The biggest surprise of all is that the medical literature does not contain a single case report of stomach rupture among competitive eaters. Which brings us full circle to Mr. L. and my original point. By and large, it’s not how much you eat that kills you, it’s what you eat—especially, as we’re about to see, when what you are eating is ten dozen latex bundles of cocaine.
* * *
* Though you do read case reports in which patients say they heard a bursting noise, the experience is more often described as a sensation, as in “a sensation of giving way.” The “sudden explosion” recalled by a seventy-two-year-old woman following a meal of cold meat, tea, and eight cups of water was more likely something she felt, not heard. (The old eight-cups-of-water-a-day advice should possibly be qualified with the clause, “but not all at once.”)
* With one exception. While the consumption record for many foods exceeds eight and even ten pounds, no one has ever been able to eat more than four pounds of fruit cake.
11
Up Theirs
THE ALIMENTARY CANAL AS CRIMINAL ACCOMPLICE
SHOULD CIRCUMSTANCE PREVENT a man from carrying his cigarettes and cell phone in his pants pocket, the rectum provides a workable alternative. So workable that well over a thousand pounds of tobacco and hundreds of cell phones are rectally smuggled into California state prisons each year. The contraband allows incarcerated gang members and narcotics dealers to make business calls from behind bars (and to enjoy a smoke while doing so).
“This came in on Friday.” Lieutenant Gene Parks is a contraband interdiction officer at Avenal State Prison. He is making reference to a clear plastic garbage bag two-thirds full with what appear to be but are not yams. They are plugs of Golden Leaf pipe tobacco, sheathed in latex and tapered at one end for ease of insertion, and not into pipes. The garbage bag is a “drop”—bulk contraband—that was hidden on the nearby chicken farm where two to three hundred Avenal inmates commute from the prison to work. Had Parks’s team not gotten to the bag first, the plugs would have been “keistered” by convicts into the prison yard, two or three and occasionally six at a time, and then laid like the eggs the men spend their days with.
A fruity tobacco smell has leached through the plastic. The Investigative Services Unit smells like a tobacconist’s shop. A one-pound bag of Golden Leaf tobacco retails for around $25. On the Avenal yard, an ounce sells for as much as $100, putting the yard value of that $25 bag at $1,600. The penalty, should you get caught, is mild—a temporary loss of visitor privileges. “We’ve disposed of, maybe, in the hundreds of thousands of these,” says Parks. Lieutenant Parks has wide, voltaic blue eyes and a flat, imperturbable speaking manner. The combination makes him seem at once jaded and amazed.
Parks takes me into a storage room and shows me a bank of a dozen small square lockers, one for each month’s contraband cell phones.
“All of these,” I ask, “were . . .”
“Hooped?” Parks forms a circle with his thumb and forefinger. As in, through the hoop. More slang for rectally imported. “Not all. Some.”
Parks takes two steps and reaches for another large plastic bag. “This is all chargers.” Other bags and boxes contain batteries, earbuds, SIM cards. The slang for the rectum is “prison wallet,” but it could be “Radio Shack.” On the way here, I stopped in the office of a block captain who wanted to tell me about an inmate who was caught with two boxes of staples, a pencil sharpener, sharpener blades, and three jumbo binder rings in his rectum. He became known as “OD,” for Office Depot. They never found out what he intended to do with the stuff.
• • •
THE HOOPERS OF Avenal use the rectum for the basic purpose for which it evolved: storage. The nether distances of the gastrointestinal tract are a holding chamber for what remains of a meal once the intestine has absorbed what it can of the nutrients. Water is absorbed from the digesta as it travels along, and if all goes optimally, it leaves the body around the time it’s reached a manageable water content: somewhere between 2 on the Bristol Stool Scale* (“sausage-shaped but lumpy”) and 5 (“soft blobs with clearcut edges”). The lovely upshot is that one need only attend to the emptying once or twice a day.
