Stuff like this really makes me feel my age. Suddenly, at 43, I’m undergoing “procedures” that I used to hear my dad’s contemporaries talking about. I’m paying attention to my fiber intake, talking with friends about prostate exams and dealing with chronic heartburn. Middle age arrives in all its glory.
Over the past 5 years or so, I have periodically had these “attacks” while eating, an extremely intense stabbing pain at the base of my esophagus, under my breastbone, as if a muscle spasm had closed the end of my throat at the stomach. When it hits, I can no longer swallow anything, can’t breathe easily and have intense waves of nausea, but no actual vomiting. The attacks pass in 7-10 minutes, and leave no after-effect.
They have happened 10 or 15 times over this period, and have occurred on business trips, at home, in pubs, and dining with friends. They seem to have no predictable pattern nor triggering food, as I have been eating steak, lobster, chicken wings, and even stew at the time of the attack.
I had an endoscopy 4 years ago, in which a three-foot long tubular camera snaked down my throat to visualize the entire esophagus, and results were unremarkable. A wonderful amnesiac called Versed meant I have, mercifully, no recollection of that procedure, save that it was done on St. Patrick’s Day. Even semi-conscious I apparently remarked to my Irish doctor that “even you can’t be drunk yet if we’re starting at 7 a.m.” So much for patient-doctor respect. After a lull of many months without an attack, they began to happen again in December. Good Dr. Stassen, in what might be revenge for my St. Paddy’s Day remark, ordered a couple of rounds of tests designed, it would appear, to be as disgusting and uncomfortable as possible.
I spent last Thursday morning, after strict “nothing by mouth after midnight” orders, drinking radioactive chalk on an empty stomach in what is innocuously called an Upper GI Series and Barium Swallow. Garbed in scrubs too small on top, too large by 3 sizes on the bottom (why do they even make XXXL scrubs?) I was first asked to pound two shots of an Alka-Seltzer like substance in mid-fizz, then strive not to burp. I thought of “Mikey” (who according to urban legend died drinking Pepsi while eating carbonated “Pop Rocks”) as my stomach began to bloat. The idea, the toupee-wearing radiologist explained, was to distend my empty stomach by inflating it. Oh boy, this was going to be a fun morning. I was then handed a cup of what appeared to be concrete slurry or plaster of Paris, and nearly dropped it. Barium, used as a contrast agent on the series of X-rays and fluoroscope films, is a heavy liquid—an 8-ounce cup weighs almost one pound. The orange-haired radiologist suggests holding my pinky under the cup for support. My seasoned pinky, instinctively sensing a drink in my hand, is already there.
Then, squeezed between a giant lead wall and a fluoroscopic x-ray machine I was directed to fill my mouth with an ounce or two of this liquid, then swallow once and only once, on command as they shot films. The barium was chilled, and nominally mint-flavored—but let me tell you, Smoothie King need not be worried about the competition. It was like licking a chalkboard eraser, and the urge to swallow was huge, since a mouthful of this nasty liquid was heavy, weighing on the back of my throat and tasted so bad my body wanted nothing more than to get it out of its mouth.
Again and again I did this “swallow on command” trick as the doc attempted to expose film in mid-swallow. I finished almost a quart of this paste, and then he produced a pill the size of two stacked dimes, also radioactive no doubt. It is sized to just about fit through the opening of my throat, and just barely pass through the ring at the end of my throat; they are going to shoot movies of its trip down my pipes. I choke the horse pill down with a tiny swallow of the first water I have had in 9 hours and feel this bullet stick, then slip down. They of course, miss it on film. Let’s repeat that, shall we?
I now have in my too-empty stomach, 3 ounces of tummy-expanding fizz, a quart or so of nasty barium chalk slurry, two giant horse pills and a swallow of water. I am visualizing pancakes at Kerbey Lane.
