November 16, 2013 Leave a comment
Did you know you can’t have your appendix taken out on a whim? Unless you are going to work in Antarctica or the moon the only way you can have your appendix removed is if you are doubled over in screaming agony in an emergency department. Even then it is not straight forward.
The thing about doctors is that in order to maintain the status quo they have to know more about you and your symptoms than you do. Mostly this is not a problem, but when you go in and say I have this sharp pain in my lower right abdomen and do they think it might be appendicitis, they will go to great lengths to tell you all the symptoms of appendicitis that are not a pain in the lower right abdomen. And if you say, between gritted teeth, ‘But I do have a pain in my lower right abdomen’ they will smile condescendingly as if to say ‘You’ve been googling again haven’t you?’
There are lots of tests and markers for appendicitis and almost all of them are inconclusive. Pretty much the only definitive marker is if the thing bursts, which is why they keep jabbing at it with their pointy fingers. What they like to do is put two fingers over the appropriate area and push with all their weight for an agonising few seconds and then leap back with a theatrical flourish and ask whether it hurts more when they poke or when they let go. At this point you need to make a decision (while resisting the urge to say let me try it on your eyeballs and see what you think). If you want them to remove your appendix then simply answer yes to the latter. If you wish to defer to their superior knowledge and experience (and truly you don’t know if the pain is to do with ovarian cysts or gall stones or contortions of your liver) then just tell the truth. However, if your pain does not increase when they let go they will not know what to do next.
If you find yourself in hospital with a rapidly diminishing, mysterious (lower right) abdominal pain but with no raised temperature, no heightened infection markers in your blood, no rebound pain when they stop poking you, nothing but blobby gray shapes on your ultrasound and a surgeon who says it is 50/50 and he usually doesn’t operate unless it is 60/40, then you have another decision to make. If you decide that since you are actually feeling fine now and since the hospital you are in is due for decommission in two years time and has threadbare carpet, broken light fittings and a bathroom which is half a kilometer up the shuffling corridor (and by the way, the cannula in your hand gives you the heebie jeebies,) then this is the point at which the surgeon will suddenly change tack and decide he is leaning towards 51/49. This is probably the time to whip out your copy of Catch 22 and bone up on some of the finer points.
Yes, clearly, looking back, you should have agreed to having your appendix out when the surgeon briefly wavered in that direction but it is entirely possible that if you had pushed to go ahead then he would have decided not to. Therefore it is quite likely that you still would have ended up doubled over in Sydney airport two month later with the choice of heading to emergency (in a city where you have no friends or family or change of clothes or copy of Catch 22) or waiting out the pain and then bluffing your way back onto a plane home to Perth. The trouble is that once the pain has subsided enough to fly home your GP won’t refer you to a surgeon to have your appendix removed because you no longer exactly have acute appendicitis.
‘But…’ you might say, ‘Surely it is better to book an appointment and pack your bag yourself and fast for the appropriate time and head to a nice hospital where thirty years of paying but not using private hospital cover might ensure a room with an ensuite shower, would be better than walking about for the next few months with the possibility of lurking peritonitis?’ But all your GP will do is shake her head sadly and suggest that maybe, if you are lucky, the thing will burst over the weekend and remove all doubt.