Colonscopy and Liver Treats

 A sneak peek into How To Examine a Wolverine, which will be published by ECW Press on September 28, 2021. No, this peek does not involve wolverines. You'll have to buy the book for that. 

Colonscopy and Liver Treats

I'm sure you're wondering how colonoscopy and liver treats relate to each other, and if you've formulated a guess, I can almost guarantee you that it's wrong.

   

     Let's start with the liver treats. I've written before about how the rapid advancements in medical science and in the role of veterinary technologists have dramatically changed veterinary practice, but I'm here to tell you that nothing has had a greater impact on my day to day life as a small animal veterinarian than the advent of the freeze-dried liver treat.

    

    There are all sorts of good reasons for wanting my patients to like me. It makes my job more fun, it makes my job safer and it makes my patients dread seeing me less, which in turn means that my clients are more likely to bring them in when they should. And the best way to get them to like me is with food. This is trickier with cats, where less than half accept treats, regardless of the quality, but with dogs, if you have the right treat, 90% will take it and ask for more. We used to have terrible treats. They were the veterinary equivalent of the pediatrician handing out sticks of broccoli as a reward to the children coming to her office. Some dogs didn't care, but enough did that we decided to try and find something else. Something else that was at least respectably healthy. Fresh bacon would have been popular too, but there would have been... issues with that. Enter the freeze-dried liver treat. They are literally little chunks of dry liver. If you look carefully you can see the veins and stuff. I don't recommend you do. Dogs act as if they've just seen the face of God the first time they are given one of these. Dogs don't just like me now, they love me. I hand them out when I come in the room, I hand them out as I do things such as give needles and, most importantly, I hand them out at the end of the visit.

    Why "most importantly"? This is where colonoscopy comes in. Bear with me. In 1996 the Nobel prize-winning behavioural psychologist, Daniel Kahneman, and his colleague Ziv Carmon demonstrated what is called the "peak-end rule" using colonoscopy as an example. This rule states that people (and presumably animals) judge the quality of a remembered experience primarily by its peak, or most intense moment, and by how it ends, rather than by an aggregate or average of the entire experience. To demonstrate this they divided a group of human colonoscopy patients into two groups. The first group was subjected to the standard colonoscopy experience. The second group was given the identical colonoscopy with one key difference - at the end of the procedure the tip of the colonoscope was allowed to linger for three minutes longer and then slowly withdrawn. The second group subjectively evaluated their experience as significantly less unpleasant, even though it lasted longer. More colonoscopy was actually preferred! Why? It was less unpleasant because although the peak of the experience was the same, the end was better. Apparently, leaving the scope sit for a few minutes felt better than having it jostling around right up to the end. This has practical implications because the patients in the second group were more likely to agree to subsequent colonoscopies when recommended. (Incidentally, this experiment also begs important questions about sedation protocols wherever this was done, but never mind.)

    So, gentle readers, this is why the little mints and chocolates at the end of a restaurant meal are so important. Tips apparently increase on average by 14% when these are given. You may not even be conscious of it, but your feelings about the meal are most heavily influenced by the peak of it (most memorable moment) and by the last part. Just like colonoscopy. And I'm betting Rover feels the same way about his visit to my clinic. And even if he doesn't remember for next time, at least he's happier for that moment. That's worth something too.

Bas Cam!

This post is from my travel archives.

“Feelip, Feelip! Bas cam!”

A never-fail recipe for wholesale disorientation is to be awoken in the middle of the night by someone shouting incomprehensibly at you.

“Feelip, Feelip! Kwik! Da bas cam!!”

Arms, legs, blankets, backpacks, flashlights, bamboo mats, everything was in chaotic motion as Lorraine and I jumped up, thrashing about, trying to make some sense of the shouting.

It was Tapu.

Tapu was outside our hut and was hollering at us. I checked my watch. It was 2:30 in the morning. Neurons began to align. Tapu was trying to tell us that “the bus come”. The already objectionably early 5:00 a.m. bus to Apia was absurdly ahead of schedule.

We were on the remote and thinly populated south coast of Upolu, Western Samoa’s main island. Apia, the capital, was on the far side of the island. We had been staying with Tapu and his family for the last week and it was time to go to the airport. It was time to leave what had been a surreal cliché of South Seas living. Tall palms, empty beaches, sparkling water, thatched huts, happy people, seclusion, disconnection, peace... well, mostly peace.

Tapu had become frantic. “FEELIP!!! Da bas go! Da bas go!!!”

Sure enough, as we fell out of our hut, unzipped packs half slung over our shoulders, the thrashed yellow school bus began to inch forward.

“I need the bathroom!” Lorraine shouted, while running.

“No time!” I shouted back. This would prove to be a mistake.

