There are two theories about the human appendix: One holds that the thin, four-inch tube below the intestines acts as a repository for “good bacteria,” the other that the appendage is a useless remnant from our evolutionary past. My own theory is that the purpose of Rafael Nadal’s appendix is to ensure that 2014 will go down as one of the most frustrating years of his career.

Nadal embarked upon the Shanghai Masters this week knowing that he has appendicitis, which occurs when the appendix becomes inflamed and ruptures, more or less exploding like, well, a Nadal forehand. Nadal was diagnosed last Sunday in Shanghai, and he hoped that a robust course of antibiotics could keep the developing condition under control as he played on.

“I’m not going to go for surgery,” he told the press in Shanghai on Tuesday, after spending Sunday and Monday resting in his hotel room. “That's great news for me today. That's why I'm here practicing for 45 minutes and trying to play tomorrow. But obviously I am not in my best condition.”

Nadal’s analysis was borne out today in his first match. Looking sluggish, the world No. 2 made twenty-seven unforced errors in the course of losing to fellow countryman Feliciano Lopez, 6-3, 7-6 (6).

Afterward, Nadal soberly explained, "For sure [I don't feel] perfect. It's the same way that I felt before. A little bit more dizzy now. But that's it. Nothing that I have to worry about. When you lose a match, it is not the moment to talk about obvious things. I lost. Feli played better than me."

This is more than a rare, de facto opening-round loss by Nadal. Coming into Shanghai, Nadal was ranked ahead of his Swiss rival Roger Federer by a scant 285 points in the rolling, 52-week rankings. Nadal was defending 360 semifinal points in Shanghai, which will now drop off his total and be replaced by a mere 45—leaving him behind Federer, who’s already equaled his third-round performance of 2013. Upshot: Federer will take over the No. 2 ranking from Nadal at the end of the week no matter what happens over the next few days.

Bad to Worse to Worst

Bad to Worse to Worst

Advertising

For a long while today, it looked as if Federer might have contracted some sort of sympathy illness when he heard the news about Nadal. He struggled mightily against talented underachiever Leonardo Mayer, facing down five match points before he converted his own to win 7-5, 3-6, 7-6 (7). On his first chance to win the match, Federer struck a sweet backhand topspin lob that Mayer could only stare at in dismay as it flew over his head and landed just inside the baseline.

Nadal will certainly have to undergo a typical appendix removal surgery; it’s not a matter of “if” but “when.” And that leaves him in a tricky position for the rest of the year. He has already qualified for the ATP World Tour Finals, at which the winner rakes in a whopping 1,500 rankings points. That kind of takes away any impetus he might have had for closing up shop for the season.

Should Nadal decide to undergo surgery in the coming days, he might still recover in time to have a reasonable chance in London—at least if playing professional tennis at the highest level would fall under what the medical profession calls “normal activities.” Joe Citizen usually can resume normal activities two to three weeks after surgery, and even less if the patient elects to undergo a more advanced, less invasive procedure, an option Nadal surely would choose.

Nadal sounds optimistic about somehow completing a year full of surprises, most of them unpleasant. “My thoughts is continue with Basel, Paris, and London,” Nadal insisted after his loss. “Is true that the past few months I did not have the best of luck. I didn't have the best of luck since Wimbledon. I was playing a good year, very positive year. After that I was unlucky with the wrist, what's going on now. Now there remains three more tournaments for me.”

It’s unclear just how much of a chance Nadal has to stick with his schedule. Basel begins in just 12 days, so even the most un-invasive of surgeries may not afford him sufficient recovery time. But even if Nadal is able to return quickly to get in a few matches and still play the grand finale in London, the outlook for him is anything but rosy. Nadal is trying to meet his challenges with a brave face, but things since Wimbledon have simply gone from bad to worse to worst.

Bad to Worse to Worst

Bad to Worse to Worst

Until last week’s tournament in Beijing, Nadal had not hit a ball under duress since he was ambushed in the fourth round of Wimbledon by hard-serving Nick Kyrgios (who has already quit on the year, citing burnout). Nadal arrived in Asia looking to salt away a few matches and round his game into shape following the three-month hiatus he was forced to take immediately after Wimbledon because of a sore wrist. The enforced break caused him to miss the two North American summer Masters events, as well as the chance to defend his U.S. Open title.

Nadal won two matches in Beijing last week, but he was waylaid in the quarterfinals by gifted ball-striker Martin Klizan. Now Nadal has some very tough decisions to make regarding the rest of the year. Allowing his rivals, most prominently Novak Djokovic, to stockpile points in the coming weeks would leave Nadal far off the pace in the hunt for the No. 1 ranking in 2015, and it might even jeopardize his ability to prepare comfortably and confidently for the Australian Open.

But the main takeaway from the unexpected events of the past few days is that Rafael Nadal really, really wants to play tennis. He’s had an unscheduled three months of rest, so you can expect him to do anything within his power to finish the year on a high note—one that may be very hard for him to hit in a year that has turned ugly.