There is small organ that lies at the junction between your large and small intestines. It is called the appendix. On average it may measure 10 cm long and a centimetre or two in diameter.

Just like in a document, an appendix does not serve a significant function in the human body.

This small organ is only thought to be useful among children in helping the body fight against disease. It has no role in adults. 

So useless is the appendix that if we ever make that incision, we must remove it even if it appears healthy. I should not forget to mention that most of the times, a diseased appendix is removed by the junior most members of the surgical team.

Yet in up to 1 in 10 people will have their appendices diseased. And the disease process may progress to put one’s life in immense danger. It can burst and pour the contained filth into the entire abdominal cavity and plunge the patient into overwhelming sepsis and shock, even death!

A couple of months ago, my medical officer walked into my consultation room. It was during a surgical clinic. He needed to consult about a lady with abdominal pain, having entertained (though with doubts) the diagnosis of appendicitis ( inflamed appendix).  

She Looked Okay Despite the Disease

She looked okay when I examined her. She did not run a fever, nor was her heart racing. Her tummy looked mildly obese but otherwise moved with respiration. I ran my palm over her belly while my gaze remained fixated on her eyes. When I pushed my palm deep into her belly just below and to the right of her navel, she squirmed but did not wince. Add this to the nearly normal white-cell count on her blood test and I understood my colleagues reservations. It was not typical of appendicitis. Besides, she was in her late 50s or early 60s, not in the peak of the 3rd or 4th decades which is the demographic group typically afflicted by this disease. 

It came to my attention that she had used antibiotics for two days before coming to the clinic. As I went through the packets of tablets she had, I realised she was also using tablets to control blood sugar. That is when she volunteered the information that she suffered from diabetes as well. Now, diabetes can easily mask the symptoms and signs of a disease, especially an inflammatory one like appendicitis. I would wait for the scan of the abdomen before making the next move, I informed her.

Ruptured Appendix

The scan revealed that the appendix had ruptured but luckily her body defence mechanisms had cordoned off the surrounding area. The infection did not spread to the rest of her belly. But in that half foot right lower quadrant, her abdomen was filling with a concoction of dead and dying bacteria, destroyed white blood cells and the debris that is the aftermath of the duel between the body and the bacteria. All this concoction is termed as pus. And a collection of pus is called an abscess. Appendicular abscess was the diagnosis when I reviewed her in the ward and asked my team to prepare her for surgery.

We removed the appendix and washed out the pus collection. After such a procedure, the recovery is usually uneventful. But that is not the case in a diabetic patient. The wound healing is usually hampered, leading to a protracted convalescence. Add diabetes to obesity and any surgeon will tell you what a challenge wound care can be following surgery. This was a diabetic, obese, aged patient recovering from abdominal surgery where pus had been washed out. I knew we were looking at a long and rough ride handling the wound.

So when the rough ride came, we embraced it. We adjusted the materials used for cleaning and dressing the wound a couple of times. Often the nurses and interns complained to me that we were not making progress.

“As long as we are not back tracking, let’s keep dragging,”I would counter. 

Sometimes she would feel bloated and vomit. Yet she did not have fever or evidence of infection as per her blood tests. One weekend she developed diarrhoea and I had to ask for an urgent scan of the abdomen, fearing that the pus had re-accumulated in her belly and trickled down to her pelvis by gravity. It is something we often see. And patients experience poor appetite with irritative diarrhoea-producing only little watery amounts when they go for a long call.  Again the scan came back clean. It was another of the many false scares and deceptions that her body kept dangling at us.

Nearly a Month in Hospital

After nearly a month, she walked home. But at what cost? A month in hospital, a couple of tests and scans, numerous reviews and consults and countless dressings and drugs. Not to mention the lost man hours, or the scare and fear. All because of a useless organ called the appendix. 

One experiences such a case and wishes there was a way nature would consume the appendix once it becomes a spent force. To eliminate the 10% chance of developing the disease. 

The appendix has given me an interesting analogy outside of medicine, in our day to day life. Of friends and relatives that were so useful when I grew up! The appendix is rumoured to be useful in childhood, remember? But then once in a while they become a huge impediment to individual progress because of selfish priorities. The same applies to friends and colleagues, present and past. How important are they to my present life? 

The appendix has taught me a new outlook to life. I call it ‘the wisdom from the surgeons’. Not everything that puts your life in danger is absolutely important in your life, at present. Make your decisions wisely. Identify your priorities soberly. Your life may depend on that. If you have to be pushed to the limits, let it be by things that matter, not the peripherals.