In my long career as a patient (a career I never wanted to embark on, but which, like all careers we don’t choose, ends up teaching us something anyway) I have, over time, undergone various invasive diagnostic tests, including three “scopies”: cystoscopy, colonoscopy, and gastroscopy.
Although these exams may seem similar, they are, in reality, three completely different procedures not so much because of the medical technique itself, but because of what they entail in terms of experience and our consciousness.
Personally, I found cystoscopy to be the most unpleasant exam, and I believe the reason is, all things considered, physiological: the male urethra is narrow, and the insertion of the cannula is extremely uncomfortable, especially considering that the only relief comes from a laughable amount of topical lidocaine, whose effectiveness lies (I believe) more in triggering a placebo effect than in its actual anesthetic function. In that context, in fact, the mild - and scant -lidocaine can, at best, be as useful as the feather was to Dumbo, but in reality, it doesn’t work.
Yet, while on the one hand it doesn’t work, on the other there is a notable consistency: you are conscious, and you feel a tangible discomfort that you will remember very well. It is, therefore, a fully experienced medical procedure, for better or for worse. In cystoscopy, there is really nothing philosophical about a cystoscopy; on the contrary, it is all terribly mundane and boils down to the cycle of presence-pain-memory. We are faced with a simple triangle that aligns with what is generally expected from any routine, invasive medical procedure.
A colonoscopy, on the other hand, is the exact opposite because heavy sedation leads to a loss of consciousness (albeit for a relatively short time), and you find yourself suspended in a sort of temporal parenthesis that opens and closes without any particular aftereffects. The exam is a small slice of life that passes by, unlived. You sleep for a short time, but so soundly that you wake up pleasantly groggy. You regain your strength within half an hour, and then your day can continue as normal. The colonoscopy, in fact, does not exist in your experiential biography because, whatever happened, it happened to your body and not “to you.”
And then there’s the gastroscopy. And this is where things get more interesting.
In hindsight, I can say that the subjective memory of the gastroscopy is comparable to that of the colonoscopy. If someone asked me to describe my experience, I’d give the usual answers of someone who was sedated that is, that I didn’t feel a thing and don’t remember anything. I have only a few confused flashes of moments that, presumably, weren’t pleasant, but they are mere instants a few insubstantial fragments, entirely incapable of recall into a genuine memory.
Nevertheless, one detail irrevocably undermines this apparent equivalence.
During a gastroscopy - and for reasons I believe are procedural, that is, related to the nature of the exam and how it must be performed the medication used is not the same as that used in a colonoscopy. The drug used in gastroscopies belongs to the category of hypnotics that is, substances that do not erase the experience as it happens, but act on the memory afterward.
This difference is enormous, and I realized it later, connecting two seemingly meaningless episodes.
In the waiting room, just before my own exam, I could hear a young woman undergoing a gastroscopy before me. I heard her screaming and moaning, and I also heard the staff trying to calm her down, while I distinctly caught imperative phrases spoken in a firm, loud voice, such as: “Stay still,” “Stay calm,” alternating with more soothing ones like: “We’re almost done,” “Just a little more patience,” and so on. Hearing these things, I felt a sense of anxiety within me that was hard to rationalize, as if the typical pre-exam jitters were much more pronounced at that moment. Then it was my turn, and shortly after, darkness… or almost.
Because I remember clearly that after the exam, more precisely, about twenty minutes later, when I was in the adjacent room where we were taken to fully recover, The nurse said something to me that later turned out to be a revelation. He said, “Did you know you were wriggling around a lot? We had to hold you down.” It struck me, but at the time I didn’t pay much attention to it; I was still dazed. But it was in the days that followed that, all of a sudden, everything clicked into place in my mind.
I realized that during the endoscopy, I had been fully present. I had gone through that procedure, and in those moments, I had definitely been conscious. Thinking back on it now, I know I must have felt physical discomfort, and I imagine anxiety as well and probably a kind of primal panic. Only later, and thanks to the medication, was the entire experience erased from my memory as if it didn’t belong to me. So I realized that I had lived through that experience, but I don’t remember it.
And while this may seem like a negligible detail, I challenge anyone to think that way when facing a gastroscopy, to think that way before undergoing the procedure.
This peculiar aspect makes gastroscopy something radically different from the other two exams mentioned earlier. It is not a painful experience that one remembers, like cystoscopy, but neither is it an experience one has never lived through, like colonoscopy. It is an experience one goes through, yet without retaining it in memory. But one goes through it.
And it is in this that, in my opinion, gastroscopy becomes a purely philosophical act.
Because, when all is said and done, on a practical level, gastroscopy and colonoscopy are absolutely equivalent, since afterward, one remembers nothing. But from a philosophical perspective, no: gastroscopy introduces a disturbing rupture between experience and memory, between the self that has lived through it and the self that remembers. This is a dissociation we normally associate with those reflections in psychology -including social psychology -that revolve around personal identity, consciousness, and the coordinates of the self; reflections that explore its continuity and that we would hardly expect to arise from such an ordinary diagnostic examination. And I very much enjoy capturing reality when it bursts into philosophical speculation on its own. Gastroscopy, therefore, forces us to grapple with a thorny question, which can be summarized as follows: is an experience of which no memory remains truly our own experience? If something has been experienced by my body and my consciousness, but ‘I’ cannot remember it, can I say it happened to me? Or did it happen to a version of me that no longer exists (and perhaps, in Star Trek, Dr. McCoy wasn’t entirely wrong in refusing to use the transporter)?
And that is why, knowing I have to undergo a gastroscopy, always brings me a strange sense of unease. But not because of the pain (which I won’t remember anyway), and not because of the medical procedure itself (which doesn’t scare me and which I rationally understand): it unsettles me because it highlights, and not because of the medical procedure itself (which doesn’t scare me and which I understand rationally): it unsettles me because it highlights - perhaps all too directly - a truth we generally tend to repress, one that concerns the fragility of our very sense of self: we are not what we experience, but only what we remember having experienced. And when memory and experience separate, there is no longer any “I” that can claim identity. Gastroscopy is therefore a routine procedure, but during the time it takes place, it also becomes a small, intense exercise in applied philosophy. As a patient, then, I believe that this reflection not only should be made, but is almost a duty: how can one fail to grasp a dynamic in which medical technology, without intending to, systematizes a philosophical event that succeeds perfectly every time? The examination forces us to question something we take for granted, mistakenly: the relationship between our experience, the consciousness we feel we possess, and memory as an element that constitutes us. And so, this reflection becomes necessary for me, and I publish it because it imposes itself almost autonomously. I think that if, for me, cystoscopy was a fully coherent experience (despite its unpleasantness), and colonoscopy was a non-experience (from the perspective of the self, having had the bios as its exclusive object), then gastroscopy is a full experience even if, paradoxically, it is not autobiographical. It is profound because it happened to my “self.”
And there is no doubt about that. But I also believe that it is precisely the experience that cannot be recounted that opens us up to that sense of unease. The fissure is perceptible precisely because we are largely self-narration. My fear, in the final analysis, does not arise from what I felt, but from the vertigo of not being able to know what I felt: and this is a different kind of thrill. On closer inspection, this is the same conceptual framework that recurs in the themes philosophy often addresses: time as the construction of the before-during-after sequence, identity as an emergent phenomenon, the fragility of the self, and the grounding of its continuity and its anchorage, whether organic or metaphysical. But here, however, we are no longer in the realm of abstract speculation; here, philosophy is embodied, chemically induced, and then certified by a public institution. And even if the gastroscopy were a reflection imposed upon me, I believe it would have been a real shame not to embrace it.