A friend my age who works in public health recently told me the story of his colonoscopy to get me comfortable with the idea of submitting to all the bullshit that the medical geniuses have determined, in their wisdom, that people like us have to endure. My response, quoting bits of his email, is below -- for posterity & stuff.

> They use something called conscious sedation (versed and fentanyl)

Doesn't sound like that much fun. If the medical types are going to talk me into letting them shove things up my butt, they're going to have to offer the fun drugs as compensation.

> cleaning out the plumbing) was the most trouble and that was not painful, just unusual.

It's good, I guess, that they don't put you in actual pain over these speculative procedures ( a word I detest in this context), but even the 'unusual' part makes me turn away from such things. I don't see the point of intervening in the functions of my friggin' organs unless there's something actively wrong. I get the statistical likelihood that they'll catch some sign and prevent future nastiness. I guess that's all fine. But I weigh it against the present nastiness of subjecting myself to their procedures, like I'm some set of squishy Legos that they can snap apart and snap back together in ways more pleasing to them.

I have a low-grade but compelling aversion to the whole medical process, to the point that I involve myself in it only at need. I don't know if it comes from all the trips to the emergency room as a kid, when the parents were in booze mode, or if it's just some fundamental distrust of strangers. But I really dislike interacting with the doctors, with all their suppositions and diagnostic heuristics, and the nurses even  moreso. I hate their brisk, artificially friendly little banter as they carry out whatever series of tasks they need to complete, using my person as the tool of their trade, so I should just sit there and submit and live up to the term 'patient.' Fat chance, honey. Unless they can convince me I'll be materially better off as a result of them manipulating parts of me in whatever way they choose, they can just keep their grimy paws to themselves.

I mean, what kind of person wants to earn a paycheck cleaning the gunk out of the colons of strangers? Do I want such a person coming up behind me with some unknown equipment in hand while I'm lying there all stoned? My answer is: No. I do not.

> They found and removed a polyp (40% of screens turn up something) but most are benign

Better not to have such things in there than to have them, I guess. But I don't want to know about polyps, whatever they are, or the different kinds or whatever. I've had to learn some about knees and spines as a result of various mishaps, but that's part of the deal. I'll leave well enough alone until it's no longer well enough, then I'll decide what to do.

> if they are not removed, you have an almost certain future with the bad stuff.

That's an important fact. Another one is that addressing that possibility requires 100% certainty of submitting to the medical procedural routine. To avoid the uncertainty of some badness, I would have to accept the absolute certainty of this other kind of badness. It's less bad, hypothetically anyway, so that's supposed to make it all OK. In truth, if I were to develop cancer, I would have a hard time going ahead with the treatments. Living the way my friend PJ did for something like 4 years to forestall the disease that ate him up in small pieces anyway just doesn't seem like a decent percentage. If I were in his position, with a business to run and young daughters to raise, I would fight for whatever chance I could get. But I'm getting old now, my commitment to the boys is pretty much fulfilled as far as I can tell, and I don't need to answer to anyone else anymore.
 
> I get to pony up a few bucks for the privilege.

Well, and the medical types get to bank a nice chunk of your and your insurance company's money for their part of the deal. Probably the cost-benefit numbers work out that it makes sense to pay for the privilege. There's a vast industry out there churning out 'services' that meet that test, people making their living using others' bodies as their finished products. I don't see that as any sort of sinister conspiracy, but it is certainly driven by companies looking for revenue. And the huge treatment bills they manage somehow to get people to pay skew the cost-benefit arithmetic in ways I find highly questionable. If treatment were not absolutely outrageously expensive, would the cost for a lot this stuff really be justified? I look forward to health-care reform ratcheting a lot of that abuse back over time, possibly making the diagnostic and prevention routines more sane.
 
> Lots of my work is convincing people to put up with a little inconvenience now for potentially better outcomes in the future.

I know, and that's why I'm responding at length. I don't want to beat you up about your work, certainly, or question your health care decisions. I know you're telling me about this stuff in an effort to help. I only want to present another perspective from the patient (or impatient) side of the exchange.

I'm looking at talking to the doctor about blood pressure. Part of it is the extra 40 lbs or so I'm carrying, and part of it might be drinking too much. I'm sure I get a lot more salt than I need in buying lunch every workday. I try to moderate all that to the extent I can. I hit the gym four days a week, on average, and I'm pretty active on weekends. I don't smoke, not so much because it killed both of my parents but just because it's stupid. I don't drink enough to make me actively sick, unlike both parents and most of both of their siblings. But I'm not going to subsist on rabbit food and water just to add enough years to my life that the boys will have to put a leash on me to keep me from wandering in traffic. Maybe I'll have to take medicine or something to lower my bp, but I really dislike that idea too. I'd rather do the best I can and see what happens from there.

I've given the question considerable thought, and I'd rather have a shorter, more pleasant life than a longer decline to the point that I'm somebody's logistical problem. These schedules of tests and procedures and stuff that they start recommending at our age seem like just steps in that long march toward death. I'd rather march in my own direction, and death can find me where it finds me.

For what it's worth . . .