Is That a Ruptured Appendix in Your Pants or are You Just Happy to See Me?

The other morning shortly after I woke up I started feeling a strange type of pain from the middle of my abdomen.  I figured it was probably something I ate, though it wasn't the normal sensation I often get from the food here.  I was scheduled to go out into the field, so I continued with my preparations.  Over a very short time the pain grew and grew until it felt like someone had tied my eyeballs to my nuts and was trying to yank them both out through my belly-button with a tuna gaff.  I went to see my good friend who's been working in the area for almost 20 years and has pretty much seen it all.  She called over a friend of hers, a retired army nurse, and he went to work.  He quickly suggested that it was a problem with my appendix and suggested that we go to the local "hospital" (the place I went when I had dysentery).  He gave me some painkillers, antibiotics, and something I think must've been Valium.  After lying down for an hour and a half or so the pain started to subside and we went down to the "hospital".  

Poke Poke Poke...

At the hospital a couple of nurses came in to check me out.  I told them where that pain was and they started feeling around to check if there was any sort of intestinal blockage or swelling.  When the nurse got to my appendix area I told her the most severe pain was a little left and further down, but she didn't go for it.  I guess she'd heard that one before. 

Eventually the doctor came in.  "I think maybe you have appendicitis, but we need to check your white blood cell count to know".

The nurse came in and took my blood, and after about ten minutes the doctor came in with a big grin on her face.  "It's just as I suspected", she said with glee.  "You have appendicitis!"

"Am I going to die?" I asked.

"Maybe!" she replied in the same cheerful sing-song voice.  She added that it didn't seem that serious and prescribed a course of antibiotics and painkillers. 

I decided to cancel my trip to the field and lay low for the rest of the day.  I told my good friend and colleague Wendy about my little adventure.  Wendy, who is also from the department of Geography at the University of Hawai'i and even has the same advisor as me, is also doing her PhD research in Indonesia.  Wendy is the type of person that knows exactly what to do in the worst-case scenario, and she's actually had to have someone extracted from the wilderness of Borneo who was suffering from appendicitis.  Wendy basically texted me the entire contents of the AMA reference on appendicitis along with a comprehensive description on how to diagnose and field-treat the affliction.  I had also seem the procedure done on an episode of Dr. Quinn Medicine Woman and I once built a ship in a bottle, so I figured if it came down to it I could do the surgery myself with my parang, shaving mirror, and mess kit. 

As the day wore on I didn't experience any more pain, so I started to doubt the diagnosis.  I figured I better get a second opinion, so I went to see another doctor, one who I'd seen before and who has a very good reputation in town.  She gave me a good going-over and expressed doubts about the appendicitis diagnosis, but said I should continue taking the antibiotics and be careful. 

"We can do the procedure here", said the doctor.

"Whoooaaa doc let's not get ahead of ourselves" (1).

With the rest of the day I bummed around town chatting with the locals.  I asked a bunch of folks about sakit usus buntu (appendix illness), and evidently it's pretty common here (like every place else around the world).  Lots of folks told me that you can get appendicitis from eating too much chili, as the seeds from the pepper get lodged up in the appendix and cause an infection.  I don't know if there's any truth to this.  I also looked around on the internet for information about appendicitis, but there is a lot of conflicting stuff there.  Fortunately for me one of my friends in Hawai'i is a doctor.  I was able to ask her about my symptoms via Facebook, and she graciously responded within a couple of minutes after each inquiry. 

Getting Treatment....

Since I had to go to Jogjakarta anyway about an immigration issue, I figured I might as well visit the hospital there and see if I could get some tests done.  My friends in town suggested Panti Rapi hospital, which is evidently operated by some padres, friars, and sisters, and when I got there I was amazed at how well-run and clean the place is compared to the New Bethlehem conditions that pervade in Sungai Penuh.  Thank God for the Catholics and the Jews, otherwise there wouldn't be any good hospitals anywhere.

The first step after the initial consultation was an ultrasound.  Though I had a good time joking with the technician and playing with the machine, the results were inconclusive; he couldn't find my appendix.  He told me that if it was inflamed or infected it would probably show up on the scope, so I figured I was finished.  But when I went back to the specialist's office he told me he wanted to run another test to make sure, and it would require me staying a day longer in town.

