Know Your Enema
So my consultation was on Wednesday, January 8th, 2025 and they immediately sent off for the pre-authorizations I would need for proton pencil-beam therapy. This included a PET Scan and an MRI, both of which still needed to be scheduled. Of course none of it mattered if my insurance didn’t approve it.
On Monday, January 13th, when I logged into work, I had an e-mail saying a decision had been made on my prior authorization and I could go view it on the interwebs. But part of me really didn’t want to because, although I was hopeful it would get approved, I had about a 70% surety in my soul that either the proton therapy wouldn’t be approved OR they would only approve 5 treatments and then I couldn’t do it any way.
But after a few dep breaths, I opened the message and to my surprise, everything had been automatically approved. My heart jumped into my throat and felt like my favorite team had just scored the winning touchdown in in the playoff game (which, in fact, my favorite team, Notre Dame, had done just that the previous week, so maybe I had some leftover excitement from that blessed event).
But…and there is always a but…the approval only mentioned five visits. Fuck my life. My excitement disappeared and fell into my shoes as I scanned and re-scanned it to make sure I hadn’t missed it. But no, this list only included 5 treatments. But that was five CT Visits. It didn’t say proton therapy visit. Confusion ushered in a headache and I sat back in my chair.
But (yes, another “but!”) wait! An approval letter was attached to the bottom of the form. I opened it, scanning through the words like a kid at Christmas, breathlessly reading hoping at the end was my Red Ryder bb gun.
The letter wasn’t that long and the last paragraph was what I was looking for.
“Proton Beam Therapy is considered an experimental therapy,” my heart sank as I read, “And your doctor has requested 28 treatments of proton beam therapy for your prostate cancer. It is the decision of Evernorth Healthcare that…”
My stomach turned and my blood throbbed in my temples, “we do approve all 28 treatments…”
There were more words, but I didn’t read them. “Approved all 28” was all I needed to see. Praise the Lord, and Hallelujah. I felt like I was truly blessed with a miracle.
I had immediately contacted my wife as I read through everything from my excitement about it all being approved to my dread of it looking like only five treatments to my euphoria over it actually being all 28 treatments. She shared in all my emotions and we both breathed a sigh of relief. This moment felt like…victory.
The next day I got a call about the MRI and PET Scan appointments and that they wanted me to have them both on the same day. I thought that might be asking a bit much, but then I realized that having the Xanax and getting them both out of the way at almost the same time really did sound like a good idea.
“So does Thursday the 23rd sound like it would work for you to have the MRI at 9:45 and the PET Scan at 11:30?” the scheduler asked.
“Sure,” I answered. I mean what choice did I have? “As long as it all gets approved.”
I still didn’t have approvals for the MRI or the PET Scan and I wasn’t paying it out of my pocket.
“Great,” she said, “I get you listed on the schedule. And don’t worry, if we have some kind of hiccup with approvals, we’ll cancel these appointments.”
Part of me hoped they would and that way I could avoid having to undergo the torture of these scans. I already felt anxiety welling up at the thought of my hefty body being buried completely in these machines.
“Oh, and we’ll be sending your Xanax prescription to your pharmacy,” (yes!), “And you’ll need a driver. Oh, and as prep for the MRI you’ll need to do an enema that morning.” (No!)
“Um…a what?” I asked.
“You’ll need to clear your colon so you have to do a fleet enema in the morning about 30 minutes before you come.”
“Well,” I told her, “I’m an hour away, so it’s going to be more than 30 minutes prior that I’ll be doing the enema.”
I sure as hell wasn’t doing it in the car.
“Oh, yeah ok,” she said, “That makes sense. We’ll let you know if there are any issues with the approvals. “
“Sounds good,” replied and ended the call.
But I sat staring for a few minutes. An enema? Seriously? I’m 57 years old and not once in my life had I ever had to do an enema. What new hell would this be?
Not too surprisingly my approvals for both scans came in the next few days so the next step was buying a Fleet enema. The scheduler told me they should be easy to find in any pharmacy, so off to Kroger I went. I had a few other things I needed, anyway.
I strolled through the pharmacy of Kroger scanning the laxative shelves for a Fleet Enema. I had no idea where to look, but this seemed like a good starting point. Finally after looking across every shelf from top to bottom, I saw them on the bottom shelf, but a guy stood in front of them. Now normally I wouldn’t mind saying “escuse me, buddy,” and grabbing what I needed, but I didn’t really want to draw attention to myself reaching for an enema, so I waited.
Well the dude was reading through a Pepto-Bismol bottle like his life depended on it. Just standing there staring at the back of the bottle. Look, pal, this isn’t the fucking articles of confederation, for crying out loud. It’s Pepto-Bismol. I finally had enough and did excuse myself and snatched the box with the fleet enema and just tossed it into my cart like I had nary a care.
Then I grabbed the other couple items I wanted and made my way to the checkout. I laid the enema, the KY lube (the enema tip was lubed but my asshole wasn’t so better safe than sorry), 3 bacon-wrapped filets and a case of beer on the conveyor belt. As the items inched towards the check-out girl, I suddenly realized how bad this might look to her and what thoughts she might be having as she rang them up. Like, “What kind of party are they having? And how many of these things are going up his ass?”
Well, none of her business. I just smiled, paid for them all and headed out. Mission accomplished.