The lead wall behind me now lowers to become a table, in a scene reminiscent of Bride of Frankenstein, with me in the Elsa Lanchester role. I am flat on my back, curiously aware of the contents of my stomach and possessed of an overwhelming urge to belch. Dr Toupee suggests fighting the urge. Now the rolling begins. In an attempt to coat my entire stomach with radioactive sludge, I am directed to roll over completely in one direction, then the other, then to turn to one side, then the other. The medium-sized scrub top is beginning to feel especially confining. The fizzy sludge pill water mixture in my stomach now seems to be reacting in some way to the movement, and I begin to think of Violet’s inflation in Willie Wonka. Farting had better be OK or this room is going to need paint.
Several new films are exposed, and more fluoroscope live-action video, which I can now see on the monitor. It is very strange to see your throat and stomach on television, highlighted like some sort of cartoon image, with ribs and spine and such in evidence as well. I look fat, even in x-ray. I roll on one side, breathe deeply, hold my breath and repeat on the other side for shot after shot as what seems a Chernobyl-sized dose of radiation is passed through my body. I feel we are wrapping up, when the Frankenstein table takes one more turn, lowering my head to about six inches below my feet as I am instructed to hold on to the sides so I don’t slip off. As I cling to the smooth metal table with a death grip, Dr. Toupee sticks a flexi-straw in my mouth and says, “I want you to swallow continuously until all the liquid is gone.” Blood rushing to my head, Kilauea erupting in my stomach, sweaty palms trying to hold myself on the table, I contemplate swallowing against gravity as I pray that what is in the cup is NOT more chilled minty sludge. Thankfully it’s water this time, but I am suddenly sucking eight ounces of water through a straw, swallowing “uphill” and hoping that nothing happens when water hits barium.
My lasting image of the day is the doctor’s rug, plastered against his head like a bathing cap of orange hair, inches from my face while he holds a cup of water and says “swallow, swallow, swallow, swallow” over and over. Not my idea of a dream date. But finally, with an admonition to “drink tons of water all day,” I was sent home.
[Scatological humor warning]
Left undiluted, Barium has a tendency to solidify in the digestive system,
useful if you’d like a post-mortem plaster cast of your colon, but not a good
idea if you ever want to eat (or shit) again. So, strangely unhungry after the tests, I began drinking lots
of water, and eating Ry-Krisp for a little solid food. About two hours after I got home, I
discovered that in addition to being “radio-opaque” barium is also a damn good
laxative.
The rest of the day was spent alternating between ingesting water and shitting glow-in-the-dark uranium-enriched poo. Unmolested by the best efforts of my digestive system, the leaden institutional green slurry had become heavyweight identically shaded green turds, though roughly doubled in quantity. I swear I must have shat a gallon of that stuff, despite only drinking a quart or so. I discovered that barium also befuddles the flushing mechanism of my toilet. Ten times heavier than ordinary shit, “ghost poo” appeared again and again after flushing, nuclear turds returning unscathed from an unsuccessful trip out of the bowl. I am far more familiar with my digestive output than I ever hoped to be. Eight to ten hours later I am still producing barium, wondering if I am subject to a nuclear non-proliferation treaty. Cottonelle moist wipes—take me away!
Having survived shitting myself inside out, and the radiological assault on my system I headed for the second round of tests, called EMM, or Esophageal Motility & Manometry. It sounded simple enough—a test to measure the internal pressure at various points in my throat, like a blood pressure cuff does. Then I thought about it—they are going to need a really big cuff to wrap around my chest. Unless…they have invented some sort of internal system? Yikes. I saw it immediately as I entered the small testing room. Attached to an office copier-sized device replete with gauges and dials was a three or four foot length of soda straw diameter clear tubing, marked with metric length measurements and containing sensors all long its length, especially a big one at the end. I am afraid I am going to have to swallow it.
