Updated 11 June 2015

A guy's worst nightmare

William Smook found a large amount of crimson blood in his stool. Could it be cancer? He goes on an embarrassing journey to find out.


There has to be a good reason for you to allow two total strangers to insert cold, hard devices and liquid metal where the sun doesn’t shine in a single day. William Smook did it without being tied down. Here's why.

She's petite and looks like a cross between Sade and Halle Berry. She smiles reassuringly and asks me to undress and join her in a room containing what looks like a drill press. Soon I'm wearing a neatly pressed blue gown that ties at the back and leaves little latitude for dignity, let alone imagination.

Only George Clooney looks good in these things - I can feel a draught. I'm hungry, gritty-eyed, tired, thirsty, nervous and light-headed. And there's a lingering sensation that someone has had a go at my nether regions with sandpaper. Also, it's 9 a.m. and I haven't had any coffee.

It started four days earlier when I found a large amount of exuberantly crimson blood in my stool (not bar furniture - it's medical terminology for a dump). I'd seen darkish bits before, but fresh blood was new. I'm not fetishist about what comes out of me, but I think it's a good way to gauge my health. So I called my doctor, who said he'd like to see me the next day: "Probably nothing to worry about, but let's be sure."

Liquid metal

I expected the surgical-glove-and-KY-Jelly routine, but instead he booked me in for something called a barium enema. "It's more than likely an internal haemorrhoid, but bleeding of this sort does occasionally indicate something more sinister." He meant cancer of the colon, but didn't say it. Colon cancer is big: in the US, only heart disease kills more people.

About 93 800 cases of colon cancer and 36 400 of rectal cancer were reported in the US alone in 2003. Colorectal cancers are the third most common type of cancers in men. An estimated 56 300 deaths (47 700 from colon cancer, 8 600 from rectal cancer) were reported in the US in the same year. In South Africa colorectal cancer is the third most virulent form of the disease.

A major cause is eating too many fatty foods and not enough fibre. I do neither, but I also forget about my muesli some mornings, so I’m a little worried. I was booked for the enema at a private hospital: in short, a barium enema is where they shove liquid metal up your bum and then make X-rays of it to see whether there are any growths.

The second invasive procedure of the day would be colon hydrotherapy, where they very gently (I'm told) pump warm water into your colon to flush it out. This would help rid the plumbing of any remaining barium, as well as cleaning me up generally. It wasn't part of my GP’s normal procedure, but having read about it I think it should help.

Candid camera

I called at a pharmacy to collect a kit that I'd need to purge myself the day before the enema. I handed in my form and was asked to wait. What followed was like a scene from Candid Camera: with a dozen or so people waiting in the dispensary and the receptionist called: "WHO'S HERE FOR THE ENEMA MEDICATION?" Heads whipped around like in a music video. All I could do was join in with the fun. I leapt up flicking my right into the air like the time back in primary school when I knew the date the Titanic sank, and went: "Me, me, me." And then I collected my stuff and left briskly.

The kit consisted of a typed sheet stating what I was allowed to eat, and stapled to it was an envelope containing three yellow tablets and something the size, shape and weight of a .38 Special cartridge sealed in tin foil. Charming – a glycerine suppository.

The day before the enema I followed the diet prescribed by the pharmacy judiciously. Instead of my usual hearty fare, I actually ate less than they prescribe (Note to supermodels: worrying can be a handy appetite suppressant), but made an effort to drink plenty of water. I skipped the generous allowance of a slice of bread at lunch and supper, but tucked into my single helping of jelly and one block of chicken stock dissolved in hot water. I bought milk of magnesia at an all-hours chemist and downed 125 mls of it in water. It tasted like whitewash mixed with fine river sand. About an hour later it hit my intestines like a flash flood in a ravine.


I'll spare the details, but it was an unforgettable night that's best forgotten, like the only time you ever allowed your older sister to set up a blind date for you. I remember an old black & white Titanic movie (Not the blockbuster where Lanky Leo posed at the sharp end and the Canadian lass with good bone structure sang "My Heart Will Gooo Waaaaaaaaaahhhhhnn.").

