Medicine in Muck Boots
How To: remove an epidermoid ear lobe cyst. TRIGGER WARNING: blood and pus
I didn’t always want to work in medicine. When I was a kid, I think I thought I would be a marine biologist, an artist, or rescue stray dogs for a living. Turns out all of those things make somewhat of a challenging career choice, and I’ve always been the type to take the path of least resistance.
Working in healthcare has been difficult as a self-proclaimed follower, especially during the covid ‘healthcare heroes’ era when we [healthcare personnel] were all expected to be extraordinary leaders. Cringe. Of course I care about people and health, but I’m just doing my job… the glorification made me feel awkward. I’m a natural follower, and a very good one. Not in the sheep kind of way, but I am attentive and feel empowered to take action and do my part when inspired by a strong leader. I truly have no desire to fill the role of leader, and yet I often find myself in a leadership position. Don’t get me wrong, I avoid it at all costs, but when you go from bedside nurse to medical provider, the career shift from follower to leader naturally occurs as you assume more responsibility. Making medical decisions for others is a monumental responsibility, especially when someone doesn’t have strong feelings about their health or is extremely trusting in your decisions as their provider. Sometimes I prefer the patient that is stubborn and argumentative or the patient that demands the magic pill, but both present challenges. I’m a believer in autonomy. People will make the best decisions for themselves, and my job is to present the evidence and provide as much education as possible. It’s up to you to make the final call once carefully considering the benefits v risk profile of any given health decision.
It’s true that you can follow every rule in the book of medicine, and yet there is still some room for differences in practice, aka, the art of medicine. I’ve been faced with the art of medicine of small magnitude many times, and most recently with a massive earlobe cyst my brother desperately wanted removed. Why go to a specialist when you can bully your sister into removing your earlobe cyst, right?
Should I lance it or remove the sac entirely? Neither would be wrong. removing the cysts entirely will increase the chances that it won’t grow back, but this will be more labor intensive and is more invasive (higher bleed risk, maybe higher infection risk). Lancing it will be quick and easy, but there will be a much greater chance of regrowth, especially considering he has had this cyst lanced 3 time in the past (by me, himself, and a dermatologist) and it has regrown each time.
We decide to remove it completely. I mean, this is an earlobe cyst after all, risks are risks, but they very very small in this scenario.
We decided Super Bowl Sunday was the best day. Something fun to pass the time while waiting for the game to start. I set my brother up on my parents dining room table with some yoga mats to make it comfortable. I wasn’t actually wearing muck boots but I might as well have been…I don’t do this procedure often so it took me some time, about two hours total. First we sterilize what we can, clean the skin well, and anesthetize the ear. I used an 11 blade scalpel to make the initial incision on the back of the lobe, about 1.5 cm. Once I could see the cyst capsule I clamped it with a needle driver to create tension, careful not to pop it. Then I flayed the skin up and around, away from the cyst slowly with the blade.
Once I had separated the cyst from the skin completely, I cut it at the base and my assistant (Pete) held pressure to slow the bleeding while I nursed River during a quick intermission. After she was full, I returned and clipped away some of the excess skin with my mom’s hair scissors (sterilized of course) before irrigating the wound with saline and suturing the back of the earlobe with 6 stitches for a somewhat normal ear appearance.
We ceremonially sliced into it after it was removed and all exclaimed “EWWWWWW” as the contents erupted.
One of the best parts of working in healthcare is being able to help family and friends when I can.
The cyst was so big and I’m no plastic surgeon, so I would say the final product is okay. Tully says he’s just happy to no longer have a third testicle on his ear. I take that as a compliment.
And thats medicine off the mainland.
Disclaimer: This post is intended for entertainment purposes only. Do not attempt any medical procedure without proper training. Always consult your Doctor or healthcare provider.
Dr pimple popper!! This is so so good
I hated this but also I laughed the whole time 😂 the intermission to nurse while Tully bleeds out on the table