Done in by a less than glamorous blocked bowel, Bruce Kanegai, a 58-year-old karate instructor and high school art teacher from Simi Valley, CA, became the tenth Survivor: Panama -- Exile Island castaway to be eliminated from the game.

Thursday night's CBS broadcast of Survivor: Panama -- Exile Island's tenth episode began with the Gitanos tribe having returned from the Night 24 Tribal Council session in which the game's predictable post-merge "pagonging" continued, resulting in former La Mina member Sally Schumann being voted out of the competition.

The next morning, Terry Dietz, the sole remaining La Mina member, was feeling mixed emotions -- although he was upset to see his last La Mina ally go, he was also looking forward to the fact that since he was in possession of the secret hidden Immunity Idol, a Casaya tribe member would be the next castaway to go home even if he failed to win his fourth straight individual Immunity Challenge.

Although he appeared to have given up hope of breaking up the Casaya alliance and was instead focusing on having to win "at least three of the next four" Immunity Challenges, Terry also recognized that the odds weren't in his favor. "What is going to be interesting now is the longer I hang out, the longer I get to see how they end up turning on one another," he explained to the cameras. "The one good thing I had going for me as far as the Tribal Councils recently is I didn't have to vote against my tribemates -- there wasn't any of that, where these guys are going to have to turn on each other and I hope I'm the fly on the wall."

Meanwhile, as Terry struggling to find a way to stay in the game, Bruce was struggling with an issue of his own: severe constipation. "I feel really constipated and sick to my stomach... it's difficult just to stand," Bruce told his Casaya allies. "My stomach is so bloated it hurts and I haven't gone to the bathroom since just before the Panamanian village feast [on Day 15]... I'm just blocked up and it's very, very, very painful," Bruce explained during confessional.

Later that day, the castaways retrieved Tree Mail that included an additional surprise -- jumbo size voodoo dolls that the castaways were told to attempt to style into their own likenesses. Afterward, the tribe competed in the long-running reality show's latest variation on the famous Survivor: Marquesas "Coconut Chop" challenge that, after exposing the pecking order of the game's dominant alliance, resulted in lower standing alliance members successfully turning on the alliance's leaders.

A Reward Challenge, the challenge required the castaways to "see how well you know the people you're been living with" by having all the castaways privately answer a series of questions and then, after Survivor host Jeff Probst tallied the results, attempt to determine which castaway's name had been listed as each question's answer most often. Every time they correctly guessed the most popular answer to a round's question the castaways would get to chop one of three ropes that were keeping torches from burning their voodoo dolls. After all three ropes were chopped, a castaway's voodoo doll would go up in flames and they would be eliminated from the competition. The last castaway left in the competition would get an overnight visit to a spa, where they would get to shower, wash their clothes, get a massage, sleep in a real bed, and feast on all the food they could handle.

As per its design, the challenge quickly began to generate hurt feelings and expose some of the Casaya alliance's internal relationships. Once Terry was predictably eliminated first, Bruce immediately went next, confirming that as he'd suspected, he was at the bottom of the alliance's pecking order.

After that, the five remaining Casaya members balanced their cuts, resulting in the challenge going several more rounds before Danielle DiLorenzo was eliminated next. Meanwhile, the revealing nature of the most popular answers themselves began to take their toll on the competition, with Shane Powers growing resentful that he had been the most popular answer to "Who mistakenly believes they are running this game?" and Courtney Marit getting upset that her name was the answer to unflattering questions such as "biggest poser" and "most annoying person." Shane began whining at Courtney after she chopped one of his ropes for a second time, causing Aras Baskauskas -- clearly a veteran Survivor viewer -- to remind his fellow alliance members that the challenge "was meant to splitter us" and that they needed to work to "raise above it."

Courtney and Shane were eliminated next, leaving only Aras and Cirie Fields in the running to win the challenge. Cirie's status in the final two further irritated Shane, who openly dubbed her performance "under the radar." Ironically, the next question was "Who would never survive on their own?," which Cirie correctly answered by selecting herself. Since she still had two ropes remaining to Aras' one, Aras' answer would have been mute if Cirie answered the correct answer, and he appeared to use the opportunity to take a shot at Terry by showing Terry's name as his answer to the question. Taking the dig in stride, Terry asked Aras if he had "done that on purpose," causing the 24-year-old yoga instructor -- clearly resentful of Terry's reputation as the game's superman -- to foolishly crow that he didn't think the 46-year-old former Navy fighter pilot, undefeated Immunity Challenge champion, and frequent Exile Island visitor "could survive a day in the wilderness."

As the challenge's winner, Cirie decided to once again send Terry back to Exile Island. Additionally, Jeff surprised Cirie by revealing that she would be able to take two other castaways with her -- setting off a begging competition between Aras, Courtney, Danielle, and Shane. In the end, Cirie cited "promises" to Aras and Danielle and selected them to accompany her -- a decision that upset Shane, who launched into his latest temper tantrum and openly criticized Cirie's decision to take Danielle instead of himself.

After taking a helicopter to the spa, Cirie, Aras, and Danielle enjoyed an afternoon full of food and relaxation. Meanwhile, Shane began to stew back at camp, still upset that Cirie had selected Danielle and wondering if the move was an indication that the Final 3 alliance that he believed he'd formed with Cirie and Aras was in jeopardy. "I've always though that me, Aras, and Cirie were tight in a three-way thing [but after] today, I dunno," he explained to the cameras. "I gotta ask myself where is Cirie with Danielle."

Meanwhile, Courtney was also upset to have learned about her fellow tribe members' negative perceptions of her. "Courtney destroyed herself today," Shane explained. "She takes a lot of stuff personally anyway and just to hear some of the answers to what the tribe thinks about her, it's just really got her at an all-time low... she got a lot of bombs dropped on her."
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That night, Bruce's constipation continued to get worse, with the physical pain finally becoming more than he could bare. Writhing in pain and confident that Courtney's singing wouldn't help the problem (there's a shocker), Bruce finally decided that he needed medical attention, resulting in Survivor's medical team visiting the camp. Unable to rule out that problem might be his appendicitis, the doctor decided that Bruce needed to be evacuated, creating a bit of a Richard Hatch flashback when a naked Shane -- sleeping in the buff due to the "baby rash" his constantly damp shorts had been causing to his privates -- had to immediately help load Bruce's stretcher onto the waiting boat.

The next day, Cirie, Aras, and Danielle received the cold shoulder when Courtney and Shane, both still upset about the previous day's Reward Challenge, failed to go out of their way to greet the returning castaways. "The tension at the camp when we got back was so thick... I didn't know if it was safe," Cirie later joked in confessional.

After learning of Bruce's departure, Aras and Cirie set about trying to mend fences with Shane, who later claimed that his behavior had all been part of a big master plan. "The whole discussion was a big rant and was absolutely calculated by me in order to get ahead of Cirie and Aras mentally," he later gushed in confessional. "And it played exactly how I wanted it to."

Still unsure of Bruce's status, the tribe was surprised when rather than receiving Tree Mail for their Day 27 Immunity Challenge, a production boat carrying Jeff and Terry (who would normally rejoin the tribe at the day's Immunity Challenge) visited the camp. After filling a still oblivious Terry in on Bruce's medical evacuation, Jeff explained that although he eventually would make a full recovery, Bruce's blockage had been very severe and he would not be returning to the game. With Bruce out of the game, no Immunity Challenge would be held and a Tribal Council session would not be held that evening.