It’s Invasive, It’s Unpleasant And It Can Save Your Life

March 14, 2000

“It’s time. You’re over 50,” my internist said casually during my routine physical in November.

“I’m sure you don’t want to hear this, but you really should have a colonoscopy. Is there colon cancer in your family?”

“Actually, there was,” I answered. “My maternal grandmother had it late in life.”
“Then this is no longer elective,” he added decisively. “You have to do it.”

Great. Another invasive procedure. I already had multiple sclerosis, with my share of ordeals by procedure, steroid injections under my eyes and catheters snaked through arteries from my groin to my brain. I didn’t particularly want to participate in this next adventure. I just wanted to be indemnified against another disease.

So now it would be the tush test. A television camera inserted into my rectum. The closer I came to the appointed hour with the gastroenterologist, the more I realized my utter horror was increasing and was out of proportion. What’s wrong with this picture?

Colonoscopies save lives. They can detect colorectal cancer early. Most malignancies in the colon begin as benign polyps. Only one in four people will have a polyp, which can be removed painlessly during the procedure before it ever becomes malignant. The only colonoscopy with an uncertain outcome is the first. There is no way to know in that situation what is growing and how long it has festered before being discovered.

My story, precisely. A polyp was removed and no one thought much of it. Over 90 percent are benign. It was biopsied, and I learned I had a malignancy. It took four hours of surgery and a resected colon, but soon enough the cancer was gone.

I was left with a sore lower back from the incision and a powerful sense of how lucky I was. The cancer was found early. The colonoscopy had saved my life. I realized, though, how close I had come to postponing, if not altogether ignoring my internist’s advice.

During the pre-op work-up, I had asked my 69-year-old internist with the unequivocal advice when he had last subjected himself to the dreaded procedure.

“I’ve never had one,” he muttered.

“Why?” I asked, not even trying to mask my incredulity.

“Stupidity. Denial,” he admitted. “I want to be a doctor, not a patient.” Then, he added, “I’m going to get one next month.”

Right.

Never has a single procedure, a test that can save lives been greeted by more resistance, indeed repulsion. Colon cancer is the second leading cancer killer in America. Contrary to popular belief, it hits both genders as an equal opportunity killer. Undergoing a colonoscopy every five years, three, if there is a family history, is practically a fail-safe guarantee against the disease. Yet many people don’t want any part of the procedure.

“It’s a shame. People don’t know what colonoscopies are about today,” said Dr. Blair Lewis, a gastroenterologist at Mount Sinai. “They’ve changed. It’s not like the old sigmoidoscopies, which were blunt instruments examining the lower colon. People don’t understand that today the instrument is flexible and the whole thing is painless.”

It is painless. I know that now. A cocktail of sedatives takes the edge off the discomfort, which is more in our heads than in our rumps anyway. There are no pain receptors in the colon, and you can watch the event progress on a television monitor at no extra charge. The pictures seemed almost impressionist, very color intensive to me. Maybe it was the drugs. Only slight abdominal pressure registered, but the truth is, our phobias are all about the instant of entry, the long anticipated, awful anal invasion that makes grown men cringe.

Face it. Guys are wimps. Women are used to routine medical invasion. Alas, it is their lot in life. By the time a woman hits 50 and heads for the doctor, earlier if there is a family history, she has been probed and prodded in every orifice. Women who have borne children should laugh at such male distress. When Colonoscopy Claus comes down the chimney, women may not jingle bells, but they seem to sigh and embrace him.

“I just did it.” says Neen Hunt, executive director of the Lasker Foundation, which supports medical research. “My mother died of colon cancer, and I had my first colonoscopy when I was 40. I’m now 57, and I’ve had a few more. It’s too important to my family not to do it.”

My mother, Terry Cohen, a retired registered nurse and staff instructor, has had three colonoscopies and a few sigmoidoscopies before that. “I didn’t have any particular anxieties about them. I wasn’t happy, but I just did it. As a woman, I’ve been through worse than that. I was just concerned about the outcome.”