Now Thursday came way too fast but at least I could finally stop worrying about it all. The day was here and I had to get it done. In fact, I had spent a lot of the week mentally preparing for the day. If, at any time during the week, I got anxious thinking about the twenty pound bag-of-shit that I was getting stuffed into a ten pound hole, I closed my eyes and did some deep breaths until the moment passed and I could move on with my day. And I kept psyching myself up all week that I had to get this done. I was going to get this done!
Now I stood naked in the bathroom, towel spread across the floor reading the instructions on an enema. How was I going to get this done? One thing I did know is not to take the Xanax first. It would probably have created a huge mess, but at least I wouldn’t have cared.
The enema itself looked like a small plastic water bottle with a 3” long orange tip attached to the top. The instructions were very helpful (dripping with sarcasm) and stated things like “insert lubricated tip in the direction of your navel.” Well, what other direction was I going to insert it? If I somehow could have inserted the bottom of the bottle in my ass, I only would have wound up with wet feet.
Casting the box aside and deciding I already had the right amount of training, I lay on my side and got down to business. What I had read earlier in the week on the internet is that the fluid from the enema should stay inside for anywhere from 5 to 15 minutes. Thankfully I did read enough of the instructions to see they said the time was 1-5 minutes.
I don’t know whose superhuman anus could stay closed for up to 15 minutes, but 3 was more than enough for me. I’ll spare you the details of the results other than to say imagine a really dirty Niagara Falls and there you have it.
So I showered and my chauffeur wife loaded the Xanax, the binder and the blindfold I packed for the MRI, and off we went. Traffic was far easier than either of us figured. We though Nashville traffic at 8:45 would be a cluster-foxtrot and take us at least an hour for the drive. But there was no traffic so I didn’t even need to take the Xanax until I got to the parking lot of the imaging building.
My wife was downright shocked at my easy-going nature. Up to this point she thought I would be despondent and angry, swearing and stomping my feet all the way and snapping at her every other sentence. In fact, she was so shocked by my affable attitude that she turned to me half way there and asked, “Why are you being so nice?”
All I could say was I had been practicing breathing exercises and this stuff had to get done if I was going to beat cancer, so my whole attitude had to change. Especially towards my wife who was my biggest supporter. I told her I was focused on not being so much of a dick.
By the time they called me in for the MRI, the Xanax had started to kick in. Now it wasn’t overwhelming like my wife and I though to where I might need a wheelchair to get anywhere. It really just make me sleepy and took the edge off. Like a couple of stiff drinks.
I got into the room and they put an IV needle in and I remember they put some large headphones on my ears and the nurse shouted some instructions that I could barely hear due to the headphones. I laid on the gurney bed and told them I was claustrophobic. They said they knew and immediately put a washcloth over my eyes. As I felt the bed getting pulled into the machine, I continued to remind myself that no matter what, I could NOT remove the washcloth.
I actually think it helped that I tried to do an MRI before, even though I failed. I already knew what the machine looked like and how small the entrance was, so it didn’t shock me. And the Xanax not only helped me forget some details of the MRI but I even nodded off a time or two, even with the loud banging that went on inside the machine.
Next this I knew a nurse was yelling “Okay, you’re coming out now” and a wave of relief washed over me. I did it. The nurse even said I was in the machine for 45 minutes. Well, thank you Xanax. My new best friend.
The nurses in the MRI building asked me if I had a PET Scan next and I tole them I did so they left the IV in my arm.
“It’ll save you from having to get stuck again. But don’t tell the people up front or we’ll get in trouble.”
Well unless they read my blog, your secret is safe with me. Now my wife shipped me across the street to the PET Scan building. Once again I was greeted by a nurse and taken back almost immediately. This time I kept my clothes on but I needed a radioactive fluid injected that took an hour to spread through my whole body. The nurse laid me back on what looked like a glorified camp chair that reclined. I told her I still had the IV needle in my arm and she replied that they had already called and told me I would. I thought that was supposed to be a secret?
At any rate, the nurse put a hypodermic into it and said, “this might burn a little,” and a little my ass. It burned like hell as she put it in, but only at the entry point. After that she offered me a pillow, which I accepted, and told me she’d be back in an hour.
I certainly still had the affects of the Xanax, although they had lessened, but I lay there and wondered what exactly I would do to pass the time because even though I closed my eyes, I didn’t think I’d fall asleep.
What seemed like seconds later, the nurse knocked at the door and said “okay, it’s time to go.” I had passed out almost immediately for one of the best hour-long naps I could remember. One of those naps that made my legs wobble as I tried to walk to the machine room. Well, the nap and the Xanax.
The PET Scan machine was about half the size of the MRI and had a four-foot-long tunnel in the middle that moved back and forth. I received no washcloth this time as the nurse helped me lay in the machine. But that seemed ok because my whole body would never be in the machine at the same time, and I still had Xanax coursing through my veins.
The nurse told me I had to have three scans of my whole body so to lay still or it would prolong the procedure, which she said would last about forty minutes, I resigned myself to once again “get’er done” and laid as still as I could and, in fact, dozed off another tie of two. Without any issues, the nurse declared we were finished and I would go.
The Xanax now felt like it was nearly gone and I felt a great pride at the day. I had conquered and enema, an MRI and a PET Scan all in the same day and still had time for lunch and quick stop at Total Wines. That was more of a reward for my amazing wife who stayed with me every step of the way.
But overall, it had been such a successful day and I glowed with success about it all. Let her buy whatever wine she wanted. Lord knows she deserves it and needs it putting up with me. But one more hurdle crossed and now all we could do was wait for the results. Everything from here on depended on those. And it wouldn’t all be good news.