The Rear Deck Express to Deathville

“Think continually how many physicians are dead after often fretting over the sick.”

I repeat this line from Marcus Aurelius as I chat with an anesthetist prior to a recent up-the-butt adventure trek at the hospital here in Siberia With a View.

The guy readies me for the procedure room where, after I am rendered senseless, a tube will be jammed through my rear entrance and up my colon, allowing a surgeon to take a gander at that glistening byway, and snip away any worrisome blips. (I also opted for endoscopy, figuring to double my fun.)

It’s not my first colonoscopy. Seated as I am before the threshold of oblivion, aged and addled, I’ve endured the process several times in the past, as part of insurance-funded attempts to stave off the more costly blight of colon cancer. I am a tube pro — and a moron, since I already have a cancer flitting about in my body in search of a roost, a cancer no tube can reach, one that will likely prompt my demise before colon cancer has the opportunity.

Yet, here I am, being readied for another colonoscopy. Some might call me a fool; others might claim I enjoy having things put up my ass. All might be right.

The anesthetist employs a style with which I’m familiar. A physician raised me, I grew up around physicians, I know the facades and techniques, and I enjoy observing the behavior of members of the medical profession as they go about their work. Most develop rudimentary acting skills designed to keep them at arm’s length from patients. We must grant them the right: they cannot afford to form too many emotional attachments, given they practice an art that ultimately ends with failure. It’s difficult to inform a terminally ill patient that he or she has no chance, though it must be done, but it is unnecessarily cruel to tell a patient she has no chance, as she arrives for her first-ever physical exam. A measure of tact is required, so as to skirt the truth; the doctor who delivers a babe to the arms of its parents should not remind them the cherished newborn is doomed.

This guy is more than slightly detached: he seems to have taken one too many med school classes in Restrained Bedside Manner. No warmth radiates from him as he stands behind a rolling stand bearing a computer and monitor, burly and gowned, businesslike, a surgical cap plopped atop his large head. The man has muscular forearms, and I gather he’s a member of the Crossfit cult, whose devotees obsessively display the rewards of their primitive exertions.

The anesthetist projects a matter-of-fact demeanor, complete with calm, deep voice, his mastery obvious, an air of confidence buttressing his affect. As he runs through the pre-op checklist with me, I imagine he’s pondering options for lunch, or that he’s fretting about his wife’s latest furniture purchase. Our meeting should be routine: I am one of five or six patients he will deal with during an average day’s excursion on the Poop Chute Express. I decide to derail the train.

Allergies to medications?




No. But, if I had a stroke, there’s a good chance I wouldn’t be able to remember it.

I am amused, he is not.

Is that a no?

Yes, it’s no.


Breathing problems?

Only when I move too often, or too far.

He asks again, his gaze fixed on the monitor. He elevates his eyebrows, and I detect a barely audible sigh.



Do you use oxygen at night?

I use it 24/7. Mammals require it. Fish do, as well.

He asks again, in an unmodulated tone, eyes glued to the monitor, thick finger jabbing a keyboard. I detect a barely audible sigh. The man seems fatigued, and it is only 8 a.m.



Do you drink alcohol?

Why, yes: often, and with abandon. How soon can I drink after the procedure?

Are you a heavy drinker?

Heavy to Carrie Nation, or heavy to Charles Bukowski?

It’s obvious he knows nothing of Carrie Nation, or Buk. He frowns, then uses hand gestures to illustrate his question, as if he’s dealing with an unruly, stupid kindergartner. First, he holds his hands two feet apart, and asks, Heavy, like this? Then, he draws his hands near to one another, and asks, Or heavy, like this?

Let’s say eighteen inches heavy. Perhaps a bit more on weekends.


Have you ever abused prescription drugs, or used illegal drugs?

How much time do you have?

Do you use these kinds of drugs, now?

