In honor of turning 50, I got a colonoscopy.
I know -- everyone’s got that one friend who wants to tell them about their medical procedures. Don’t worry, I’m not actually that friend*. What I do want to tell you about is social injustice.
Yeah, everyone’s got that one friend, too. But I’m the quirky friend, so I’m going to relate it to toilets.
We don’t have one.
In case the connection to commodes isn’t glaringly obvious: in dutifully reading the six-page preparation guide provided to me by The Medical Establishment, I found that it assumed that all patients have access to a bathroom that they can commandeer comfortably and without interruption for at least half a day.
I repeat, we don’t have one.
We have an outhouse.
Okay, that’s super-weird. But at the
same time, it’s not weird. About 7% of
Fairbanks North Star Borough residences are in this category – a small but not
insubstantial minority. Shouldn’t the
literature at least recognize this?
Shouldn’t the literature at least recognize this?
Right. In registering my own mild affront, I started thinking about everything else that is, so to speak, not recognized in the literature -- not in the particular literature I was dealing with, not in the literature for mammogram I also had and the shingles vaccine I need to get because I’m now officially Sort of Oldish, and not in the broader and more metaphorical Literature of Medical Assumptions.
It’s amazing how a tiny lack of privilege can highlight what a boatload of privilege I DO have. In contemplating my outhouse, I started counting my advantages within a rigged system. There are a lot of them.
First, I have health insurance. This is huge.
Second, my employer nags me about getting checkups, and provides me with incentives to do so. This is annoying as hell, but even with all that nagging, I still managed to procrastinate for six months, so… yeah.
Third, I am well educated. Like, way over-educated. I have a PhD in biology, so I at least know how a colon works, assuming that I can remember even 10% of what got me through the GREs.
Fourth, I have connectivity and information access. I have Google, and I also have 24-7 EBSCO access to articles with improbably long titles. If I’m in the right mood, I even read them. A primer: colonoscopies are not only useful for screening and catching cancer early when it’s still treatable and survivable; they also prevent cancer. Colon cancer starts as precancerous polyps. Polyps are routinely removed during colonoscopies. Boom, no cancer ten years later. Nice.
Fifth, I have transportation and time: a working automobile and a driver’s license, and a spouse with the same. We both have vacation time, flexible hours, and the ability to work partially remotely.
Sixth, I have enough income and savings to not have to worry about minor out-of-pocket expenses, deductables, fancy fluffy toilet paper, whatever.
Many of these privileges were already on my mental radar, but I’d never really added them up until I read through the multi-page prep instructions. The assumptions are all there: you can get to a pharmacy or a grocery store whenever you want, buy all the necessary items, and get them home with you. You understand exactly why going through all this hassle is totally save-your-life worth it. You do not fear it, even though the document offers no FAQs to assuage potential worries. You can take two whole days off work, during which you apparently do nothing at all -- no childcare, no remote work, no chores. You can get to the hospital or clinic, and you also have someone who can be there to pick you up, because the paperwork insists upon no walking, no taxis, and no Ubers due to the after-effects of sedation -- although it fails to mention that the sedation itself is NOT mandatory.
This is a lot – financially, logistically, structurally, educationally, emotionally, and socially. This is not a given, for a lot of Americans.
Even a very brief session of #4 (All the Scientific Articles) uncovers some harsh truths. People are dying, and they are doing so in a manner that disproportionately affects racial minorities and anyone who is poor. They’re dying because they are not getting screened. Colonoscopy reduces the risk of death from colorectal cancer by as much as 88%. The strongest correlations with lack of screening are lack of high school diploma, income below the poverty line, and lack of health insurance. Gee, what a surprise.
There are quite a few academic papers that attempt to unravel why this is the case. Most of them seem to conclude “it’s a lot of things”. Yeah. See the list above. It’s a lot of things. A lot of privileges that a lot of people don’t have. A lot of reasons why people might avoid doing something that not only sounds totally gross, embarrassing, scary, and mystifying, but is also a massive financial and logistical hurdle.
And now, back to the toilets.
Toilets are obviously not the biggest factor, but I’m going for Toilet Symbolism here – whereby toilets represent all the unanswered questions and all the unacknowledged privilege, not just the assumption that you can hog a bathroom for hour upon hour, presumably in your suburban home with its 2.5 baths. Toilets underscore privilege. Go take a moment to admire your privilege. Aaaaah.
Back now? Good.
So, as you might guess, outhouses in November in Fairbanks, Alaska are not a reality that meshes very well with colonoscopies. But I’m living this weird cabin-in-the-woods lifestyle because I want to, not because I’ve been economically forced into it. As such, I got myself a hotel room for one night. It was luxurious.
“Luxurious” is probably not a word most people would use to summarize their colonoscopy. But there you have it. Not everyone can afford bathroom-related luxury -- or any of the aforementioned logistical, social, and informational luxuries. So, weird as it seems, our society is set up such that colonoscopies are a luxury.
Wait. There’s one more luxury that I almost overlooked: Advantage #7. Due to the fact that so many of you, my friends, are socioeconomically A-OK, we have the advantage of Social Support Via Demystification. In other words, I lied; for your own good, I am going to tell you about my colonoscopy.
It was… fine. Non-stressful. The prep was a bit tiresome and somewhat hungry, but not as much so as I expected. Mostly I was lolling on a comfy bed, typing on my laptop as usual, and eating non-red lollipops. This felt decadent, in a goofy little-kid way.
The procedure? Slightly humorous, and kinda fascinating, because I chose not to be anaesthetized (you knew that was an option, right?), and there was a big viewing screen. Cool! Cecum! I’m a biologist, I have the sensibilities of a twelve-year-old, and I enjoy Ms Frizzle and her Magic School Bus.
The results? The doctor found, removed, and biopsied two sesame-seed-sized polyps. Serrated sessile adenomas. Definitely not cancer – yet. Those two tiny lurkers are gone now, no longer a potential threat to my ten-years-from-now self.
The future? Because of those pink dots, I get to do this all again in five years, rather than the usual decade. And… that’s a privilege.
There you have it. If you’re part of my 1972 cohort or some even more archaic gang, be sure to take advantage of the luxury available to you. Appreciate it. And, of course, in the true spirit of Advantage #7, be sure to tell all and sundry about it.
*Yes I am. Obviously.
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