Washing myself in the shower, it suddenly registers that I haven’t farted this morning. Straight away I know I am in trouble. A tummy ache is a commonplace, tummy aches come and go, but this one is different. My bowel has fallen silent. No wind music. Big news, bad news.
I dry myself, lie down and palpate my abdomen.
Is it distended?
Hard to tell.
Is it tender?
Listening with the stethoscope, I hear nothing.
I listen harder, longer.
Silence. A clamorous silence, speaking in clinical tongues of bowel obstruction, of an absence of vomiting, of a pain that has been colicky in nature, and is worsening.
I am 64.
A person of that age with a large bowel obstruction most probably has bowel cancer.
That can’t be me. I don’t do cancer. I eat, I run, I work, I fart, I tell fart jokes.
I am large with life, I don’t have cancer.
And yet I hear myself observe that this patient is an Ashkenazic Jew. He has no comforting past history, of diverticular disease, of ulcerative colitis, of Crohn’s Disease. And his aged mother had a pre-cancerous bowel polyp.
This old bloke, this rationalising self-deceiver has bowel cancer.
I feel a surprising, deep calm. I have cancer, I have ignored two decades of advice to undergo colonoscopy, and now I have bowel cancer.
I will die.
A peaceful knowing. So this is how it comes, this is how. I know now the what and the how, and I have some intimation of the when.
It is 9.00 am. I haven’t eaten since last night. My tummy ache saw to that. All I’ve had is a few mouthfuls of water.
Time to call some colleagues. I could call Peter. He treated Mum for her polyp. He and I used to go to the same youth group. Peter’s a very good general surgeon. But for some reason I don’t relish Peter looking up my bum.
I ring Nick. He’s already made one incursion into my bowel. Prior to repairing my twin hernias, Nick checked my prostate. Prior to that, it had always been one-way traffic in my colon, all southbound. I never aspired to any change, but nowadays I am a regular thoroughfare for any doctor with a glove and a pretext.
Nick is an excellent surgeon, a kind man, he’ll do.
I phone him, give the history of an unnamed 64-year old, give my diagnosis, suggest prompt admission and surgery.
Nick concurs. Subject to his examination, some imaging, and so long as the patient is fit enough and well hydrated, he’ll operate today.
Only now do I divulge the identity of my patient, myself. As I do so, I am the hero in my own story. I have a feeling of singularity, the same feeling of unrecognized celebrity hidden in the shell of my ordinary self that I had on the morning of my wedding day.
Nick is taken aback.
Are you kidding, Howard?
No, Nick. Dead serious.
Nick arranges to admit me to the Mercy. He asks me to continue fasting and to get myself down there straight away. No tablets, they’ll give me an injection for the pain when I arrive.
I know I am a doctor. Does the admissions clerk know?
Do I really have to read these informed consent pages?
Must I deliver, straightface, answers to a thousand questions about past health, present health, family history, drug allergies, today’s symptoms?
I could just say, I am a doctor. I know my diagnosis, there is no relevant past or family history other than Mum’s bowel polyp. Do we really need to go through all the routines that you have for patients?
Yes we do.
I smile at my absurdity. A good thing on a day of bad news: humour carries you a long way on this uncertain, highly certain, path to dusty death.
Was it was only last night that I was reading Solzhenitzin’s Cancer Ward? A patient is offered a book to read.
“Why should I read? I am going to die.”
“Just read faster then.”
I might need to read a lot faster. Among the few things that I packed for hospital are the short poems of Emily Dickenson and “War and Peace”.
At home, I did family things, ordinary person things. I talked to Mark, my lawyer, dictated over the phone the simple change I want to make in my Will.
When I rang work and told Caitlin I’ll be out of action for six weeks, and why, Caitlin gasped, her voice caught in a quick sob. I comforted her.
Julie, the clinic manager, is older. But she sounded distressed too. I explained that, apart from a belly ache I was feeling ok. “I’m feeling myself, Julie. The only difference is I can’t fart.”
Unusually, Julie had no laughter. I comforted her too.
I had become a doctor again, not an ordinary person.
It‘s more manageable that way.
Postscript: Many members of my family do not like this piece. The only true elements are the facts that I am a doctor and that doctors do not readily adjust to being patients.
This piece is a sketch of how this doctor imagines he’d react to the astonishing experience of a fartless morning and a diagnosis of bowel obstruction.