Mom, dad, and I took the 5 train from Brooklyn’s Borough Hall up to 96th street on the green Lexington line. Out of the subway, we walked towards Central Park, but stopped at Mount Sinai, on 98th between the Park and Madison. The austere waiting room had beige walls with still lifes, water cooler, stiff chairs, television muted with captions. The other patients were older and seemed dazed. At least it was a good environment for reading, but they only had piles of People magazine with celebrity gossip between glossy advertisements, someone already scratch and sniffed the cologne sample. We waited twenty minutes, fifteen past the appointment time before the nurse called my name. I made a mental note to always bring a book with me to doctor appointments. 

We walked back to his office where he greeted us at the door and shook our hands, moist mitts, “Nice to meet you, I’m Dr. Mayer.” We sat down around his desk cluttered with books and papers, packed shelves behind him, he grabbed a manila file and opened it.

“So, I want to start off by telling you that you’ve come to the right place. I’ve reviewed your colonoscopy results and believe that your intestinal inflammation is confined to your colon, so my diagnosis is ulcerative colitis. I have a lot of patients with UC, and we have a lot of success achieving lifelong remission. Mt Sinai was actually one of the first hospitals in the United States to treat Inflammatory Bowel Disease, so we have a lot of experience here.”

“We were told it could also be Crohn’s disease by the last doctor,” replied my father.

“Right, that’s the other form of IBD, it’s a possibility, do you have any acute symptoms other than stomach pain?”

“No, I don’t think so, just my stomach.”

“Eyes? Joints?”

“No, everything else feels fine.”

“And how many bowel movements are you having per day?”

“Four or five.”

“So, like I said, the inflammation is confined to your large intestine, but there’s a chance the inflammation could develop elsewhere in your intestines. If it’s Crohn’s disease, then everything from your mouth to your rectum can be at risk for inflammation, esophagus, duodenum, ileum, or colon. If that happens, the diagnosis would change to Crohn’s, which can be tougher to deal with. Crohn’s and colitis are very closely related but have different treatment implications, since colitis is confined to the colon. Inflammatory Bowel Disease is a serious concern, but in this day and age nobody dies from it, there are surgical solutions if medication doesn’t work.” Non-fatal, like the first doc said, relief, but I must take all my meds or I might need surgery.

He smiled and looked me in the eye, “But you’re young and you look healthy, and you caught it pretty early, and fortunately we have a lot of great new options for treatment that we didn’t have when I first started practicing medicine. It used to be that IBD was debilitating and ruined patients’ lives, but that’s not the case anymore. I see your last doctor prescribed Asacol, which works well for some people, so let’s keep you on that. Have you been feeling any better since you’ve been taking it?”

“I’m not sure. I’m still having some cramps and bloody bowel movements.”

“How’s your pain?”

“Not bad if I can run to the bathroom, but if I’m on the subway or somewhere else without a bathroom and have to hold it, it gets pretty painful.”

“Okay, well I want to look at some new bloodwork numbers, and if the inflammation indices haven’t dropped significantly, I’m going to add Mercaptopurine, also known as 6-MP. It’s another anti-inflammatory but a little more dynamic. So before you leave, Monica will take a blood sample, okay? Do you guys have any questions?”

He mainly looked at my parents as he talked, mother was taking notes on everything he said.

“Are there any side effects with the 6-MP?” she asked.

“There can be. If you get nauseous or anything feels out of the ordinary when you start taking it, definitely give me a ring. There are some side effects, but they are all very rare.”

“So do you have any idea what causes this ulcerative colitis?” asked my father.

“The etiology is unknown, and we honestly don’t know why some people develop these diseases and others don’t, though there are trends among patients. Genealogical and environmental factors are involved,” nature is to nurture as Science to humanities, “For example, it’s much more prevalent in western, industrialized, first-world countries, and urban areas specifically. Also, since it’s an autoimmune disease, often patients report having flared for the first time during a phase of their life that is particularly stressful.”

Life ills poisoned my body.

“My biochemist brother told me Advil can be bad for stomachs,” said mom, “Could it have been caused by taking a lot of Advil years ago when he got the flu?”

“I really can’t say, but Advil can indeed irritate the lining of your bowel. I recommend that my patients take Tylenol because it doesn’t cause intestinal inflammation. We also know it’s good to avoid alcohol and stimulants like caffeine and nicotine.”

“What about food?” asked mom.

“That depends on the patient. If you feel like anything is causing you pain, try cutting it out of your diet and see if that helps. Fibrous food can be tough to digest sometimes, but there has been extensive testing trying to find a link between certain types of food and IBD and none of them have been conclusive.”

“What about playing soccer?” I asked.

“As long as you feel up for it, you should play as much soccer as you want. Exercise is one of the best things you can do for your gut.” Keep playing.

“Do you guys have any more questions?”

Mom looked at Dad and I. Overwhelmed.

“Well if you think of any, or anything else comes up, don’t hesitate to give us a call. I hope you feel better. Leave your pharmacy information at the desk so that I can call in the Mercaptopurine prescription and make a follow-up appointment in four weeks, please go with Monica for the blood work.”

The nurse walked in, “this way,” she said, punctuating with a symmetrical smile. She led me to an examination room.

“I have to take three viles of blood for the doctor, and if you consent to submit your blood for a study on IBD, I will take an extra five. The study is helping to find curative medication for Crohn’s and ulcerative colitis, will you participate?”

Despite the instinct to appear resilient for her, needles had always made me nervous, and eight vials was far more than I’d had drawn before, “I’ve never had that much blood taken, so I don’t think I can do it, maybe next time, sorry.”

She seemed disappointed, “that’s reasonable, I understand.”

I didn’t watch, but I felt her find a vein on the inside of my elbow. She tapped it twice with her index and middle finger.

“Make a fist.”

Then she cleaned the skin with a cold wipe of rubbing alcohol, pinchprick from the needle. The sting faded after she took the first of three vials, and I wasn’t lightheaded or nauseous or anything. I felt irrational and a little guilty for not having given blood to a Science experiment, but next time I would. “Ok, you’re all set, they’ll take your copay at the front desk.”

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