It was called A Night To Remember and the sound effects were similar to my travail: the rushing of water, explosions (the ship's boilers, in the case of the movie) and cries of anguish. The next few hours scored 5/5 on my misery scale: imagine having root canal work while listening to Boney M's greatest hits and you're about there.

My sympathetic wife eventually put a pillow over her head. The cat went to sleep in the lounge, and my young son demanded that I play with him at 4.40 a.m., seeing that I was up anyway. At 7 a.m. I weighed myself and found that somehow I'd lost 7kgs in three days. I felt moderately gratified. I peeled the sliver bullet and thumbed it into the chamber – ouch.

So now, two hours later I'm in my drafty gown and the petite radiologist bids me stand with my back to a steel wall and bare feet on a rubber platform. She hits a lever and the entire apparatus tilts backwards, with me on it. The metal is cold. Apart from wondering whether I'll come out of all this with bolts through my neck and impressive scars across a heavy if green-tinged brow, it feels okay. I'm not doing any of the work.

Mike Tyson

Halle Berry asks me to roll onto my side and draw up my knees and suddenly I wonder whether the fact that she's cute makes this easier or more difficult to handle. She says she's going to gently insert a speculum into my rectum: "It's not big. It's no thicker than my little finger," she reassures me. I'm grateful suddenly that she's so small-boned, and that Mike Tyson chose boxing over radiology.

She adds that there's a small balloon at the end of the speculum that she'll inflate to keep the barium in. I try not to think about this. Every inflated balloon I've ever seen was bigger than my head. In goes the speculum: it's cold, hard, and far less fun than Windhoek Draught (no pun intended) - but less torturous than Boney M.

It hurts a little and is pretty uncomfortable, but I'm still breathing. Once the balloon’s inflated I’m conscious of its presence, but there’s no pain.

Halle Berry asks me to roll onto my back on the cold steel and tells me she's going to pump some barium into my colon, followed by a "small amount" of air. The barium will coat the walls of the colon. Filling it with air will provide better contrast on the X-ray, enabling those who know what to look for with the best possible view.

I look around. The cheery blue and white plastic bottle of barium hangs from a stand and is hooked up to the pipe protruding from under my blue gown. Maybe quaint hospitals in the Greek Islands look match its colour scheme, all white, and dark and light blue. Barium itself looks suspiciously like milk of magnesia.

I try to read what's on the bottle. It has a Pick 'n Pay No-Name Brand colour scheme. Perhaps it is: my medical scheme will be relieved.


Halle Berry pumps some barium into me. If I tilt my head I can see a monitor that's linked to the X-ray machine and which shows my innards. I watch, trying not to feel too narcissistic. The barium is a dark cloud that is moving slowly. I start feeling full, which is okay, if you like eating a huge bowl of muesli and then redefining the term anal retentive for two days. In short, I'm fighting the urge to push. But I want to get the procedure over and I know that shooting the Pick 'n Pay-in-Santorini bottle across the room will make Sade/Halle Berry think I'm an idiot. So I grit my teeth. I’m hearing Boney-M again, or maybe it’s Death By Bouzouki.

The actress lookalike then dons a lead-filled apron and retreats behind a glass screen, and I worry. Is the reinforced glass and body armour in case I erupt when she fills my colon to 2.5psi? I recall the scene in Monty Python's The Meaning Of Life where the fat diner explodes. I feel the air go in and the cramps start: it's like those chicken curry bunny chows I used to have for supper when I was a studnet cramming for exams in Durban.

My colon (and yours - believe it) loops in an inverted U from near your hips, under your ribs and back down. Hungry as I am, I can do without the gaseous curry aftermath. The radiologist is sympathetic. Turn onto your stomach, please. She graciously arranges the back of my gaping gown (I wince. I have a pending pimple on one cheek - I just know it) and retreats behind the reinforced splatter-shield for a photo opportunity.

She takes images of my colon from both sides, front and back, and asks me to turn by degrees on the table, like a rotisserie chicken with bad dress sense. All the while the air gurgles about, causing little spasms of pain.

