WHERE THE SUN DOESN’T SHINE
Prevention, we are told, must occupy a larger place in our lives if health care costs are to be reduced. Colonoscopies, for instance, help people avoid colon cancer, one of the most prevalent types of cancer in this country.
Four years ago, I had my first colonoscopy. The doctor found enough precancerous growths called polyps to recommend having another after three years, rather than the more usual five.
Anyone who has been through this medical equivalent of a rotorooter job will understand why I haven’t been religiously diligent about having the second one done. It isn’t the procedure itself that’s a deterrent—few people can recall the event because the anesthesia level is so high—and even the cost, $900 for the last one, isn’t much for anyone with health insurance, at least compared with other things that happen in the operating room. Nor is the aftermath particularly unpleasant, though it can be challenging for some to find a driver willing to sit and wait through it because the scoped are doped to a point where it’s not safe for them to take the public transit bus or a taxi.
The howl comes with the bowel. For the remote probe that enters the territory where the sun doesn’t shine to see anything, all the usual contents must be evicted, evacuated, eliminated—taken to the point where push comes to shove and shoveled out.
The last time, this involved something called a Fleet enema. The name made me wonder if this would be a bag of liquid with a tube to send it to its appointed destiny, but instead it was a fairly small bottle of a salt solution. Not table salt—sodium chloride—but something in the same general family of chemicals.
The body doesn’t like these substances. Mark Twain once wrote that after he drank warm salt water, he felt as though he had thrown up his immortal soul. Something of the same sort is true for the Fleet enema, except it has to do with the other end of the gastrointestinal tube. Out West, under the big skies, it is possible to watch a distant cloud unload in a downpour. Pictures of this phenomenon irresistibly remind me of the aftermath of taking a Fleet enema.
Under normal circumstances, you can feel the urge and know that true urgency will come later, or it might even be a false alarm. With a Fleet enema, there are no false alarms, and there is no such thing as waiting for someone else to finish in the bathroom. Is it a good idea to wear protective underwear? Depends.
This time around, I have been prescribed a gallon—repeat, a gallon—of something called ______. At the pharmacy, you get a plastic gallon jug with white powder in it and several packets of flavoring, in case you think polyethylene glycol would go down better if it tastes like the chemical imitation of pineapple, cherry, raspberry, and so on. As I recall, ethylene glycol is antifreeze. Ah, the indignities. But it beats going around wearing an ostomy bag.
The larger point here is that a shift toward prevention in health care will only come with a shift toward less harried lifestyles, which in turn depend on a redistribution of this country’s wealth. Not a sudden grab from the rich, but policies and programs that reverse the well-documented erosion of the middle class during the past several decades. A colonoscopy takes time, predictable circumstances, and a degree of freedom from stress, as well as adequate income or insurance.
Saying the only freedoms we need are those in the Bill of Rights—a bundle of amendments that constituted an admission that the Constitution as originally written was not adequate to the needs of this nation—ignores or slights the degree to which our development has resulted, like any natural development, in expanded differentiation and increased needs for coordination. Freedom from stress gets no mention by the drafters, who lived at a time when it was possible for Thomas Jefferson to envision a future in which small farmers would predominate. But the erosion of this freedom has been cancerous, literally as well as figuratively.
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