Not often, they’re far too expensive, and most of my connections have died, or they’re in jail. Plus, university-trained botanists have created bud strains too powerful for me. But my friend, Joe, concocts a potent tincture and I indulge a dropper-full now and then; it’s strong enough that I get confused when I’m at the grocery store, but not so powerful that I can’t drive home. You know, I started smoking weed at fourteen, and …


Do you have liver problems?

No, but my liver does.

He doesn’t stir. He does sigh, however. It’s barely audible, but I hear it.

I underwent tests a few weeks ago; they revealed a smidge of fattiness, but the liver works remarkably well, given the abuse it’s endured for fifty-plus years. I like to say I am seventy, but my liver is three hundred-forty. I find the comment revealing, and entertaining.

He does not.


Kidney problems?

I still have two of them, as far as I know, but we should check for scars. There are Indonesian rogues who befriend you at a lounge, slip you a drug in a cocktail, then remove a kidney with an X-Acto knife while you lie unconscious in the bathtub in a motel room, leaving you bedded in the muck, to be discovered by a member of the housecleaning staff the next morning. I can’t be certain this hasn’t happened.


Heart problems.

An elephant has yet to sit on my chest.


Did you complete the required cleanse?

Swallowed it all, crapped it out. Nasty business.

Was the residue yellowish to clear this morning?

It reminded me of watery peach nectar, two shades of pale behind what my grandmother, Minnie, drank nearly every morning at breakfast. Minnie loved peach nectar, and Toad in the Hole. It’s easy to prepare, you take a piece of bread …


Are you familiar with the anesthesia process?

Know it well. I’ve been sliced, diced, drilled, probed, and modified quite a few times. A couple of times in severe fashion. I know the dark side. “Le petit mort” would be an apt description, were it not already in service.


The guy has no idea what “le petit mort” refers to, and I surmise his wife experiences it only when she’s alone.

I look at the ceiling tiles above me and imagine drawing those tiles, employing a loose linear perspective, sketching a plain of rectangles that recedes, jittery, toward a horizon line obscured by a distant wall, my feet, encased in hospital booties, protruding from beneath a blanket at the bottom of the picture plane.

I wonder if this might be the last time I see ceiling tiles. Bad things can happen when a somber doc squirts Dim Juice into a vein.

Do you have any questions?

Why, yes: I just finished work on a book, so do you know any decent agents? And, I have to sell some paintings. I need cash, stat! Do you like art? Does your wife need something to go with the new couch?

Doc remains unmoved, refusing to make eye contact with me. He sighs (barely audible), then puffs out the enormous chest behind his scrubs, and delivers a dose of med-wisdom. He aims to put the wise guy in his place.

The anesthetist huffs, smirks, then says: A lot of people, just like you, pretend to be stoic. But, when they drop their act, they’re terrified.

That’s when I hit him with the Marcus hammer. I reread The Meditations every year; I know my material. Perhaps I’m the first real Stoic (of a dilute sort) he’s met. I consider tossing him a morsel of Epictetus — tiny souls toting corpses, etc. — but I realize the gift would be wasted. I learned over the years that few doctors are widely read, or agile thinkers, for that matter. It’s a good thing: while I was frittering away my days sleeping through literature and philosophy classes, physicians-to-be were learning that the hipbone is connected to the leg bone. I can entertain dinner guests with comments about Pre-Socratic philosophers and obscure French writers, but no one at the table should trust me to perform bypass surgery.

The great Roman’s thought fails to make an impression on the anesthetist, as expected, leading me to think that a terrified being lurks behind the doc mask, a tiny soul toting a corpse. Physicians see too much to not know fear.

Before we take you to the procedure room, he says, I’m going to give you a little something through your IV that will mellow you out.

Anything you add to the main dose is welcome. In the past, I loved to mix powerful substances. Visit me when I’m moved to the recovery room, and I’ll tell you a story about the greatest speedball ever, Philadelphia, 1968. It involves a young woman with green teeth, whose mother made meatballs for a living.

