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My first colonoscopy

From the August ACP Hospitalist, copyright © 2010 by the American College of Physicians

By Rachel R. Hammer

Being a first-year medical student is like getting a colonoscopy.

The preparation is rigorous, some might say inhumane. Even so, you are grateful to have an appointment. You show up and give consent to your superior, and are quickly put into a trance. Tight as you are, you get filled up with air. (Some have more room for this than others.) Many people gather to watch you struggle as more and more is shoved your way.

Every so often, something unpleasant is discovered that must be removed. If not, you pass the test, and the scrutiny is slowly withdrawn. Afterwards, you don't remember much (or at least you still feel as stupid as you did when you came in); someone drives you home to recover; and when you do regain consciousness, you have only gratitude that it is over.

If excessive studying mimics Versed for a medical student, I am ever-thankful that, at my medical school, we are given precious intervals of reprieve from our stupor—an an-ascetic, if you will. We get two weeks after every block to wake up, repolarize, and explore our own interests. For me, this meant a field trip to round with the hospital service at St. Mary's Hospital of the Mayo Clinic.

I had the good fortune to spend a morning with gastroenterologist Dr. Thomas Viggiano. Sometimes shadowing can feel more awkward than your first dance in middle school—you're hovering on the perimeter of the inner circle, too sweaty and nervous to say anything, too uncoordinated (mentally and physically) to move gracefully, and always the last wallflower to be arranged into the dance space.

But with Dr. Viggiano, I felt like I was being asked to do the father-daughter dance at my wedding. His demeanor gives you faith in yourself; it's the same smile your dad had for you on graduation day. It says, “You've already accomplished so much by showing up dressed properly. Good for you!”

He put his arm around my shoulder and ushered me with avuncular grace into the inner sanctum of gastrointestinal diagnostics—the narrow hallways leading to little diverticula-like procedure rooms where tubes are muscled into spaces taboo. I smiled as I realized that even being in the hallway of the GI ward felt like being in a colon—cramped, torturous, a bit peristalsing with nurses and techs squeezing past each other with their instruments on wheels and carts.

Perhaps the architecture was meant to be educational. But then one would expect to see flying buttresses at chiropractic appointments, rose windows and domed ceilings in mammography rooms, perhaps an inspiring colonnade at the fertility clinic. Even as I write this, I'm noticing the low ceilings and lack of windows in my basement apartment and worrying what these dim portents may foreshadow for my medical career.

On the first colonoscopy I watched, I felt a little seasick, digitally lurching deeper and deeper into the Bowels of Darkness. Visually, it was like a roller coaster ride in a sewer. Occasionally you bump into the walls or are washed in yellow-green grainy excrement. There was another student who sidled up to the bedside for a moment next to me, but after ten minutes he had to excuse himself. I knew why. I was silently fighting to stay put and appreciate the educational experience.

One patient farted loudly with every shift of the scope, and would then wake from sedation, apologize, and drift back into unconsciousness. I didn't know what the proper etiquette was in that situation. At first I said, “It is okay to fart on me, sir. It happens all the time.” I thought about that and corrected, talking loudly to his posterior, “Sorry about that. It's not you, actually, it's our air that's farting, so we are doing it to ourselves, really.” Dr. Viggiano looked like he was straining not to let something of his own out, and I blushed, realizing it was best to say nothing. He told me later that Versed, which the patients are given, has amnesic properties, so the patient wouldn't remember even if I farted! I wish I had access to Versed in middle school—strictly for research, of course.

All day scopes came in and out, patients bobbed in and out of consciousness. There was a beautiful ebb and flow to the procedural routine. For me, the day was a noteworthy one. It was my first day wearing scrubs. When I told Dr. Viggiano that, he smiled and said, “Aw, someday I'll get to say, ‘I knew Rachel when she was in her medical diapers.’“

Rachel R. Hammer is a second-year medical student at Mayo Medical School.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated