I want to tell you what happened with the colonoscopy that I philosophized about last year. A lot happened, actually, though it mainly involved the same thing repeated four times. Yes, friends, I traveled through my fiftieth year as a man for every season, and I met every season curled on my side in a hospital gown, unconscious. I still managed to learn a thing or two.

The rest of this post gets a little frank about my bodily and medical experiences; proceed with caution. I’m doing fine! You won’t miss worrying news if you bail out now.

My prep strategy

Before I get into the whys of it, let me say that having my first four colonoscopies all happen within one twelve-month period allowed me to rapidly refine my prep techniques. “Prep”, here, being the common nickname for the nasty stuff you must swallow to thoroughly clean out your guts for a proper examination. I learned that prep takes many forms, today. As a first step, I had to choose one.

My doctor gave me three choices of prep medicine: the old-school method of chugging a full gallon of “GaviLyte-G” solution, a newer technique that involved only two glasses of a different formula, or gulping down a lot of pills. I chose the big bottle twice, and the smaller drink twice. I found significantly more success using the GaviLyte, also known as GoLYTELY. Even though it’s the least pleasant of the options, I intend to continue choosing it in the future.

By my fourth round of prep, I had settled on this step-by-step:

1. Two days before the procedure, mix the prep according to its instructions, and refrigerate it.

2. The afternoon before the procedure, place these items on your kitchen counter:

   • A liquid measuring cup.
   • A drinking glass.
   • A little dish. If you have a dish in a fun shape that makes you happy, use that. I used a concrete banana designed by Alabaster Pizzo.
   • Eight coins or other tiny objects you can use as tokens. Do not put them in the dish yet.
   • A handful of hard candies, any color except red or purple. Pick something sweet and fruity. I used an assortment of sugar-free Jolly Ranchers.
   • A timer. I used the “Hey, Siri” voice controls on the various Apple devices I surround myself with.
   • Plenty of drinkable water. I just used tap water.
   • A paper towel or two.

3. At least eight hours before your usual bedtime, begin drinking the first half of the prep, repeating this procedure until all the tokens are in the dish:

   1. Measure out eight ounces of prep, then put the bottle back into the fridge.

   2. Pour the measured prep into the drinking glass.

   3. Put a hard candy in your mouth.

   4. Drink all of the prep that is in the drinking glass.

      This is the hard part, and you have to do it a lot. Go at a slow and steady pace, alternating sips with sucking on the candy. You don’t need to chug, but you do need to get that whole glass down within a few minutes. If you start feeling sick, take a short break to focus and breathe, without putting the glass down. Then get back to it, sip by sip.

   5. Place a token in the dish. This is you putting a point on the scoreboard, right? You’re one step closer to finishing.

   6. If there are still tokens outside of the dish, then set your timer for ten minutes.

   7. Take the candy out of your mouth and put it on the paper towel. You’ll use it again for the next glass. (Or just chew it up and eat it if it’s almost gone.)

   8. Fill the drinking glass with water, and drink the water.

   9. If you set the timer earlier, rest until it goes off. When it does, go back to the step “Measure out eight ounces of prep.” Otherwise, continue to the next step.

4. By this point, the prep should be half gone. You can take a longer break now! Set the timer for up to 60 minutes and relax. You can rest a little longer than that if you need to, but you shouldn’t delay for much more than an hour.

5. Remove all of the tokens from the dish.

6. Drink the other half of the solution, eight ounces at a time, following the same steps as before, starting with “Measure out eight ounces of prep.”

7. If there’s still a little prep left, drink it up using the same pacing and technique.

And that’s it; all the prep’s inside you now, doing its thing. This whole ordeal can take around six hours to complete, but you have to budget further time to handle the consequences. In my case, things don’t start moving until a couple of hours after I finish the prep.

I prefer to start in the afternoon and not the evening in order to avoid the misery of being awake past midnight with more drinking to do. You could start the process even earlier in the day, but since you cannot ingest anything besides water once you have emptied yourself, that just means a longer fast for no benefit. My method, when paired with a morning procedure, tries to balance a shorter fast with getting a good night’s sleep.

As for the the actual business of elimination, I find it untroubling. While the experience does resemble extreme diarrhea, the fact that it’s voluntary and predictable imbues it with a sense of accomplishment, rather than uncontrolled illness. It just happens, in a coldly mechanical way, until it’s finished. You have certainly weathered worse than this.

But now let me tell me why I did this four times.

How not to screw it up

My third colonoscopy happened because the second one revealed an unusually flat and large polyp that the team couldn’t casually snip away with the tools at hand. I needed to return for the services of a specialist-among-specialists to perform some trickier internal surgery. That went fine, but required a fourth visit several months later to confirm that it healed properly. I’m pleased to tell you that it had.

My second colonoscopy happened because I, the patient, utterly botched the preparation for the first one. My colon was flooded with “opaque liquid”, as the medical team put it, and what colon walls they could see were caked with undigested, grainy food. “It looked like birdseed in there,” the team lead told me, as I lay confused in the recovery bed.

Here is why this happened:

• I ignored the admonition to swallow nothing in the critical hours before the procedure. I somehow thought that water didn’t count—I mean, it’s water, right? Water!—so I chugged a tall glass or two right before leaving for the hospital, on the theory that it is always good to hydrate before a stressful situation. Reader, there are exceptions to everything, it turns out.

• I am sure that my doctor told me to switch to a low-fiber diet a few days before the procedure. Obviously, I didn’t listen. I love eating seeds and grains and lentils and fibrous roots and vegetables of all sorts, num num num. But, counterintuitively, you want to denude your guts of all these friendly helpers of day-to-day digestion. The doctors can’t see through this stuff while it’s wallpapering your colon, and the prep solution absolutely does not need its help in moving things along.

I adjusted both parameters for my next three colonoscopies, and none of these problems surfaced again. I didn’t need to turn my life upside-down for the diet: I just ate mindfully for the three or four days leading up to the procedure, and then restricted myself to only hot broth on the final day, right up until that first glass of prep goes down the hatch.

I am, as ever, very grateful to be alive now, when the technology and expertise exists to help my middle years stay as healthy as possible—and also lets me share what I’ve learned with you. I hope the year to come brings us both good health and prosperity, inside and out.

For further reading and friendly advice, see the delightful Welcome to Colonoscopy Land by Anne Helen Petersen. Thanks to Fogknife reader Tully H. for sharing this article with me last year.