The halachot of colonoscopy

Our sages tell us that the month of Elul is a time for looking deeply into ourselves, and so it seemed as good a time as any to undergo my first colonoscopy.

I was a bit surprised when I walked into the gastroenterologist’s office. The man across the desk from me had a large knitted kipah, a long beard, long tzizit, and no lab coat. He was learning Sefer Devarim. Were we going to study the parashah, or talk about my innards?

“Read this carefully,” he instructed me, handing me the prep sheet for the procedure. I had known that there were a list of steps one had to take so that the coast would be clear during the procedure, but nothing prepared me for the halachic treatise he handed me. For example, section 3b read:

On the morning of the procedure, consume the second package of Picosalax powder and a liter of water (Note: it will be difficult to wear tefillin in the hour-and-half after you take the Picosalax. It is recommended to carefully coordinate tefillah times and the preparatory procedures for your examination).

I wondered: had I been given a gender-specific version of the prep sheet? Who could imagine that a colonoscopy prep sheet would include instructions about tefillin? Only in Israel.

Jewish holidays that fall out on a Sunday often have certain leniencies concerning their halachic observance relative to their observance when they fall out on other days of the week. And so I was delighted to discover that my procedure was “a colonoscopy that falls out on a Sunday.” In section 3a of the prep-sheet we read:

On the day prior to the procedure one must not eat past the hour of 15:00. If, however, the procedure is scheduled for a Sunday, then one may consume a slice of challah for seudah-shelishit, and the measure of a ka-zayit for melaveh malkah.

I was puzzled. Either the fast begins at 3pm or it doesn’t. Does the body make special dispensations for our holy Sabbath? And then it all made immediate sense: on Shabbat, just as the calories we put away don’t go to our waistlines, so too, it must be, the solids we consume don’t block our colons.

I don’t normally partake of the customary post-Sabbath melaveh-malkah meal, but I sure wasn’t going to pass up the opportunity this week, especially under orders of my gastroenterologist. But just how big is a ka-zayit, “the size of an olive”? For the mitzvah of eating matzah on Pesach I normally subscribe to the lenient opinion (again, an intersection of halachah and gastronomy…). Could I now turn around and rule for this melaveh-malkah in accordance with the more stringent opinion, and enjoy a larger repast? R. Moshe Feinstein ruled that one could observe mourning during the earlier days of sefirat ha-omer one year, and the latter days of the omer in another. Perhaps flip-flopping was permitted here. To whom was I supposed to direct my question: my rabbi or my gastroenterologist? Who knew that having a colonoscopy could be so halachically complicated?

With the procedure over, I realized that looking deeply into yourself is hardly something you can do on your own. So I asked my wife what it is that I need to work on in the coming year. The procedure was a lot like my colonoscopy. You put it off because you don’t really want to do it. You make yourself vulnerable and exposed before the person performing the procedure. You become aware of some of the less seemly aspects of who you are. But you do so because you firmly believe that you are in the hands of a trusted specialist.

As with a routine colonoscopy, there might indeed be results that require attention. But being told what you need to do is actually empowering, because you can focus on that specific goal, and it might just be attainable. But above all, asking your spouse what you need to work on, just like the colonoscopy, is incredibly liberating. Having made yourself vulnerable, and having received the results, you move forward with the knowledge and security that you have pursued the truth rather than running away from it.