Medicine ought to be science, or is it?

 

 Only three years ago I was seeing an appendix a week in young adolescents and kids from a sample of just over twenty seven thousand households in NW and Gauteng before that. Yes, over ninety percent were lily whites if you need to know; criminal you have to admit but all were clinically cured.

 
Less than a thousand kilometres away I have yet to see an acutely presenting appendix from a sample size ten times larger, over a time span of a year and a half and counting. Thirty years of cherished and practised clinical pathology magically dissolved into thin air, without not even a single variable to explain this.
 

Those patients that do reach the hospital present as generalised peritonitis with no clear picture as to what the original source of the surgical abdomen was. Most get confused with ruptured peptic ulcers, save for the exaggerated pyrexia and septicaemia. Add to this the renal failure complicating the presentation because of pre-treatment with herbs from the local bone throwing compatriots before coming to hospital. You as the admitting doctor have to resuscitate and stabilise before you can even attempt to diagnose. The appendix gets to be diagnosed after the exploratory laparotomy or post mortem if fortunate enough to have one done.
 

How does the clinical picture change so drastically from one region to the other? What is a student of medicine in the university of Natal expected to take home as a message from such pathological variants? When can such a student do a lily white appendix in a controlled environment with a registrar and a consultant as a guide? You get very little useful academic knowledge from abdominal washout and drains.

  
Ninety percent of what we used to operate on were not appendix abscess or anything close to the above picture. Ninety percent walked out of the hospital a day after the surgery with nothing more than three centimetres of a classical appendix scar. Ninety percent had only an appointment by the primary health care nurse with nothing more than dry flowers as a thank you note for getting rid of the major absenteeism generating rudiment as a reminder of what we’re guilty of; if lilies had to be a crime. More importantly none died and none was laparoscopic. We were happy to be named as the doctor responsible for the missing appendix, all outcomes considered. If we got a complaint it usually was because we waited too long, specifically with reproductive females when the diagnoses was not in black and white.
 

This side of the Vaal the post-operative ICU convalescence is close to a month. The scar and drains from the encounter when it eventually closes leaves little to imagination. The adhesions and the bowel obstruction presentations afterwards stay a constant reminder years into post-operative recovery period of what we could have done better.

There has to be a middle ground to this seemingly parallel dichotomies. If I had to choose one or the other though, my kids will go through the first option. If I had to modify and weed off the negatives patients need to see me first, then consult a herbalist after excluding an appendicitis, only then could I assume a lower incidence of appendicitis on regional basis.

 

If physiology and biochemistry of health health are the elements of every mix, then results are assured