Bad medicine
I have this thing in my "area." Maybe, some of you are familiar with Dr Bartholin, of the Bartholin gland fame? The man's discovery, the afore-mentioned glands, have been more or less the bane of my existence for the past 4 years. To be exact, just the left one. It has formed a cyst, you see, as they do. And the cyst chooses to swell and ebb at its leisure, ruining my day in the process. The trouble with these cysts is that they do this off and on, and aspirating one of these is useless because they always come back.
They're fairly harmless, unless they get really big. Or, unless you're a fan of a symmetrical vulva. Or enjoy sex without pain. Or even jogging.
Sick of such abuse of my body, I went ahead and had a procedure done about 2 years ago, called marsupialization. It's when they slice open the cyst, and tack the edges back, making a little pocket (hence, marsupialization) such that the cyst drains and doesn't form a collection. Uniformly successful, apparently, marsupializations are.
Except in my case. "Never seen this happen in 20 years!" Said my OB when I returned 3 months after the initial procedure, all lopsided and fluctuant. This is after I suffered through vagina surgery and all the pain that followed. I do love to be a special case, I told her. She then tried to do the procedure again, this time, in the office and not the OR. It worked for a little bit, but every time my "area" saw a little action, the cyst would rise to power and take days to recede. I tried unspeakable things to make it go away, countless sitz baths, experimentations with syringes at home, abstinence... but to no avail, so I just decided that eventually, if I ignored it, it would get bored and leave me alone.
And it did!
Until I got pregnant. All that increased pressure in the abdomen and pelvis, the cyst felt very ... well... pressured ... and reappeared.
Fortunately, it went away after the baby came. In fact, during labor, in the blissful post-epidural stage, when I was feeling chatty, I asked Dr Clark, who delivered Munchkin, if there is any risk of infection or other weirdness post delivery. She said, "I can see the cyst AND where it's been incised. Don't worry: if it busts open during delivery... well... great! It will have drained!" As luck would have it, though, I ended up with a c section, which, while painful to me and disruptive in many other ways, left the Bartholin cyst altogether undisturbed. As my abdominal contents went back to normal mass and volume, the cyst imploded back and I forgot all about it again. But I should really have known better. This thing is like the Freddy of fluid collections.
So, a few days ago, I felt a familiar nudging down in Australia of my body, and was all ... oh noes...
But usually, after I tried to do away with it by surgical means, and once I decided we'd have to peacefully coexist, what the cyst does is appear and annoy me, but generally, it doesn't cause any drastic lifestyle changes. This time, though, the usual twinge of pain rapidly escalated into something horrendous I'd never experienced before. Imagine, your genitals in a vise?? And of course, it was the weekend. So, I was forced to sit around, legs, pardon my french, ajar, and watch this thing develop into an egg sized doohickey. I did some maneuvering with a compact mirror, and my eyes bugged out at the size of the thing and the deformed quality of my entire vulvar region. I even made my husband check it out, and assess for signs of infection. He said, literally, "oooooooffff!!" and shrugged. But what does he know, he's just an amateur vulva observer...
Finally, unable to take it anymore, I headed to the ER with my hubby and the baby, thinking that I could get the OB to come see me in the ER, and pop this thing and relieve my pain.
It actually happened to be Dr Clark, who's familiar with the "area." After the usualy courtesy of admiring her work, ie the baby she delivered, she said something along the lines of, holy crap, that's the biggest Bartholin abscess I've ever seen...
Note the key use of the word "abscess." That means, that the cyst was no longer content just being a cyst full of mucinous harmless material. This time, it had become a breeding ground for some nasty gram negatives or positives or both, and has gorged itself with neutrophils and yuckiness, otherwise known as pus.
She probably didn't say that, but I like to pretend that she did, because that is how I felt.
Either way, she decided that she couldn't do an appropriate incision and drainage in the ER, and I would the operating room again.
Here is where the bad medicine part comes in.
