Getting to the Bottom of Things

Colonoscopies, Pronouns, Cancer

During the 1976 film Murder by Death (a loving sendup of classic detective fiction whodunits scripted by Neil Simon), the character of Dick Charleston (played by David Niven) goes into the bathroom and when he comes out, he finds that the entire house has changed in very odd ways. This becomes a bit of a running gag, where people return to entirely different rooms than the ones they left moments prior. I found myself living this aspect of Murder by Death two weeks ago while in the gastrointestinal services section of Glendale Memorial Hospital. I was there for a colonoscopy, a procedure they apparently only conduct in the mornings. I was their last patient of the day. As such, I had been waiting quite a while when the nurse finally came in to wheel me into the operating theater. Rather perfunctorily she asked, “Do you need to use the bathroom?” Having been waiting for a few hours, I let her know I most decidedly did need to avail myself of the facilities.

She did not seem pleased. Nevertheless, within moments, while gathering my gown about me with one hand and holding my IV with the other, I was shuffling along in stocking clad feet to the restroom. I wasn’t in there very long at all, but when I got out, I thought I was in a completely different room than the one I had left. All the makeshift curtain-walls were gone, as were the curtains themselves. All the beds were gone. All the equipment was gone. All the people were gone!

“Hello?” I called out softly, half-expecting that everyone was hiding as some sort of prank. The nurse who had not been particularly pleased with my needing to heed the call of nature suddenly reappeared and let me know I would have to walk into the operating theater under my own power as my gurney was already in there. So, I hustled along as fast as I could, and when I arrived, even the doctor seemed surprised to see his next patient entering on foot.

I was ushered back onto my gurney and given brisk instructions on how to assume the desired position. The anesthesiologist made himself known to me by uttering the phrase, “This is going to burn a little bit,” and sure enough, as the sedative entered my arm, there was a definite burning sensation. What surprised me, and slightly alarmed me, was that a few seconds later, I felt, if not a burning sensation, a definite heat in my neck. I opened my mouth to ask if this was anything to worry about, but before I could vocalize the first word of my question, or even close my mouth, I was out cold.

I came to in a pool of drool from my still open mouth. Panicked, I looked around to find that I was now in post-op. The nurse who had first admitted me, hours prior, was standing at the foot of my gurney, reading something. I asked, “How long have I been out?”

“About twenty minutes,” she said, before returning her attention to the papers in her hand. It soon became apparent that these were the results of my just-completed examination and she exclaimed, “Whatever you’re doing, keep doing it!” She was impressed, and I must say I preferred her exclamation to the first words said to me by the nurse attending me after my only other colonoscopy.

That had taken place more than two decades prior and on that occasion, I awakened to the image of a beautiful, young woman smiling down on me. Had I died? Was this heaven? A quick answer “no” to both questions was provided when the nurse said, presumably referencing my performance during the procedure, “You were so funny!” Because on that occasion I also required an esophageal examination, I was put into some sort of “twilight sleep”, where I would be relaxed, pain free, and would experience amnesia (indeed, heading into the procedure, I couldn’t even remember my name), but I would not be unconscious. And, apparently, I had a few things to say during the procedure …

More than twenty years ago, being told I was funny meant a lot to me. It still does, but not so much so coming from medical professionals, however. At 56, good news about my health means more. Not a LOT more, but more … And back then, accompanying the glowing review of my comedic performance came concerning news about my prognosis. Nothing dire was found through either test, but there were enough causes for concern that I was ordered to have a follow-up colonoscopy every three years.

More than twenty years later, I decided it was finally time for my first follow-up. I went into it knowing that my digestive health is the best it has ever been. Still, the confirmation of that fact delivered by the nurse was absolute music to my ears. Oh, and the cranberry juice she gave me was probably the most delicious beverage I have ever consumed, coming as it did after 36 hours of fasting, 24 hours of cleansing, and twelve hours without so much as a glass of water. Jokingly, she told me that the second juice was free, but that after it, each one would cost a dollar. I told her that if she could locate my pants, I had enough in my pockets to purchase seven juices at that price, but it would mean cutting into the tip I planned to leave on my pillow for the staff.

I would not consider the results of the test official until my gastroenterologist delivered them to me himself. So, this past Monday, I got up early to brave the thirty minutes in traffic, and the two hour wait in the office, followed by the five minutes of checking my vitals, so that the doctor could spend all of twenty seconds letting me know all was fine and that he would like to see me again in five years. That was it.

