Warning: graphic descriptions ahead. Continue in temporal and/or physical proximity to food and drink at your own risk.
Everyone has their abscess story. Tales of pressurized pockets of pus abound. Trust me: however far-fetched they may seem…they’re not. I had one such experience last week in which a man came to me with a painful red swollen lump on his back. It was about 2 inches in diameter, angry and fluctuant (softened) and ready to be drained, which he pleaded with me to do. So I did.
Although this is typically one of the more painful procedures I can inflict on someone, he did great. Possibly his status as a chronic pain patient on a fairly hefty baseline narcotic dose helped. Still, I was able to get away with the “I” (incision) part of the I&D (drainage) without even a local. (I’ve been told that the pH of the abscess cavity neutralizes the local anesthetic anyway, so it’s just an extra futile stick with which I was happy to dispense.)
Taking my #11 blade and jabbing it in, I was immediately rewarded with about a teaspoonful of thick bright yellow-greenish pus. Knowing there was plenty more in there, I got to squeezing, keeping plenty of 4×4’s in hand to sop up my gleanings. One particular squeeze resulted in a distinct “squirt” that landed a little pus on the man’s pulled-up shirt, which I surreptitiously wiped away. This is also why I wear glasses, by the way, though luckily I didn’t get anything on them (as I have in the past.) All future squeezings were with a strategically placed 4×4 over the wound.
Once I’d gotten out as much as I could (ie when the drainage was down to just blood), I dressed the wound and helped the patient up.*
As he’s putting his shirt back on and chattering away about his recent cruise (which was when the thing got infected and why it took him so long to come see me about it), I’m throwing away the dirty 4x4s and prescribing his antibiotics. He asks for a refill of another medication, and suddenly I see it!
Behind him, up on the wall about a foot below the ceiling, clings about a four inch ribbon of bloody green pus streaked with blood. It’s a little line of red on an otherwise spotless expanse of white wall, waaaaaaaaaaaay up high. That thing sent a squirt of pus five feet into the air!
All I can think is, “Shut up and get out of here already so I can clean that up before my next patient sees it.” Also, “And for the love of all that is holy, PLEASE don’t turn around. Though if you do turn around, please please please don’t look up.” Then he asks for another refill, and I think, “Yes, yes, yes, OMG you can have anything you want but please just get the fuck out of here!”
Eventually he leaves. Without turning around, thank all the Gods that be.
For those of you who know me, I am short. (I am also short for those who do not know me, but you probably figured that out.) I have a cute little folding step stool that I did NOT fetch. No way was it going to get me high enough. Instead I went into my storage room and found a slightly higher rolling stool, the kind with springs so that when you stand on it, it stops rolling. Thanks be to the heavens above, it worked.
I took some alcohol and a few leftover 4x4s and gingerly dabbed at it. The last thing I wanted to do was leave an enormous red smear instead of just a red-green streak. I also found myself praying that the paint was washable.
It didn’t even take all that long until my wall was again spotless. And I was left with yet another reminder of the power of pus. Never underestimate an abscess.
*Yes, I know you’re supposed to break up the loculations and pack the wound, then bring the patient back the next day to remove the packing. But frankly this one wasn’t that big, and I have found that most of these patients do fine anyway.