The Surly Young Nurse was not amused. “Lie on your side”, she said, and I did. And thus the fun began. After shoving the contraption up my butt, she proceeded to inflate the balloon using a little hand pump similar to a blood pressure cuff. Since this was my first exposure to this procedure, I was uncertain of the necessity of inflating it to the size of a regulation NFL football, but while Surly, the Nurse was also commanding and briskly efficient, so I remained silent.

Once that was done, she fiddled with a few other devices and walked out of the room. Fifteen minutes later she returned, and I asked her when the procedure would begin.

“The doctor is running behind”, she said, “and won’t be here for another twenty minutes”.

“And you expect me to lie on this table like this for another twenty minutes? Please take it out”.

“I can’t do that”.

“But it’s damned uncomfortable”.

“That will put us behind schedule”.

“I don’t care about your schedule”.

“The doctor has very strict orders about this kind of thing”.

“Fine, let him lay on this table with a football up his ass. Take it out. You can put it back in when he gets here”.

Sad to say, this was not my first - or last - exposure to the indifference of Health Care professionals. Like many in Public Service, the Customer is viewed as an Object, not a customer. You serve their ends (pardon the pun), and if their protocols mandate your extreme discomfort for their greater convenience, so be it.

Surly Young Nurse finally relented and took it out, but not before giving the cuff one extra pump before deflating the contraption.

Forty minutes later the doctor and an assistant showed up, along with Surly Young Nurse. The device was reinserted without comment, the doctor’s busy schedule notwithstanding. "Try to relax", the doctor said. “I’ll be inflating your colon to allow the easy passage of the probe, so you’ll feel some pressure”. Thanks for the truth in advertising, doc. I’ll get right to work on the whole relaxation thing.

In the not-too-distant future, they would provide anesthesia for the procedure; in 1991, no such luck. I’ll spare you the rest of the gory details except to say that the procedure had me doing furious cost/benefit analysis as a distraction to the "pressure" I was feeling, and the withdrawal of the probe felt exactly like the withdrawal of several feet of colon. Within minutes, though, the procedure was over and I was soon on my way, worn but not much the worse for wear.

Years later, I again complained about chronic heartburn and diarrhea to my new GP. After asking me a few questions about my diet and lifestyle, he said “I could schedule you for a colonoscopy, or put you on a prescription drug for Acid Reflux disease, but what say you stop eating so much junk food and stop drinking so much sugary soda instead?”, and that was that. I couldn’t help but wonder what motivated this guy, as opposed to his predecessor. On the one hand, a no-nonsense doctor with no patience for the foibles of his patients; on the other hand, a for-profit Sadist who desired nothing so much as the ill-gotten dollar begat at the business end of a device that resembled nothing so much as a Freddy Kruger handshake.

Me, I learned a valuable lesson that day: doctors are invested with not one whit more - and arguably less - virtue than other people. Notwithstanding the tendency of most people to worship them for their ability to heal, I see folks every bit as capable of being money-grubbing humps as anybody else. I see folks generally comfortable with a fatally corrupt system that has made expensive procedures like colonoscopies mandatory, and the percentage of GDP gobbled up by "Health Care" balloon from 6% of GDP in 1970 to 20% of GDP today. I see folks that - with rare exceptions - will subject you to a battery of expensive tests rather than look you in the eye and say "look, fatass, your diet of Twinkies, fast food and frozen pizza will kill you. Start eating some fucking vegetables, get some fiber in your diet and get your ass off the couch". Where others worship at their altar, I see a profession that has done the math and realized that simply treating our lifestyle-inflicted health problems is orders of magnitude easier - and more profitable - than counseling prevention. I see a profession that has collectively shrugged their shoulders and decided that they have no stake in a healthy America, minus the income side of the equation.

Just keep that in mind as the debate over Nationalized Health Care progresses. Absent some unexpected moral awakening, the same doctors who have no problem shoving a large, unwieldy and painful device up your ass for money - regardless of the merits of putting it there - are not about to deny Barack Obama and Nancy Pelosi the same opportunity, and for the same reasons.