I’m wheeled down the hallway and through a door to a brightly lit, cold room where the tube waits, coiled and ready to strike. I’m mellow.

The anesthetist turns a valve.

First, the dark.

Then, the light.

Then, the ceiling tiles.

I recline on a bed in the recovery room, my eyes open and I realize I am in a hospital. Then, I remember I am in a hospital in Siberia With a View. The hospital is a token of two types of decline and demise: mine, and that of my town.

Three-plus decades prior to tube time, the population of Siberia With a View was a fourth of what it is now, and I was nearing middle age, still healthy.

My family’s arrival caused little ripple in the fabric of the small community, its businesses providing the citizenry with few goods other than those needed to survive. The lights downtown went out at 7 p.m. as doors to several cafes closed; there was one traffic signal in the county. With an abundance of unemployed mill workers, timber men, ranch hands, and miners on the scene, the bar owners prospered.

Second- and third-generation residents comprised the foundation population, many of them with roots extending back to the creation of the community a century before. I went to work in the newspaper business and, after a short while, it was rare that I encountered a stranger.

Two doctors served town, county, and surrounding area back then, both of them young and overworked. One ministered to patients in an office located in a decrepit, moldy building near the town park; the other practiced in a decrepit, moldy facility across the highway from a decrepit, moldy grocery store.

The nearest hospital was an hour away and, until a certifiable ambulance service was established, patients in need of hospital care were motored west in the back of a station wagon. Some made it, some did not. The drive afforded views of the peaks, and the station wagon occasionally hit a deer or an elk.

If I had required a colonoscopy in the 80s, my doctor and friend, Jim, would have used a garden hose and a flashlight. I didn’t need the procedure. I needed very little in the way of medical attention. I was healthy, strong, and stupid, unaware of what would happen to my body a quarter century later, just as most residents of Siberia With a View were ignorant of what would happen to their mountain backwater in the decades to come. I suffered from minor ailments and recovered, the town suffered modest modifications, with minor ramifications. Neither of us was ready for the impending assault.

Now, I stare at ceiling tiles in a hospital, and there are doctors galore in Siberia With a View. There is an extensive emergency medical service, with ambulances, paramedics and EMTs; a big, and growing primary care facility; an ER, an ICU, beds, nurses, specialists, a surgery unit. There’s a large nursing home in town (administrators call it an extended care center, to temper the blow) with a second under construction.

There are far too many strangers wandering about, and what little remains of the old town is disappearing, fast.

Why? Because, as the greedy, zombie carnival touts cheerfully proclaim: We’ve been discovered! Isn’t it great?

Not really. Discovery has not worked well for me, or for Siberia With a View. The thing discovered might be a small town in the San Juans, or cancer blooming in one’s nether region. Regardless, the changes that follow such discoveries are seldom for the better.

With the pace of immigration quickening since the turn of this century, newcomers required the benefits they enjoyed in the cities and suburbs they abandoned; they needed a comfortable, familiar environment. Just as prostate cancer cells evaded a surgeon’s blade eight years ago, seeping out to seek a home in my bones or brain, a legion of travelers escaped cities and motored to this spot in southwest Colorado. The immigrants spread like the cells spread in my body, determined to kill the host.

Our newcomers are part of a crowd that continues to relocate to the Mountain West, and Siberia With a View is not different from other, previously isolated mountain towns. These once subdued burgs now brim with Chamber of Commerce shills, developers, realtors, and other boosters who boast of hospitals and advanced medical services. They squeal gleefully, shouting, We’ve been discovered! as they tip glasses at a wine and cheese party held near an empty lot where a decrepit clinic once stood. There are few second- or third-generation residents at the party.

