This column is based on the author's novel quotations created during a 28-year career as an academic gastroenterologist, including mentoring more than 50 fellows in gastroenterology as a fellowship program director for more than one decade, interactions with hundreds of gastroenterology nurses as the chief of gastroenterology for more than one decade, authoring more than 200 articles in scientific journals and editing more than 10 books in gastroenterology, and compiling gastroenterologic quotations throughout the author's academic career as supplemented by quotations compiled from popular literature.

Approximately 50 quotations are introduced for the first time, including more than 80% created by the author. These quotations, whether humorous or serious, provide insight into how gastroenterology nurses and gastroenterologists feel about themselves as professionals, how other healthcare professionals perceive them, and their image in popular culture. Recognition of these aspects of gastroenterology nursing and gastroenterology is important for self-improvement, correcting public misperceptions, and to fulfill a need for witticisms during dry medical lectures.

An anthology of famous quotations in gastroenterology provides manifold benefits. First, quotes can highlight the underappreciated accomplishments of gastroenterology nurses, the professionalism of gastroenterologists, and the nobility of our calling. They can encapsulate idealized professional relationships between gastroenterologists and gastroenterology nurses to which we should aspire in clinical practice. Second, witticisms can provide comic relief to reinvigorate audience interest in otherwise-dry medical lectures. Third, quotations can provide insight into how other healthcare professionals perceive us as gastroenterology nurses and gastroenterologists to foster our self-improvement or correct their misperceptions. Fourth, quotations can indicate how patients feel about us and their gastrointestinal (GI) diseases to foster improvement in our bedside manner or help correct public misperceptions.

This work presents a novel review of popular culture that surveys famous and popular aphorisms and quotations on gastroenterology and gastroenterology nursing, particularly on colonoscopy. While published in other medical disciplines (Franklin, 2009), this compilation is novel in gastroenterology, except for two previously published compilations by this author, devoted to either general gastroenterology (Cappell, 2012b) or general GI endoscopy (Cappell, 2012a).

Famous Quotations

Gastroenterology Nurses

Gastroenterologists who share their glory with their GI nurses secure greater and longer lasting personal glory.

An appreciative gastroenterologist yields a cooperative gastroenterology nurse, a happy patient, and a successful gastroenterology practice.

How could we deal with the discontents of modern civilization without gastroenterologists? How could we deal with gastroenterologists without gastroenterology nurses?

Gastroenterologists realize the importance of maintaining friendly relations with their patients for a successful practice but have to be reminded about the similar importance of maintaining good relations with their gastroenterology nurses.

Aside from the patient's colonic anatomy, which is given and unchangeable, success in colonoscopy depends upon the patient properly taking the colonic preparation, the technical ability of the colonoscopist, and the assistance provided by the gastroenterology nurse.

Extraordinary gastroenterologists have extraordinary gastroenterology nurses.

Woe to gastroenterologists who belittle gastroenterology nurses!

Celebrate GI Nurses and Associates Day every day! (see http://www.sgna.org/Events/GINursesandAssociatesDay.aspx).

Gastroenterology Nursing

There are more than 50 journals in gastroenterology, but only one journal is devoted to gastroenterology nursing. This startling statistic demonstrates the importance of the journal Gastroenterology Nursing to the art and science of nursing.

The professional journal Gastroenterology Nursing is dedicated to making the art of gastroenterology nursing into a science.

Selecting a Gastroenterologist

Do not go to a gastroenterologist, who is anal retentive, complaining about constipation. Do not complain about gas to a gastroenterologist who is loquacious about diarrhea. Seek a gastroenterologist who confronts your symptoms with perseverance and equanimity.

When you have the runs, run to your gastroenterologist. When you can't go, go to a proctologist. If you have a problem about going when you should go and about not going when you shouldn't, see a psychiatrist.

Colonic Preparation

A dirty colon defeats even the best colonoscopist.

Dear patient: The colonoscopy preparation is arguably more important for adequate colonoscopic examination than the technical ability of the colonoscopist. Therefore, drink it all!

Colonoscopist to patient: You do your part to ensure as clean a colon as possible by meticulously following my directions for colonic preparation, and I will do my part to provide you a meticulous colonic examination.

The colon preparation left me feeling washed out.

Colonoscopy is a gas (Raymond, 2009).

After surviving drinking 4 L of a vile salty concoction to purge the colon, tolerating the colonoscopy was easy (Cappell, 2011).

Toast the colonoscopy prep, for without it colonoscopy is useless.

Toast on drinking colonic preparation for colonoscopy: To drink to life, le'chayim!

Be happy, be merry, long life! Parody by Dr. Cappell of toast by Tevye the Milkman on drinking vodka in Fiddler on the Roof (see http://www.stlyrics.com/lyrics/fiddlerontheroof/tolife.htm).

