5 members like this


Views: 1956 Created: 2021.01.18 Updated: 2021.01.18

Inadequate Preparation

Inadequate Preparation

Last week I had a colonoscopy. Not nearly my first, but possibly the most difficult. With close family on both sides and a history of polyps I am on a three-year schedule, although I had put this off for nearly a year due to Covid-19.

I followed the prep instructions to the letter – No solid food all day, lots of yellow Jello, first dose of Magnesium citrate, laxative tablets, second dose of Citro-Mag, gallons of water consumed… all pretty routine. It called for a Fleet enema after the last bowel movement, followed by a second if the results were not clear. I do not like Fleets since they burn me and I asked my gastro if I could substitute tap-water enemas for the Fleets – which he approved. My wife did those honors – twice - about 10pm and I thought I would sleep, confident that I was ready for the test.

I was proved wrong! I was running to the toilet all night with bouts of diarrhea and got absolutely no sleep. More concerning was that I was still passing silt-like movements until 5am. You could see the bottom of the toilet bowl, which was always a standard for being ‘clear enough’ so I did not think I needed the ‘enema before 6am’ since I believed it would be OK.

I drove to the 45 minutes to the endoscopy clinic – sitting on an old diaper in case I farted! – and got there just as it opened at 7am. Even at that hour, there were patients waiting to be checked in. After a quick registration I was led back into the center which resembled a hospital ER, with curtained cubicles around the room with a central nursing station desk.

The admitting nurse who met me was a forty-ish LPN who could have been a waitress in any diner anywhere in the USA. She was ‘motherly’ and had a ‘Rubenesque’ figure, mousy brown hair and a pleasant welcoming smile. Right off, I was called ‘Honey.’ She handed me a backless gown and told me to remove everything except my socks, “Honey, don’t bother tying the back,” and call her once I was changed. She pulled the curtains and I changed. She returned and started with the plethora of questions about my medical history. She told me she would be doing my patient care and would pass me off to the surgical team for the procedure and would do my after-care when I was done. She then asked about the prep and if my last bowel movement was clear. I answered truthfully that I still had some brown flecks and a couple of ‘buckshot’ when I last went. She said, “define buckshot Honey.” I said, “small round pellets of stool, just a couple.”

The nurse then asked if I had taken the last enema an hour before I left home as specified in the instructions and I told her, “No, I thought I was pretty clear.” She asked if I could go to the bathroom now, so they could determine if I was clear enough so the procedure could proceed. I said, “I don’t think so, but I’ll try.” I grabbed the back of my gown and took the walk of shame past three other cubicles to the bathroom in clear view of all in the room. I sat and squeezed and a burst of mucus, brown silt, and a few buckshot erupted. The nurse knocked, entered, and looked at the result and said, “Honey, you cannot have the procedure since there is still formed stool in your bowel movement.”

I asked where that left me and she said I would have to reschedule and would be billed for a ‘missed appointment.’ I asked when the next appointment was and was told it was more than a month later. I also asked if there were any options such as later in the day if I took more of the magnesium citrate. She said she would ask the doctor, but said it usually was not done. She left me in my cubicle on the gurney - worried about being charged for the missed appointment, having to repeat the miserable prep, having another Covid test, and waiting another month to get this over with.

The admitting nurse returned shortly with another RN whom I was introduced to as the supervisory nurse. She said they spoke to the doctor who said since I was there already, “would you be willing to have an enema here and see if that would clear you out?” They cautioned that most insurance would not cover the procedure since preparation was to be done by the patient. I would probably be billed for the enema and have to pay that out-of-pocket. I readily agreed - not caring at that point about the billing – I could fight that out with my wife at some later point. The nurse said she would warm up a couple of Fleet enemas and be back shortly. I quickly told her, ”I react badly to Fleets, they burn me. I even had the doctor change my prep to tap-water enemas instead of Fleets.” She asked, “Look Honey, I’ll have to ask the head nurse if we can do that, we normally use Fleets.” She left and was back with the other RN who asked skeptically, “You would rather have a regular bag-type enema than a Fleets?” I answered, “yes, sure, if it will allow me to have the procedure, I’ll do it. It is what I would have done at home if I had known what would happen.” She replied, ”alright, since you’ve had enemas before at home, you know pretty much what will happen. Now, when you’ve had enemas before, how much solution do you take?” I answered, “normally a full bag, so, two quarts.” She said, “This will be a bit less – about a quart and a half so you shouldn’t have a problem holding it. Do you put soap or anything else in the enema?” I said, “Only a little baking soda.” She said, “this one will be saline and your nurse will be back shortly to take care of you.”