Privileged immigrants arrive loaded with an abundance of pretense and cash, and require things the old town couldn’t provide. They need mega mansions located behind massive gates that trumpet the owner’s importance and wealth; huge SUVs and diesel pickups; grotesque off-road vehicles, useful for the destruction of alpine meadows and tundra; large cowboy hats for retired corporate middle managers (all with more hat than cattle); a huge supermarket offering vital products — fish raised at farms in Cambodia and Norway, eighty brands of yogurt, expensive cheeses with foreign names, vegan treats, frozen potstickers, and gluten-free sludge; a Wal Mart (why drive an hour to buy a carload of crap?); psychics, lawyers, property owners associations, microbreweries and bistros. A hospital.

Less prosperous refugees, arriving without skills, clad in camo wear, bearing a brace of firearms and dreams of a doublewide and militia membership, need things as well: pawn shops, fast food and ammo vendors, dollar stores, cheap barbecue outlets. A hospital.

The facilities and services surely comfort recent arrivals, most of them near my age — Boomers fleeing environments they soiled to a point where Siberia With a View, by comparison, is the “most beautiful place on earth,” as advertised by cynical boosters. Some of the more naive barkers go so far as to describe the place as “pristine,” having never opened a dictionary. Newcomers buy it, and demand more change.

As I near the moment when I cross the threshold mentioned earlier, I admit the availability of the hospital and medical services is desirable, in one respect: I’m going to need them in the near future. I will soon enough be trucked to the hospital in an ambulance, with expensive tests ready for my rapidly wasting body, a host of doctors and nurses prepared to hover over me. Thankfully, I’m to the point where the inevitability of my decline occupies me only when I wake in the middle of the night.

But, the loss of the old town saddens me, regularly, as does the fact most newcomers have little or no idea of what was here three or more decades before they provoked a lethal infection. The newcomers don’t care to know. This is, after all, the most beautiful place on earth, if only because they live here. It’s a paradise — just as a healthy body is a paradise whose ruin, unanticipated, is steady on its course, noxious cells scooting through the bloodstream, releasing telltale antigens in their wake.

I gaze at the ceiling tiles, considering the fact the old Siberia With a View is gone, and that I, too, am well on my way. The hospital visit drives home the point. Patients eventually die, upon departure to be planted, burned, or left on an ice flow as food for carrion, and so, too, do places, communities, and paradise change, fail, and expire.

Tests do me little good at this point, but I continue to submit. I suppose I endure procedures in order to break my daily routine, to count the number of faces I do not recognize. An interlude allows me to toy with an anesthetist, and become familiar with one of the last places I am likely to see before I die.

I am a small soul toting a corpse. My asshole itches, and my throat hurts.

I shake off the last effects of the knockout drops, and I remember one other thing as I put on my clothes and leave the hospital, certain of my return.

“The universe is change; our life is what our thoughts make of it.”

Damned Roman.

Note: I have several Southern Ute acquaintances who push the timeline for ruin and loss in this part of the world back a century or two, so I suppose I, and my ancestors who arrived in Colorado more than 130 years ago, fit the mould of the destructive interloper as neatly as any couple fleeing Orange County or Dallas in 2010. I have little solid ground on which to stand while I act the critic. But, this won’t stop me. I am nothing, if not a hypocrite. And somewhat stoic.












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6 Responses to The Rear Deck Express to Deathville

  1. Lorraine Bowen says:

    Right on, Karl! I will stay in the big city and leave you to Siberia With a View and all the new amenities.

  2. wm musson says:

    depressing, karl, but so true for most all of america….as for the colon condition, mine is a virgin, realizing it may be a mistake, but i have fear…..9 weeks until spring….

  3. Hugh O'Neill says:

    What a great read. I just discovered this through FB. Thoroughly enjoyable. Thanks Karl.

  4. Jim McQuiggin says:

    Excellent piece, one of the best I’ve read.

    I get so lost in my own writing, I rarely get to see what good writing looks like. Glad I got to read this.

  5. Kathleen B. Isberg says:

    Good job, old guy! Very thoroughly depressing, but well thought out. You haven’t lost your touch.

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