Sixteen Vignettes In The Life Of A Pilonidal Cyst
by Lowell Yaeger

"It’s a pilonidal cyst," my doctor explained. I was still seeing my pediatrician, even though I was in my late teens.

"Do you have to cut it out?" I asked, terrified. The only thing I fear more than doctors is doctors having to do something serious to me.

"I don’t," my doctor quipped. I thought he was a bastard until I realized he was the poor guy staring into my ass. Or, more specifically, the two vertical holes at the top of my ass crack, which were puffy and oozing.

The fact that everyone working at the surgeon’s office looked like people I recognized did nothing to curb my anxiety.

The head surgeon, the one who operated on me, looked like a cross between Larry David and Dangermouse, what with his semi-bald pate, over-sized spectacles, big ears, and blazing nimbus of silver-white hair. He frequently punctuated his comments with "Ooooookay."

The nurse who assisted him looked like ex-porn star Shelby Stevens in a black wig. Despite the fact that the clinic had many patients, she knew me by name.

The second surgeon in the office looked like former Ford administration press secretary Jerald ter Horst, right down to the crooked yellow teeth, archaic glasses, and refusal to get his hands dirty. There was supposedly a third surgeon, but I never met him.

Before and after the surgery I was reading Stephen R. Donaldson’s Gap series, a five-volume space opera. One of the book’s characters, Hashi Lebwohl, took on the appearance of my surgeon.

Lebwohl was the head of research and development at a mining company. Lebwohl was also a dangerous sociopath who was incapable of distinguishing between truth and lies. This, more so than the similar physical characteristics, may have been responsible for the comparison.

Before I went to Lebwohl I went to another doctor, a short fellow best described as "roly-poly." He had tired but kind eyes and chubby hands. Every time I saw him he wore a brown blazer.

Years earlier, when I was 12, he’d lanced a boil for me. I’d sobbed like a baby.

He called my mom in and showed her the cyst. "It’s not such a bad thing," he said soothingly. He wanted to put me under general anesthetic for the procedure. Due to the operation’s potentially painful nature, I was a proponent of the doctor’s proposal.

My mom was less enthusiastic. She made her lemons-and-Drano sourpuss face and asked, "Isn’t general dangerous?"

The doctor, who had a habit of clasping his hands together while talking, frowned slightly and shrugged. "It could be, but it doesn’t necessarily have to be."

I looked at my mother pleadingly. Wouldn’t this be so much easier if I slept through it?

We didn’t go with the general.

After seeing the cyst for the first time, Lebwohl drew a picture of it on a small scrap of paper. "It’s a small pocket of subcutaneous empty space," he explained in his nasal voice.

The reason it was currently oozing was due to infection, he explained patiently.

"You can take an antibiotic, but the infection will just keep coming back until you have the area…repaired…surgically." He pushed his glasses up his nose.

He then began to explain the procedure for removing a pilonidal cyst. "We make an incision around and underneath the affected area," he said. "Once the cyst and the area around it are removed, the exposed flesh is left open to the air to heal."

"How long will it take to heal?" I asked.

"Two, three weeks," he said, shrugging.

The cyst was removed in the early summer of 1994.

I was terrified of needles, so the pre-op blood test was the worst of it. I kicked my legs and shivered like a four-year-old while the sympathetic nurse used a butterfly needle to suck blood from my arm.

After the examination, I asked to speak to a hospital anesthesiologist. The fellow I was brought to was tall, blond, and handsome. He had clean, straight teeth that were glaringly white. His shoulders were very broad. He was the living epitome of professionalism and confidence.

"Don’t worry," he assured me. "We don’t want any of our patients wide awake during most procedures, even yours. We won’t use general anesthetic, but we will sedate you. You won’t worry about a thing."

I was very calm the day of my operation. Despite a traffic jam on the Long Island Expressway, my mother and I made it to the hospital on time. I was brought into a back room, in the recesses of the outpatient surgery center, and given a gown and slippers.

The anesthesiologist arrived to take me to the operating room. He was shorter than I was, and I was only 5’4". His confused eyes swam behind thick glasses. His face was mottled with scars, as if he’d been badly burned. As we walked through the hospital, I mentioned the sedative. He stopped, frowned, and looked at me.

"Sedatid?" he asked in a thick, Slavic accent.

Following the procedure, Lebwohl went out to see my mother.

"Your son was very histrionic and immature," he told her. My mother never told me why. I have no memories of the operation. Shortly before the procedure, a spike in the back of my hand delivered something absolutely wonderful to my open-armed central nervous system. I remember absolutely nothing.

When I came to, a hatchet-faced blond nurse walked me across the hall to the bathroom and propped me up against the wall. I began to pass out, and she waved smelling salts under my nose. My brain cramped.

"You’ve taken in a lot of saline solution," she said. "You have to urinate."

"I can’t," I said. It was very difficult to even stand. I feared that forcing myself to urinate would cause the stitches to pop.

"Well, you have to. If you go home and don’t urinate by eight o’clock you have to come back here, and we’ll have to catheterize you."

I peed.

