The heartbreak of home guaiac testing

Even medical pros struggle with the more awkward situations involved in routine health care.

The heartbreak of home guaiac testing
The heartbreak of home guaiac testing

When I was a kid, there was an annoying commercial on the television about every five minutes about “the heartbreak of psoriasis.” Recently I encountered my own home-based medical heartbreak. After being hounded by my PCP and his posse for over a year, I proceeded with my “health maintenance duty” and threw down a home guaiac sample.

I'm guessing that anyone reading this knows what a guaiac test is, and if you don't, it would probably be best for you just to skim past this article. I have always considered home guaiac testing weird. I'm not exactly prudish or shy about things that come out of our bodies, being a medical practitioner and all, but I dreaded completing a home guaiac test.

Maybe my apprehension regarding testing stemmed from a flex sig experience I had a few years ago. I practically had to perform a semaphore while yodeling in French to get the attention of the MD and tech as I felt the scope come out of my nose. I finally had to yell to be heard over the conversation they were having about their kids' college options. It left me feeling - as they say - vulnerable.

Perhaps my weariness to complete the test came from the wear and tear of an onslaught of malady and illness among my family and friends. Maybe I didn't want to have to contribute to the parade of bad news with possibly bad test results. Or, maybe I was just creeped out about sending my own humanity to a stranger through the mail.

With an increasingly annoying tone, phone messages from my PCP and his team were coming at faster and more frequent intervals. “Mr. Anderson, this is your Doctor's office, please call us IMMEDIATELY!”  These messages signaled that the time had come.

Aren't ‘kits' supposed to be fun?

I had the same feeling about putting together the guaiac home testing kit that I did when I was a boy building toy models. As my brother was putting the final coat of paint on his jet fighter, I was still laying out the instructions, with plastic wings and pilot helmets scattered across my bed, feeling panicked about where to start.

I always thought a kit was supposed to be something fun and cool, like a picnic pack, a shoe-shine kit, or a plastic box with an avocado, onion, and jalapeno pepper from Trader Joe's that made guacamole. A home guaiac test kit was not like any of these.

How do you explain heading to the bathroom with a guaiac kit in your arms to your spouse?

“I'll be right back honey. I'm going to go deal with this 'Personal Use Kit.' It'll be just be a minute.”

But so it went. And after it was all packed, came the weirdest part. Mailing it.

Signed, sealed, delivered

Usually my wife takes care of the household mail, because there is a mailbox near her work. But I just didn't seem right sending my packaged up kit with her. I had to come to terms with this process. I had to be accountable. I had to mail the guaiac test myself.

“Personal Use Kit” is not exactly a subtle label on the mailer's exterior. The upper left “sender” space notes “Exempt Human Specimen.” Everyone and their dog sees the stuff in the mailbox at my small clinic, as it just sits there in the main reception area for all to see. I decided that would not do.

So out I went into the neighborhood around my clinic, sure that I could find a mailbox into which I could discretely slip the mailer. But after 15 minutes, nothing. There were no mailboxes to be found!

Pressed for time, I rushed into an Office Depot, and walked up briskly to the mailing counter and asked,“Where can I deposit this U.S. mail?”

With a broad smile and the best of cheer, an employee reached out to me and said, “I'll take that for you sir.”

I started to hand the mailer to him, but all I could see were the words "Stool Sample" stamped across the envelope. “You know sir, I just remembered I have to put one more thing in the envelope, so I will come back later,” I said.  

Back to work I went, walking quickly and with an anxious gait. I suddenly envisioned a scenario in which a police officer would pull alongside me on the sidewalk, concerned because of my agitated appearance:

“Good afternoon sir. Out for a walk, are we?”
“Yes officer, just walking back to the office!”
“Sir, can you tell me what's in the envelope?”
"Why, err, it's, err, why...”

I made it back to the office without being interrogated, and ended up dragging the test kit back home. By this time, it had seen a lot of miles traveling from my doctor's office to my home, to my work, to the Office Depot, back to my work and then back to my home. Finally it went from my home to my wife's job, and from there to the clinic

Now comes the best part. Waiting for the email from my doctor signaling me to go online to check the patient portal, and learn the test results. Then we get to do it all over again next year.

Jim Anderson, MPAS, PA-C, ATCDFAAPA, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.

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