Stuck on East Burnside

Gridlock on my route from one home visit to another.  East 3rd and Burnside. Clutch, brake, clutch, accelerate.  Illness behind, illness ahead.  The Portland winter is dark and wet.  The gutters glisten from reflected headlights.  Not even the water moves fast here, pooling into the low spots, laconically swirling as a tire passes only to settle back with an oily sheen.  Abdominal pain was the complaint.  The final diagnosis after an hour in the apartment, talking and listening, examining some lab tests: constipation.

The inability to have regular bowel movements has emerged as America’s most common invented illness.  The mammalian bowel is built to move, constantly.  It starts moving before birth and keeps moving until death. Somehow the modern urban human has managed to slow and even stop this inevitable physiological process.  The societal cost of our constipated populace is outrageous.  I am currently providing home visits for the fragile elderly, trying to help them stay well and out of the hospital.  And believe me, constipation can put people straight into intensive care.  I have worked everywhere in medicine, from primary care to hospitalist to nursing homes.  Constipation gums up the works everywhere, causing pain, then nausea, escalating worry, escalating white blood counts, creating abnormal lab tests, all resulting in long and expensive medical examinations and CT scans with the final diagnosis: full of poop.

What created the constipation crisis?  Well, the opioid epidemic has not helped, as narcotics do slow the bowel, but most people who can’t go are not taking morphine.  No, the origins of bowel immobility lie in immobility itself.  Like most modern chronic diseases, we stop moving when we stopped moving.  The inactivity of the Western lifestyle is astounding and the consequences inevitable.  Never before in history have so many people moved so little.  We stare at computers, we drive cars, we take elevators. We operate machinery.  From a chair, pulling levers.  Kids don’t play outside or run around. Adults don’t walk to work or the store.  And the elderly often never even leave their chairs.

Hand in hand with immobility, our society has created processed food.  We stopped growing food, harvesting food, and even preparing food.  So prepared food appeared, and so we ate fewer fresh foods, with less fiber, and eventually… people don’t move, they eat starchy glue-like foods, and a cottage industry of laxatives and consultants was born.

The traffic on Burnside is constipated as well, not moving except in random fits and starts.  Traffic was meant to flow, just like the intestines.  When it does not, the result is irritation, just as in the colon where I have seen stool impactions create angry, red tissue, cramps, and pain.  They have the same ancestry, the constipated bowel and the gridlocked street.  The same factors created them: humanity’s immobility and poor urban planning.  If we walked or cycled to work there would be no jam up.  If we had planned smaller urban pockets that preserved agricultural areas, we would have fresh food with fiber to eat rather than endless shrink-wrapped starch.

Humanity suffers from many real maladies that occur due to biological inevitability.  Cancer, that most captivating of all diseases, appears to result in a random way from the structure of cell division and DNA storage.  Heart disease results from a side-effect of cholesterol which is required for cell membranes.  And so on for most human disease.  But not constipation.  Mammalian evolution never imagined constipation as an issue. As modern hygiene and antibiotics increased the human lifespan, still constipation only rarely occurred.  Until we outfoxed ourselves by creating too many modern conveniences, and sank inevitably into the comfortable couch of the 20th century.

Job security, I think, as I flick on the turn signal to finally exit this self-inflicted misery of East Burnside.  We have met the enemy, and he is us.


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