An hour passed, although it was probably ten minutes, and the admitting nurse arrived carrying a full plastic disposable enema, a Chux pad, and a box of wipes. All eyes in the room were following her, as were mine, as she entered. She pulled the curtain behind her and ended their little show. She said “OK honey, you’ve done this before so it’s not going to be new, but I’ll still tell you what’s going to happen,” She hung the bag from the IV pole which was attached to the right side of the gurney. “I’ll be rolling you up on your left side and I’ll have you pull your right knee up closer to your chest. Can you do that Honey?” I did as she requested and she folded the thin blanket and the gown over exposing me to her ministrations. “OK Honey, I’m going to insert the tube, it’s small and should not hurt, but if it does, you tell me. The gel might be a bit cold.” With that, she lifted my right cheek and slipped the lubed tube into my butt and held it there. She was right – it was cold and I started. “You OK Honey?” I nodded. “OK, I’m going to start the water now.”

I wondered how far her narration could be heard in that room, since she had no ‘indoor voice.’ Several of the other cubicles were occupied and I did not doubt they were hearing all of this and following my drama.

There was no ‘click’ like enemas at home or the clacking of a ratchet clamp, since this disposable set only had a slide which I assumed she opened since I immediately felt a rush of warmth in my butt. Since the bag hung on my right side and I was positioned on my left, I could not watch the progress of the enema. “You’re doing fine Honey, it’s going good. You aren’t feeling any pain, are you?” I said, “No, not yet.” The combination of the warm water, her hand holding the tube in my butt, and the whole idea of getting an enema from a stranger started having an effect on me. This was long the stuff of my younger fantasies – getting an enema from a nurse and now it was really happening! I felt a swelling and knew I was becoming erect! I tried to think of algebra problems, political speeches, even infomercials on TV, but it just got harder. I shifted further on my side to hide the reaction, and the nurse asked, “are you alright? Are you having cramps? I can stop for a minute Honey.” I said, “No, I just needed to move a bit to get more comfortable.”

She said, “You’re doing real good, it’s mostly gone. Just a little more and it’ll be done.” I nodded, hoping my reaction would not show. “OK Honey, that’s all of it. You need to hold it for a few minutes for it to work. Can you do that?” I was sore from all the diarrhea and I was cramping, but not urgent, so I nodded and said, “OK, but not for long.” She removed the tube and wrapped it in one of the wipes and placed it on a corner of the Chux pad and told me, “you can roll back over Hon.” Then she pulled me onto my back.

I thought, “oh no! Not with this tentpole holding up my gown and the thin blanket!” But it was far too late. She looked into my very flushed face and said - in a whisper for the first time – “Look Hon, it happens. You don’t need to feel embarrassed cause I’ve seen it before. I’ve given a bunch of enemas and this happens to a lot of the guys. Hell, even my ten-year-old gets an erection when I give him an enema. Hon, you just concentrate on holding that water.” She patted my shoulder to reassure me. It didn’t help. I am sure my blood pressure was off the scale and a massive stroke was in my immediate future, but I lived.

She finally said, “OK, let’s get you the bathroom.” She opened the curtain and I waddled out half bent over towards the bathroom hoping my bent posture would conceal my predicament. She followed close behind, mercifully holding my gown closed so I wasn’t exposed to the entire center. She asked, “Do you need me to stay with you?” I assured her I could manage without help. There was a chair in the bathroom where I assume a nurse would stay with patients coming out of sedation when they used the toilet after the procedure. Before she left, she said, “don’t flush, we’ll need to see if you are cleaned out enough to proceed.” Oh God, the indignity.

I didn’t explode, but did let loose jets of fluid. Several times. After a short time, the nurse knocked and asked if I was done. Luckily, my ‘condition’ had subsided while I was engaged in emptying. I said, “give me a sec.” Then wiped, stood and looked into the toilet which was filled with rust and still a couple of pellets. I said, “OK. C’mon in.” She did and tsked at the result. “I've got to check,” she said, and called the head nurse who was hovering near the door. They both entered and the head nurse said, “Still not satisfactory. We can try one more enema if you agree, but if that does not work, you’ll have to reschedule. Are you alright with that?” I agreed, flushed, washed my hands and followed my nurse back to my cubicle.

