When I'm on the night shift, all the department heads can't sleep.

A man carrying several layers of folded towels entered the examination room sideways.

He didn't dare lean back in the chair, only sitting on the edge of the chair with half of his buttocks on it.

A towel was placed under his right shoulder blade, causing the white vest to bulge out in an unsightly way.

The woman who followed her in placed a plastic bag on the table, with iodine, cotton swabs, and a half-opened pack of gauze squeezed together.

"Doctor, could you prescribe some anti-inflammatory medicine?" She pointed to her husband's back. "He has a lump. I squeezed some out last night, but it's swollen up again today."

The man was in so much pain he didn't dare turn around, but he stubbornly insisted, "It's all her fault for not having enough strength. She almost squeezed it all out."

"You're strong, why wouldn't you let me touch you earlier?"

Lin Ye didn't rush to answer. He got up and slammed the curtain next to the examination bed shut. "When did the pain start?"

"This lump has been there for several years. It's usually only the size of a soybean and doesn't hurt. But in the last four or five days, it suddenly swelled up, and last night it hurt so much that I couldn't lie down." The man moved the towel down a bit. "She wiped it with iodine and squeezed out a little white stuff, but then she couldn't squeeze it out anymore."

"Do you have a fever or chills?"

"no."

"Have you had this level of redness and swelling before? Do you have diabetes? Have you been taking hormones or medications for autoimmune diseases recently?"

The men all shook their heads.

The woman added, "His blood sugar was normal during his checkup last year. He didn't take any medication; he just applied some iodine himself."

Jiang Wen came in and quickly checked her vital signs.

The body temperature is 36.8 degrees Celsius, and the blood pressure and heart rate are within the normal range.

Lin Ye put on gloves and gestured for the man to sit with his back to him.

There was a red and swollen area below the right scapula, about four centimeters in size, with only a tiny opening the size of a pinhead in the center. When the gauze was removed, there was only a little cloudy secretion at the opening.

He pressed gently from the edge to the center with his fingertips, and the man immediately straightened his back.

"It hurts here."

Lin Ye changed direction.

You can feel a noticeable fluctuation in the center, and there's also a soft area to the lower right, extending beyond just the small opening on the surface.

The woman leaned over and asked, "Is it still not completely empty inside?"

"Stop squeezing." Lin Ye took off his gloves. "There's only a small opening on the surface. We can't really tell how big it is just by feeling with our hands. Let me take a look with the bedside ultrasound."

Jiang Wen pushed the machine over.

The probe, through the sterile protective cover, landed on the edge of the redness and swelling. An irregular dark area of ​​fluid immediately appeared on the screen. Lin Ye carefully scanned the area around it and confirmed that the dark area was confined to the subcutaneous tissue and did not extend into the deep fascia. There were also no abnormal gas-like strong echoes around it.

He measured the area, and the longest part was a little over three centimeters.

The man tilted his head and stared at the screen: "This whole black thing, it's all pus?"

"It looks like a cavity of pus, divided into several small compartments inside." Lin Ye moved the probe away. "Just taking medicine or trying to squeeze it out through that small opening won't clear it completely. We need to cut the opening a little."

The woman glanced towards the treatment room: "Can it be done here?"

"It can be done. The abscess is just under the skin, not deep, and the person doesn't have a fever." Lin Ye looked at the man. "We'll give him anesthesia first, then make an incision and drain it. It will be painful, and there might be some bleeding. We'll have to come back for a dressing change afterwards."

He focused the ultrasound image on the widest part of the abscess cavity and pointed it out to the man: "This lump of yours has been there for several years. It's likely an inflamed sebaceous cyst, commonly known as a cyst. Today, we'll treat the redness and swelling first. Once the inflammation subsides, we'll go to the general surgery clinic to see if we need to completely remove the cyst wall."

