The significance of the title of Marcus Burnstein’s book “Bummer” will, I am afraid, be lost on many readers born and raised in the States. A bum in American English is something quite different from a bum in British vernacular, and Dr Burnstein is a Canadian surgeon at the University of Toronto specialising in disease management and surgery of the colon, rectum and anus.
To say that “Bummer” is an unusual book is to say no more than the truth, but it is also highly readable, very interesting, and above all extremely informative. It lives up to its subtitle: “What you need to know about anal health”. Burnstein is generous with his professional expertise, as he covers in simple, understandable terms, the issues he deals with on a daily basis. “Anal problems are very common,” he observes. “Many of them are preventable and all are manageable, if not curable.”
Every human being goes through the process of “potty training”, and thereafter lives with the problems that arise from time to time in the lower region. People are often reluctant or embarrassed to discuss, even with a doctor, common issues like constipation, hemerrhoids, diarrhea, or wind, and prefer to live with them. Burnstein tackles these, and a whole variety of other matters in clear, chatty terms that sweeps away inhibitions, clarifies issues and indicates when action is called for in this most private and intimate of body areas.
The first sentences in “Bummer” set the tone for what follows – a clear, uninhibited statement of facts. “The tubular gut is a 20-foot subway line that runs from the mouth to the anus. Food enters at one end. Poop comes out at the other…We’re here to talk about the last part.” He makes the point that the first part of the process can be what he calls “a spectacularly sensory experience”, shared with others and documented by selfies, whereas the latter phase is a solitary mission. “Not a lot of selfies,” he comments.
To ensure that what he is saying is easily understood, Burnstein is generous with diagrams when needed to explain a point he is making. The text, too, is far from a turgid succession of printed pages. He breaks it up with key points interposed into his exposition in a different typeface from the main text, and with case studies presented against a shaded background.
In fact Burnstein treats his 11 main topics as case studies, presumably drawn from his own extensive records. He starts each with an account of how his patient first presented themself to him, proceeds to explain how he diagnosed and then how he treated them, and concludes with a section describing the result. Throughout he takes as much account of his patient and their reactions as his own.
These 11 topics include problems like itching, incontinence and constipation, as well as issues like “I see blood” or “I have diarrhea”. Along the way he gives us his experience, also, of dealing with “Something’s stuck up there”.
He follows this with a chapter he titles “Odds and Ends”, which includes a short discourse on the comparative merits of washing or wiping. On the whole he rather favors bidets, which are apparently extremely common in Japan and Italy. He deals in brisk matter-of-fact fashion with the topic of anal intercourse, and follows this with a chapter devoted to debunking some common myths such as whether once-a-day is the desirable way to move your bowels, and whether colonic irrigation gets rid of toxins (the answer to both is No).
His last chapter is a personal account of his professional life and experience, some of the odd issues that arise, some of the jokes that circulate among his peers. Finally. in “Why I do what I do”, he confides to his reader why he considers himself so fortunate to be doing a job he loves so much. He rounds off his volume with an appendix in which he offers ten tips for anal health, and finally a 17-page glossary explaining the technical terms he has used.
“Bummer” has been aptly described as “an exceptional contribution to both medical literature and patient education.” With his clear, no-nonsense approach to a topic bristling with potential embarrassments, he effortlessly bridges the chasm that often divides patient from doctor. Complex though the topic is, the medical content, professional colleagues have affirmed, is impeccable. Yet Burnstein presents it to his readers in a style that makes it easily understood.
Most people will find “Bummer” both highly informative and highly entertaining. Full marks, Dr Burnstein.
