Colonoscopy time Part 3 – The Main Event

 At last, you are at the hospital.  Or clinic.  Hooray!  Now you get to check in!

I have an uncanny ability to find the imaging department in a hospital.  I think it’s because I’ve spent so much time in them.  Each place is a little different, but most hospitals have signs and volunteers.  And pumps of hand sanitizer.  I strongly suggest you use all three, especially if this is your first visit.

“No!” you shout.  “I shall not ask directions!  I can read!” 

“Ah, yes,” say I. “But the volunteers know which elevator to take.  And which is out of order.  And which hallway is closed because of construction.”  Twice volunteers have led me ‘the back way’ through the hospital to get to something I never would have found without them. 

Checking in

You will need to check in, letting the department people know you are there.  This step varies from place to place, but you will be asked for id, a health card, possibly a specific card for that hospital (one reason to allow extra time) and your order papers.  You will be asked if you have any allergies.  Tell them if you have allergies.  Or sensitivities.  Like, if you break out in a rash from contact with something, like Band-Aids.  That one can be important.

Some clinics are self-contained, with everything in one place, on one floor.  Others are more spread out.  You may have to check in with, say, outpatient procedures, and then go on to the endoscopy suite.  If someone is coming with you, they can generally just tag-along until you get to the IV part.  There may be a special waiting area for them, or perhaps they will be told when and where to show up to collect you.  One thing is certain; when your companion is someplace that’s not allowed, someone will speak up.

During check in, someone will ask if you know why you are there.  This is NOT the time to be sarcastic/funny.  It is part of the informed consent process.  They have to make sure you know why you are there.  Your procedure will be explained to you.  Don’t say “Oh I read all about it on the Internet”.  They hate that.  There’s lots of weird stuff on the Internet.  For all they know, you read an article that says the process will be carried out under the full moon by a specially qualified cat, who also plays piano.

At some point the following things will likely happen:

-You will be given a hospital bracelet or two.  One will have information identifying you.  You may also get a second one, possibly red, if you have an allergy that they really need to know about for the procedure.  Like the adhesive one I mentioned earlier.  If your only allergy is to cat hair, you probably won’t get a red bracelet.

- You will be asked to change.  You will probably be given a basket or bag and a bundle of hospital gowns and booties, and shown to a change area.  A really posh big-city type hospital may even have a special locker room!

Note: 

There are many different kinds of hospital gowns.  Do not be surprised if there is a diagram in the change room, explaining what to take off and how to put the gowns on.  Follow the instructions.  Yes, sometimes they really do need the diagrams. 

(Ladies: if you feel more comfortable keeping your undies on, that’s probably ok.  You can always ask the person handing you the gown, or your nurse before you get onto the bed in the procedure room, or slip them off and tuck them discretely into…uh….you know what?  Tell the nurse.  Trust me.  They are used to that, especially with ladies of a certain age, who tend to be more modest.)

-You will have someone ask you your name and age and address, again, while holding a paper that already says this in one hand, and your hospital bracelet, which is attached to your wrist, in the other hand.  Again, not the time for funny.  This is the hospital’s way of confirming that the Mrs. Jane Doe in front of them is the Mrs. Jane Doe who is supposed to be having a colonoscopy with Dr.WhatsHisName today.  It prevents mix-ups.  Don’t knock it.

-You will probably be asked if you have any symptoms of a cold or the flu, or a cough.  You will probably have your temperature taken.  This is so they can do a basic assessment of general health before beginning.  There may be some conditions under which it’s not a good idea to proceed with the scope.  Since I’m not a doctor, I have no idea what they are. 

-You will have your blood pressure taken.  It will almost certainly be higher than normal.  The nurse may be asking you questions while this is going on, you may have had to sprint to get there on time, your gown may not be cooperating, you may be nervous.  This is all normal.  The nurse may want to take your pressure again, or try the other arm.  If this happens, try to relax and follow her instructions.

(I said her! Sorry Sam from GI Oncology!  There are some great male nurses out there, but mostly the profession is female dominated.)

-You will be given an IV.  Now, I am a good patient for my nurses, except when it comes to the IV.  I’m what they call a hard-stick.  I’m sure they have other names for it, too.    I could go on and on about IVs, but that’s probably best left for a separate post.

- You will get to wait a bit, possibly even between steps above.  For whatever reason, the department will be running behind.  Why?  Are they understaffed?  Are the doctors late?  Who knows.  Odds are good someone’s procedure is taking a little longer than planned.  Or perhaps a nurse has been diverted to deal with something.  Either way, you will wait.  Hospital time is another phenomenon that deserves its own post.

This is the really, really boring part.  You probably don’t have your stuff, so no reading material.  There may be magazines lying about, but they are hospital magazines.  There might be a TV somewhere, likely tuned to either the weather channel or a news station of some kind.

