Woman with no appendix undergoes appendectomy, wonders why

Margaret Maurice, 69, was scared as she lay on an operating table in Prince Albert on Jan. 21, waiting for a surgeon to take out her appendix.

A couple of hours later, after the anesthesia wore off, Maurice woke up in a recovery room at Victoria Hospital and discovered three bloodiedbandages on her belly and a surprising revelation.

"One of the nurses told me, 'You had no appendix.' And that was it,"Maurice told CBC News. "Then I couldn't ask any questions, because they weren't around anymore."

I wanted to know what [the surgeon] did to me, what he did inside.- Margaret Maurice, surgical patient

She was told to go back to her northern village, Beauval, 300 kmaway, and return a week later. A discharge note, signed by a nurse, didn't contain information about the procedure, only a form letter and a warning to keep her wounds dry.

Ten days later, the missing appendix remains a mystery but Maurice's experience has become a clear case of how patient-physician trust can unravel over communication issues.

After the surgery, Maurice went to a hotel where she was bedridden with a headache and nausea.

She was also confused and upset.

"I wanted to know what [the surgeon] did to me, what he did inside," Maurice said. "They just left me like that to go home."

Search for answers

Her daughter, Gail, who lives in Toronto, was livid over what she calls "unnecessary surgery."

"My mom was under general anesthetic. She's in her 60s. It's not to be taken lightly. It's surgery," she said. "She has scars on her stomach and she did not know what was performed."

Gail Maurice called the surgeon, Dr. Yagan Pillay, to complain about her mother's care and decided to record the telephone conversation.

A filmmaker, she has worked for the University of Toronto as a standardized patient to test medical students on patient care.

Communication challenges

In the recorded conversation provided to CBC News,a man identified as Dr. Yagan Pillay defends the procedure. He points to misinformation from Margaret Maurice about her own medical history.

Pillay, who was certified in South Africa, has practised general surgery in Canada for a decade.

Pillay didn't respond tonumerous phones calls, messages, and attempts to verify the recording by CBC News.However, CBC News listened to the recording to hear the surgeon's explanation as to why, he said,an appendectomy made sense to him at the time.

Last fall, Maurice was suffering from chronic diarrhea and pains in her right side. A screening test for colon cancer showed blood in her stool.

She didn't tell me she had her appendix out- Dr. Yagan Pillay, surgeon

She was referred to a Prince Albert specialist, Pillay, who performed a colonoscopy on Dec.1.

The procedure ruled out colon cancer, but he says diagnostic images from inside the colon showed a hardened chunk of feces at the entrance of where her appendix should be.

"She didn't tell me she had her appendix out," he explained in the recorded conversation. He alsodismissed other diagnostic tests."I had noreason to think she doesn't have an appendix."

Maurice acknowledges she didn't know differently, either.

"I only had two surgeries in my life," Maurice said. "I had gallstones, and the other was a tubal ligation. In one of those times, maybe the doctor took out the appendix."

No appendix

Pillay booked her for a laparoscopic appendectomy, a method considered less invasive than open surgery but not without risks. It requires three cuts in the abdomen to insert an instrument with a video camera and surgical tools.The appendix is removed through one of the incisions.

He said, during the surgery, he couldn't find an appendix. He probed around searching for it for about half an hour, then stitched up the incisions.

When challenged by Maurice's daughter the day after the surgery, he offered to meet with Maurice immediately.

However, she says the offer came too late for her.

Maurice confirms she received repeated phone calls to her hotel room from Pillay's office a day after her surgery, but that she refused to answer.

The Metis woman already harbours a distrust of medical professionals, tracing back to a tubal ligation she says a doctor in Meadow Lake, Sask.,pressured her into when she was just 22.

Surgical specialists consulted by CBC News were reluctant to assess the clinical aspect of the case, citing the many variablesin diagnosis of appendicitis. However, they all agreed the communication was poor.

Patient right to know

When something doesn't go according to plan, it's part of disclosure.- Chris Power, Canadian Patient Safety Institute

Chris Power, CEO of the Canadian Patient Safety Institute, says communication is a critical component of patient care.

"When something doesn't go according to plan, it's part of disclosure," Power said. "Harm doesn't need to happen always to disclose, but if things don't go quite as planned the patient has the right to know that."

Medical experts interviewed by CBC News also said a nurse may provide patient debriefs in typical cases, but that this case wasn't typical.

The Canadian Medical Association Journal has published studies over the past two decades showing that effective physician-patient communication not only improves health outcomes, but also reduces the number of complaints about doctors to licensing bodies.

Lost trust

Maurice has already contacted the College of Physicians and Surgeons of Saskatchewan to start the process of a formal complaint against the doctor.

She says she also filled out a complaint form on the Prince Albert Parkland Health Region's website.

Back home in her village, Mauriceis refusing to return to Prince Albert for a follow-up appointment with the surgeon.

She has asked for a referral to a different doctor.