Song, sung upon taking colonoscopy prep: I stool, you stool, we all stool for colonoscopy. Parody by Dr. Cappell of famous line in a song recorded by the popular band Waring's Pennsylvanians in 1929, "I scream, you scream, we all scream for ice cream" (available at: http://icecreamjournal.turkeyhill.com/index.php/2010/12/13/the-history-of-the-i-).

The Colonoscopy Experience

Patient asks 15 minutes after colonoscopy began, "Are we there yet?" Quick-witted gastroenterologist responds, "I'm running behind." Patient's retort, "I see you are backed up."

Question by patient during colonoscopy, "Doc, did you find my dignity yet?"

Answer by colonoscopist, "I see too much undignified stool to tell."

A torturous colon tortures the colonoscopist. A colon in spasm renders the colonoscopist spastic.

When contemplating my first colonoscopy for red blood occasionally coating my stools and age greater than 50 years, I worried about drinking a vile, salty, liquid colonic preparation; the indignity of having a tube pushed through my rectum with my backside exposed; and intra-procedural pain. It was easy to passively delay scheduling the colonoscopy because I was so busy at work.

When I finally underwent colonoscopy, the experience was, however, surprisingly benign. The preparation was unpleasant, but rapidly drunk and quickly forgotten. Consuming only liquids for 1 day bothered me little. During the procedure I was in propofol heaven, with no memory of the experience. Colonoscopy demonstrated only internal hemorrhoids, which had produced blood coating the stools, probably related to my sitting on my ass too much writing too many medical articles. I concluded my concern about undignified exposure was less important than my satisfaction about having no serious colonic lesions. (Dr. Cappell, describing his emotions while undergoing screening colonoscopy. Cappell, 2011)

Referral to another colonoscopist after incomplete colonoscopy: The worst of colons requires the best of colonoscopists.

Philosophy of Colonoscopy

Colonoscopy is not a race judged by time, but a competition judged by performance.

I am both a colonoscopist and a physician. Gastroenterologist responding to criticisms by hospital administrators that the gastroenterologist spends too much time talking to and examining patients rather than performing colonoscopy-by-assembly-line.

Henry Ford revolutionized manufacturing by inventing the moving assembly line. This innovation works for assembling widgets composed of interchangeable parts but does not work in gastroenterology where each patient is different with variable complaints, nonstandardized parts, and unique personalities.

The truth is in the colonoscopy. Parody by Dr. Cappell of famous quote by Robert Browning, "The truth lies within ourselves" (see http://www.quotationsbook.com/quote/39771).

I stool therefore I am. You stool therefore I colonoscope. Word play by Dr. Cappell, on famous expression by Rene Descartes, "I think therefore I am" (see http://en.wikipedia.org/wiki/Cogito_ergo_sum).

Colonoscopist: a doctor who puts in a hard day at the orifice. Modified by Cappell, based on "Colonoscopy: It'll crack u up" (Raymond, 2004).

I chose gastroenterology because there were lots of openings. Adapted from Raymond (2009).

I like to talk and love to eat. So why not become an academic gastroenterologist and make a living by talking about eating? Modified by Dr. Mitchell Cappell from quotation by Howard Spiro. "I like to eat and talk, and what better way than gastroenterology to sublimate the first yearning and exercise the second?" Quote cited in honor of recently deceased, famous academic gastroenterologist, Dr. Howard Spiro, as taken from his obituary. (Anonymous, 2012).

Screening Colonoscopy

When contemplating screening colonoscopy at age 50, remember the adage, "When you got to go, you got to go." Parody by Dr. Cappell on lyrics by singer Bob Dylan, "When you got to go, go now" (see http://www.bobdylan.com/us/songs/if-you-gotta-go-go-now).

Getting your screening colonoscopy took lots of guts (Raymond, 2009).

When personally undergoing screening colonoscopy, I perceived it as an unpleasant short-term experience with long-term benefits, as a child views a vaccine shot (Cappell, 2011).

The gastroenterologist GI Joe is fighting the war on colon cancer. Play by Dr. Cappell on the expression GI Joe, which refers to a military action figure made by the toy company Hasbro (Pawtucket, RI) and also refers to gastroenterologists (see http://en.wikipedia.org/wiki/G.I._Joe).

Colonoscopist's Adage

Patient's curse: May you have an interesting disease. Colonoscopist's curse: May you have an interesting colon. Internist's curse: May you have interesting patients with interesting diseases. Dr. Cappell, based on ancient Chinese curse, "May you live in interesting times." Chinese curse referenced at http://en.wikipedia.org/wiki/May_you_live_in_interesting_times.

Colonoscopy Training

I learned how to perform colonoscopic polypectomy on one patient who had about one dozen medium-sized polyps. I am grateful to Dr. Oscar Lebwohl, my attending preceptor, for patiently allowing me to perform all these polypectomies despite my slowness. I repay this debt by patiently allowing young gastroenterologists in training to perform their first colonoscopic polypectomies under my supervision and tutelage.

