Nothin’ Butt Surgery

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-Steam profile of “Monsterzero”, who I play Counter-Strike with.

I was really hoping I was going to write this post hopped-up on pain medication, but alas, that’s not the case. I had butt surgery. This post will be filled with plenty of cheeky puns. Can’t stop, won’t stop. Let’s rewind about 10 years or so.

I was a 14 and nearly a freshmen in high school. Summer was in the air, the sun was shining, and naturally I was enjoying that by playing basketball indoors. Seeing as I had grown many, many inches the past few years (which I believe science attributes to “eating all my vegetables), I was lanky, awkward, and still hadn’t grown into my feet. That and I weighed about 40 lbs less than I do now. Ergo, there wasn’t a lot of padding on my rear end when I went to back it up to box out an opponent going for a rebound. I believe kids nowadays call that “twerking”.

Cue searing pain as this dude’s knee hit what I referred to as my “tailbone” (aka coccyx for you medical people out there). I thought I had broke my butt. Literally. After going to sit out, going home, and assessing the damage, I’m going to save you from the scene that I saw. Let’s just say I had a pilonidal cyst. Click that at your own risk or if your morbid curiosity gets the better of you. Long story short, I basically had the equivalent of a huge boil right at the “superior intergluteal cleft”. I’m still trying to remember the medical word for “buttcheeks”, but it’s not coming to me. There’s gotta be a word for it. In fact, there are probably 5 words for it, knowing medicine.

Pilonidal cysts are basically what happens when your genetically predisposed body gets angry about you sitting too much, a hair ingrows (or not), and you basically have a balloon that grows in your body. It was originally called “Jeep Riders Disease” because so many soldiers in WW2 developed them from riding around trails in bumpy jeeps. Long story short, your body sometimes doesn’t like abuse. It can then get infected, swell up, and be a pain in the ass. Sitting sucks, moving sucks, pretty much everything sucks. You can drain the stuff out of this balloon, but the way to make sure it doesn’t come back is to remove the balloon entirely. What followed upon my diagnosis was a series of pain-in-the-ass treatments culminating in surgery, which involved excising the cyst, stitching it up, and me going on my merry way. And having no problems for about a decade.

Until 2 weeks ago.

I was on spring break, in the middle of a Counter-Strike: Global Offensive bender fueled by a lack of showering and impeded only by retrieving another box of Chicken in a Biscuit crack(ers). I was probably sitting down for 14 hours that day, at a minimum. Sometimes, I’m a disgusting human being. I woke up the next day and thought, “hmmmm, sitting doesn’t feel good”. Upon inspection, I thought maybe I just sat too long and the scar tissue from my surgery a decade ago wasn’t happy. However, over the next few days, my tush threw a pretty crappy fit, and it sucked to sit. My cyst had recurred.

Medicine isn’t an exact science by any means, and unfortunately even surgery, often hailed as the “end-all” in a lot of medical procedures, doesn’t always work. These cysts still recur in somewhere between 20-30% people who have them surgically removed, which is nature’s way of laughing at the unlucky people who are not only unfortunate enough to have what I affectionately call a “butt-cyst”, they also didn’t get to the bottom of the issue. I am one of those people. Yay genetics.

The next few days were fairly painful, and I was in denial up until it hurt to lay down. Then, I made an appointment, got it drained, and was then faced with the awkward aspect of when to get surgery. I decided to nip it in the butt and get it done ASAP. I didn’t want to wait until right after USMLE STEP 1 to get it done, as knowing my luck it would have gotten re-infected two days before the test. I would have hated my life. That and I would have to go to my first third year rotations with stitches between my buns. No funs.

Inso-facto-blammo, here I am recovering from surgery. And honestly I feel pretty great, which is a plus. I’ve got a whole bunch of hydrocodone if I feel like making it a real party, but I think I’m going to pass.

