What’s that smell?!?

Last night I took care a patient who arrived in the ER complaining that she had “a ball in my cootchie”. Despite my initial thought, it turned out she did not put a round object into her va-jayjay, but she actually had a large painful mass on her labia. Apparently this patient had had this mass for about 10years and it would come and go without getting too large or painful. About 2 days ago the mass tripled in size and started to cause excruciating pain while sitting, walking, peeing…just about anything was painful for this poor lady. While examining her I confirmed that shewas suffering from what is known as a Bartholin’s gland cyst, a common condition which is caused by a clogged duct in the labia that leads to accumulation of fluid and pus. I explained to my patient that the treatment for this painful lesion was to make an incision with a scapel and drain all the pus out after which I would place a tiny balloon catheter in the incision which would remain for 6 weeks and allow the cyst to drain continuously so the fluid would not reaccumulate. Very few females relish, understandably, the thought of having someone cut into their flower, even with local anesthetic, and since her cyst was one of the largest that I had ever seen we decided to perform the procedure under sedation. I would give the patient medicine to put her to sleep for 5 minutes and when she woke up the procedure would be done and she would never remember it. Now I have drained many, many pus-filled abscesses and most of them smell quite foul, but imagine a cyst that has been growing and receding over 10 years, a pocket of pus that had been putrefying and curdling and increasing it’s disgusting factor over time. Now imagine cutting that thing open and releasing the decaying putrid pressurized fluid into the atmosphere. As soon as I made the incision and the pus started pouring out I knew we were in trouble. My nurse turned green, retched a little, and then fled from the room. Stoically I clenched my jaw and continued draining the abscess by gently probing the cyst with forceps to release all the septated pockets of funk from their biological cave and drain more pus thereby filling the confined room with some of the foulest odors known to man. About that time the little old lady who was sharing the room and was being evaluated for altered mental status (more altered than her baseline dementia) arrived back from getting her head CT. Upon entering the room and catching a whiff of the smell from hell she suddenly woke up and started screaming “what’s that smell!” “what's that SMELL!” Rather than explain to this poor demented that lady that she was experiencing a decades worth of enclosed and anaerobically putrefying bacteria and cells that had been unleashed into the environment like the opening of an old Egyptian tomb I called my ER tech and had the patient rapidly moved to to different, less malodorous, room . The old demented lady kept screaming "what's that SMELL!" all the way down the hall until she arrived in her new quarters. My nurse finally returned to the room wearing a benzoin-enhanced surgical mask to block the funk that now lay over the room in an almost visible haze, and I was able to rapidly complete the procedure and clean the patient’s wound. Shortly thereafter my patient regained consciousness, and, as she quickly became aware of her surroundings, she exclaimed “WHAT is that smell! That’s terrible! Oh my God, what is that! Is that from me??” Uh-oh. Rather than traumatize her further after her ordeal I simply reassured her that the horrible odor she was experiencing was actually the product of the little old lady who had an especially foul bowel movement, probably from all her protein drinks, and she had to be quarantined in another room to protect the rest of the ER. The patient gave a sigh of relief, felt much better with my explanation, and was discharged home blissfully unaware that her female anatomy had been harboring one of the foulest pus pockets known to man.