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But even though I did manage to make the appointment despite my belief that I had nothing at all to fear, I found a different way to act against my own interest beforehand. I knew full well that I wasn't supposed to eat for at least 36 hours leading up to the test, but I nonetheless sneaked a few mouthfuls of lunch just 18 hours before. How could it hurt, especially for someone as healthy as me? I said nothing to my doctor about this and reported for my test the next day.
During a colonoscopy, many people are completely unconscious. Another option is twilight sleep, which eliminates pain while leaving the patient partly conscious. I chose that, and I also opted to watch on the monitor as Dr. Jon LaPook, my gastroenterologist and friend, conducted the test. It didn't take long before he began grumbling about the inadequacy of my prep. My colon was littered with the lentils I had heedlessly eaten the day before. I had been a mediocre patient, the kind I lecture about — and to — in my practice and public life. As I lay on the gurney, a snapshot of thousands of conversations I had had in my office with patients on whom I was about to operate formed vividly in my mind. My emphasis in those situations is always pointed: I look them in the eye and tell them I need their help, that this is a combined effort and that we will get through this together but that we both have responsibilities. I always feel frustrated when my patients seem to think that precise medical instructions based on years of experience don't apply to them. I was now that person.
LaPook scolded me for having disobeyed instructions, but he did so playfully; I was in a vulnerable enough position at that moment as it was. The banter ended fast, however, when he looked up from the monitor and announced that he had found a suspicious polyp that needed to be removed. I shifted my gaze to the screen, and there it was: a little teardrop of tissue attached to the colon wall. For a brief period, emotion superseded reason. The growth coming into focus indeed looked precancerous, but that was impossible! I have lived a pious life! I was feeling fear, yes, but also — irrationally — anger. LaPook coolly carved out the polyp and forwarded the specimen to pathology for rapid diagnosis. But it was a Friday — a Friday the 13th, as it happened — and there would be no results until Monday.
The Long Wait
The weekend was what you would imagine the weekend to have been — which is to say, lousy. All these years I have been telling people bad news, sad news, scary news. Now I was experiencing what they so often experienced. The very lonely terrain of awaiting diagnosis is bad enough. But as every parent or professional or employee knows, your responsibilities at home or at work don't stop just because your mind is whirling with worry. The same is true when you're a healer — when your pager continues to go off and the messages continue to come in and your patients expect, and deserve, your full attention. In the free moments I had that weekend, I went through my litany of medical options. Best-case scenario would be a hyperplastic polyp, which behaves like a skin tag and would never have hurt me. Worst case, I had cancer that had spread through the protective lining of the colon, and I would need surgery to remove my colon.
Monday morning at last arrived, and LaPook called and asked if I could come to his office. I immediately knew I could eliminate the best-case scenario. Doctors are taught to share good diagnoses over the phone but to deliver bad news in person, so as to offer better counsel. I sat attentively across from him as he told me that yes, my polyp was premalignant, the kind from which cancer arises to afflict 5% of Americans. The odds are higher if you have a relative with this cancer, if you are obese or if you smoke. I had none of these risk factors, nor do the majority of men and women diagnosed with an adenomatous polyp. This bears repeating, in case any of you believe you are even healthier than I thought I was. Most people with precancerous polyps have no risk factors. If I had not been showing off at my birthday party, I could have easily caught my problem too late and been facing major surgery and perhaps a colostomy, chemotherapy and even death.