What this whole experience allowed me to do was experience healthcare from the patient side again. It’s incredible how even two years of training has completely morphed my understanding and my experience as a patient. That warrants a whole other blog post in and of itself, but I just feel so…comfortable. I feel informed. I know what’s going on in my body, at least at a level appropriate for a second year med student. That’s a massive amount of information and knowledge over the average Joe, and I feel like it’s made me a lot different as a patient. I know for a fact that I’ve been a pain in the ass as a patient previously, but now that I understand how physicians and other healthcare professionals work, I know how to just relax. It’s kind of cool: I actually know something.

It’s been a decade since I’ve had surgery. Over the past two years, it seems more and more that surgery is going to ultimately be the field I enter. I decided to use this as a refresher on what surgery feels like as a patient. Granted, it’s incredibly small-scale, mainly because I’m a very informed patient, this is a very minor surgery, etc. However, even I wasn’t immune to being nervous, as my blood pressure hit 147/80 on my pre-op appointment – JEEZ! I usually run 115/70 or so. That aside, it was an incredibly fluid process.

My roommate and I always use the joke, “How do you know someone is a med student? Don’t worry, they’ll tell you”. Honestly, it’s probably 100% true. I made sure to let the nurses know during my pre-op appointments, but maybe not for the reason you might think. I wanted them to know that I was a capable patient, but I also wanted to see how they’d treat me. They did a wonderful job. They explained everything to me perfectly and were very nice, and I know that even 3rd grade me would have understood it. However, they did acknowledge that I was a med student and were maybe a bit more technical, which I enjoyed. I resisted the urge to tell the nurse to press the bell end of her stethoscope a lot harder and put it on my skin instead of my clothes, that way she could truly hear my heart and lungs. Protip: diaphragm end needs a lot of pressure, the bell end is light pressure. I guess med students wouldn’t be med students without at least a little ego, right? But I’m smart enough to not say anything, she was doing her job. Hilarious thing was that we get lectured all the time on living wills and end-of-life care, and the nurse asked me if I had a living will. I don’t, but I picked up the paperwork just to see what it said. Might as well practice what I preach. A nearly 24 year-old with a living will, now that’s a thought.

I was taken into the hospital this morning, put in my room, got dressed in the super-fun gown, and met various people before my surgery. Everybody was real friendly, and in part I think it helped that I was friendly back. My surgeon was probably the one who said the least words to me, but that’s because I know him pretty well. He’s one of the surgeons where you say, “He’s a surgeon?! But he’s not an asshole!” They all explained everything I was, for some reason, nervous about anesthesia and the thought of being put to sleep not under my control. Weird. But the anesthesiologist did a great job, and I just slowly drifted off to sleep. I made jokes about them having the golden opportunity to look at my butt for 45 minutes. I usually charge for that.

And just like that, I was waking up with my family around me. It felt like I was drunk and was alternating between “blacking-in” and “blacking-out” for however long that took. Evidently I said some funny stuff to the nurse when I was coming out of the OR and out of anesthesia. Luckily for me, she evidently disappeared, so my family couldn’t get a hold of that information. However, I was still funny as I was regaining consciousness, which took me awhile to be fully alert/remember what I said. Aside from that, I felt like a million bucks. Once I had some water and was ready to stand, I was out of there.

Even now, some 6 hours after coming home, there’s not pain. Just a vague feeling like I’m missing a part of me. Good riddance. Now I get the magic of not being able to sit down properly for a week, followed by another week of being careful, then getting the stitches removed and I’ll be on my merry way. Here’s to rolling the dice and hoping I’m part of the 70% that doesn’t have this recur. Optimism.

So, what did I learn from all of this? Knowledge is power. Having a patient who is informed and knows about their condition really helps to quell fear. Even though most of my patients won’t be medical students (I hope), I know that I want them to feel like they have a good understanding of what’s going on with their body. I also learned that being friendly goes a long way towards making a stressful situation a lot better, and the need for compassion is at least directly proportional to stress of the situation. I felt like the staff cared about me. I hope they enjoyed my booty jokes. It was a good experience to see through the eyes of a patient in a way that I could only experience by being a patient myself. I wouldn’t recommend any future healthcare worker to get a pilonidal cyst to see that point, but when life gives you lemons, you’ve got to look for the other cheek.


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