"Doc, is it absolutely necessary?  I have to get back to work," I pleaded.  "Is there something else we can do?" 

"Well, I could take your appendix out now without the test results...."

"Christ Doc, isn't that a violation of the Hippocratic Oath or something like that?  You wanna take out my gall bladder and a kidney as a precaution too?"

"I don't think that's necessary at this point....."

In many instances in this life you face a choice: you can do the smart thing or you can do the stupid thing.  The advantage of getting older and having experience is being able to tell the difference between the two before you make your decision.  In this case the stupid thing to do would be to go back to Sumatra and continue working.  I'm currently at the stage of my research where I'm planning to follow some forest ranger patrols for several days at a time, and it would be completely irresponsible to follow along with them knowing I might have a medical condition that could create an emergency situation for them at any time.  So though I continued to doubt the appendicitis diagnosis, I decided to follow the doctor's advice.

He sent me back down to the radiology department where they gave me something called "English salt" (Epsom salt, which I was to mix with water and drink 2-4 hours before drinking the barium sulfide (Barium is an element named for its discoverer, current US President Barrack Obama (2)).  I'd never had Epsom salt before, but it tastes pretty wretched.  Then as per the instructions I gulped down the Barium Sulfate, which doesn't taste nearly as bad as you'd expect radioactive material to taste.  I did some more looking on the internet about the use of barium sulfate for appendicitis detection, and there isn't a lot of information about it.  However one "medical" page I looked at said that it shouldn't be used for detecting appendicitis, which is completely contrary to the advice I got from the doctors in Jogja, as well as my friend in the US, who really knows her stuff and said that it's absolutely the best course of treatment. 

In the morning I went back to get the x-ray done.  The barium sulfate is used because it shows up on the x-ray, and so it makes your insides very visible so any abnormalities can be seen.  It didn't take long to receive the diagnosis of "chronic appendicitis", and when I went back to the specialist he said the best thing to do would be to cut the wormy little culprit out of my body.  We went over the procedure and made arrangements.

"I've got two questions Doc.  First, you're not going to put a tube in my pee-pee are you?"

"You mean a catheter?"

"Don't say it, Doc.  The very mention of the word brings tears to my eyes".  I'd experienced this medical marvel during emergency surgery about ten years ago in Japan when, due to an old lady's carelessness, my right leg was crushed between the front bumper of a Mercedes and the engine of my motorcycle.  I wasn't too eager to experience it again.

"We will try to avoid it.  I will make a note."

"There is no 'try', Doc.  Next, can I keep my appendix once you take it out?"

"What do you want to keep your appendix for?"

"Well, my religion dictates that whenever a part of my body is removed I have to bury it at the foot of a baobab tree.  Failure to do so might anger the giant turtle that bears the awesome weight of the world upon his shell.  This would have catastrophic consequences for all of us."

"You are an oddball", said Doc.

"Are you making fun of me, Doc?"

"A little bit.  But I like you.  You are funny.  You can keep your appendix after I take it out".

"I like you too, Doc."

My real plan is to take the eviscerated organ to one of the silver shops Jogja is famous for to see if I can't get it dipped to save as a keepsake.  

Anyway, all my friends back in the US are worried about me, especially those that don't know anything about Indonesia.  "Aren't you worried about getting surgery in the third world?" they ask.  Of course I ham it up as much as possible.  "I might not have long to live."  Or "If I don't make it back it's been great knowing you.  Live long and prosper."  The reality of it is that there's pretty much no risk above what I'd face if this happened in the US.  And to top it all, I ran into my good friend Agus, who runs Wisma Bahasa, the excellent language school where I learned Indonesian, and he offered to accompany me to the hospital when I have to check in and take care of anything that I might need.  So it's no big deal.  But if you don't hear from me in a couple of days, it's been great knowing you....

(1) If yelling at foreigners was an Olympic event the people of Sungai Penuh would be perennial world champions.  If the space race was based on yelling at foreigners, Sungai Penuh would've built the Death Star by now.  Of course it would've fallen apart due to corruption in the tender and bidding process because the contractors would be forced to use substandard materials.  But poking around my insides with sharp instruments isn't part of what I would consider Sungai Penuh's "competitive advantage".

(2)  This isn't, strictly speaking, factual.