“Stuff § Colonoscopy”, Scott Alexander2009-07-30 (ethics, anesthesia)⁠:

I will never think of the phrase “trouser snake” quite the same way again.

I spent the last two days shadowing a gastroenterologist: that’s a doctor who treats the digestive tract. A lot of it is colonoscopies. Today it was just one colonoscopy after another, for 8 hours. Colonoscopies are not fun to watch…

Then you go to the hospital, lay down in a lab, and get anaesthetized. The doctor, nurses, and technicians undress you and lay you on the table. Then they take a long metal snake-like robotic tube and stick it up your anus. On the front of the tube are a light and a video camera. The inside of your colon gets displayed on an HDTV screen for all the surrounding medical professionals to look at.

The procedure takes about 20 minutes, during which about 5 feet of tubing get stuck into your anus. If at any point the doctor sees something smallish that shouldn’t be there, he sticks a set of tiny mechanical scissor-y pincer-y things in the robot arm and cuts it out. If he sees something biggish that shouldn’t be there, he gives the robot arm a little lasso, and the arm lassos it, tightens, and then drags it out (giving a whole new meaning to the phrase “ass cowboy”).

…about a quarter of the time, the anesthetic didn’t work too well, and the patient was awake and in horrible, horrible pain. Outside of movies and TV, I’ve never seen someone in such pain before. And watching someone literally writhing in agony is a terrible, terrible experience.

What did the doctor say? He told me that they couldn’t up the anesthetic because an overdose could cause respiratory arrest, and that it wouldn’t matter because the anaesthetic on any dose caused severe short term memory loss and whatever happened the patient would forget all about it.

The second point, at least, was right on. One patient spent the entire procedure writhing in agony and screaming something incoherent to God. The doctor finished the procedure, took out the endoscope, and cut off the anesthetic, and the patient turned his head, looked the doctor right in the eye, smiled, and said, laughing “Wow, that wasn’t bad at all! Guess I slept right through it!”

It’s a philosophical conundrum. When I’m 50, and I want a colonoscopy, do I get one knowing it could be excruciatingly painful? Does pain even matter if 10 minutes later you don’t remember ever having it? If not, does any pain matter, seeing as we’ll all forget about it at death, if not earlier?

Eh, I’ll probably get the procedure. I was told most patients who the anesthetic doesn’t work well for are alcoholic, so not being a heavy drinker I’ll probably end up in the lucky 75%. And it does save lives. Still.