The jokes are always the same. I pretend they’re not and say them like they’re new. The patients appreciate this. They spent the past day fasting, haven’t had anything solid to eat in almost two days, and the bowel prep meant to clean them out by bedtime kept them on the toilet all night, so, a little humor gets us by. We joke about the five-pound weight loss, how they really were full of it. They sign the colonoscopy consent and I witness their signature, saying, “We get you in the end.”
            
            They always laugh at that one, but they laugh more when I have to tell them how sorry I am for the wait but, “The doctor’s running a little bit behind today.”
            
            I have fun with them and it puts them at ease. They don’t know what we’ll find up there, hidden in the dark corners of their colons, what years of not eating right or bad genes caused to grow. Plus, when I ask some men what procedure they’re having done, they say, “You’re going to violate me.”
            
            They don’t like the idea of what’s going to be done, about what’s going up where and how far it’s going to travel. I promise them good drugs or say how it’s margarita Friday, or I repeat Dupont’s old commercial and say, “We believe in better living through chemistry.”
            
            If they’re having both procedures done, the upper and the lower, we joke about being able to stomach it and how we do the upper procedure first. “Otherwise it’d leave a bad taste in your mouth,” I say before explaining that it isn’t even the same scope.
            
            Of course, not everyone’s in the mood for joking. Some come in with stories long enough to match their faces. They’re the ones who quell the jokes or change what’s said. I need to listen before I can make them smile. A middle-aged woman tells me about her breast augmentation that didn’t work: “My husband hasn’t slept with me for two months. I wake up at two, three, four. I get no sleep. I can’t swallow, eat, drink.” 
            
            Another woman comes in with her husband and he tells me what’s really wrong with her: “She’s just a complainer. She’s always been that way. She’s going to have this done for nothing,” he says. 
            
            The woman looks at me, shrugging apologetically. “Well, I guess we’ll see soon,” I say, hoping we’ll find something bad, but not too bad, just to prove him wrong.
            
            One man talks about his daughter’s drug overdose. “My wife’s the one that found her. I woke up to screaming and thought someone was breaking in.” He talks of CPR on his daughter’s stiff body, the death-groan sound she made as he pushed on her chest. “I knew she was gone. I did it for my wife. Had to.” His eyes stare out behind me as they fix on nothing. “That was a bad year.”
            
            Many—young and old—come in with a drug list two pages long; the medications aren’t working, and the symptoms have no diagnosed cause. One guy takes enough morphine and valium to sedate him away from daily life—he has a flat affect and doesn’t make eye contact, someone he barely knows gives him a ride home. Another patient hasn’t got a ride home because her husband’s on a cruise. 
            
            One woman tells me, “My son was murdered.”
            
            “I’m sorry,” I say.
            
            “It was drugs. I can say that now. He was cooking it in a lab.”
            
            “That must’ve been hard for you.”
            
            “It is what it is.” 
            
            “You miss him?”
            
            “I guess. How can anyone be close to a drug addict? There isn’t anything you can do but watch them self-destruct. Al-Anon taught me that. If it wasn’t for Al-Anon, I couldn’t speak of it.”
            
            I listen and fill out their paperwork, making sure the spaces are all filled in and they understand what’s going to be done. I wrap the blue blood pressure cuff around their arms and record what it says, take all their vital signs down. They talk about car wrecks that weren’t their fault, or the ones that were. I hand them a gown and tell them the opening goes in the back, their belongings in the bin. They talk about mothers who’ve died, fathers who are still hanging on, sons they don’t speak to, daughters who don’t speak to them, brothers, aunts, and in-laws. I tie the tourniquet around their forearms, swab their skin with alcohol, and start their IVs.  
            
            Sometimes, their blood pressure is too high and I have to take it again, after the IV is inserted and they’re lying down in bed trying to relax. If the blood pressure’s still too high, I find the doctor who tells me to get a 12 lead EKG. The reading I print out, from all the different angles of their hearts, always looks fine on paper. Still, the doctor worries the drugs we’ll give might cause more than sleep, might cause their hearts to struggle or stall, so he enters the room and asks for more details about their history. “What’s that you said, you had some chest pain about a month ago? When’s the last time you saw a cardiologist?” 
            
            If the blood pressure doesn’t come down, the procedure will be cancelled. “We could give you some medicine to lower your blood pressure,” he says, “but that won’t tell us what’s going on with your heart. Something else besides anxiety can cause your blood pressure to go up.” 
            
            The patients look horrified each time the doctor says it. They’re remembering the fasting, smelling their spouse’s dinner they couldn’t eat, the bad tasting prep they almost didn’t get down because of nausea, all the food commercials on TV, their night in the bathroom, all the times they thought they wouldn’t make it to the toilet in time, and maybe the time they didn’t. They cleaned out their bowels, emptied out their heartbreaking thoughts to some nurse, laughed at the stupid jokes, and, now, they might have to go through it all over again?
            
            “I’ll sign something that says I’m not going to sue you if anything goes wrong,” some say.
            
            Or, “If I don’t get this done today, I’m not coming back. Not here. Not for this. Not again. You won’t get me back.” Their desperation to follow through, to not repeat anything, is palpable. 
            
            There’s nothing I can do. When the doctor tells them, “We’re going to have to cancel your procedure,” they look at me as if it’s another joke. They’re ready for the punch line. But there is none. The doctor closes off their hope, saying, “We don’t want to take any chances with your heart.” 
            
            I marvel at his wording. He doesn’t know what he’s saying. He doesn’t know what chances have already been taken. I do everything in reverse: give the patients back their clothes, remove the IV, walk them past the scales and the bathroom. The whole time they look stunned. “I’m sorry,” I say, wishing I could say more, or say something to see them smile. “I’m sorry.”