Again with the abscesses?!

Well, I've seen a lot of them in the ER, and while most have made me want to run from the room leaving a trail of vomit behind me, sometimes you just have to laugh.

We had another one of these poor souls who, upon meeting them your first thought is, "Wow, you're only 45?" Drugs will age you folks, and not gracefully either. She needed the dressing changed on her abdominal abscess. Simple enough. If you get your abscess opened and drained at the hospital, typical treatment involves packing the hole with a long strip of damp fabric and slapping a bandage over the whole thing. You usually get a course of antibiotics and some pain medications, and you're instructed to return daily to get the wound flushed out and the packing strip changed. Over time, the abscess heals from the inside out, and you need to stuff in less and less packing strip each time. It's a pretty easy procedure to do (which I guess is why they let the medical assistants handle them).

I'd been doing this all day, so my mind was probably elsewhere as this lady laid down and lifted up her shirt. I took off the old bandage and saw two holes in her rather large belly, each about the size of a golf ball. OK. Next step, remove the old packing strip. I started pulling it out of the top hole, and to my surprise, saw the stuff in the bottom hole start to move... wait a second... oh God, they're connected! OK, so now I know we're dealing with a "tunnelling abscess." By the time I had taken out all of the packing strip, I had removed several feet of the stuff.

By this time, the lady was starting to squirm. She said that putting the new packing strip in always hurt her and said she needed some lidocaine. We rarely give anesthetic for this procedure, so I gave her a minute to collect herself while I left the room to do something else. When I came back, I noticed she was wet. This was odd, since we don't even have a sink in that room. Our conversation went like this:

Me: "You're wet."

Her: "No, I'm not."

Me: "Yes you are. See, right there. What happened?"

Her: "Oh that's just lidocaine."

Me: "Where did you get lidocaine?"

Her: "From over there. See?"

She points to a large brown bottle on the counter. I looked at the label. Sure enough, lidocaine. But not in the quantity that we'd ever give to a patient; it looked like a liter bottle.

Me: "Where did you get that?"

Her: "Mmpf. I ain't telling."

Me: "What did you do?"

Her: "I put some lidocaine in it. I told you I needed it."

I looked at her abscess, which was now literally full of lidocaine. The next twenty minutes were spent removing several syringe-fulls of the stuff out of her belly-holes, checking with the doctor to make sure that she wouldn't die from an overdose of self-administered topical anesthetic, finishing up the dressing change, and taking away her liter of lidocaine while she called me a "stupid power-trippin' doctor-man." The Aristocrats!