Bearable, but let's get it done. She advances on me with a steel frame containing X-ray plates and asks me to face away and hold it against my stomach while she exposes it. I wonder if I'll get a mention in the credits. A man with a beard and no body armour injects some Buscopan into my shoulder to ease the cramps, then leaves quickly.


I'm then asked to walk to another drill press room where more X-rays are taken. Hobbling down the passage I meet several women and I try to think I'm Scott Glenn in The Right Stuff. But it's not easy to look hard and ripped and suave when you're carrying tubes that disappear suspiciously under your gown.

I'm terrified of standing on the bulb and pumping gouts of air into myself. So while I do look like a screen personality, it's more Quasimodo than Chuck Yeager.

And then it's over. Halle Berry tells me to assume the position again and gently extracts the speculum. I find refuge in a toilet and try to push out the remaining barium - which can't be much, I reason. Not so - fade in the old Titanic soundtrack (not the one about the Canadian's heart).

I finally get dressed and wait in the radiologists' reception. I try to scan the old Time magazines but a set of industrial grade stomach cramps hit me and I nearly cry out.

The discomfort of the speculum pales beside the torture induced by air bubbles toyi-toying kinetically in five feet of very sensitised hose. On the musical misery scale this is like taking a ten-hour drive to your own funeral listening to Mungo Jerry’s “In the summertime” or worse, non-stop pan flute music. After 35 interminable minutes of agony the X-rays arrive and I leave bearing an expression best described as thoughtful.

Two hours later I’m again wearing a hospital gown and again not looking like George Clooney. I’m at the rooms of Pieter du Toit, a brawny colon hydrotherapist who looks nothing like Halle Berry or Sade - more like Harvey Keitel with a dash of benign, unarmed Charles Bronson. He does what’s beginning to feel like standard procedure: in with the speculum.

Colon hydrotherapy uses sterile water that’s been passed through four filters, including an ultraviolet one (to kill any bacteria), and then warmed to body temperature. The water is gently pumped into your colon to loosen and purge the stuff that’s built up there.

Du Toit says compacted faecal matter and toxins in the colon are a primary cause of colorectal cancer. Cleaning out the colon helps prevent disease by giving the colon a chance to regain its elasticity. It also allows the healthy bacteria that are present naturally to build up again.

I recline on a bed while he seats himself before the unit that controls the flow of the water. As the water flows into my colon I get the full feeling I had with the barium, followed by a sharp surge of relief as Du Toit releases the water. The water flows out through a glass tube that enables me to see what’s leaving my gut. After the .38 Special suppository and the milk of magnesia I expected to be pretty cleansed inside. Not so.

There’s a fair amount of dark green muck and bits of what looks like white sand. Du Toit says the latter is barium that's started to harden. He shows me a packet of what looks like plaster of paris, hard as a rock: “This came out of a patient 11 hours after she had a barium enema.”


Du Toit says junk food, high sugar intake and a couch-potato lifestyle create ideal conditions for a deterioration of the colon. Eating pork, shellfish, sushi, raw or rare meat mean there’s a good chance that you have intestinal worms or parasites in the colon.

These uglies lurk and breed behind the impacted and putrefying faecal matter. If your colon is in poor enough shape it can also lead to something called autointoxication, where undigested food enters the bloodstream, leading to serious trouble.

Daunting stuff: Americans spend 400 million dollars on laxatives annually, but if your colon has a good solid lining of impacted faecal matter laxatives will just dehydrate you without dislodging the stuff that’s been there for years. And your common or garden enema only cleans the first foot or so of colon. It’s also been estimated that 80% of diseases start in the colon, he says.

The session is scheduled to last 45 minutes, but it takes nearly two hours before the bits of barium stop flowing through the transparent tube.

A week after all this, I’m still being judicious with muesli and Oatbix. I eat plenty of yoghurt to help build up the good bugs in my colon. There’s a puddle of barium lying like sediment in the bowl of our en-suite toilet. I’d rather have it there where I can see it, and after a couple of hundred flushes it may even go away. And the X-rays showed I have no growth in my colon worth worrying about.



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