Oh! And yes, the instructions do say to keep drinking, but this does not mean you need to keep sipping your bottle of water right up to the procedure time.  The nurses will take it away from you.  Please do not cause a scene (yes, I’ve seen it happen).

The main event!

Yay!  Your name has been called!  You walk down to the colonoscopy procedure room.  And…

It is probably smaller than you were expecting. 

For such a scary sounding thing with so many steps, shouldn’t there be a giant room?  Perhaps with medical students looking on?

Nope.

 It’s you, your GG and two, maybe 3 other people.  It depends on what we are doing today, and how big the room is.  Because I’m a regular, I tend to have students and new hires watch my procedure.  But that will be another post.

-You will get on the bed, and do what they say.  You may have to start on your back and have them raise the table, or you may start off on your left side, knees bent, everything covered up.  To start.

- Your IV  drip will be started with saline/glucose, if it wasn’t already. 

- A clip will be put on your finger.  I can’t tell which one, it depends on how the room is set up. 

- Oxygen may be made available to you.  Don’t panic.  It’s just easier to do it now.  You may not ever need it. 

-You will be introduced to the people in the room.   They are often called ‘The Team”. They will not expect you to remember their names.  They may make a joke about it. 

While they are getting everything ready, The Team may chat amongst themselves.  This will sound nothing like the medical shows on TV, and everything like what  people talk about where you work.   

Why is that?  Are they being unprofessional? Shouldn’t they be shouting “Stat!”, carrying clipboards?  Wearing stethoscopes?  Running?  And shouldn’t someone be biting her lip and looking dreamily while some older guy fumes about something?

Nope.  This is reality. 

This is the team’s day job.  Pretty boring?  Good. You, as a patient, want boring.  As my GastroGuy once said, “The thing you never want to be as a patient is ‘interesting’.  And never, ever, ‘exciting’.”

- Your Gastroenterologist (GastroGuy, or GastroGal, or GG) will probably confirm with you that you are who you say you are, and that he is who he says he is, and that you are going to have the procedure you expected.  Again, double-checking is a good thing. 

- You may be palpated.  That’s a fancy doctor word for poked with the flat part of the fingers.  If your doctor’s hands are warm, please mention this in the comments.  I’ve yet to meet a warm handed doctor.

- You will be told to reposition, and the team will artfully arrange the covers so that only the part they need to see is visible.  Also, they almost always point the camera at the floor, or a blanket or something right up until the last possible moment. 

Which is nice, because you really don’t want to see your backside on a 21 inch screen.

- You may be facing a monitor on top of a bunch of computer-related looking things.  You may see a jumble of wires and tubes.  Don’t panic.  They are all supposed to be there.  They have a purpose.  It’s OK if they look messy from where you are.

- You will have a digital rectal exam.  This does not mean they are going to use a digital camera and then look at the photo of your bottom. 

The medical term for a finger is ‘digit’.  Your GG is going to stick his (or her) finger in your rectum.  I don’t know which finger, but you can feel free to ask at the time.   It will probably be very cold and uncomfortable.   

- Your GG will explain the sedative to you.  Most people have something called ‘conscious sedation’.  It means you won’t feel pain, but will be able to feel pressure.  You see, they need to shove this tube with a camera and stuff in it into your rectum, then snake it all the way to the end, and slowly remove it, looking around the whole time, while also removing stuff that looks suspicious.

 And as we all know, you can’t push on a rope, unless it’s frozen.  And even then, it may not be that easy.

Your colon has 3 parts, from the rectum to the small intestine, they are: descending, transverse, ascending.  Here, take a look.  

See that bend?  The one between descending and transverse?  That is the most difficult one to negotiate, apparently.  People are different, and everyone’s bend is a little different.  Your GG needs you to be aware when the scope goes through this part, so that you can tell him if it hurts, etc.  He/she will probably explain this to you better than I can.

Sedation

My GG was lovely at explaining this to me:  When it enters the vein, it will feel a little cool, as it is lower than your body temperature.  In about two heartbeats, you will feel like you’ve consumed several beers way too fast. 

Now, I don’t drink, so I was worried. 

He was right about the cold.  And in two beats, I felt very relaxed.  Limp even.  My eyes didn’t blink at the same time, and I felt like the room was spinning ever so slightly.  What I said was “Issh a gud thing immm laying down becahush I feel likesh I rally need to laa downsh.”  And then I don’t remember much.  Except:

My GG saying “And that’s our cue to start”, followed by, “I’m going to insert the scope now, you may feel a little pressure”.  I remember feeling the scope go in a little bit, and then things went black. 

Colonoscopy, itself

You may be facing the monitor during the procedure.  If you handle sedation like I do, you will “float to the surface” every so often.  If/when you do, you may talk.  I’m told this is normal.  And that they don’t laugh at you.  But they will ask you to please stop singing.  And they will tell you that they cannot “change the channel”, no matter how boring the nature program is.

