N Touch
Sunday 19 January 2020
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You deserve a colonoscopy

I grew up with the grief and dread of cancer. The disease whose name you dared not speak.

Having a nurse for a grandmother, far from unpacking things medical, simply brought my child’s senses up closer to the mysteries of that world, the sneak-tour of the operating theatre, the awe of bright lights, sterility, needles, rubber, mechanical tools, glass bottles of lifewater, the scratch of starched uniforms, the smell of ether. The impenetrability of language.

For years now, I swoon visiting hospitals.

I remember the afterwork row between her and my mother, the bloodstained blouse, their sudden departure for the doctor. My parents had separated that April, which had had dramatic heights, and she’d hidden her illness to avoid being a burden.

Spite lingered into her death at 68 that December, her wish he not bear her coffin undone by a shortage of pallbearers, compelling him into carrying her left foot to her grave on Christmas Eve.

School afternoons before that, my sister and I would sit doing homework in the sun or waning light of the Caura compound’s circular road, the car parked to view the window of the ward where we’d watch my smiling grandmother wave. Then only a hand; and eventually the waving stopped. And the sobbing began. Every evening. Driving all the way home. It usually struck up once we hit the Beetham’s stretch; my big sister and I mounting a helplessly relentless chorus in response: “Mummy, don’t cry.” Over and over.

I remember the dread that followed for years. The panics. The obeah. The megadoses of Vitamin C. But it wasn’t until around 70 that my mother’s schoolfriend Kiddy found a lump in her breast. Treatment entailed the same emotional quality of family drama. But she would live another decade and a half.

Cancer is now small thing across my family, with several varieties between us; no longer the thing of such helplessness and shameful whispers. It’s serious, but matter of fact, something we live with, manage relatively rationally, bring up in polite conversation; exercise choices around. It still is, of course, something we die from; my mother four years ago with a tumour in her colon.

But that’s because much about cancer has changed. Radically more is known and understood than in the 1960s. A lot of cancer is now preventable and treatable. We’ve gone from a maze of uncertainty and contradiction about diet, lifestyle and genetics to some fairly reliable things that are not at all scientifically controversial. One of them is population screening as a public health measure.

Despite the unease of the Catholic church (which also opposed condoms way into the HIV epidemic, remember) you can protect your daughters – and sons – from cervical, anal and throat cancer with a vaccine against human papillomavirus (HPV). Mammograms and pap smears are routine parts of gynaecological care. The Prime Minister has schooled the nation’s men on suspending dread of the digital-rectal exam (DRE) – he was far more graphic – for early detection of prostate cancer.

Cancer is no respecter of age. When it develops in young people, it can be particularly heartbreaking. But cancer is also a factor of ageing: old bodies simply get cancer over time.

Cancers of the colon/rectum are the third most common globally, and in the Caribbean, and in TT’s top five causes of cancer death for both men and women. (Men in neighbouring Barbados had the sixth-highest rate globally.)

Western medicine’s gold standard for colorectal cancer-screening is the routine colonoscopy, starting at age 50. My young gastroenterologist Dr Shin told me playfully last month that at my age I deserved one.

But, unlike other cancer detection and prevention methods I’ve listed, colonoscopies aren’t as cheap, easy or low-tech; so for many doctors here, including my GP, they aren’t stressed. A flexible tube with a camera and tools inserted through the anus under anaesthesia allows a medical professional to visualise and remove tiny clumps of tissue or polyps that might become cancer. If they’re found pre-cancerous, the procedure is repeated in fewer years than if not. Colonoscopies are estimated to prevent two-thirds of lower-colon cancer deaths. Young people with family history of colon cancer are screened earlier than 50. New detection methods of stool-sampling are gaining popularity for their cost and ease (you’ve seen the TV ads), but positive results still require colonoscopy.

Colonoscopies have as much colourful legend – or more – than DREs. Polyp detection depends on a clean colon. The current standard for achieving that is a two-day liquid diet and Gatorade, followed by downing four litres of an unpleasant osmotic solution, and having a jet-ski experience over the loo.

For all my cancer literacy, this was all ignorance to me two weeks ago. I’d like to open up a playful, lifesaving conversation about colonoscopy. Start one with your doctors and loved ones today.

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