The Smell....

The first pt this afternoon was a "re-check cyst." This guy is in his 60's, in a wheelchair and has Parkinson's. But none of that is relevant.

He had a HUGE cystic mass on his chest wall, over the lower ribs, halfway between the sternum and mid-clavicular line. The mass was easily 6cm, firm, semi-moveable with surrounding erythema.

TIME TO INCISE AND DRAIN!!!

Luckily, my preceptor was quite happy to let me do the whole thing, without supervision. He knows I like derm stuff, and I get the feeling that he doesn't.

A little betadine and lidocaine later, I was stabbing the mass with my #11 blade. Then I squeezed...

EIGHT FEET. The sebum from this highly pressurized cyst flew 8 feet across the room, just as I had been warned time and time again that it could do. There was no stopping it. Even if my gauze had been properly placed, the exudate probably would have ripped through it like a comet through the atmosphere. It came out with the speed of a bullet train.

And oh god...the smell. I have a STRONG stomach, but this was up there with the smell from the autopsy I observed.

I spent 20 minutes squeezing an un-ending amount of just disgusting crap out of what turned out to be a golf-ball sized abscess in this man's chest wall. Easily 40-50 cc's...unbelievable. I then packed in 20cm of iodinated gauze, and even though it wasn't really enough, I had made the premature mistake of cutting the gauze prior to packing, so 20cm was all I was going to get.

After the pt left, the exam room had to be closed for 2 hours because of the smell. Seriously, every surface was wiped down and the garbage was taken out. The nurse who had to retrieve my instruments almost vomited just being in there for 20 seconds. My preceptor told me I got an A plus-plus-plus-plus on the procedure. I think he was just impressed I didn't blow chunks all over the pt and his wife.

IT WAS AWESOME!!!!

Jen