Will it hurt?

I wouldn’t say that it hurts.  Not really, no.  It doesn’t feel good, that’s for sure. 

To move the scope along, your intestines will be inflated a bit.  Generally this doesn’t hurt, it just feels like, well, lots of gas in your intestines. 

The negotiation of the bend may involve a bit more movement, and your GG will want to know if you are uncomfortable or in pain.  Answer honestly.  And if you ever do feel pain, or like throwing up or something speak up immediately!  Don’t try to ‘tough it out’.  You aren’t helping anyone. 

Polyp removal doesn’t hurt.  It does feel weird, because you can feel pulling inside your intestines.   The best way I can describe it is like this:

Gently pinch the little flap of skin between your thumb and index finger.  Got it?  OK, now, tug a little bit.  Feel that?  You can feel the pinch, and you can feel the tug, but it doesn’t hurt, right?  That is pretty much it.

Removal of larger growths (should you be unlucky enough to have them) also doesn’t hurt.  In both cases, because there are blood vessels in your intestines, you may bleed a little bit.  Your GG and team will take care of that.

Another thing you may feel is the irrigation.  Blasting water at the sides of your intestines doesn’t hurt.  It feels cold, and you can feel the pressure, which is very strange.  Suctioning of air, water and residue from your purge doesn’t hurt, either.

About half an hour or so later, the whole thing will be over, and you will be wheeled into the recovery room.  Hopefully nothing of any interest whatsoever will have happened.

Really?  All that buildup?  And we’re DONE? 

Yep.  Really.

You will be left to recover in the recovery room, with the curtains pulled around your bed.  It is during this time you "deflate", and the sedation wears off.

The recovery room

As your doctor will have explained to you, your colon will be expanded via compressed air or gas during the procedure.  They are able to let most of it out before you leave the procedure room, but not all of it.  While you are in the recovery room, you should expel the gas.  You may feel very self conscious.  It seems really rude.  But it’s ok.  The recovery room is for this.  Everyone in there is in the same state. 

Nurses will check on you every so often.  Even if you can’t see them, there is someone pretty close by, keeping an eye on everything.  There is no need for you to rush off.  Take your time.  You do not have to hurry up and wake up all-the-way-fast-fast-fast.

When they are satisfied that you are ok, they will remove your IV, let you get dressed, ask you a bunch of questions, give you any papers your GG left for you, and ask you who is there to take you home.  They may even give you a small amount of gingerale or juice or something.  But not always.  It depends on the hospital, etc.. 

In the (very unlikely, I hope) event that something suspicious or even bad was seen by your GG, he may have a chat with you before you leave.  Or, if you have been anxious, he still may pop in for a quick chat, even if nothing is wrong.  Basically, if something isn’t right, someone will tell you.

By the time you are discharged, you should be fairly alert, and not feeling too bad.  A little bloated maybe.  You will be told what you can and can’t do after the procedure, and when you can eat.   You will be told what to expect following the procedure, especially if your doctor found and removed polyps.

You should under no circumstances drive home.  While you feel fine, and can see and everything, your reaction time will have been severely affected.  I know a gentleman who knocked over a bottle of water, then watched in shock as it fell and emptied completely before he could move his hand over and pick it up.  And that’s someone who has cat-like reflexes, usually.    Within a few more hours he was basically back to normal, however. 

If you have any concerns, talk to either your doctor or one of the recovery room nurses before you go home.  Since they are trained medical professionals who do this every day, they are far more qualified than I am to give advice on this bit.

You will probably still feel a little bloated the next day, and continue to deflate for a bit.

And that’s it.  For such a scary sounding thing, it’s mostly preparation.  And a half-hour or so procedure.  Kind of a let-down, isn’t it? 

I hope you find this information helpful.  Colonoscopy is a very important diagnostic procedure.  It really isn't as scary as some people make it out to be. 

But, what if?
-You need a pedicure? They don’t care.  And you should wear socks anyway.  Hospitals are cold.  Especially when you aren’t wearing pants.

-You forgot to shave? They don’t care.

- It’s almost time for the scope or IV and you need to visit the bathroom again?  There tend to be bathrooms available near the procedure rooms.  You are not the first person to require them.  If you have to leave a waiting area to use one, tell someone.  This way they won’t page you when you are indisposed.  But they may knock on the door.  Or try the handle.

- It is your ‘time of the month’?  Tell the nurse who takes your vital info.  The one who is taking your blood pressure, or going to give you an IV.  You may not wear a tampon during the procedure.  You might not be able to insert one afterwards.  Remember the sedation?  Wear a pad, and bring a spare or two.

-       Something else happens that I’ve not covered here?  Ask a nurse in the department.