Gulp: Adventures on the Alimentary Canal (32 page)

Jones points out that the body has a tendency to rewire itself as it sees fit. A 1984 study followed four patients who’d had the operation. Within two years, the diarrhea had returned.

For milder cases, a shift of perspective may be helpful. “When I see a patient with a little bit of diarrhea,” Michael Levitt told me, “I say, ‘Just be happy you’re not constipated.’”

*
But not boiling hot coffee. The contemporary fad for coffee enemas has sent more than one person to the emergency room with a partially cooked colon. I first heard about this from a veteran ER nurse. “You have no idea what people will do to themselves,” she wrote in an e-mail. “Forget to remove the potato that you used as a pessary until you noticed a vine sprouting between your legs? Decided to do your own nose job at the bathroom mirror and replace the cartilage with a leftover piece from last night’s chicken dinner? You have no idea.”

*
The
D
stood for “Doctor.” Garfield’s doctor was Dr. Doctor Willard Bliss. For reasons lost to time, Bliss’s parents named their boy after a New England physician, Dr. Samuel Willard. It would seem they mistook the doctor’s title for his first name, for rather than naming their son Samuel Willard Bliss, as the custom would dictate, they christened him Doctor Willard Bliss. Perhaps to simplify his life, the boy went into medicine—despite a seeming shortage of aptitude and professional ethics. In addition to allegedly hastening Garfield’s death (and then submitting a bill for $25,000—around half a million in today’s currency), Bliss is said to have employed untrained cabinet members’ wives as nurses. Conveniently, no matter what happened, even were he stripped of his medical license, he would always be Doctor Bliss.

*
Why an entire book about rectal alimentation? Because, said Bliss, it is “more interesting than any romance.”

*
The priestly handbook
The Celebration of Mass
helpfully enumerates other substances that may enter the digestive tract without technically breaking one’s fast: gargled mouthwash; swallowed pieces of fingernail, hair, and chapped skin from the lips; and “blood that comes from . . . the gums.”

*
Given the situation with rabbits and their fecal pellets, you would think the producers of commercial rabbit food would have steered clear of the word
pellets.
When, say, the Kaytee brand boasts, “Quality, nutritious ingredients in a pellet diet that rabbits love,” I don’t necessarily picture a bag of kibble.

*
Which explains the otherwise curious legislative decision to pass an edict that “no Roman need feel reticent about passing flatus in public.”

*
Is drinking holy water allowed? Clearcut answers are elusive. One priest I contacted pointed out that holy water is baptismal water, meant for blessing and dunking, not drinking. Another, however, directed me to the website of McKay Church Goods, which sells five different models of “Holy Water tanks.” These are six-gallon freestanding dispensers with push-button spigots, along the lines of the office water cooler but with a cross on top. There are definitely parishioners who drink it, and priests who wish they wouldn’t. St. Mary’s Parish in Cutler, California, has had both. In 1995, Father Anthony Sancho-Boyles, to discourage tippling, resorted to the old practice of adding salt to the holy water. The following Sunday a woman complained, saying that she used the holy water to make coffee in the mornings, and now her coffee tasted funny.

*
Pronounced “nidarians.” But not to be confused with the Nidarians, elite players of the online game Remnants of Skystone. The cnidarians are covered with stinging cells. The Nidarians are covered with purple mold and are entitled to “two extra attacks per class,” “a 10 percent discount when using Spores,” and “more baking and brewing possibilities.”

16

I’m All Stopped Up

ELVIS PRESLEY’S MEGACOLON, AND OTHER RUMINATIONS ON DEATH BY CONSTIPATION

L
ENIN’S TOMB IS
unusual among public memorials in that it displays the man’s actual remains. As such, it attracts not only those who wish to pay respect, but others, like me, who are simply curious. Either way, death demands a respectful silence, and one cannot easily distinguish mourner from gawker. I was reminded of Lenin’s tomb when I visited the Mütter Museum, in Philadelphia, to view the remains of a man identified as J.W. There was the glass case and the careful curatorial lighting, the transfixed but largely unreadable faces of the visitors, the general hush and horror of it.

The J.W. vitrine doesn’t exhibit a corpse—just a colon. That this glass case is not much larger than the one that holds Lenin tells you two things: Vladimir Ilyich Lenin was a small man, and the colon of J.W. was enormous: twenty-eight inches around at its most distended point. I remember standing there thinking,
It wears the same size jeans as me
. A normal colon, perhaps three inches around, has been laid alongside for scale.

What happened here? Hirschsprung’s disease. As J.W.’s embryonic self was laying down nerves along the length of the colon, the process petered out. The final stretch was left without. As a result, peristalsis—the wave of contraction and dilation that moves things through the gut—stops right there. Digesta pile up until the pressure builds to a point where it shoves things through. The shove might happen every few days, or it might take weeks. Just behind the dead zone, the colon becomes overstretched and damaged—a floppy, passive, swollen thing. The megacolon may eventually take up so much room that it begins to bully other organs. Taking a deep breath is a struggle. J.W.’s heart and lungs were thrust upward and outward to the point where they pushed the ribs aside and began jutting horizontally from the torso.