Her outcome was just fine, but that doesn’t seem to be what is on the minds of men. Jim Hightower, former agriculture commissioner of Texas and author of “If the Gods Had Meant Us To Vote, They Would Have Given Us Candidates” (HarperCollins), stopped by for lunch recently. I talk about this stuff with everyone these days.

Jim is 57 and has yet to undergo the procedure. “My father died of colon cancer,” he said, shaking his head. “I know I should have one.”

With colon cancer in the family, any person’s risk of acquiring the disease doubles by age 40. For those people, resisting colon cancer screening is playing Russian roulette. Jim claims he watches his diet and eats fiber regularly and, yes, is going to get a colonoscopy. “I’m going to do it. I just haven’t gotten there yet.”

Right.

The most common method of colon cancer screening is flexible sigmoidoscopy because it is now covered by Medicare. It is not adequate in more than 50 percent of the applications, though, because it does not reach the upper colon. So, colonoscopy remains the probe of choice. The modern, flexible sigmoidoscopy is less intrusive, but still there is resistance. The American College of Gastroenterologists runs a never-ending advertising campaign with the warning, “People will die of embarrassment.” Beyond embarrassment, the mere thought of these procedures touches on a common fear of invasion with many men.

“Fear of the procedures and the failure of doctors to adequately explain them are the problem,” explains Dr. Philip Schoenfeld, director of gastroenterology research at the National Naval Medical Center in Bethesda, Md. Personally, I think it is the failure of Americans to just grow up. While there are no firm numbers, researchers estimate that only about 15 percent of people over 50 get colonoscopies.

Look. These tush tests stink. You have to drink hemlock and pour your guts out in preparation for the blessed event. It is sort of like the morning after going to a bad ethnic restaurant. But clean intestines are happy intestines.

Insurance hassles never end, if you are lucky enough to be insured at all. Carriers go out of their way to cut costs, of course, and they can make screening colonoscopies almost impossible to obtain. Usually, the procedure is covered only when there is cause. But the bottom line, so-to-speak, is that these procedures are just not fun.

Whoever said that fighting cancer should be fun?

After the Fall

April 11, 1993

He tumbled into that narrow space like a shiny penny disappearing into his new ceramic piggy bank. It was a slow-motion movie sequence, and I was powerless to stop it. A quick glance up at me, devoid of all expression, and he vanished. Our careful choreography had gone awry. Parent instinctively trying to watch over child. That grown-up caution that guides the movements of a little boy, not yet 4, had broken down. Failed. People always say, when it happens, it is sudden. It was.

The train ride was to be a small reward for a large rash he was withstanding and learning to ignore. More than I can say for his parents. We had driven into the city to consult with the dreaded doctor. That called for some token goodie, more than lunch at “Old McDonald’s” could provide. A train ride was as good as it got, at least as far as Ben was concerned. So why not?

Truffaut’s film “Small Change” long ago had gently placed the idea of quirky and unpredictable childhood crises into a little wrinkle of my consciousness. How could life be so fragile and children so durable in the same moment? I didn’t have children of my own then. I could not even imagine it. But the horror of that child in the movie plunging out of a 10-story window reaches inside and tears, though in the movie the baby laughs with delight and crawls on.

The sky was bright this Saturday, and when we got out of the car at Marble Hill, on Manhattan’s northern tip, and yelled “Bye, Mom” and “See you at Ardsley,” we headed down the steep stairway to a platform on the river. Ben’s Blue Train would be along shortly. Trains are Ben’s passion. Thomas the Train, the Red Train (Amtrak), the Blue Train (Metro-North). They speak to him. They are childhood’s friends, benign and exciting. Their engines huff and puff across the countryside and tell him wondrous tales in his bed at night. Our train pulled in and sat motionless, poised to head up the Hudson.

We held hands, especially there, because of the dangerous, wide gap between platform and train. The physical contact felt good. Ben needs me too, I always think, when he reaches for me. I am so acutely aware of his magnetic link to his mother. We jumped onto the train and then, as others came and went, Ben suddenly looked back at the platform and yelped: “Look, Dad. Your CNN card.”