Normally, this is a 14 minute procedure done under conscious sedation. Just a couple of hits of the good stuff to get me through the slice and dice, pow bang boom, and home with little repercussions. General anesthesia is total overkill for something like this. Unfortunately for me, though, I am an honest idiot, and when asked, when was the last time I ate, I told the truth: I had a granola bar and coffee at 7 am. The anesthesiologist was a young buck of a guy, who said that my granola bar "muddles the situation," as he gave me Bicitra. Which tastes like acidic ass, by the way. God forbid, 7 hours later, the granola bar was still loitering in my stomach. And I should have known it then. But by the time I took the bicitra, I had already been given several doses of pain killers to try to loosen the genital vise, ie relieve my pain, as the doohickey was really setting up a permanent home in my "area" and nudging out the rest of its normal occupants, who were protesting, resulting in a serious battle down there, and much much pain for me. I was in the clouds, headwise, so dind't connect the dots: the bicitra is given before intubation for people who might still have stuff in their stomach to prevent aspiration.
I woke up from the procedure with a horrific dry cough and dropping 02 sats. I do tend to get a little reactive with viruses and such, but ... What's with the cough!! I was informed that my throat was sprayed. With what? Lidocaine. He really sprayed that shit in there, said the nurse. WHY? The problem was way below my throat... Oh - for the breathing tube. What breathing tube? The one they put in to breathe for me.
Wait, what???
The buck anesthesia guy apparently decided that 7 hours after my coffee and granola bar, I was still at risk for aspiration pneumonia, and chose to use general anesthesia with the whole nine yards for this 15 minute abscess drainage. now, if you make a patient NPO past midnight, and you take them to the OR at 7:30, as often happens... isn't that the same thing? So, now, I - a nursing, working, new mom - am feeling like ass run over by a train, every single muscle fiber in my body in pain from, I'm assuming, the succinylcholine, a horrible sore throat and hoarse voice, and forced to pump and dump my milk because of all the garbage running through my system. And no one asked me, or discussed it with me. They just did it. If they had asked me, I would have declined, and they could have written in my chart: Patient refuses reasonable intubation and is aware of risks, that crazy bitch. But at least, I'd still be feeling half way decent.
The vagina doesn't hurt anymore b/c Dr Clark did a nice job. It does sport 12 stiches now, and has a black eye, but at least it's not throbbing in pain. But the GETA fucked me up nice and good. Because the protocol said.... granola bar is no goodsky.
That is bad medicine because Dr Buck did not appreciate the subtleties of the situation, and plowed ahead aggressively like a tank, throwing the baby out with the bathwater. So to say. Baby being my well being. Bathwater being, aspiration risk, small as it may have been.
Thank you for your attention.
They're fairly harmless, unless they get really big. Or, unless you're a fan of a symmetrical vulva. Or enjoy sex without pain. Or even jogging.
Sick of such abuse of my body, I went ahead and had a procedure done about 2 years ago, called marsupialization. It's when they slice open the cyst, and tack the edges back, making a little pocket (hence, marsupialization) such that the cyst drains and doesn't form a collection. Uniformly successful, apparently, marsupializations are.
Except in my case. "Never seen this happen in 20 years!" Said my OB when I returned 3 months after the initial procedure, all lopsided and fluctuant. This is after I suffered through vagina surgery and all the pain that followed. I do love to be a special case, I told her. She then tried to do the procedure again, this time, in the office and not the OR. It worked for a little bit, but every time my "area" saw a little action, the cyst would rise to power and take days to recede. I tried unspeakable things to make it go away, countless sitz baths, experimentations with syringes at home, abstinence... but to no avail, so I just decided that eventually, if I ignored it, it would get bored and leave me alone.
And it did!
Until I got pregnant. All that increased pressure in the abdomen and pelvis, the cyst felt very ... well... pressured ... and reappeared.
Fortunately, it went away after the baby came. In fact, during labor, in the blissful post-epidural stage, when I was feeling chatty, I asked Dr Clark, who delivered Munchkin, if there is any risk of infection or other weirdness post delivery. She said, "I can see the cyst AND where it's been incised. Don't worry: if it busts open during delivery... well... great! It will have drained!" As luck would have it, though, I ended up with a c section, which, while painful to me and disruptive in many other ways, left the Bartholin cyst altogether undisturbed. As my abdominal contents went back to normal mass and volume, the cyst imploded back and I forgot all about it again. But I should really have known better. This thing is like the Freddy of fluid collections.
So, a few days ago, I felt a familiar nudging down in Australia of my body, and was all ... oh noes...