We didn't want to leave. Of course we didn't want to leave. In part this was for the usual reasons people don't want to leave a beautiful place, but in part it was for other reasons. We were trying to come to terms with the fact that this could be the final leg of our eight month around the world vagabondage. The previous summer we had quit our jobs back in Winnipeg, put our possessions into precariously stacked boxes in Lorraine's parents basement, said goodbye to family and friends in an open-ended sort of way and then left without any actual plan for the eventual abstract “after”. Tanya and Byron, the tall guitar playing American couple who were also staying with Tapu were headed to Micronesia next and we wondered, could we stretch our funds just a little further?

We leapt onto the bus just as some advanced gear was engaged and it lurched forward from its slow roll into shuddering, swaying, flatulent propulsion. The driver flashed us a gappy grin and twisted the volume knob on the cassette deck bolted onto the ceiling. Bob Marley began to overpower the engine. We slid onto a small varnished wooden bench and stared in frank astonishment as Christmas lights festooned all around the inside of the front windshield, as well as an oversized Jesus nightlight on the dashboard, began to pulsate in perfect syncopation with “Buffalo Soldier”.

Not a single light was on anywhere outside and it was moonless and overcast, so the black surrounding our festively lit bus was otherworldly and dimensionless, creating the strong illusion of voyaging through outer space until suddenly the bus would slow and faces would materialize out of that void. These faces invariably belonged to colossal women in floral muumuus. Fat is beautiful to the Samoans, so if the vastness of the new passengers was anything to go by, the south coast was awash in hot women. The villages themselves were un-seeable in the black, but women kept appearing and kept climbing onto the bus, all of them full of remarkable good cheer given the hour. Through some trick of spatial geometry they managed to squeeze two abreast onto each little bench until all the benches were full.

The villages on the south shore had no shops, so the trip to Apia was primarily a shopping trip for most of them. Perhaps to pick up a few luxuries. Perhaps to stock up on Spam. Spam and corned beef had been introduced by the missionaries and were considered delicacies. In fact, as honoured guests we were served generously sized Spam chunks floating in ramen noodle soup (another store bought indulgence), while the family ate papayas and fresh greens and banana leaf steamed fish. Every garden was a rainbow riot of vegetables and chickens and fruit and cocoa trees that Sina, Tapu's wife, harvested, roasted, ground and made into hot cocoa for us every day. The sea was so thick with fish that they didn't bother with boats. A small group of men just waded out with sticks and beat the water, herding the fish into a net.

With some difficulty we persuaded them that we would prefer the local food too. Dinners became long delicious affairs in Tapu's open sided hut as we sat on the floor and ate the freshest most natural food imaginable while Byron strummed and Tanya sang softly. Eventually Tapu's family would start rolling over wherever they were sitting and fall asleep right there, starting with the grandmother and ending with Tapu himself. And then finally only the four foreigners were left awake, so we would quietly get up and wander back to our own huts in the starshine of a soft South Pacific night.

Eventually the bus entered another cluster of villages as again the faces appeared and again the aisle was filled with muumuus, smiles and a great deal of flesh. This was going to be interesting, I thought, as every bench was already occupied to an extent never dreamt of by the Blue Bird school bus manufacturers.

And it was interesting.

Friendly smiles were exchanged between sitters and would-be sitters and then the would-be sitters delicately clambered onto the sitters’ laps until there were four enormous women per bench. You may want to read that over again. Four. Per. Bench. Two above. Two below.

Finally Lorraine and I had the only remaining double occupancy bench. And then I was smiled at. I stared at the smiler. She smiled some more and began to swing her prodigious hind quarters around towards me. Zapped into action, I grabbed Lorraine, plunked her on my lap and slid to the window. Two women gracefully inserted themselves beside us. One above. One below.

Marley played on. Jesus pulsated. The bus lurched and farted deeper into the Samoan night.

You will recall that Lorraine needed the bathroom earlier. She still did. Even more so. Her brow was glossy with sweat and her mouth was set like a vice. With every lurch and bump she winced softly. This went on for almost two hours. How she didn’t succumb to a rupture, I honestly do not know. I suppose some of us just have inner sphincter strengths that we are unaware of until they are truly tested.

We finally sputtered into Apia’s main market at 5:30. I had assumed that the early start had been to allow everyone to get to the market for opening. But it didn’t open until 7:00. It was empty, save a handful of skeletal dogs scavenging through yesterday’s market’s remains.

It is so strange when I think back on this now, but when I calculate the time change, at that very moment back home my father was undergoing emergency brain surgery for a tumour that had suddenly declared itself with a storm of seizures. We had been a week without any communication with the outside world. There had been no way for anyone to reach us, although they were beside themselves with efforts to try. There in Apia, in the cool pre-dawn, looking out at the deserted market and trying to see the funny side of the bus situation, I had no idea that my life was being profoundly rearranged on the far side of the Pacific.

It was time to go home. The lack of a plan for after was no longer a problem, but a blessing.

We disembarked just as the eastern sky began to colour rose and saffron. Everyone else stayed on the bus and, including the driver, went immediately to sleep, their snores mixing with Bob Marley and the sounds of a small tropical city just coming to life.