The Follow Up Visit

I recently had a colonoscopy which revealed three new, small polyps which were removed. They went to the lab and were found to be benign. It is always a relief to get a clean bill of health since colon cancer was found on both my mother and father’s side of the family.

A week ago, I got a call from the gastroenterologist’s office. The tech told me my doctor wanted me to come in for a follow-up due to some concerns the doctor had regarding the procedure. I told her I had received the report – per the requirements of the CARES Act – and there were no abnormal results. She said the issue was the very high blood pressure readings noted during the procedure that were still high before I left the facility. He was concerned and wanted me in for a follow-up check due to my age and propensity for clots. So, I made an appointment and showed up last Monday.

As usual I had to wait in my truck until called, had my temperature taken upon entering, and went through the weigh-in by a nurse before being shown to an exam room. Once there, the nurse took my blood pressure - it was my usual 125/80 - and told me I would be seen by the nurse practitioner (NP) who was part of the practice rather than by my usual doctor.

The NP arrived. Younger than my own daughter and I would say she was pretty in scrubs and a lab coat. She had a tablet and introduced herself as ‘Nurse Sue’ and explained she was fairly-new to the practice. She asked, “What brings you here today?” I said I was summoned because my blood pressure was high during my recent colonoscopy. She looked at what the nurse had charted and said, “It’s not high today, in fact for a man your age it is excellent.” I nodded and said, “For no good reason, I have OK blood pressure. I eat meat, I drink milk, am over my screening weight, and have been far too inactive during the quarantine.” She continued to look at my file on her screen.

“It says your pressure was dangerously high when you had the colonoscopy, and it was still high upon discharge,” I answered, “Yeah, I had just been through a day without food, a week without aspirin, hours of laxatives, a series of enemas followed by a night on the toilet without sleep. I was exhausted, anxious, and not really looking forward to the procedure. Since I choose no sedation parts of the procedure also are very uncomfortable. That’s why my BP was high.”

She asked why I forgo the sedation, and said it was very uncommon. “Less than 5% of patients in the practice do not take sedation.” I said, “My wife works double shifts and cannot drive me; I have no friends, so that is not an alternative; and if I am gonna be on TV, I am damn sure gonna watch!” She asked, ”no friends? I find that hard to believe.” I answered, “No friends willing to get up at 5:30 to drive me an hour to a 7 AM appointment!” She smiled a bit at that and continued reading the file.

“I see you were not adequately prepared for the test and a ‘time-out’ was called for 45 minutes while you were given enemas until you were sufficiently clear for the colonoscopy. Did you follow the preparation instructions?” She asked. I answered, “Yes, to the letter, except I skipped the ‘enemas before 6 AM’ since I thought I was clear enough after the enemas the night before.” She read from the screen, “You still had formed stool still present in last bowel movement. That doesn’t sound clear.”

“In previous colonoscopies, I was told if the returns are clear enough to see the bottom of the toilet bowl, that is clear enough. I only had a couple of ‘buckshot’ size pellets which I didn’t think would matter,” I said. She again read from the screen, “Two enemas were administered by the admitting nurse. The patient tolerated the treatment well and the result was felt to be satisfactory.”

I nodded and said, “embarrassing as hell, but I’d have done two more to prevent having to reschedule!”

She asked again why I had not done the Fleet enemas before I left the house. I said, “I do not use Fleet’s. I requested and was granted permission by the Doc to substitute tap-water enemas instead. Fleet’s burn me and I won’t use them.” I then said, “I was running late before 6 AM, my wife was asleep and unable to help, and there was no time to fix and take enemas and be sure I was empty enough so I wouldn’t have a major accident on the drive to the center. As it was, I sat on a diaper in case I leaked!”

“Oh! You take real old-time enemas, like with a bag?” I just quietly said, “Yeah.” She said that it was very unusual to find anyone who would have a large enema rather than a Fleet. I said, “The nurses at the endoscopy center said the same thing – just before they gave me those two 3H enemas!” At that she laughed and said, “where did you hear that?”

I told her when growing up, many years ago, four of my aunts were nurses and I was no stranger to their ministrations and terminology and my mother was also a great believer. I joked, “In my house, if you had a headache you got an aspirin, if it was anything else, you got an enema!”

She laughed and said she had not heard the term ‘3H’ used since her time in nursing school. She added that large volume enemas were now usually used only for preoperative surgery or for cases of impaction. Then she said, “Even in the months I’ve been with the gastro practice I’ve only seen a handful of tap-water enemas prescribed.” I said, “Well I can attest they are used right here in your own clinic!” I added that the nurse who performed the enemas was very kind and tried her best to preserve my privacy, even in the crowded clinic. She said knew who I meant and she would pass along my comments to the admitting nurse who was part of the same practice.

She said,” OK, I see you are scheduled for another colonoscopy in three years. The doctor says you should follow a two-day prep next time.” Then she added, “and next time don’t leave the house until the returns from those enemas are really clear!” I said, “I promise I won’t make that mistake again.”

She smiled and said, “You are an unusual man. Since your BP is fine, unless you have any other issues, we are done.”

I left, ‘Unusual man!’ If she only knew just how unusual!