Bryson City Tales — Wet Behind The Ears (Part 1)

This is from the thirteenth chapter from my best-selling book, Bryson City Tales. I hope that you’ll enjoy going back to Bryson City with me each week, and that if you do, you’ll be sure to invite your friends to join us.

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A few days later Dr. Mitchell and I were discussing several of the patients I had seen in the office the day before—as well as looking at some of the plans for the new office building. I was growing to appreciate Mitch’s wisdom, experience, and common sense. Suddenly Helen came in to tell me, “Walt, your first patient is ready and in the procedure room.”

“Whatcha doing, Walt?” inquired Mitch.

“I don’t know,” I answered. I looked up to the nurse. “Helen, what am I doing?”

“Well, I’m no doctor . . . ,” she began, with her usual and somewhat sarcastic disclaimer, “but it looks like a small noninfected sebaceous cyst.” She paused for a second and then inquired, “You gonna use the iodine?”

At first I thought she was discussing the substance I would use to clean the skin prior to making an incision to remove the cyst. I thought, Doctors haven’t used iodine for operative prep for years. Most doctors use Betadine. My mind quickly reviewed our protocols at the hospital. Dr. Mitchell uses Betadine in the OR. Wouldn’t he use the same thing here in the office? So I decided to question her question—not necessarily a wise decision.

“Helen, I usually use Betadine. Don’t you have that?”

Initially she looked confused. And then she began to laugh, covering her mouth to try to hide her laughter. She looked at Mitch and then at me.

“Dr. Larimore . . . ,” she giggled.

I looked at Mitch. What was so funny? I wondered.

“Walt, didn’t they teach you about removing sebaceous cysts with iodine crystals at that fancy medical center?” Mitch chided.

Now it was my turn to look confused. “What in the world are you two talking about?”

Mitch stood there chuckling. “Helen, let’s teach this wet-behind-the-ears youngin’ an old dog’s trick, whatcha say?”

“Sounds good to me, Doctor,” she replied. She looked down her nose at me and turned to leave, while Mitch got ready to give me another lesson on how medicine had been practiced in these parts for the past fifty years. Mitch sat on the front edge of his desk, arms crossed across his chest. It was lecture time. “Actually, Walt, I didn’t learn this technique in school or in the service. Dr. Bacon taught me this, and he picked it up from the guys that were here before him.”

He thought for a moment, then continued, “Gosh, I guess I’ve been using this technique for over thirty years, but I don’t think I’ve ever seen it in a medical article or a textbook.”

“Mitch, you’ve got my curiosity up. Tell me about it.”

“Well, Walt, you can only use this technique to remove an uninfected sebaceous cyst. And you can only use the technique in areas where the skin is fairly thin. Just won’t work if the skin’s real thick or if there’s any infection or inflammation. In those cases it’s best to just cut it out by using the standard surgical technique. But in the right cases it works like a dream and is great for most of the local folks because they don’t have to come back to the doctor for follow-up or to have stitches removed. All you do is numb up the skin over the cyst with a little bleb of lidocaine. Then make a two- or three-millimeter stab wound, using a #11- blade scalpel, down into the cyst. Take one or two iodine crystals—we get them from Doc John at the drugstore—and place ’em deep into the center of the cyst after you’ve made the inci- sion. Put on a Band-Aid, and that’s all there is to it.”

I was dumbfounded. “How does that get rid of the cyst?”

“Well, son, it doesn’t.” Mitch was quiet, but his eyes were laughing. Was he pulling my leg? Was this a joke? He continued, “Apparently the iodine desiccates the cheesy sebum in the cyst. Causes it to shrink, blacken, and harden into a rock-hard little stone. This takes several days. While that painless chemical reac- tion takes place, there is just enough drainage to keep your stab wound open. After, say, five to seven days, the patient or a fam- ily member can just squeeze on the cyst, and out it will pop—like a pea out of a pod.”

“I’ve gotta see this,” I exclaimed.

