June 3, 1866
Dear Journal,
It’s the night before we set sail, and the atmosphere at Sphincter Dockyards is… tense, to say the least. Dad—the captain of the S.S. Peristalsis—has been stomping around the ship barking orders like a drill sergeant. “Clear out the debris! Secure the electrolyte supplies! Go lightly, go lightly!”
I’ve heard this speech so many times I could recite it in my sleep. But this time is different—Dad’s letting me come along. He says it’s because I need to “learn responsibility” and that one day I may navigate the endoscope. I’m nervous, but I’m ready to prove I can handle it.
The crew is bustling to prepare. Dr. Lieberkühn is strict but kind, and I think she secretly likes having me around. Then there’s First Mate Lynch, who handles the peristaltic oars. He’s… grumpy, but when he thinks no one’s looking, he sneaks me laxatives from his ration pack (don’t tell Dad).
And, of course, there’s Chef Myra, the ship’s microbiome specialist. She’s packing vats of short-chain fatty acids, just in case the colonic epithelium needs reinforcements. She said she’d teach me how to ferment fiber into butyrate if we have downtime.
The night ended with Dad giving me a serious talk about the dangers ahead: polyps, strictures, and the risk of obstruction currents or even volvulus. He even made me wear a life jacket. Ugh. I mean, I know this is serious, but does he have to treat me like a kid?
I’m writing this from my tiny bunk in the lower deck. The room smells faintly of antiseptic, but it’s cozy. Still, I can’t stop thinking about home. I miss Mom. She packed me extra snacks… nothing with seeds or nuts, and told me to keep a journal. So here we are. Jenny said this trip would be “gross and weird,” but I think she’s just jealous. She’s only 13 and Dad can’t trust her to behave herself inside of someone’s colon yet.
January 4, 1866
Dear Journal,
Too excited to sleep last night. We launched today! The Rectum Port was as chaotic as ever, bustling with stool barges waiting for their turn at the Anal Sphincter Locks. As we set sail, the rhythmic contractions of the canal swept us forward like clockwork.
Dad was on the bridge, shouting orders, while Dr. Lieberkühn scanned the walls for erosions or fissures. Lynch kept the oars in sync with the peristalsis waves, grumbling about how “kids don’t belong on ships.”
Honestly, the locals here freak me out a little. The squamous epithelial guards at the anal transition zone are gruff and suspicious, but I met a few friendly ones who told me stories about travelers they’d seen over the years. They gave me a good-luck charm—a tiny figurine made from mucus and epithelial cells. It’s kind of gross, but I didn’t want to be rude.
There was one boy, maybe a little older than me, who works as a mucus ferry operator. His name is Elias, and he had these bright, curious eyes that seemed to sparkle even in the dim luminal light. He asked me if I was scared. I said, “No way,” of course, but my heart was racing.
Elias told me something really profound that I wanted to write down before I forget. “The colon tells a story if you’re willing to listen.” He dreams about leaving the Rectum and working somewhere upstream, maybe in the ileum. I wanted to tell him that he would never get any visitors there, but I held my tongue. Instead, I wished him luck and said, “Maybe I’ll see you on the way back!” His smile stayed with me for the rest of the day.
January 5, 1866
Dear Journal,
The Sigmoid Colon is like a rollercoaster, its sharp bends tossing us side to side. Chef Myra said this is where the stool begins to solidify, and you can definitely tell from the smell. Dad says you get used to it eventually.
We ran into some trouble today: a sessile serrated polyp blocking a narrow passage. It looked harmless at first, but Dr. Lieberkühn spotted its irregular edges and insisted we navigate around it. She said that these things are precancerous, and we should treat them with caution.”
You can’t help but feel small here. The endless walls of epithelium, the sheer complexity of the place.
I helped Lynch maneuver the oars to steer us clear, and for the first time, he actually said, “Nice work, kid.” That felt good, if I’m being honest.
I wonder if Elias has ever steered a ferry around a polyp. Probably not. I hope he’s doing okay back in the rectum. And I wonder if he thinks about me,too. Ugh, I sound ridiculous.
January 6, 1866
Dear Journal,
We made camp tonight at Haustra Cove, a series of pouch-like outcroppings where we could rest and resupply. The haustra locals are industrious, busy reclaiming water and electrolytes. Chef Myra traded some SCFAs for a batch of freshly synthesized vitamin K.
I spent some time talking to the local microbiota. They’re fascinating! I sat on the deck and watched Bacteroides break down dietary fiber while Dad was negotiating with Lactobacillus. I don’t know how it ended, but he brought a sample of their fermented goods on board. Dr. Lieberkühn says I should be careful about bonding too much with microbes, but I respect the work they do, and feel for their plight. I guess I’m pro-biotic. Like a fancy yogurt.
And people say the bowels are irritable, but I think they are just misunderstood.
January 7, 1866
Dear Journal,
The Transverse Colon is like entering a different world. It’s loud and chaotic, bustling with metabolic activity, and the air practically sparkles with hydrogen gas. It’s also where we faced our scariest challenge yet: a villous adenoma. This was just supposed to be a routine screening voyage, but I guess that’s why you do it.
It loomed ahead like a coral reef gone rogue, its tentacle-like structures waving ominously in the lumen. Somehow, Dr. Lieberkühn stayed cool the whole time. She jumped into action, deploying her endoscopic tools to collect a biopsy. Meanwhile, Lynch and I worked together to steer the ship past it.
For the first time, Dad looked proud of me. He said I’m shaping up to be a real sailor.
I think Elias is right. The colon does tell you a story if you listen. But as I’m lying in my bunk tonight, I wonder what my story is. And who will I tell that story to?
January 8, 1866
Dear Journal,
The Ascending Colon was calm, almost serene. The stool formations here are still soft, and the locals are more relaxed. We passed by the Cecal Basin, where we expected to find the appendix —a quiet sentinel rich in lymphoid tissue, but it wasn’t there. Dad says that happens sometimes.
I spent some time reflecting as the S.S. Peristalsis approached the ileocecal valve. This journey has been intense, but I’ve learned so much about polyps and the importance of early screening for colorectal cancer. I know now that it typically begins at age 45 for individuals at average risk, per updated guidelines from the American Cancer Society and the U.S. Preventive Services Task Force.
As we passed through the ileocecal gate into the small intestine, I felt a strange mix of emotions - pride, relief, nostalgia, and realization that if a precancerous polyp is removed, follow up colonoscopies may be recommended every 3 to 5 years, depending on the number, size, and type of polyps found.
Tomorrow, the S.S. Peristalsis begins the long journey home. I keep thinking about all of the people I’ve met along the way. I’ll probably never see them again, and I feel a little pang of sadness when I think about it. But they’ve left their mark on me. And they helped me realize that while other screening methods, like stool tests and colonography may be appropriate for some individuals, colonoscopy is still the gold standard.