Defecating was impossible. I tried several times before it actually happened, and each time the pain and fear of damaging the spider’s web of stitches and sutures drove me weeping out of the bathroom. Finally, after four days worth of food piled up at the end of my digestive tract, I trembled on the edge of the inevitable. I bit my bottom lip and squirmed on the toilet. Drops of sweat formed on my forehead and upper lip. And then–revelation.

I felt like the hero of a movie about a brutally handicapped person who overcomes the odds to run a marathon / paint a picture / write a novel. "My Left Cheek."

The second night after the operation, I woke up and caught myself picking the sutures in my ass. The site was shaved smooth as a baby’s head and terrifyingly sunken, dropping like an upside-down cone to an inch-deep dark bottom, where the sutures lay like a tight knot of lanyard. They felt like guitar strings. I was lying in bed, wide-eyed, amazed that I was doing something so stupid. I mean, it didn’t even itch.

Shortly thereafter, one of the sutures broke. The pain was incredible. I managed to relax by listening to the Ramones’ Mania. I only had it on tape.

The wound did not heal for two years. In turns, it would get better and worse.

For example, I would sit in class and wince, alternately placing my weight on either buttock as the base of my spine tingled and buzzed. At night, I would roll over in the wrong direction and the pain would wake me. Weeks passed where the pain wasn’t so bad. Weeks passed where it was. In the morning, I would stand in the shower, teeth gritted, and pick off strips of caked blood from the top of my ass crack. They would stick to my body hair and only came free with a great deal of pulling and yanking.

I was forced to deal with an irritating list of tasks necessary to the wound’s healing. I had to place gauze around the wound to prevent its sides from healing improperly. I had to hold the gauze in place with medical tape. As the operation dwindled into a painful memory the hair on my buttocks returned, making the flimsy tape more of a liability than anything else.

I had no sex during this time.

My course of care was inconvenient.

Eventually, I became nonchalant about it; even people with colostomy bags probably get used to wearing a Ziploc filled with feces. In late summer, I went to the annual Lollapalooza fair with two friends from high school. I remember sitting on the bleachers at Randall’s Island as the sun was setting. The Beastie Boys were tearing into "High Plains Drifter." I deftly reached behind me, under my shorts, and plucked out a piece of soaked gauze that needed changing. I had no opportunity to replace it (the Porta Potties were far too forbidding), and no place to throw out the gauze. So I just chucked it into the aisle while my friend gazed off in the opposite direction.

"Wow, that guitar is, like, three times bigger than Adrock," I observed.

I saw Lebwohl every few weeks.

"I’m sure you want to stop coming here," he would say. "We want you to heal as much as you do. After all, you’re not paying us anything for these visits." As if I was intentionally keeping the wound open as an excuse to feel Lebwohl’s small hands on my buttocks.

He would place me stomach down on a mechanical bench that made the Craftmatic seem like a lawn chair. Then he would swab my throbbing wound with sticks of silver nitrate. They looked like long matchsticks capped by silver heads. The nitrate burned off flesh that was growing inappropriately into the wound. If allowed to go unchecked, the wound would heal improperly and the cyst would return.

I would wince and groan, caught between the pain of my pubic bone as it bore the weight of my awkwardly twisted body and the pain of having raw, new flesh burned away. I later learned that silver nitrate is used for silvering mirrors, dying hair, and coloring porcelain, and should be treated as a possible teratogen, mutagen, and tumorigen.

I can’t say telling everyone about my cyst made it feel better, but it was certainly good material.

"Gather round, and I shall tell ye a tale of two assholes, one granted by genetics, the other by modern science."

At closer inspection, it looked significantly different from an ordinary asshole, but from a distance of a few feet that’s just what it looked like: another puckered sphincter, a few inches above the original.

My audience would sit, fascinated, as I told them the details of the procedure and the agony endured. I delivered my practiced monologue with the air of one who suffers but prevails.

"Sure, it’s starting to close up now. But just when I think I’m healed, it starts bleeding again. You know what the worst is? The summer. In the summer, it’s hell. Because I’m sweating so profusely. Is anyone else going to eat this last slice of pizza?"

I did not whine. I was not looking for pity.

A few months after my surgery, Lebwohl suggested I get a water pick–the kind used on teeth.

"They sell them in Genovese. You get the pick, and it shoots a very tight stream of water, very quickly. You can use this in the shower to pick off the little bits of extra flesh that I burn off with the silver nitrate. Then our little sessions won’t be so bad, and you’ll heal quicker."

I tried it. The tube from the pick to the faucet was barely long enough. My lack of eyes in the back of my neck prevented any kind of accuracy. I furtively returned the water pick to where I bought it. ("I got it as, uh, a gift. I already have two.") So if you live in Nassau County on Long Island in New York State, and you bought a water pick in the summer of 1994–ha ha!

(A few years later.)

"How’s your second asshole doing?" people would ask.

"It’s gone," I’d say. I had stopped seeing Lebwohl. I’m unsure if the wound healed improperly. For all I know, there may still be a cyst. If there is, I don’t care. It doesn’t bother me and I don’t bother it.