Disclaimer: I am not a doctor. None of this is medical advice. We are speaking of appendicitis in a purely fictional context. If you are having symptoms you suspect may be appendicitis please stop reading and seek medical attention from a qualified practitioner immediately.
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“Four people are sitting around the table talking about baseball, whatever you like.
Five minutes of it, very dull.
Suddenly a bomb goes off. Blows the people to smithereens.
What do the audience have?
10 seconds of shock.
Now, take the same scene. And tell the audience that there’s a bomb under the table and that it’ll go off in 5 minutes.
Now the whole emotion of the audience is totally different. Because you’ve given them that information.
Now that conversation about baseball becomes very vital. Because they’re saying to you, don’t be ridiculous, stop talking about baseball there’s a bomb under there.
You’ve got the audience working.”
— Alfred Hitchcock
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I hear Alfred Hitchcock talk about Suspense and I think Appendicitis. A bomb strapped under the table that only the audience can see? No—a vestigial organ in everyone’s abdomen.
What is Appendicitis?
Appendicitis is an infection of the appendix—a small vestigial organ on the end of the large intestine. Most of the time the appendix is no problem. It just hangs out in your digestive tract, doing nothing, asking nothing.
However, sometimes the appendix gets infected.
At which point it starts doing and asking a lot.
Symptoms of appendicitis include: loss of appetite, fever, nausea, diarrhea, vomiting, and sharp abdominal pain. The point of pain is a particular clue. The appendix in most people is located near the hipbone crest on the right-hand side. Poking or tapping this area in someone with appendicitis produces excruciating pain not present elsewhere in the abdomen. Thus tapping becomes an important diagnostic tool for physicians.
What causes appendicitis? Good question! Until very recently medical science had few to no answers. Nowadays we know that the appendix becomes infected when its blood flow is blocked off by calcified fecal matter, a tumor, or some other mechanism. This is not anything most of us have any control over or can plan for, which is why it takes most people by surprise.
While its causes may be mysterious and its occurrences strike almost at random with little-to-no forewarning, it has a (relatively) simple and straightforward cure. The removal of the appendix, called an appendectomy, is a near-instantaneous fix. Given antibiotics to control the infection, recovery is rapid (especially when compared against other abdominal surgeries) and the life of the patient afterward continues as normal.
Once the appendix becomes infected, its swift removal is imperative. If left to its own devices it will burst, spreading its infection throughout the abdominal cavity and becoming significantly less survivable—but not impossible with modern antibiotics. Still even with adequate medical care it is far preferable to have the appendix out sooner rather than later.
Appendicitis has been the force behind many exciting moments in the history of medicine. Leonid Rogozov was in a remote research station on Antarctica when appendicitis struck him in 1961. Fortunately there was a doctor on base. Unfortunately he was the doctor. He successfully operated on himself and removed his appendix not a moment too soon—according to his own estimations it would’ve burst less than a day later. Today some doctors headed to Antarctica are required to have their appendices removed beforehand.
(Rogozov was not alone in removing his own appendix. Fellow surgeon Evan O’Neill Kane performed an appendectomy on himself in 1921, not for a lack of other practitioners available but because he wanted to test the efficacy of local anaesthetic in surgery. More on self-surgery in a future blog post.)
Now that we know what appendicitis is, the question remains…
Why Write Appendicitis?
Of all the ailments in a writer’s toolbox, appendicitis offers supreme narrative convenience.
1. Every human being has an appendix.
2. It can go bad basically at any time with little to no warning.
3. If it goes bad there’s a limited time-frame to do something about it before it bursts and becomes significantly less survivable.
4. However if caught in time the fix is relatively simple and life without an appendix doesn’t have a significant detrimental effect on the survivor (as compared to, say, a spleen or a gallbladder or heaven forefend a still more vital organ).
So basically it can strike whichever character the author wants, whenever it’s most narratively convenient, and has a built-in tension-creating mechanism.
Which means that from a storytelling perspective it’s perfect.
Need to ramp up the stakes? Strike your protagonist down with appendicitis. Need your characters to get way closer, physically and psychologically, and fast? Uh oh, sounds like somebody needs to perform and/or undergo an emergency appendectomy in the wilderness. Need a life-threatening excuse for emotionally repressed romantic leads to confess all, lest one of them perish without knowing how deeply the other cared for them? Woe, appendicitis be upon ye.
Also, because appendicitis is not contagious, the recovery can have all the tender caretaking moments without any of the other characters having to worry about catching the illness—as compared to, say, consumption or cholera.
The only downside is that everyone only has one appendix, so you can only pull this trick with a character once. Additionally if more than one character in the same story gets appendicitis it becomes significantly harder to suspend disbelief. (Rather like lightning striking twice. Possible? Yes. Probable? No.)
I do worry that if I write book after book where the protagonist gets appendicitis, readers will eventually get bored. Then again if straight romance authors can write one thousand discrete Billionaire Duke’s Secret Baby novels, I think I should be permitted at least three Appendicitis novels, as a treat.
As matters stand, I’ve only written one appendicitis novel so far.
Fiorenzo is a fantasy-of-manners romance featuring swordplay, hurt/comfort, and a happily-ever-after. I won’t spoil the who or the when of the appendicitis that occurs, but I can promise you it leads to a whole lot of hurt/comfort.
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Sebastian Nothwell 