She collected up the empty enema bag and the Chux and said she would be back shortly. When she returned, she had a fresh pad, the filled enema bag, and a tube of Surgilube.

This time she said, “You know what I’m going to do, so I don’t need to tell you all over again. So, let’s get down to business, Hon.” With that she hung the bag, and with a wet fart-like sound put a glop of the lube on a wipe –– and had me roll over on my left side. Again, she uncovered my butt and lifted my right cheek. “Here it comes,” she warned as she slid the now slick tube into my butt. “Now the water,” she said. “Let me know if I need to stop.” The saline flowed in and she kept telling me how good I was doing. I could not see the bag – it was behind my back – but she said, “It has about 1/3 to go and I’ll stop it for a minute. It might be good if you turned onto your right side to let the fluid fill your transverse.” So, with an effort, as she held the tube in place, I lumbered to my right side. “OK, I’m starting it again, Hon. Are you doing OK?” I was cramping, but nodded.

Sooner than expected it was done. Thankfully my earlier embarrassment was not repeated – no hard feelings this time – so I rolled onto my back without the tent pole. This time I was directed to massage my belly to relieve any cramping – no help was offered. After the required few minutes I was again escorted to the bathroom, noting that the center was much more filled than when I started the pre-procedures. I again felt every eye was upon me, and why not? If you’re in one of these cubicles just waiting to go in for a procedure, you look and watch everything that happens around you.

Once inside I sat and stuff poured from me in one long stream. This kept up for several hours – except it was certainly no more than a few minutes. A big fart blasted which signaled the end of the flood. As before, the nurse knocked and entered after I said I was done. I was almost afraid to look, but did; and she did as well. Although the water was cloudy, you could see through it and NO BUCKSHOTS! She once again summoned the head nurse who said, “We’re going to call this satisfactory enough to go with the procedure. I will notify the doctor and surgical nurse.”

My nurse chimed in with, “Good job Hon, I hope it all turns out well.” In short order, I was plugged with an IV port – even though I forgo sedation. Then I had to do ‘informed consent’ - I must have signed ten documents signing away my rights, fortune, liability, and maybe the title to my truck – it was all very fast.

My doctor showed up and asked if I was ready to go. He said, “After what you’ve been through this morning, the procedure will be a piece of cake.” He asked one more time if I was sure I wanted no sedation, and I assured him I did not – and told him I had no ride home so I could not take sedation anyway. With that I was wheeled into the procedure suite. I was introduced to the surgical nurse and the med tech – both cuties behind their masks and hair nets!

In short order I was positioned on my left side again, my butt exposed and without much pause, the doctor had a finger up my ass. “OK, I am going to introduce the scope now.” He did and I watched the thing snake its way through my colon. Even after the prep and the enemas there was still sticky debris in some sections of the intestine, and even some pellets of stool which required flushing and vacuuming by the doctor with the scope. He said the pellets hide in the diverticula and are very hard to clear. Except for a couple of small polyps, I had no issues. The doctor did note in his report that some sections could not be properly evaluated due to “Inadequate Preparation.” He prescribed that I should return for another scoping in three years and follow a two-day prep the next time. He added that next time I might also try ‘enemas until clear’ before I left the house.

I was wheeled out and back to my cubicle and was greeted by my nurse. She was treating me like an invalid, “Ok come sit in the chair, do you feel dizzy? Do you need to go to the bathroom, can you stand up?” I said, “I did not have sedation, I’m fine except I’m full of air!” She said, “Oh Hon, I’m sorry! You need to pass gas now before we can let you out.” I answered her with an award-winning fart, to which she said happily, “Oh, that’s very good.” It was the first time in my life I had been congratulated for farting!

I donned my clothing, still farting like a steam train, left, and drove until I found the first diner. I was starving and had pancakes and bacon for my late breakfast. I then headed for home wondering just what two enemas were going to cost me?

Comments

kaspars 3 years ago  
poorly patient 3 years ago  
eboyhou 3 years ago  
bburl 3 years ago