If the ideal of an academic clinician is "See one, do one, teach one," the ideal of an academic clinical researcher is "See one, improve on, and publish on." Based on the adage, "See one, do one, teach one" (http://virtualmentor.ama-assn.org/2003/12/ccas3-0312.htm).

Proctology

Turning the other cheek takes on a new meaning when visiting your proctologist.

As an expert in posteriors and rectums, hemorrhoids and anal retention, anospasm and high colonics, and constipation and flatulence, I am a proctologist extraordinaire.

Sign on proctologist's office: Poopologist extraordinaire!

Sign on proctologist's office: I treat bad stool.

Proctologist, a brain surgeon for lawyers. Modified by Dr. Cappell from "Gastroenterologist, a brain surgeon for lawyers" (Raymond, 2004).

Proctologist: dedicated to the science of stool and stooling.

Manual Disimpaction

Manual disimpaction is better in theory than in practice.

Manual disimpaction provides an exception to the rule that it is better to give than to receive.

Performing one manual disimpaction is enough to last a lifetime.

The motto, "See one, do one, teach one" is best applied to manual disimpaction without the middle step. Based on the adage, "See one, do one, teach one" (http://www/virtualmentor.ama-assn.org/2003/12/ccas3-0312.htm).

Overeager applicant for gastroenterology fellowship: The reason I want to go into gastroenterology is to perform manual disimpaction.

If you've seen one manual disimpaction, you've seen them all. Parody of famous quote by Vice President Spiro Agnew, "If you've seen one city slum, you've seen them all." (http://www.brainyquote.com/quotes/quotes/s/spirotagn134186.html).

Colonoscopy Practice

Sign on entrance door to colonoscopy suite room: Please back in to expedite your visit. Sign on rear entrance: Proceed directly ahead. Modified by Dr. Cappell from Raymond (2004).

Sign in colonoscopist's office: #1 in the #2 business. We push harder. Modified from original, "We're #1 in the #2 business" (Raymond, 2009).

Rectal examination: If your finger cannot fit, you must quit. Play on famous statement, "If the glove doesn't fit you must acquit." Modified by Dr. Cappell from original at: http://answers.yahoo.com/question/index?qid=20070713011233AANfIsj

Colonic Function and Dysfunction

Although the role of enteric flora in the formation of stool and intestinal disease is likely the greatest unknown in gastroenterology, research in this area is stymied by our aversion to studying stool.

Irritable bowel syndrome is the most irritating disease to the patient, and even more so to the gastroenterologist.

Irritable bowel syndrome patient: My bowel talks to me and I don't like what it says.

In our society three stools per day is considered the magic number ordained by God, but normal ranges from one stool every 3 days to three stools per day.

To naturopaths, who argue for colonic enemas for health, I respond, "High colonic enemas do not solve the problems of life."

Gastroenterology Historical Tidbits

All gastroenterologists and gastroenterology nurses have heard about Crohn disease, but what about Oppenheimer's disease or Ginzburg's disease? In 1932, Drs. Leon Ginzburg and Gordon Oppenheimer, physicians at Mount Sinai Hospital in New York City, had collaborated on writing a rough draft of a paper reporting five cases of a new clinical entity, terminal ileitis, that they had differentiated from ulcerative colitis, when Dr. Burg, the Chairman of Medicine at the hospital, insisted that they allow Dr. Burrill Crohn to add his two similar cases to their paper and become a coauthor. The paper was published in the Journal of American Medical Association, in which the authors were listed alphabetically, so that Crohn became the first author. The disease then became known as Crohn disease, according to the first author of the paper, instead of the awkward nomenclature of Crohn-Ginzburg-Oppenheimer disease. This historical injustice is ironic because the other two authors had priority of discovery and contributed most of the reported cases. By Dr. Cappell based on Cappell (2011), Crohn, Ginzburg, & Oppenheimer (1932), and Ginzburg (1974).

Did you know that one of the first complete colonoscopies was performed by first swallowing a weighted string that was allowed to pass out through the anus by peristalsis while the other end of the string was taped to the skin around the mouth? A colonoscope was then attached to the string exiting the anus. The string outside the mouth was then tugged using a pulley system (details omitted) to guide the colonoscope retrograde (from anus toward cecum) through the colon to reach the right colon even up to the cecum. Several hundred colonoscopies were successfully performed using this technique (Provenzale & Revignas (1969). Thank God, we invented a better way to perform colonoscopy!

Colonoscopist's Blessing

May you enjoy reading these colonoscopy quotes more than I enjoyed undergoing my colonoscopy.

Colonoscopist's Finale

At my deathbed, I am unlikely to lament as a gastroenterologist, "If only I had done one more colonoscopy," but I am likely to lament as a father, "If only I had spent more time with my kids."

REFERENCES