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Andy crawled to freedom through 500 yards of shit-smelling foulness I can’t even imagine — or maybe I just don’t want to. Five hundred yards. That’s the length of five football fields; just shy of half a mile. Andy Dufresne, who crawled through a river of shit and came out clean on the other side.”
Ellis Boyd ‘Red’ Redding, The Shawshank Redemption.
Monday was one of those days. At one point in the morning, I left my office to use the bathroom. Having done what I had come to do, I flushed and washed my hands. Then it happened.
Many of you will recognise there can be absolutely no feeling of terror as intense as that when you flush the toilet and see the water level, with its scatological bounty bobbing around menacingly on top, flirt with the top of the pan and threaten to pour forth its putrid contents. This is magnified when it occurs in a bathroom that’s not your own. I attacked the toilet with the nearest implement, which was a toilet brush that thankfully did the trick and the waters stalled, but didn’t recede. As they calmed, I noticed a flashing LED-type light winking back at me. Now, the bathrooms in our offices are unisex and my first thought was that some depraved pervert had installed some sort of camera. What was I to do?
Well, I rolled up my sleeves and fished it out. It was actually a bleep belonging to one of the oncology consultants. I scrubbed it and me as hard as I could and dropped it off in his in-tray. I didn’t think I’d done anything especially strange or heroic, but my actions were perceived by most of my colleagues as something only a gastroenterologist would do. They’re probably right — as a specialty, we ply our trade where angels fear to tread.
My wife has always had certain qualms about the fact that I spend a good deal of my working life in intimate proximity to human excrement, or that each week I probably digitally penetrate in the region of 15 to 20 anuses, or anii (whatever the plural is — you’d think I’d know that one). She tells me that she employs the same sort of mental reservation that Carmela did in The Sopranos, when she managed to separate the deeds her husband carried out in his line of work from the husband and father she built a life with.
Colonoscopy has been described in many colourful ways in the popular media. A newspaper from Australia, unsurprisingly, described the procedure as “like having a lamp-post shoved up your arse to take a photograph of your tonsils”; another (and my personal favourite) euphemism was “being violated by the black snake”. Generally, I don’t mind it. As a trainee, by the end of my SpR training I had performed 813 colonoscopies. On a long flight once with nothing to do, I calculated that based on a 93 per cent completion rate and an average bowel length of about 75cm, that I had probably waded through 600m of faeces in three years to come out clean on the other side, which left Andy Dufresne from The Shawshank Redemption very much in the ha’penny place.
There are occasions though, every week or so, when somebody has been sent for a procedure who has only taken negligible amounts of bowel preparation and has not only diverticulosis, but all the sphincter tone of goal netting, where I do reflect on the series of questionable life choices that has led me to this point where another human being craps on my right arm for 25 minutes and I get paid for the privilege.
It would be misleading though to say this is a frequent thought and of the many messy experiences I’ve had, none in particular stands out as being especially disgusting. Certainly nothing as vivid as the recollection of the time recently when I couldn’t control an emergency torrential and fatal upper GI bleed and I spent 15 minutes in the locker room at 8 o’clock on a Friday night choking back tears while scrubbing a stranger’s blood out of my shoes and ID lanyard.
And then the knock on the door comes. There’s another sigmoidoscopy that needs to be done and you’re two hours delayed and everyone else is gone home. Nothing for it but to wield the snake again. For what must be the strangest kind of glory in all of medicine.
Gastroenterology is not a career for the faint of heart, feeble of constitution, the seekers of glory or the virtue-signallers, but perhaps our greatest attribute is we keep coming back to do it again every day in all the foulness the rest of you seemingly can’t even imagine.