“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.[70] 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.”[71]
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.”
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[72] 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.[73] 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.
United States v. Montoya de Hernandez set the precedent for the 1990 case of Delaney Abi Odofin, who spent twenty-four days in detention before passing the first of his narcotics-filled balloons. “An otherwise permissible border detention,” the Justia.com summary concluded, “does not run afoul of the Fourth Amendment simply because a detainee’s intestinal fortitude leads to an unexpectedly long period of detention.”
How is such fortitude even possible? Why didn’t Odofin’s mass contractions seize the day? Why didn’t his colon burst? Whitehead explained that the body has yet another rupture-preventing protective mechanism. A rectum that remains distended long enough will eventually trigger a slowing or even a shutdown of the production line, all the way upstream to the stomach if need be. Contractions of the colon and small intestine wane, and gastric emptying slows. This mechanism was documented in a 1990 study in which twelve students at the University of Munich were paid to hold back as long as they could. To see, one, whether and how long it’s possible to suppress the urge, and, two, what happens when you do. The authors were impressed. “Volunteers succeeded in suppressing the urge to defecate to an amazing extent.” Having just read Odofin’s case, I wasn’t all that amazed. Only three of the twelve made it to the fourth day.
The other thing the Munich researchers reported, and a mild duh here: the longer the material was held back, the harder and more pellet-like—the more scybalous—it became. Because as long as it sits in the tube, moisture will keep on being absorbed from it. The harder and drier the waste gets, the tougher it is to eject. Holding it in causes constipation. The authors concluded their work with a word of advice for constipates (to use the exotic and rarely employed noun form): “Follow each call to the stool.” Or, in the words of a British physician quoted in Inner Hygiene, James Whorton’s excellent and scholarly[74] history of constipation, “Allow nothing short of fire or endangered life to induce you to resist… nature’s alvine[75] call.”
Constipation is the least of an alimentary canal smuggler’s worries. About 6 percent of drug mules suffer bowel blockages[76] when packets logjam or the ends of the condoms become entangled. And there are overdoses. In the early days of alimentary canal smuggling, mules would wrap drugs in single condoms or fingers of rubber gloves, a thickness sometimes dissolved clear through after a few hours in gastric acid. Depending on the quality of the latex, the drugs would also leach through intact packaging. In more than half the reported cases of cocaine-swallowers spanning 1975 to 1981, the suspect died of overdose. (An antidote exists for heroin, but not cocaine.) Insult to injury: should you die on the job, you run the risk of your accomplices gutting your carcass to recover the drugs,[77] as happened to two of the ten dead Miami-Dade County, Florida, drug mules whose cases were covered in the American Journal of Forensic Medicine and Pathology paper “Fatal Heroin Body Packing.”
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Especially if the exam entails defecography, which is pretty much what it sounds like. The patient is the star in an X-ray movie viewed by an audience of technicians, interns, and radiologist. “As close to pornography as medicine will come,” says gastroenterologist Mike Jones. Worse, the patient is passing a barium-infused “synthetic stool” crafted from a paste of plasticine (or in simpler days, rolled oats) and introduced wrong-way into the rectum. For the constipated patient, notes Jones, it can be a real ordeal. “It’s like, ‘Dude, if I could do this, I wouldn’t be here now.’”
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Customs officers at Frankfurt Airport have it easier. Suspects are brought to the glass toilet, a specially designed commode with a separate tank for viewing and hands-free rinsing—kind of an amped-up version of the inspecting shelf on some German toilets. P.S.: The common assumption that the “trophy shelf” reflects a uniquely German fascination with excrement is weakened by the fact that older Polish, Dutch, Austrian, and Czech toilets also feature this design. I prefer the explanation that these are the sausage nations, and that prewar pork products caused regular outbreaks of intestinal worms.
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Other red flags for customs agents include the unique breath odor created by gastric acid dissolving latex, and airline passengers who don’t eat. For years, Avianca cabin crew would take note of international passengers who refused meals, and report the names to customs personnel upon landing.
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Occasionally the justice system has no choice but to step right in it. In
My thanks to Judge Colleen Weiland, who drew my attention to the case and did me the favor of forwarding a logistical question to the presiding judge, Judge Mary Ann—may it please the author—Brown. “It appeared,” Brown replied, “that he liquefied the material and then dripped it or sucked it into the tube.”
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Seriously, published by Oxford University Press. But highly readable. So much so that the person who took
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Of or relating to the belly or intestines. With crushing disappointment, I learned that Dr. Gregory Alvine is an orthopedist. Staff at the oxymoronic Alvine Foot & Ankle Center did not respond to a request for comment.
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You would think the percentage would be higher, but in fact 80 to 90 percent of nondigestible objects that make it down the esophagus pass the rest of their journey without incident. If a man can swallow and pass a partial denture, a drug mule has little to worry about.
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Close to but not quite the most egregious indignity bestowed on a corpse by drug dealers. Smugglers have occasionally recruited the mute services of a corpse being repatriated for burial and stuffed the entire length of the dead man’s GI tract. Heroin sausage.