If you’ll allow it, a closer look at the process. Six to eight times a day, unbeknownst to your thinking, feeling self, a peristaltic muscle contraction called a mass movement squeezes the contents of the colon farther along. Eating reliably triggers this, via something called the gastrocolic reflex. The bigger the meal, the more vigorous the push. Any older detritus that had been parked outside the rectum now gets loaded inside. In with the new, out with the old. “It’s a defensive reflex,” explains William Whitehead,† co-director of the Center for Functional Gastrointestinal and Motility Disorders at the University of North Carolina. It prevents the colon from bursting.
When a load pushes against the rectum walls with sufficient pressure—as measured by stretch receptors—the defecation reflex is triggered. (You can trigger it prematurely by bearing down; this raises the pressure on the rectum walls to the requisite level.) The defecation reflex causes the rectal wall muscles to contract—that is, squeeze—at the same time the anal sphincter muscles relax. To the conscious mind this registers as urgency—somewhere between “Hello” and “Drop what you’re doing.” The larger or more liquid the load, the more pressing the urge and the tougher it is to hold back. Water will leak out a very small opening. As one gut expert put it, “Not even the sphincter of Hercules can hold back water.” Take this to its end point and you have the simple saline enema—and an urgency that is not easily, if at all, overridden.
Though you can surely try. The defecation reflex has a manual override. Learning to employ that override is the essence of toilet training. Clenching the anal sphincter aborts the reflex and causes the urgency to fade—in most cases, long enough to pull off the highway or finish the aria and get to a toilet. (For patients who struggle to hold back the tide—sufferers of overbearing “postprandial urgency”—gastroenterologists recommend smaller, more frequent meals so that mass movements provoke a less intense onward push.)
Ahmed Shafik, the late, great chronicler of lower body reflexes, vividly demonstrated the defecation reflex in his lab at Cairo University. Volunteers were outfitted with devices to measure the squeeze pressure of both the rectum and the anus. A saline-filled balloon played the role of Turd. Filling the balloon with about a cup of water distended the rectum to the point where the reflex was triggered. The researchers could see on their instruments the sharp increase in rectal pressure—the squeeze—and the simultaneous drop in anal pressure—the letting go. “An urgent sensation was felt and the balloon was expelled to the exterior.” Ta-da! When the subject was instructed to hold back, the rectum relaxed and “urgency disappearance” ensued. Mission aborted.
Setting aside the occasional interference of enemas, intestinal bugs, and Egyptian proctologists, adult humans are rarely at the mercy of their bowels. We need not soil our bloomers or drop our trousers and succumb there and then to the urge. Respect your equipment, people. The rectum and anus, working in concert, are a force for civilized human behavior.
And, occasionally, uncivilized behavior. Lieutenant Parks and his colleagues have called up some highlights of security camera footage from the visiting room. On the monitor, we watch a man palm an apricot-sized packet of something illegal that his wife has just slipped him, and then reach behind his back and deep into the seat of his pants, all while playing a board game with his son.
Based on the boxiness of the monitor we are viewing, Avenal’s computer hardware does not appear to have been upgraded since the turn of the century. Budgets are lean. When I asked why the prison doesn’t install a Body Orifice Security Scanner (a high-tech imaging chair that relieves guards of the distasteful tedium of bend-over-and-spread), Parks laughed. There isn’t even money to reorder business cards. The prison was built for twenty-five hundred men, and now houses fifty-seven hundred. Everything, right down to the pin
k plastic flyswatter in Visiting Services, is broken or old or both. Meanwhile, the inmates are watching movies on smuggled smartphones.
The newer smartphones contain enough metal to set off the Avenal metal detectors, so they are hooped mainly by one inmate, a man with a hip replacement. His hip gains him a pass from the metal detector. “And we can’t X-ray him without a court order or someone from medical saying that it’s medically necessary,” says Parks. The man hoops two or three phones at a time. The yard price on a smartphone is $1,500. “That guy is making a pile of money.” Probably more than Lieutenant Gene Parks.
Three smartphones—or tobacco plugs—is a load far larger than the cup of water in Ahmed Shafik’s balloon study. Given what I’ve learned about the physiology of the human rectum, it must be a tremendous struggle to keep it all in.
“That’s something you can ask them yourself.” Parks has arranged an interview.
