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July 22, 2008 at 2:08 am #187566
Dave Barry’s Colonoscopy Journal:
I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy. A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis.
Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner. I nodded thoughtfully, but I didn’t really hear anything he said, because my brain was shrieking, quote, ‘HE’S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!’
I left Andy’s office with some written instructions, and a prescription for a product called ‘MoviPrep,’ which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America’s enemies.
I spent the next several days productively sitting around being nervous.
Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn’t eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor.
Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water.
(For those unfamiliar with the metric system, a liter is about 32 gallons).
Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes – and here I am being kind – like a mixture of goat spit and urinal cleanser, with just a hint of lemon.
The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, ‘a loose watery bowel movement may result.’ This is kind of like saying that after you jump off your roof, you may experience contact with the ground.
MoviPrep is a nuclear laxative. I don’t want to be too graphic, here, but:
Have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at whic h point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet..
After an action-packed evening, I finally got to sleep. The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, ‘What if I spurt on Andy?’ How do you apologize to a friend for something like that? Flowers would not be enough.
At the clinic I had to sign many forms acknowledging that I understoodand totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actuall y naked.
Then a nurse named Eddie put a little needle in a vein in my left hand.
Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep.
At first was ticked off that I hadn’t thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode.
You would have no choice but to burn your house. When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthetist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere.
I was seriously nervous at this point. Andy had me roll over on my left side, and the anesthetist began hooking something up to the needle in my hand. There was music playing in th e room, and I realized that the song was ‘Dancing Queen’ by Abba. I remarked to Andy that, of all the songs that could be playing during this particular procedure, ‘Dancing Queen’ has to be the least appropriate. Ã¢Â€Â˜You want me to turn it up?’ said Andy, from somewhere behind me.. ‘Ha ha,’ I said.
And then it was time, the moment I had been dreading for more than a decade.
If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like:
I have no idea. Really. I slept through it. One moment, Abba was shrieking ‘Dancing Queen! Feel the beat from the tambourine …’ and the next moment, I was back in the other room, waking up in a very mellow mood. Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that it was all over, and that my colon had passed with f lying colors.
I have never been prouder of an internal organ.
ABOUT THE WRITER: Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald.July 22, 2008 at 2:39 am #233116
OMG I love Dave Barry. I am not sure that there has ever been a better book written than “Dave Barry’s Guide to Guys.” I am not sure how I missed his version of a colonoscopy. I know he’s written pretty funny stuff about a prostate exam.
Although I am younger than Dave Barry, I am old enough to know what he is talking about, here, and in many more and funnier words, he has pretty well summed it up. I tell patients, “The prep is hell, but the procedure is great because they give you drugs!!!” As Dave would say, I Am Not Making This Up.July 22, 2008 at 1:02 pm #233117
As someone with GI issues for many years and having several colonoscopies over the past decade, the prep being hell is so, so true. And on my last one, not only was I physically “violated” as it were by my friend, a GI guy who more hyper than myself, he blew me up with so much air that my colon went into spasm leaving me in gas pain. It wasn’t until several hours later when I passed gas for oh 15-20 minutes straight that felt relieved. Was it over? Oh no, not quite. I was then violated yet again when I found a bill from the anesthesiologist (sorry Dave) who was not part of plan (how was I to know?) and I had yet to reached the very high deductible. So forked over a grand to the guy. Frankly, it felt like a colonoscopic gang bang!July 22, 2008 at 7:29 pm #233118
Yeah, yeah, yeah – piss & moan, piss & moan. You both know this experience is much much better under the influence of “Milk of Amnesia” that it is on some paltry dose of valium/versed +/- demerol.
Better living through pharmaceuticals!!
Besides, a fellas gotta make a livin somehow?July 23, 2008 at 2:06 am #233119
I really hate to post off-topic on this fabulous thread but a quick note to Rich: when this happened to us (daughter had outpatient surgery at a hospital, with a surgeon, both chosen for their in-plan status, then later found out the anesthesiologists at that hospital were NOT in plan), we kicked up a bit of a fuss and ended up having them take the ‘in-plan’ reimbursement.
To this day (this was a long time ago) it pisses me off: what is the point of the anesthesiology group being out-of-network when the surgical facility is IN network??????? Dave maybe you can explain it.
very very very tired and grumpy…. when I explained what I could and could not do vis a vis a patient’s insurance plan today, she of course got angry at ME for telling her that her insurance wouldn’t let her do x, y or z. Huh.July 23, 2008 at 9:02 pm #233120
To be perfectly honest – you got me? Why in hell a surgical facility would have its surgeons “in network” & not have the anesthesiologists “in” as well sounds pretty freaking retarded. My first guess would be that the insurer tried to stick the anesthesia group with a total shit-stick of a deal.
Anesthesiology bills in a different format than any other group of physicians. As Mary can attest, the billing & coding stuff is infinitely complex – the quantum theory of gravity is child’s play by comparison – and appears to be designed so that Doc’s will say “f–k it!” & bill at the lowest level. However, long before all of this coding idiocy began, anesthesiology got its act together & developed a very solid & easily substantiated system of billing. Each ‘basic’ surgery or procedure that we do has an assigned number of RVUs (relative value units – very different from the RVUs you will see referred to by other physician types). Each procedure can be modified for complexity & by the pt’s comorbidities & even further by units of time (in 15″ increments). The numbers behind all of this are very solidly substantiated by years of records maintained in a database & are periodically updated to reflect changes in standard of care, practice patterns & advances in technology.
The system accomplishes several things in anesthesiology’s favor. 1) It precludes the monkeying around insurers are famous for trying to minimize billing/payment. 2) The language & rates are clear, concise, reproducible & scientifically validated. 3) This system provides an accurate – not under nor over – statement of what an anesthesiologist does & the intensity level at which these procedures were performed. The system is so airtight that it has withstood many legal attacks by 3rd-party payers trying to invalidate our system & force anesthesia to sink into the much & mire of the coding/billing system everyone else is subjected to. Even the gov’t/CMS has not been successful in forcing anesthesia, vis a vis the courts system, to adopt the BS system others have to use. Believe me, everyone has tried because it would save them major bucks by allowing them to systematically screw anesthesia.
It also helps that anesthesia is probably the most procedurally intense medical specialty. Everyone associates “procedures” with surgeons. However, even in private practice, surgeons spend a lot of time doing clinic & follow up whereas anesthesiologists basically do only procedures all day long.
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