My work ID was lying on the platform by the open door. It surprised me, and I quickly told Ben to stay where he was while I fetched it. In an instant I was on the platform, only a long step from the doors, bent over and recovering my card. When I heard Ben yell, “Let me help,” my hand shot up instinctively in the universal language of, “No.”

It’s truly a blur now, but I think I did it. I didn’t know he had jumped to follow, and I think it was my extended arm that knocked him back and down the slot into the toaster. It took a moment to register that Ben was down. Squeezed in between platform and train, thousands of tons of huffing, wheezing steel, ready to roar on. No longer benign, it was a metal monster about to eat my son.

I have covered bloody conflict from Lebanon to El Salvador, and I have never known the razor-sharp terror like that uncertain moment when a little person, your little person, is in mortal danger and you don’t know what to do.

The lesson of the Beirut rooftop comes clear: Do something. The hiss of a rocket-propelled grenade, and anyone who hears it has about two seconds to act. Just do something. Anything.

I pleaded with startled travelers not to let the doors close. Trains with open doors don’t move. People were horrified and motionless. Mannequins. I guess no one knew what to do.

“My God,” I quickly wondered, “where is the third rail, humming with electricity?” The toaster with a knife sticking out.

“Ben, don’t move,” I yelled, as my eyes adjusted to the darkness down there and I saw him half-prostrate in front of a wheel twice his size. He was trying to get to his feet.

“Put your hands in the air. High. As high as you can!” Two little tightly clenched fists appear below the level of the platform. I drop to my belly and scoop up the dazed child I have knocked down there in the first place. No hero. Just the survivors of a self-inflicted wound.

The nightmares have started now. In two beds. It was all probably less threatening than what the mind’s eye captured that afternoon. What might have happened. The videotape in my head plays and replays the hideous possibilities: the disaster that might have been. The same fall on an empty platform with no help. The fruitless scream and a Blue Train in a hurry to make up for its chronic tardiness. It could have happened across the platform where the third rail runs under people’s feet as they get on and off the train.

It’s hard to know what is in Ben’s head. He’s not saying much, though at least he is not accusing me of trying to do him in.

“Tell me about the tracks,” he says when he wakes in the mornings. And before he goes to sleep. He has his videotape, too, but he does not seem to be sure what the images say to him.

“Leave your wallet home. Please,” he beseeches. “You won’t lose your card when you go to New York City.”

Ben also suggests from time to time that he is too young to take the Blue Train for a while. And he tells his mother the Blue Train is crying because of what happened that afternoon.

Fathers have enough trouble convincing themselves, never mind moms, that we are competent guardians for the children, even when we are only out on a summer expedition. She didn’t blame me for the accident, but I wonder what she really thought. I knew that it was my fault. The chasm was wide, the fall quick, but I let it happen. My tears just weren’t good enough.

I won’t stop thinking about this for a long time. I hope Ben does.

In war, your number is up when it’s up. Even at home, on the battlefield that matters, our hold on life is fragile. Sometimes we get only one mistake. Our children can only look up at us. The trust in the eyes of a child is overpowering. Especially when you know you have failed once and been given a second chance.

To Reporters: Quit South Africa

August 31, 1987

South Africa is winning the war of images, and that is changing the way the entire world looks at the human struggle in that faraway land. In the name of more accurate and sensitive coverage, perhaps the time has come for Western news organizations, specifically American network news operations, to say ”enough” to the Government in Pretoria and to pick up our marbles and go home.

The current state of emergency regulations imposed by the Government have now been in effect for more than a year. These restrictions severely limit what publications and broadcasts can say about events in the townships or homelands or anywhere else there.
More significantly for television, the rigid prohibitions extend to pictures. Here’s what that means: We cannot broadcast or even shoot pictures of any unrest, which is defined by South African authorities. We cannot show police or security forces acting in their official capacity trying to ”keep the peace.” Our cameras are not supposed to be within telescopic range of such events. The point is not what the media can no longer do, it is what the public no longer sees.