ASIDE FROM A basketball backboard (I changed that from hoop, as a courtesy to you), and a few chairs set in a receding slice of shade, Yard 4 is bare. With rocks, someone has spelled out “4-YARD” in the rubbly parched dirt beside the gate. I think of inuksuks, the signposts that Arctic travelers build by piling stone slabs. In prison, as in the Arctic, you express yourself with the little you have at hand.
My escort from the Avenal Public Information Office, Ed Borla, calls to a guard to open the gate. A few inmates glance over as we cross the prison yard, but most ignore us. I am really, I think to myself, getting old.
Like all the yards at Avenal, this one has a row of amenities, each identified with a hand-painted red block-letter sign: GYM, LIBRARY, LAUNDRY, COUNSELOR, CHAPEL. It’s like a tiny homegrown strip mall. I wait in one of the staff offices while Borla goes to find the man I’ll be interviewing. I ask the staffer whose office it is whether he knows what my inmate is in for. He types the number on his computer keyboard and then turns the monitor toward me. The cursor blinks calmly beneath the word MURDER, just like that, in capital letters.
Before I have time to process this interesting piece of new information, the prisoner arrives in the hallway outside. I will call him Rodriguez, because I agreed not to disclose his real surname. Borla points to an empty office across the hall. “You guys will be in there.” I glance down at my list of questions, which includes “Might hooping be a form of what the Journal of Homosexuality calls ‘masked anal manipulation’?”
I explain myself as best I can. Rodriguez doesn’t seem to find my line of inquiry to be freakish or surprising. As one of Parks’s colleagues said earlier, of hooping, “It’s a way of life.” Rodriguez begins at the beginning, twenty-some years ago, in San Quentin. He belonged to a gang, and a leader of that gang approached him with an assignment. “I was told, ‘Look, somebody is going to get stabbed in the—’”
I can’t make out his last few words. “. . . in the arm?”
Rodriguez suppresses a smile. The very thought of a gang leader ordering an arm injury. “In the yard.”
Rodriguez doesn’t project the personality that his rap sheet suggests. He is friendly, engaged. He looks you in the eyes. Smiles easily. Has beautiful teeth. You’d be happy to sit next to him on a long flight. You would never take him for a prisoner were it not for his pants, which say “PRISONER” in 200-point type down the length of one thigh. That’s kind of a giveaway.
Rodriguez was ordered to smuggle—from work detail into the prison—four wrapped metal blades, a package twelve inches long and two inches fat. If he refused, he was told, one of the blades would be used on him. It was a harrowing experience, but he managed it. Since then, he has mainly hooped tobacco. “If you’re going to go to the hole”—the other hole, solitary confinement—“you wrap up your tobacco, your lighter, matches . . .”* In the air, Rodriguez traces the outline of the smoking kit. It strikes me as far larger than one of Shafik’s balloons. I explain rectal stretch receptors and the defecation reflex. “Are you always having to fight to hold it in?” I have an awareness that I must seem like an unusual person.
“Eeeh, yeah but . . .” Rodriguez looks at the ceiling, as though searching for the right phrasing, or beseeching God to intervene. “It finds its spot.” In physiological terms, the defecation reflex has been aborted. After a certain number of aborts, the body gets the message and backs off for a while.
Gut motility experts will tell you that things happen to people who habitually abort the urge to go. Most are not smugglers. They’re what gastroenterologist Mike Jones calls the “one more thing crowd.” “They need to go, but they’ve got to do one more thing first.” Or they are “bathroom-averse”; they’re reluctant to use public restrooms because someone might hear or smell them, or because they’re anxious about germs. By continually aborting the urge, these people may inadvertently train themselves to do the opposite of what nature intended. Their automatic response to “the urge”—even in the privacy of their home—is to tighten up. The medical term is paradoxical sphincter contraction. You’re pushing on the door at the same time you’re holding it shut. It’s a common cause of chronic constipation.* And one that all the fiber in the world won’t cure.
“You can figure out these folks really easily,” Jones says. “You stick your finger in their rectum and you go, ‘Okay, push,’ and you feel them clamp down.”