Had he not heard of Telehealth? Sure, this guy is no doubt an OG but certainly he experienced the pandemic and the need to do much of his consulting via phone or Zoom. Right? And certainly the “all clear, come back in 5 years” could have been delivered in a phone call that would have saved me my entire morning. Maybe he is so used to delivering bad news that he isn’t going to deprive himself of those in-person occasions to deliver good news. Whatever the reason, I was sort of pissed off when I left – grateful for the confirmation of what I knew to be true, but feeling like the entire process from prep, through procedure, through follow-up takes up way too much time to really warrant coming back again in the future.

Naturally, in five years, I will be singing a different tune, and I will be chugging the colonoscopy prep cleansing solution as if it’s my job. Still, I told a friend I have known since we were in college about the ordeal and how it didn’t seem right that I should be made to feel sort of shitty for several days just to get a clean bill of health. My friend told me that because of her health history, she has to undergo a colonoscopy every year, and because of that, and the toll the procedures take on her, she now forces her gastroenterologist to give her a Virtual Colonoscopy. Also known as CT Colonography, and while still requiring the full-cleanse prep, the external imagery used in this process does not require sedation or the invasive, flexible scope used in traditional colonoscopies. You can bet MY ass (since that’s the one at stake) that I will be calling upon my gastroenterologist to use this virtual imaging technique when it comes time for my next exam. Of course, my doctor hasn’t heard of Telehealth, so expecting him to master the intricacies of this 21^st century technology is probably going to prove an uphill battle. Change can be confusing and terrifying, even for doctors.

It’s a sign of the times in which we live that in writing about the conversation I had with my old college friend and in thinking that, perhaps, I should fully protect her identity by using a gender-neutral pro-noun, I wondered if doing so would imply that my friend was trans-gendered or non-binary identifying. Change, again, can be confusing. And none of us enjoy feeling stupid. I have a good friend and colleague who, in reviewing a document I once created, explained to me that I did not need to leave two spaces after a period, that one space was now accepted as standard. “When did that happen?” I demanded to know. It turns out the change in standard had happened some twenty years prior. Where was I the day that was decided? And how had no one told me about it in the intervening years? I had authored a lot of documents during that time, and no one pointed out the error. It was a real Rip Van Winkle type moment for me when finally I was told.

Earlier today, in researching the life and career of a filmmaker whose new work I greatly admire, I read a sentence referring to this individual as “they” and despite years of retraining myself in the usage of pronouns, my immediate thought was that this usage was a typo, or a reference error. When the usage was repeated later in the article, I did then realize the reason for its usage. Still, despite my best efforts, I get confused and I know that feeling confused is not fun for people. Again, no one wants to feel stupid, and everyone above a certain age, it seems, has had their own Rip Van Winkle moments.

At a meeting not that long ago, it was announced that we would begin by going around the table and in addition to introducing ourselves, we would state our preferred pronouns. I decided to have fun with this. I like having fun, after all. And so, when it was my turn, I declared that my preferred pronouns are “I” and “Me”. Immediately, it was clear that someone at the table was not happy about what I had said. This person looked at me and said, “I feel triggered by your joke.” Certainly it had not been my intention to upset or poke fun at anyone else.

So, I apologized, before adding, “Still, I can’t help noticing that you used the word ‘I’ in that sentence.” It seems to me that when we say what our “preferred pronouns” are, we are actually stating what pronouns we prefer OTHER people to use when referring to us. Some people clearly have trouble referring to people the way those people wish. To me, it’s just good manners to try and do so, like remembering someone’s name, and not just the name they were assigned at birth, but the name the individual chooses to go by.

When I was a young student, teachers would take roll call attendance the first day of class, and most of them, after calling out the “official” name of the student (i.e. the one they were given at birth, or, at least, the one under which they were registered for school), they would be interested in learning the names we wanted to be called. It was the teacher’s classroom, of course, so they could, to a degree do whatever they wanted. We students were merely temporary guests in that classroom. Good manners would suggest the importance of making one’s guests feel welcome, however, and the best way I know of making one feel welcome, is to make that person feel seen and appreciated.

Apparently, it is against the law for teachers in Florida to display good manners. There a state law requires teachers to use the pronouns that align with a student’s sex assigned at birth, even if the student identifies with different pronouns. Would those teachers be allowed to refer to a student as “Phil” if his given name at birth was “Philip”? I hope so, because if that student is anything like I was, then they associate the use of the full name “Philip” with their mothers getting angry with them! And if teachers are allowed to use a student’s preferred name, then … why are they allowed to do so? After all, their preferred name might not have been “assigned at birth”.