So the recent strike by black miners against the gold and diamond industries is reported almost as a routine labor story. Never mind that workers have been herded out of company owned housing and sent away. Never mind that miners have been shot and killed by authorities under mysterious circumstances. Because we cannot see pictures of these incidents, it is harder to comprehend what is going on.

The American consciousness about South Africa, I believe, was formed and maintained by the constant television images of brutal repression in many forms: the image of the padded, faceless policeman, club raised; the image of a black youth with fear covering every inch of his face as he throws a rock. These were constant and common images, and now they are missing.

One day in October 1985, an innocuous truck, driven by whites, moved ostentatiously through the streets of Cape Town. It was out of place and provocative, and when black kids began throwing rocks, the truck stopped and armed police jumped out of boxes on the back of the truck.

At CBS, we always referred to that day as the ”Trojan Horse” incident. The surprise attack, the beatings and arrests were captured in frightening detail on videotape by a CBS cameraman who risked great injury to keep his camera rolling. Such were the risks our South African colleagues took daily. Those pictures were broadcast that night on the CBS Evening News and were seen by millions of Americans. By the next morning, they were all over European television.

They are called tight shots. The camera moves in close enough to see the expression on a face, even the look in an eye. In South Africa, they are the narrow, harrowing images of oppression. If a picture is worth a thousand words, television can do what column inch after column inch of newspaper copy cannot. Television can raise the consciousness of a nation.

These images are no longer on American television because we cannot broadcast them, for fear of being expelled from South Africa. We play an insidious game of video appeasement with the Government. Walk up to the line. Don’t cross it. Show as much as you think you can get away with, never more.

While we compromise to keep our credentials in South Africa, we no longer truly cover events as we used to. As a result, Americans’ passion for that story, the identification with the human struggle and the underdog have receded.

I wonder if the American people wouldn’t be better served if the networks were thrown out of South Africa or just left on their own. In this day of quality home video, there would probably be many sources for pictures of the events that we can no longer legally record or broadcast. We would get pictures, a colleague once pointed out, from every cowboy with a camera. The gloves would be off. No more deals with the Government. We smuggle pictures out of the wilderness of Afghanistan. We could do the same in South Africa.

Pretoria knows that. Perhaps that’s why we’re still there.

Sightless On the Subway, Smelling Trouble

February 16, 1998

Because I’m legally blind, my daily descent into the subway is a journey into ominous fog, a comedy-adventure where the audience gets a few cheap laughs and the actor doesn’t much like the script or the jokes. He does like the adventure, though. To the sighted, it probably sounds more terrifying than what it really is: just another day down below. There is an underground world beneath the streets that I can observe with total clarity, a shrieking circus, a sideshow of perpetual motion and vast proportions, and the ticket is only a token.

Besides, I have hidden guidance systems to get me by, in my other senses and my general talent for survival. My nose, for example, is terrific, maybe the organ most useful in steering me through stations and subway cars. I know which seats to avoid and which characters to keep at a distance, even when my back is turned. When you can’t see, the phrase “smelling trouble” takes on a very literal meaning.

My audio radar is always on, too. I hear a train approaching, and I also hear someone behind me who should be in front of me. I keep the types who sound threatening between my vulnerability and the tracks.

Fortunately, my awful eyesight is mostly my secret, usually undetectable. I don’t follow a dog, carry a cane or even wear a pair of Coke-bottle glasses to signal my disability. Others with poor vision can put on spectacles, of course, but there is no prescription to correct optic nerves ravaged by multiple sclerosis. No, I’m just some guy regularly bumping into pillars and falling on the stairs. My passage along the platform is not exactly subtle, and sometimes I think you’d have to be blind not to notice. But nobody seems to. I’ve never even had my pocket picked.

