Lucy Ricardo and The Three Stooges

Last week, I told you a story about an intern draining pus.  ( http://badtadmd.com/grand-geyser/ ) It makes sense to follow that with another story of an intern draining pus.

First, some medical background… The Bartholin’s gland sits at the opening to the vagina and secretes fluid for lubrication. Like other glands, it has the potential to get plugged so the fluid can’t get out. The gland, which is normally not even identifiable under the skin, keeps making fluid and starts to swell. To make matters worse, the fluid in the gland is great for bacteria to grow in, so a plugged Bartholin’s gland often becomes infected. This causes redness, pain and more swelling.

The treatment for a Bartholin’s gland abscess is to cut it open and drain the pus. To keep the abscess from reforming, the abscess cavity needs to stay open so it can drain until it is fully healed. A guy named Word invented the absolutely coolest thing to help do that.

The Word catheter is a silicon tube about two inches long and about as big around as a pencil. One end can be blown up with water to form a balloon about an inch in diameter. The other end of the tube has a place to insert a needle to fill the balloon with water. This is what it looks like when the balloon is filled:

After numbing the area, a small hole is cut into the Bartholin’s gland to drain the pus. Then, the rounded end of the Word catheter is placed into the abscess space and the balloon is inflated with water. The balloon allows the catheter to stay in place for about a month while the infection drains and the body’s natural defenses allow complete healing.

So, that’s the background. Now the story:

One night, an intern told me she had a young patient with pain and swelling at the opening to her vagina. That was about enough information to make the diagnosis of Bartholin’s gland abscess. One peek down there was enough to confirm it. Hers was a very large one.

The intern had drained abscesses in other parts of the body but never a Bartholin’s gland abscess. She was excited to drain this one. I verbally took her through the procedure, including some caveats to make things go more smoothly. First, I warned her to not make the hole too large. (I did that once and the balloon wouldn’t stay inside the cavity.)  I also told her it can be hard to pass the catheter through the incision if you wait until the abscess is empty. So, she should make the cut and then quickly insert the catheter before the pus stops flowing out.

After giving the patient morphine for pain, we put her legs up in stirrups and coaxed her to relax as much as possible. The intern numbed the area. I warned her that the pus would be under a lot of pressure and might squirt out once the cut was made. I positioned a suction device to capture any pus that came out.

When the intern poked the scalpel into the abscess, the pus immediately started squirting out. The sudden gush of pus caused the intern to freak out. She hollered and jumped back. Pus squirted all over. The intern pulled herself together and tried to push the catheter into the hole. Unfortunately, she had not made the hole large enough, so the catheter wouldn’t pass into the cavity.

With pus continuing to squirt out, she tried to make the hole bigger but was still unsuccessful. I quickly took the scalpel and made an appropriately larger hole. Pus continued to spurt out as the intern tried to pass the catheter into the cavity. At that point, she made a bad move. Somehow, she pulled the needle out of the catheter and she poked herself with it. Again, she jumped and hollered. I told her to hurry and put the catheter in. Finally, just as the pus stopped flowing out, we got the catheter in place and blew up the balloon.

The intern pulled off her glove and saw blood on her hand from where she got poked with the needle. That caused her a lot of alarm until she realized she had been poked with a clean needle.

Everything ended just as it should have.

Well, almost everything. I had been prepared to suction the pus as it exited the abscess. But, when the intern freaked and needed my help, I was less than diligent in my suctioning than I could have been. We ended up with pus on the patient, the bed, the floor and the intern.

In the end, the procedure was perfect but it really felt like “The Three Stooges” or “I Love Lucy” while we were doing it.