But usually, after I tried to do away with it by surgical means, and once I decided we'd have to peacefully coexist, what the cyst does is appear and annoy me, but generally, it doesn't cause any drastic lifestyle changes. This time, though, the usual twinge of pain rapidly escalated into something horrendous I'd never experienced before. Imagine, your genitals in a vise?? And of course, it was the weekend. So, I was forced to sit around, legs, pardon my french, ajar, and watch this thing develop into an egg sized doohickey. I did some maneuvering with a compact mirror, and my eyes bugged out at the size of the thing and the deformed quality of my entire vulvar region. I even made my husband check it out, and assess for signs of infection. He said, literally, "oooooooffff!!" and shrugged. But what does he know, he's just an amateur vulva observer...
Finally, unable to take it anymore, I headed to the ER with my hubby and the baby, thinking that I could get the OB to come see me in the ER, and pop this thing and relieve my pain.
It actually happened to be Dr Clark, who's familiar with the "area." After the usualy courtesy of admiring her work, ie the baby she delivered, she said something along the lines of, holy crap, that's the biggest Bartholin abscess I've ever seen...
Note the key use of the word "abscess." That means, that the cyst was no longer content just being a cyst full of mucinous harmless material. This time, it had become a breeding ground for some nasty gram negatives or positives or both, and has gorged itself with neutrophils and yuckiness, otherwise known as pus.
She probably didn't say that, but I like to pretend that she did, because that is how I felt.
Either way, she decided that she couldn't do an appropriate incision and drainage in the ER, and I would the operating room again.
Here is where the bad medicine part comes in.
Normally, this is a 14 minute procedure done under conscious sedation. Just a couple of hits of the good stuff to get me through the slice and dice, pow bang boom, and home with little repercussions. General anesthesia is total overkill for something like this. Unfortunately for me, though, I am an honest idiot, and when asked, when was the last time I ate, I told the truth: I had a granola bar and coffee at 7 am. The anesthesiologist was a young buck of a guy, who said that my granola bar "muddles the situation," as he gave me Bicitra. Which tastes like acidic ass, by the way. God forbid, 7 hours later, the granola bar was still loitering in my stomach. And I should have known it then. But by the time I took the bicitra, I had already been given several doses of pain killers to try to loosen the genital vise, ie relieve my pain, as the doohickey was really setting up a permanent home in my "area" and nudging out the rest of its normal occupants, who were protesting, resulting in a serious battle down there, and much much pain for me. I was in the clouds, headwise, so dind't connect the dots: the bicitra is given before intubation for people who might still have stuff in their stomach to prevent aspiration.
I woke up from the procedure with a horrific dry cough and dropping 02 sats. I do tend to get a little reactive with viruses and such, but ... What's with the cough!! I was informed that my throat was sprayed. With what? Lidocaine. He really sprayed that shit in there, said the nurse. WHY? The problem was way below my throat... Oh - for the breathing tube. What breathing tube? The one they put in to breathe for me.
Wait, what???
The buck anesthesia guy apparently decided that 7 hours after my coffee and granola bar, I was still at risk for aspiration pneumonia, and chose to use general anesthesia with the whole nine yards for this 15 minute abscess drainage. now, if you make a patient NPO past midnight, and you take them to the OR at 7:30, as often happens... isn't that the same thing? So, now, I - a nursing, working, new mom - am feeling like ass run over by a train, every single muscle fiber in my body in pain from, I'm assuming, the succinylcholine, a horrible sore throat and hoarse voice, and forced to pump and dump my milk because of all the garbage running through my system. And no one asked me, or discussed it with me. They just did it. If they had asked me, I would have declined, and they could have written in my chart: Patient refuses reasonable intubation and is aware of risks, that crazy bitch. But at least, I'd still be feeling half way decent.
The vagina doesn't hurt anymore b/c Dr Clark did a nice job. It does sport 12 stiches now, and has a black eye, but at least it's not throbbing in pain. But the GETA fucked me up nice and good. Because the protocol said.... granola bar is no goodsky.
That is bad medicine because Dr Buck did not appreciate the subtleties of the situation, and plowed ahead aggressively like a tank, throwing the baby out with the bathwater. So to say. Baby being my well being. Bathwater being, aspiration risk, small as it may have been.
Thank you for your attention.
Comments