In fact, I like the subway; I enjoy the types I meet down there. I just have to be a little more cautious than other riders. One of my favorite tactics is simple avoidance of eye contact with anyone, but it’s difficult to maintain, because my stares are necessarily long and intense as I struggle to keep my bearings on a moving subway car. The result is that people who just need to talk to someone can spot me from the far end of the car. I’m an easy mark, though usually the most they demand is small change. The subterranean branch of the Jehovah’s Witnesses also has demonstrated a special concern for my salvation.

Yes, mine is truly a different kind of ride above and below Broadway, and it stays different when I struggle up into the altered state of negotiating the avenues and streets in a haze. With a navigational system that is all noise and an occasional whiff, I cruise a city I cannot clearly see. It is unnerving and a great challenge, an opportunity to experience New York on a level utterly apart from the average commuter. For someone who is visually challenged-or as some of us prefer, goddamned blind-a commute is frequently an exercise in beating the odds one more time.

My city is blurred into an Impressionist canvas, forever on the easel. It changes with the light, the humidity and my own mood. It fades from detail and clarity into undefined shapes and washed-out colors, often only the merest suggestion of what is actually out there. The picture begins at about 10 paces away, the critical distance in any respectable duel. That is as far as my visual reach extends in my daily sparring with New York. Beyond that distance, I operate on instinct, if not by wits.

The Fellini feeling of my travels is often defined by little mishaps: the ladies’ room I thought was the men’s room, the jar I assumed was Parmesan cheese. Have you ever liberally applied sugar to a slice of pizza? It’s no great shakes.

The other day, I was headed for an early appointment in midtown. I ducked into what I thought was a deli on Seventh Avenue to pick up a bagel. I followed my nose on that one, but I figured I had walked through the wrong door and was in the kitchen, where men were busy baking and paying no attention to me, the customer.

As I approached what I took to be the entry into the restaurant portion of this place, I saw a man heading into the same short passage, walking right toward me. I politely stepped to the left to let him pass. He did the same. I moved the other way. He mimicked me again. I looked up at him in my usual silent rage, then suddenly realized I was staring straight into a large mirror, taking umbrage at my own choreography.

The guys behind the counter didn’t applaud, nor even blink. They just stared, wide-eyed, as I blushed and hurried out. I’ve never learned to conceal or even deflect embarrassment, though occasionally I can’t help laughing. It is pretty funny, and sometimes I am great spectator sport.

I am a terrific jaywalker. Jaywalking is an art, and blind people play the piano, so crossing the street should be as easy as child’s scales. The key to successful survival as a blind jaywalker is all in the ears. It’s like audibles called at the line of scrimmage.

My ears tell me a car is starting and about to move. They measure the speed of a vehicle already in motion. I can even determine what gear the auto is running in. My ears, however, are not so good at determining whether that cab bearing down on me is going to stop or just run over me. By the time the brakes squeal, it could be too late.

O.K., jaywalking is risky, but so is life. I’m in it for the experience, you know, the thrill of victory. I’m certainly in no hurry, having learned to leave for any appointment on the early side. It takes time to zigzag across the street constantly, searching for some restaurant when I know only which block it’s on and can’t read the actual address. Sometimes I can correct my compass by smelling the food from down the street.

I’m not going to claim with phony cheerfulness that it’s just terrific sport to be legally blind in this or any other city. It was a lot more fun, when I still had my eyesight, to jump in my car and head for the nearest urban fire exit. And I used to sprint across streets without worrying about falling into a manhole. In the end, though, New York remains its own best show, even for someone who can’t quite see it.

Yet my emotional endurance is tested constantly by the effort not to humiliate myself too much, to maintain my optimism and self-confidence. Limitations may be camouflaged and kept almost private, but they cannot be denied to oneself. The loss of control is certainly humbling. Anyway, everyone I know thinks that he or she is suffering. If I were a psychoanalyst, I would soon be yelling at every patient to stop complaining, to just quit whining.

I don’t think I’m a whiner, and I’m not always careening out of control, anyway. Actually, I know the city better than you do. I connect with it every day on levels that you, the sighted, cannot see. I will surely survive New York because I know what I am up against, and my eyes are wide open.