A group of German constipation researchers point out that “untoward conditions during the anorectal examination”—e.g., a stranger has his finger up there—can incite the anal sphincter to contract. Thus paradoxical sphincter contraction can be an artifact of diagnostic exams.† Though the authors acknowledge that for some patients, paradoxical sphincter contraction is assuredly the cause of their woes.
The medical staff at Avenal report that constipation is a common complaint.
• • •
THE ALIMENTARY CANAL is an accommodating criminal accomplice, but it has limits. The fuller the rectum and the longer you hold it back, the sooner the urge returns. Like a digital alarm clock, the more you ignore it, the bossier it gets. Twenty-four hours is about the limit for the average hooper. After that, Rodriguez says, “your brain just keeps telling you it wants to use the restroom.” I picture Rodriguez’s brain, desperate but polite, tapping him on the shoulder.
Swallowing contraband packets rather than hooping them buys the smuggler extra time. That’s one reason swallowing is the preferred carrying technique of the Latin American drug mule. Out of the 4,972 alimentary canal smugglers caught in Frankfurt and Paris airports between 1985 and 2002, only 312 had the goods packed in their rectum. Everyone else had swallowed it. Even on a ten-hour Bogotá–to–Los Angeles flight, swallowed packets typically don’t reach the rectum by the time the plane lands. Mules are instructed not to eat anything during the flight. In this way they avoid triggering mass movements of the colon. (They may also take antidiarrheal drugs that shut down peristaltic contractions.) Thus even a cavity search of a suspected “swallower” may fail to produce any evidence.
Swallowers present a legal conundrum in that border detentions are required by law to be brief. Agents may detain a suspected smuggler only long enough to search luggage—checked, carry-on, and anatomical—and confirm or refute their suspicions. In a case that turned the lowly defecation reflex into a matter of Supreme Court deliberation, Bogotá resident Rosa Montoya de Hernandez was held for sixteen hours by customs agents in the Los Angeles International Airport. A patdown and strip search had revealed a stiff abdomen—for Montoya de Hernandez’s gastrointestinal tract was packed with eighty-eight bags of cocaine—and two pairs of plastic underpants lined with paper towels. She was given a choice: agree to an X-ray or sit in a room with a garbage bag–lined wastebasket and a female customs agent charged with, as they say at Avenal, “panning for gold.”*
Montoya de Hernandez refused the X-ray. She sat curled up in a chair, leaning to one side and exhibiting, to quote Court of Appeals documents, symptoms consistent with “heroic efforts to resist the usual calls of nature.”
&nb
sp; Unfortunately for drug mules, the usual calls of nature are amplified by anxiety. Anxiety causes a mild contraction of the muscles of the rectum walls. This reduces the receptacle’s volume, which means it takes less filling to activate the stretch receptors and confer ye olde sense of urgency. Rodriguez confirms this: “You have to relax. If you’re nervous, your body clenches up.” (Even mild anxiety has this effect. Using rectal balloons and regretful volunteers, motility researcher William Whitehead found that anxious people tend to have, on average, smaller rectal volumes.) In an episode of markedly high anxiety—giving a speech, say, or smuggling heroin—the effect can be dramatic. It’s the last thing an “alimentary canal smuggler” needs. Mike Jones tells the story of a drug mule whose sphincter surrendered on a flight into O’Hare. The man retrieved the packets from the airplane toilet and, rather than wash them off and reswallow them, stuffed them into the socks he had on—with predictable and life-changing results.
Montoya de Hernandez’s lawyer tried, unsuccessfully, to argue that the plastic underpants and the eight recent passport stamps into and out of Miami and Los Angeles* did not constitute a clear indication that she was smuggling, and that her lengthy detention had been in violation of her Fourth Amendment rights. The U.S. Court of Appeals for the Ninth Circuit, however, reversed the conviction. And on it went, until Montoya de Hernandez and her stalwart anus made their way to the highest court of the land.† With Justices William Brennan and Thurgood Marshall dissenting, the Supreme Court reversed the Court of Appeals judgment. By refusing an X-ray and resisting “the call of nature,” the Court concluded, Montoya de Hernandez was herself responsible for the duration and discomfort of her detention. The phrase “the call of nature” occurs so many times in the text of the case that I found myself applying a David Attenborough accent as I read.