Rarely in life does one get the opportunity to meet the Angel of Death. For every patient I see, this very notion arises in their mind. In a short span of time they will meet and submit to a universally distasteful if not taboo violation of their body. In addition they know when they leave this room they may know they have cancer.
Why in hell would they do this? Because they believe that early detection is the best way not to die from cancer, or so they've been told. An even better question is why anyone would walk into the room with the intention of performing a sigmoidoscopy on these fearful strangers? The answer is that the person must truly believe in the early detection principle. In my case I do believe in that principle and therefore have chosen the business of colon cancer screening. I'm a Registered Nurse Sigmoidoscopist and early detection is my business. Business is looking up...Looking up every patient that crosses my path.
After registration and filling out a questionnaire about family history of colon cancer and personal history of prior sigmo or symptoms each patient is led into the room (slaughterhouse) and instructed to strip from the waist down, wrap in a flimsy paper sheet and sit on the exam table facing the middle of the room. Here is where they gawk at the equipment, examine the wall for blood stains and fingernail scratches, and say a prayer.
I find the chart and questionnaire on the door of the room, knock and walk in. "Hello Ms. Smith my name is Tony Dombroski. I'm the nurse that does the exam. How are you today?" I grab their hand give it a shake, look into their eyes read as much as I can in an instant. I look for those downturned frown eyes and quivering lips. What am I gonna' find in this individual? I listen for the answer to the question "how are you?" Folks say, "I'm scared, I'm nervous, You tell me, I don't know." I agree. However they feel they are not lying. They have a right to feel anything they like and I can't change that. By agreeing I let them know I won't argue their own construct of reality.
"Well you certainly are right there. I don't know anyone that's looking forward to these exams, but most folks are here 'cuz they know it's part of the way to stay healthy. I'm in favor of staying healthy. Congratulations for having the courage to come in. Many folks avoid the question of health, but I really believe that this is the right way to respond to the question of colon cancer (They knew I'd say that word) in the population"
Pretty serious so far. They see sincerity as my eyes drift from around the room as if searching for these words for the very first time to chilling eye contact at key words like cancer. The serious mood is rising and we wonder who is going to break into a sobbing fit first. "You have some general idea of what I'm going to do today?" We discuss. "And you've done the preparation?" More discussion as I sink from my saintly posture standing before them clutching their chart like the scriptures to a more comfortable seat next to them. The Fred MacMurray posture with a Tom Bodette voice. I move to become familiar, relaxed as I feign interest in the chart punctuating now with the eye contact that statues of Jesus have. If body language had a volume knob mine would be set at 10 and the message is familiar comforting.
Now I begin more motion standing to set the chart out of the way. "This exam is rude and embarrassing." (Hey! so let's have a beer and call it a day) "It feels like two normal everyday feelings however." (Yea! sure if you're a bull rider at a rodeo) "It feels like you have to go to the bathroom, like you have the urge to pass stool. You get that urge a couple times a day maybe. This feels like you REALLY gotta go. When you get THAT urge you pull off the freeway and find a gas station and you respond to the urge. During the next ten minutes you won't be able to respond. (TEN MINUTES Yikes!!) It also feel like you have to pass gas. You pass gas. Everyone passes gas. When you get the urge to pass gas you let it go. YOU BLAME THE DOG." This is an eye contact moment.
They see my coy smile. They grin. (This guy's funny) "I can do the exam in five minutes, but it's more painful if I rush and besides I don't sleep well with the memory of screams in my head" More giggles.(He should be on Leno) "We're gonna do this together. You're gonna promise to tell about the discomfort because it helps me do what I gotta do" I gesture like I'm twisting knobs on the scope. "Now on top of everything, this discomfort is worse because it's embarrassing". I strike the pose Norman Rockwell would paint of a kid in shorts and a baseball hat sideways whose ice cream has just jumped off the cone. "I don't have any medicine for embarrassment. If I did I'd be a very rich man now wouldn't I? (Maybe he should be IN Leno) So If you have no further questions, curl up on your side facing away and we'll begin. If any question pops into your mind while I'm doing the exam, sing out. I talk all through this procedure. You want the winning LOTTO numbers? Ask me." More giggles...
And so the patient gets to know me. The way this reads it sounds as if everything is scripted, cold, plastic. You can see Sean Penn attempting Shakespeare and failing miserably in any attempt to convey belief. I have to tell you that this is an outline of a process. No two exams are alike. I approach every person in a slightly different way. I have to admit, though, that the 'blame the dog' line is a big hit.
Examine how through history drama has been incorporated in healing rituals. The Native Americans used smoke and chant and rattles to create the appearances necessary to heal. I wonder if the dance was more to create the proper mood in the healer.
When I do this exam I'm not a good actor. I'm a great actor. It really is me saying the lines and ad -libbing the comeback. You cannot distinguish the character from the real me. The professional distance created in order to do this for a living is deep inside me. It would not work to adopt the distance the clerk has at Neiman Marcus when you ask a price. "If you need to ask the price then you most certainly can not afford it, Sir." My distance is a nanometer of space that protects my core.
Often when the news is not so good and a lesion is found and I sweat to explain the nature of the findings I do feel a crush, but not a permanent one. I have been both tearful and joyous with patients after the exam, and I always comment on how great they were to have put up with pain. And I mean that sincerely.
For my effort I suffer the acclaim of a patient on his way out of the clinic standing in the hall screaming "Hey, this guy is great"! He was ushered to a pencil and the how was your visit form.
I listen to their fart jokes and talk about their kids and surgeries and relatives. We exist as humans together, and in that existence we share a principle with humor. That principle is paradox. (No not the two physicians in the next room.) Paradox the principle that shit happens (and don't I know it). It influences life and humor as illustrated by the Three Stooges. Life is not a linear stream of quantifiable events There is nothing funny in that and nothing lifelike either.
As an afterthought to this tale I am reminded of a Saturday Night Live skit with John Lovett as a thespian. If questioned about the skill in communicating illustrated in my story he would reply, "ACTING". To this I would reply, "NURSING" with equal ridiculous bravado.