“Won’t take but a minute for me to show you. Come on.” I followed him down the hall to the procedure room where

Helen already had the patient settled onto the operating table. “How you doing, Jimmy?” asked Dr. Mitchell as he washed his hands and put on a pair of gloves. “Let’s take a look at that thing.”

There was a half-inch lump on the young man’s scalp, just behind the ear. “How long’s this thing been there?” Mitch asked.

“Don’t rightly know, Doc. Don’t rightly know. But it’s sure getting bigger. And it bugs the dickens out of me when I try to brush my hair. Sure would like it out.”

“No problem, Jimmy. Let me numb it up a bit. I want to show our new doc how we do this around here. Jimmy, this here’s Dr. Walt Larimore.” Mitch nodded in my direction. “He’s just joined us. Did his training down at Duke. But they didn’t teach him everything down there, did they, Walt?”

“Nope, guess not. Good to meet you, Jimmy.”

“Good to meet you, Doc. You’re learning from the best here. He’s took care of all our folks. My daddy and my daddy’s daddy. Won’t find better. Nope, you won’t.”

“I’m sure you’re right, Jimmy.”

“Jimmy, you hold tight. I’m gonna numb this a bit.” In only a second or two, Mitch applied a bleb of lidocaine and then Helen took the syringe and handed him a scalpel. He quickly and deftly made the stab and squeezed out just a bit of the malodorous and cheesy-looking sebum from the cyst.

“Walt, that confirms the diagnosis. Nothing but nothing looks or smells like the contents of a sebaceous cyst. The body has millions and millions of microscopic sebaceous glands. There’s one or two in each pore of the skin. The sebaceous oil from these glands is one of the body’s natural oils. But if the gland gets plugged up, it just keeps making the oil and it builds and builds until a pronounced cyst forms. I sure like seeing them when they’re not infected. One whole heck of a lot easier to treat.”

By now Helen had fetched a small black bottle and a pair of forceps. “Walt, you just take one or two small iodine crystals . . .” He reached into the bottle with the forceps, withdrawing a small black crystal, “ . . . and jam it into the middle of the cyst.” Which he did. Jimmy didn’t flinch.

“That’s it, Jimmy. This thing will be ready to squeeze out in about a week. I’ll have Helen here explain to you how to do that and how to care for it until then. If you have any trouble, you let us know, ya hear?”

“Yes, sir. I hear ya. Thank you, Dr. Mitchell.”

Then I heard, for the first time, a statement for which Mitch was famous. It made the patient feel good about coming in for the visit and magnified the doctor’s reputation throughout the region. “Jimmy, you got to me just in time with this thing. If you had waited much longer, it probably would have gotten infected, and I tell you, that’s a mess, son. But I believe we got it just in time.”

“Thanks, Dr. Mitchell. Sure appreciate you.”

“You bet, Jimmy. No problem at all.” Mitch paused just a moment, and I could see an idea dawn in his head. “Tell you what. Instead of me having Helen tell you how to pop this cyst out in a week, how about you drop by the office and let me show young Dr. Larimore how this works? That sound OK? I know you work just down the road. We could see you on your lunch break, and there’ll be no charge for that visit. Sound OK?”

“You bet, Doc. No problem at all. Always enjoy those free visits. After all, you don’t do that very often.”

Mitch smiled. “Gotta pay those bills, Jimmy. Gotta pay those bills.” He looked at Helen and me. “Jimmy, you wouldn’t believe what it costs to hire good help these days.” We smiled.

“Jimmy, you be sure to tell your dad and mom hi for me, you hear?”

“Be glad to.”

Mitch signaled me with his eyes and a nod of his head. We stepped out of the room.

“What do you think of this old mountain technique?” Mitch asked me.

“I’ll have to admit it’s pretty neat. Does it really work?” “Nearly every time. Piece of cake, son, piece of cake.”

He paused for a moment as though reminiscing, then continued, “Nothing like the practice of medicine, son. Nothing like this profession. I’ve got to have the best job on earth.” He turned to head into the next examining room. As he closed the door I heard him saying, “Good thing you got here to see me, Sammy. Let me look at that thing.”

I smiled.



© Copyright Walter L. Larimore, M.D. 2016. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.

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