The perky technician is wonderful, and takes time to cheerfully explain the process. Yes, that thing is going in my throat. No, I am not exactly going to swallow it. A sensor the size of a dime is taped to my ribcage, another to my throat, where they will record my breathing and swallowing. She coats the end of the hose liberally with a viscous fluid that looks suspiciously like snot from that Alien that Sigourney Weaver pissed off, and brings it close to my nose. I flash back to pre-med, and to Dr. Robinson’s anatomy class: how does the nose connect to the throat exactly? Is there a valve? A flap? An open pipeline? Before I can visualize it she explains.
She is going to slide this lubed tube up my NOSE, until she meets resistance, then wiggle it a little to enter my “pharynx” at which point I will feel “something in my throat,” something I learn is a euphemism for “a baby’s fist.” Then I will swallow hard a few times as she pushes, and this reel of clear garden hose will unspool down my gullet.
The body is a wonderful thing. It has all sorts of defenses, set up to instinctively ward off things that might cause it harm. Put your hand near flame, it jerks away. Snort dust and you sneeze. Put a baby (any mammalian infant) underwater and a diving reflex closes their throat and mouth. Wonderful. Way to go God! —Nice work. Friday I discovered another one, up close and personal. Stick something too far back in your throat and your body says “Whoa! Get that thing out of me!” and retches—the “gag reflex.” I’d like to think that years of shall we say, practice, had all but eliminated my gag reflex. Several dates have commented on that fact, some in utter amazement. Well, it’s still there. God is apparently not gay.
As the alien snot-lubed baby’s fist left my pharynx on the fantastic voyage to my esophagus, I immediately wondered just what I might vomit on the perky little technician, having once again endured fasting since a few chicken wings I finished just before midnight. Chicken? Celery? Pure stomach acid? It won’t be pretty. She deftly handed me not a bucket as I had hoped, but a tissue. She is an optimist. As I gag, she slides another yard or so of the magic tube into my throat, and the nausea passes, mercifully without output.
Nausea is replaced by that feeling you get when you try to swallow a huge pill without enough water—something totally stuck in the back of your throat. I lay down on the bed, wishing there were naked pictures or something similarly distracting on the ceiling. There is a thing in my throat. This delightful feeling remains for the 45 minutes or so the test takes, and is made even more fun by the knowledge that a long slippery tube is now sticking out of my NOSE and an awareness that the thing at the end is tickling the entrance of my STOMACH. I feel like I am being flossed.
I am now directed to swallow though there is nothing but saliva and a bit of leftover alien snot in my mouth. This sends little needles looking like a huge seismograph skittering all over a graph. I repeat this several times, while breathing, sometimes while holding my breath, as the technician slides the tube upward and downward a millimeter or so in my throat, measuring different points of pressure in the sphincter that closes the esophagus off from the stomach. My mind flashes between the thing stuck in the back of my throat, the slippery tube in my nose, the tickle at the base of my esophagus and the graph I can almost see out of the corner of my eye on the monitor.
After measuring the strength of my lower esophageal sphincter, she slides the tube out about 2 inches, and squirts an ounce of cold water into my mouth with a syringe, instructing me to swallow once and only once. This is repeated a dozen times or so, and I’m enjoying the cold water at least. It does not appear to be radioactive and does not taste like chalk. The tube is raised (pulled out) a bit at a time as she measures the contractile strength of various points in my esophagus. Alien snot is beginning to collect on the tip of my nose as it’s withdrawn. It seems that a foot or so has been pulled out, and yet I am still aware of it in my throat and beyond. As the test progresses, it reaches the point I am dreading, when the baby’s fist re-enters the pharynx. With a tug akin to that used when starting a chain saw, the technician whips the tube the rest of the way out before I have a chance to gag again.
I’m left with a vague soreness in my throat, and alien snot remnants dripping from my nose. The tissue comes in handy and I look at the computer screen, now covered in the onscreen equivalent of rolls of paper tracing. My own personal earthquake seismogram. A throatquake. If I had that monitor in me yesterday I’m sure it would have looked like the eruption of Mt Saint Helen’s.
At least there was no barium this time.