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Thesis Time #3- Vestiges

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Hello, lovely readers. I’ll be posting pieces I wrote for my senior thesis for the next couple of weeks. If you’d like a PDF of the whole mess, shoot me an email. 

I’m not crazy about this one, but it was my advisor’s favorite and he’s smarter than I am anyway. In the printed formatting I used horizontal lines between sections, and here I clearly do not, but I think you’ll be able to read it. 

Pain. Dull, achey, inescapable pain. For twelve hours my world has been a fever haze broken only by coke syrup doused over ice. Cloyingly sweet and blessedly cold, a momentary relief at best.

A week ago I got a cold or flu, something unpleasant but typical, but the seventh day of toast and tea turned into a night of violent heaving. I’m twelve. I get sick often, but except for regular bouts of strep throat I’ve avoided anything serious until now. I figure I’m over-reacting.

On the right side of the abdomen, nestled near the ileocecal valve (where the large and small intestines meet), the appendix sits in vestigial limbo. Its full name includes the description vermiform, from the Latin for wormlike. It does look remarkably like a worm, trailing as it does from the wide, rounded base of the colon.

For the first time I can remember, my temperature is above 100: 102. Not dangerously high for most, but my healthy body temperature rarely crawls above 97 degrees Fahrenheit. I feel profoundly unwell, almost too sick to sit up. Worse, the pain in my stomach, a pulling I’d chalked up to muscle damage from a night of vomiting, has focused itself on one throbbing point.

A vestigial structure is one that’s been rendered useless by time and evolution. Wings on a penguin are one example. Humans have the coccyx, reminiscent of a lost tail, and wisdom teeth from the days of massive herbivorious jaws. We also grow useless muscles under our ears, once used to move them beyond a party-trick wiggle, and stunted third eyelids in the form of plica semilunaris, a fold of tissue in the inner corner of the eye.

Surely the peskiest of human vestigial organs, the appendix saw its heyday come and go some two to three million years ago. Before then, our evolutionary ancestors relied solely on foraging, eating only plants and seeds. Special bacteria were needed to digest enough cellulose (plant cell wall) material for proper caloric intake. These bacteria lived in the appendix.

With time, humanoid diets transitioned to omnivorous. Eventually people began to cook, making whatever plant material they did eat much easier to digest. Soon the appendix wasn’t necessary for survival. Without death by starvation to weed out them out, wimpy, worm-like appendices became the human norm.

My mother, a physician, diagnoses me on sight and drives me straight to my doctor. He feels my belly, probing for pain in the expected areas, but a coincidence in timing has him unconvinced: I happen to have my period. He says I must be experiencing normal cramping.

If this is normal, I mutter, take me in for a hysterectomy instead.

I’m very cynical for my age.

My mother insists that it isn’t normal, and we’re sent to another doctor for a second opinion. By now I clutch my belly, whimpering with every movement. It feels as if something is trying to kill me from the inside out.

Wormlike structures, being long and skinny and not-so-regularly shaped, have a habit of getting things wedged inside of them. Being attached to the colon, which handles fecal matter, doesn’t help much. In fact, it’s a wonder more people don’t get killed by wayward appendices. After something has been wedged inside, blocking the attachment to the rest of the digestive system for awhile, mucus will build up and swell the organ. As blood vessels become strained, necrosis begins to occur. The organ dies slowly, attracting bacteria and white blood cells in turn. The white blood cells usually can’t persist against the bacteria and their toxins, so they die and produce pus. The dead appendix, full of pus and mucus, has no way to avoid bursting.

In appendicitis, the bursting of the organ produces a sharp spike in pain levels before, surprisingly enough, a period of relief. This eye of the storm can occur for a few hours before the released bacteria make their way to the stomach lining, causing a dangerous infection called peritonitis.

Another office, another man telling me I just have bad cramps. Still, he agrees that it’s better to be safe than sorry. My surgery is confirmed and I’m brought in through the recovery room so I can be slipped in between scheduled procedures. The doctor who’ll be performing my appendectomy isn’t even on call, but that doesn’t faze me. I’m a doctor’s kid. I know the entry codes for the back door of the ER.

My sister is away at camp, and my mother calls her so she can speak to me. She’s sobbing. I shouldn’t be surprised, because this is the girl who cried when I crushed my finger in a car door in third grade. Still, her hysteria reminds me for a moment that this is my first time going under for surgery. Anything could happen. My mother asks me if I’m scared, but I tell her I just want it to stop hurting.

Everyone else in the room has already been treated. Their families are hugging them in relief and joy. We’re the only ones that have to pretend we’re not saying goodbye.

Two to four hours after an appendix bursts, the peritoneum—the membrane surrounding the abdominal cavity—turns from the slick greyish color of health to a dull surface. It weeps a fluid that grows thicker over time. As the body becomes full of more dead and infected tissue, the immune system reacts to excess.

I am amazed that being wheeled back to the operating room is exactly like it always looks in movies. One door opens onto a sterile white hallway, then another, then another. They lift me onto the table and do the final surgical prep. The last five minutes before I go under will be lost to the effects of the Propofol being injected into my arm. Doctors call it “The milk of amnesia” for good reason.

Laporoscopic surgery, considered minimally invasive, usually requires three incisions of about a centimeter in length. The abdomen is inflated with carbon dioxide, creating a dome under which the surgery can take place without touching abdominal wall.

A camera is inserted through the largest incision, projecting the surgical site onto a screen placed in the operating room. The remaining incisions are used as entry points for a multi-pronged tool. Using the image on the screen for guidance, a surgical team will sever the appendix from the large intestine and remove it. It isn’t uncommon for the appendix to burst on the operating table, but at this stage massive doses of antibiotics will prevent a spread of the infection.

I wake up to my surgeon telling me that my appendix was really infected, as if there can be degrees of such a thing. I guess he means that it was totally necrotic and close to bursting, which is a scary thought. How is it that I’ve survived the death of one of my organs? It seems so strange.

That night, my mother braids my hair and I beg for food. A nurse brings me a ham sandwich and a waste pan, telling me I shouldn’t expect to keep anything down two hours post-op.

I eat, the first step in bringing my body back to a healthy equilibrium. I fall asleep. In the morning, all will be well.