Without surgery, a megacolon like J.W.’s will prevail. If the specimen is spectacular enough, it finds its way to a museum, earning a toehold in medical history while the man himself fades to obscurity. This was the case, too, with the megacolon of a Mr. K., written up in the
Journal of the American Medical Association
in 1902. In a photograph that accompanies the article, the organ lies on what appears to be a hospital bed, as though it grew so big that it eventually eclipsed Mr. K. entirely and the doctors and nurses took to caring for it in his place, changing the sheets, bringing meals on trays, putting bendy straws in its ginger ale. All we know about poor Mr. K. is that he lived in Groton, South Dakota. Everything else has been subsumed by the details of the autopsy and a frightful chronology of doctor-assisted evacuations. From a medical aside, we glean that Mr. K. had a family and that they seemed to care about him: “June 22, the report was received that he had passed an ordinary pailful of feces. . . . There was much rejoicing in the family.”

Anna Dhody, the Mütter Museum curator, led me down to the basement
^*
to see what we could learn about J.W. the man. The file holds a reprint of a paper presented at the College of Physicians of Philadelphia on April 6, 1892, by Henry Formad, Demonstrator of Morbid Anatomy. On top of overseeing the “rather voluminous autopsy,” Formad had interviewed J.W.’s mother. The woman recalled that “disturbances in defecation” and abdominal swelling had been evident by age two, suggesting Hirschsprung’s. J.W. began working at sixteen, first in a foundry and later a refinery. All the while, his belly continued to swell. In a photograph taken shortly before he died, he stands in a doctor’s wood-floor examining room, naked except for hospital slippers, baggy white socks, and a few days’ growth of beard. He looks directly at the camera with a demeanor of calm defiance. Imagine the biggest potbelly, the longest overdue triplets, on a meager frame of knobby limbs. The bastard offspring of Humpty Dumpty and Olive Oyl. To better capture the great torso on film, the photographer had instructed J.W. to raise one hand to his head. The cheesecake pose invites you to stare, but everything else says, Look away.

By the age of twenty, J.W.’s physique had grown so peculiar that he was hired by a freak show in Philadelphia’s old Ninth and Arch Museum. The museum’s first floor housed carnival-style tests of strength and fun-house mirrors, and I imagined J.W. hanging around those mirrors on his breaks, positioning his girth just so and taking in the bittersweet sight of himself as a normally proportioned man. J.W. was exhibited under the carnival name Balloon Man, along with the Minnesota Woolly Baby
^*
and an assortment of other human and animal oddities.

Formad made no reference to J.W.’s emotional state other than to note that he was unmarried and, justifiably, given to drink.

Y
OU DON’T NEED
a megacolon to fall victim to “defecation-associated sudden death,” but it helps. At the age of twenty-nine, J.W. was found dead on the floor of the bathroom at the club where he regularly took his dinners. The autopsy report described the death as instantaneous, but there was no evidence of a heart attack or a stroke. Likewise, our Mr. K. died at 2
A.M.
while straining, as they say, at stool.

“That’s what killed Elvis,” said Adrianne Noe. Noe is the director of the National Museum of Health and Medicine, which has its own megacolon, from an unknown party. As we were about to get off the phone, Elvis Presley dropped into the conversation. Noe related that she’d been standing by the megacolon exhibit one day and a visitor told her that Elvis had had one too. The man added that Presley had struggled with constipation his whole life and that as a child his mother Gladys had had to “manually disimpact” him. “He said that’s why Elvis was so close to his mother.”

A quiet moment followed. “Really.”

“That’s what he said.”

I had heard that Presley died on the toilet, but I’d assumed the location was happenstance, as it was with Judy Garland and Lenny Bruce: an embarrassing setting for a standard celebrity overdose. But the straining-at-stool theory made some sense. With all three autopsies—that of J.W., Mr. K., and E., as Presley’s intimates called him—the collapse was abrupt and the autopsy revealed no obvious cause of death. (Though Presley had traces of several prescription drugs in his blood, none was present at a lethal level.) What Elvis’s autopsy did unambiguously reveal was a colon two to three times normal size.

At the time it happened, no one pinned Presley’s death on his colon or efforts to empty it. It wasn’t until years later that Dan Warlick, the coroner on the case, came forward with the megacolon/straining-at-stool theory. Presley’s longtime doctor, George “Nick” Nichopoulos, was an eager adopter of Warlick’s theory. Nichopoulos had been vilified for overprescribing prescription drugs, and many fans blamed him for Presley’s death. He wrote a memoir and made himself available to talk to the press. Few seemed inclined to listen. The reference I came across was on a website hawking herbal constipation remedies. A short piece headlined “Elvis Died of Constipation” had run as the site’s lead story (and its middle and last story) under the category Constipation News.

Why didn’t the colonic inertia theory come up earlier? Nichopoulos says that at the time, he had never heard of it. Nor had the gastroenterologist who treated Presley in the 1970s. “Nobody knew about it back then,” Nichopoulos says.

I recall reading in one of Charles Tyrrell’s books that advances in medical knowledge about the colon had, historically, been hobbled by the organ’s repulsiveness. Eighteenth-and nineteenth-century dissectors and anatomy instructors would, he claimed, promptly cut the lower bowel out of the cadaver and throw it away, “on account of its scent-bag propensities and nastiness.” Michael Sappol, a historian with the National Library of Medicine who has written extensively on the history of anatomy, said he’d heard this too. Leading me to wonder: Does distaste slow progress in treating diseases of the bowel? Does the excretion taboo discourage research, discussion, media attention?