"As for the anti-inflammatory medication you mentioned, since you don't have a fever and the swelling is localized, let's drain the pus first. We'll see how it goes when we change the dressing tomorrow, and decide then whether we need to add antibiotics. Don't buy and take them on your own."

Upon hearing the word "cut open," the man shrank back slightly. "How big should it be?"

"Just enough to drain the pus, it won't leave a long trail down your back. The exact length depends on the cavities below."

The woman beside her grew anxious: "You were in so much pain last night that you didn't sleep a wink, and now you're scared again?"

"Who's afraid? Can't I just ask them directly!" The man shoved a towel at her. "Go ahead and do it. I can't take it anymore if I have to lie here for another night."

Lin Ye completed the notification and had him sign the disposal consent form.

Jiang Wen brought the instrument tray into the treatment room and prepared disposable drapes and local anesthetic.

The man lay down on the treatment bed, burying his face in the pillow before turning back to remind the doctor, "Doctor, give me plenty of anesthesia."

"More anesthetic isn't necessarily better; it has to be injected within a specific area. It will feel swollen and painful after injection, and it takes a while for it to take effect."

"Then wait until it really works before you make the surgery."

Jiang Wen straightened his clothes: "Who was it that said they weren't afraid just now?"

"So what if you're afraid of pain? It won't stop me from doing it."

Lin Ye repositioned the boundaries of the abscess cavity, disinfected and draped it, bypassed the abscess cavity in the center, and applied local anesthesia at several points around the redness and swelling.

Once the anesthesia took effect, he gently touched both sides of the incision with the tip of tweezers. The man only said that he could feel the touch, but there was no sharp pain.

"I'm about to begin. Don't suddenly raise your shoulder."

Use the tip of the knife to cut the skin along the grain.

As soon as the incision went past the skin, a stream of yellowish-white pus gushed out, flowing down the gauze into the kidney dish.

The man let out a long breath: "Hiss..."

"Don't move yet, it's not finished cleaning."

Lin Ye inserted the curved hemostat into the abscess cavity and gently pried open the remaining septum.

Sure enough, there was a small cavity of pus hidden in the lower right corner, which slowly flowed out from the incision after being compressed.

As the drainage decreased, he repeatedly rinsed the area with saline solution and re-examined the walls, but no obvious closed cavities were found.

Jiang Wen handed over the diversion strip.

Lin Ye left a small section according to the size of the cavity, covered it with sterile dressing, and removed the drape after securing it in place.

"You can sit up now, slowly."

The man propped himself up on the edge of the bed and tried to turn his right shoulder.

He stopped as soon as he made a slightly bigger movement, but his brows were no longer as furrowed as when he came in.

"It still hurts, but it's not the same kind of pushing pain as before."

"The incision will hurt after the anesthesia wears off, so don't remove the drainage tube yourself." Lin Ye wrote the dressing change time on the treatment sheet. "Come back for dressing change tomorrow. If you develop a fever tonight, if the redness and swelling spread outwards, or if the pain suddenly worsens or the dressing gets soaked with blood quickly, come back anytime."

The woman carefully put the bag of iodine and cotton swabs away again: "Should I still squeeze it for him?"

"Need not."

"Did you hear me?" She shoved the plastic bag into her husband's arms, "so you won't be bossing me around when we get back."

The man stood up, clutching the bag, and stopped putting the towel behind his back: "From now on, I'll leave this to the doctor. I won't ask her anymore."

"You have a good eye for people."

The two bickered all the way out of the treatment room.

Lin Ye took off his gloves and returned to the workstation to re-enter the operation record.

The indications, ultrasound findings, anesthesia method, incision location, drainage status, and follow-up time should be clearly written down, and the surgeon's name should be automatically populated in the workstation column.

A record then lit up at the edge of the field of vision:

[Skill Record Update: Incision and drainage of a localized superficial abscess, completed independently]

Lin Ye checked it once and clicked submit.

At the top of the operation log, the surgeon's name is Lin Ye.