This law has been challenged, including by a teacher in Hillsborough County who argued that it was a violation of First Amendment rights. A couple weeks back, a federal appeals court ruled in favor of the state, upholding the law and ruling that as a public employee, a teacher’s speech is subject to the state’s control. Understandably, many have seen this law as part of a growing trend towards restricting LGBTQ+ rights, representation and expression. To me, if nothing else, the law and the ruling are attacks on good manners, though I suppose I should be comforted by the fact that our courts apparently have nothing more important to do than issue rulings about pronouns.

For some reason, there are people who deem a “preferred pronoun” as an attack, or a threat. Since the advent of the #MeToo movement, I have heard a lot about supposed attacks on “masculinity”. There have been a lot of complaints by men in my demographic grouping (i.e. white guys of a certain age) about how hard it is to be a white man in this country. Personally, I have found the truth to be completely the opposite. It is easier than ever for me to navigate the world and its sometimes-confusing changes. And it was the subject of preferred pronouns that drove this reality home to me.

Ordinarily, I try to use a person’s name when speaking to them, or about them. On one occasion in an acting class I was teaching some six years ago, when using a pronoun, I got it wrong. I had known their preferred pronoun and did not use it. They corrected me and I felt bad that I had given them cause to do so. Again, it was my class. I was the host. They were the guest. As such, I owed the manners any good host offers. Beyond that, as a teacher, I want to connect on a level of communication that will resonate most directly with my individual students. So, I apologized.

Apparently, beyond the apology, it was clear that I felt genuinely bad about my faux pas. During a break, this student approached and gently let me know that there was no reason to feel bad. “We don’t expect you to get it right,” they said. “We’re just glad you want to try.”

I had spent most of my life believing I had to achieve. Now, I was being told I simply needed to try. I was almost fifty years old and I felt like I was suddenly receiving participation trophies! “Trying” is such a low bar. Certainly even I can reach that level of decency!

Since that time, I have been regularly struck by how far decency, manners, and an open-heart can get a person, especially if that person is an aging, white male. Recently, Lily received a letter from her beloved Aunt Harrington. In it, while writing about Lily’s current confrontation with cancer, Harrington revealed that she has heard I am being “a saint” during this ordeal. Again, I feel the bar is being kept comfortably low for me. Aside from the rigorous logistical requirements to achieve sainthood, the individual in question must both die AND perform a minimum of two miracles after death. So, no, I am not expecting sainthood to be bestowed upon me any time soon. In fact, I am really not doing much of anything, except all that I can to support and encourage Lily’s mental health and physical strength during this challenge. She’s doing all the work. And honestly, anything I am doing, is purely out of selfishness as her health and well-being are what matter most to me in this world.

Lily has been participating in a clinical trial aimed at women like her, who are young, healthy and diagnosed with breast cancer. The early results have been quite promising and thus far, the treatments have spared her the side effects that standard of care treatments like chemotherapy often cause. There are challenging days, fatigue, pain, but it all has proven quite manageable and she seems, in many ways, healthier than she has ever been. In fact, the hardest part of this ordeal was the duration of time between the original discovery of the cancer and the start of treatments. After initial testing, it was clear that Lily had the most Shakespearean of cancers for there was disagreement among professionals. Was she “stage 2B” or NOT “2B”? That was the question!

Given that Lily is an actress, and that we had just attended a wedding in the actual Hamlet castle in Helsingør (aka “Elsinore”), Denmark, we found this uncertainty to be somewhat amusing. On the other hand, it also set the tone for the uncertainty that would mark the next several weeks as we assembled the team in whom we would entrust Lily’s future. All the while a perceived clock was ticking louder and louder. The many tests and examinations took their tolls on her endurance, but frustration surrounding delays in scheduling was the hardest part for Lily as that clock kept tick, tick, ticking.

Still, all you can do is … all you can do. Except, you can ALSO allow your mind to rest easy in the knowledge you have done all that is within your power and you CAN decide not to worry about that which is not within your control. Easier said than done, I know, and important at all times, but at those times when a positive outlook might just be the single most important tool for you to develop, rejecting worry can actually become a matter of life and death. And again, it’s easier to do if you know you’ve done everything you can. If you have, put away the need to get to the bottom of things.

Honestly, it’s not our job to get to the bottom of things.

As Trevor Howard’s character says to Joseph Cotten’s Holly Martins in The Third Man, “Death’s at the bottom of everything, Martins. Leave death to the professionals.”

My job is to behave with as much decency as I can, with as good of manners as I can, and with as much of an open heart as I am capable. When I do that, I tend to find that life gets easier and easier, even when the challenges get scarier and scarier, and even when the changes life brings become ever-more confusing.