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How does medicine describe the worst smells humans can make?

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The worst part of a minor surgery was not what I was expecting

An epidermoid cyst, stained and under the microscope
An epidermoid cyst, stained and under the microscope
Ed Uthman

I did not truly know what a foul odor was until a doctor cut into my right breast with a scalpel to remove a growth. I am a new woman, now.

If you talk about a lump on your breast, people get twitchy; they always assume it’s potentially cancerous. Sometimes it is! But this was just a cyst, a pea-sized lump that has been chilling on my right breast, near the midline of my body, for years. Most of the time cysts are pretty harmless, unless they’re in a bad location or infected. I’d gone in to a doctor when I first noticed it, in 2012. As long as the cyst wasn’t hurting me, removing it was more trouble than it was worth, my doctor said. This seemed reasonable. So I just thought of it as, like, a not-very-demanding pet.

We're skin bags filled with blood and all sorts of other nonsense

That is, until last weekend, when I discovered it had more than doubled in size, was red and hot to the touch, and smelled weird, like dirty socks. This seemed bad, probably. So Monday I called the doctor.

The disgusting truth is that we’re skin bags filled with blood and all sorts of other nonsense. Cysts fall in the category of "other nonsense"; they’re little sacs of fluid — usually the protein keratin, plus some rotting skin cells and maybe some fat — that just kind of hang out on the body. There are a couple kinds, but the most common one is epidermoid cysts, which are the result of cells from your skin’s surface migrating too far down into the skin’s layers. (These are sometimes called sebaceous cysts.) They multiply, forming the walls of the cyst; the fluid inside is excreted by these cells.

Most descriptions of fluid from a cyst say it has a "foul" odor. This is a remarkable understatementI have read a fair amount of medical literature about cysts by now, though I will not say I understand it all. I checked in with a variety of sources (Mayo Clinic; Merck Manual; Medline; etc.) before my appointment. Most descriptions of this fluid from a cyst say that it has a "foul" odor. This is, it turns out, a remarkable understatement. I would say "foul odor" is a fair description of what the cyst smelled like before it was drained and removed, when it was still under my skin.

My doctor numbed me up and cut me open, and the stench was immediately overwhelming. The smell was far and away the worst part; not the incision nor the stitches afterward. How do I say this? It smelled like death. There was, immediately, the sweetish stink of rotting meat, with a top note of dirty gym socks; the scent opened up, after a minute or so, to what I'd describe as a strangely sulfurous wet dog, wearing those gym socks, which have been stuffed with rotting meat. I have smelled many foul odors over the years: manure, slaughterhouses, chicken coops, New York’s garbage / urine / auto exhaust killer combo, floating god-knows-what from New Jersey, sewage, garbage dumps, chemical spills, teenage boys. This was the foulest, no question. I didn’t vomit but it was a near thing; apparently I turned quite green. Someone — I am not sure who, as I was busy staring at the ceiling and trying not to puke — opened a window to at least get me air.

"Foul" doesn't even begin to describe it In no way had my amateur research prepared me for the so-called foul odor, either. "Cheesy" is a favorite description, appearing in the American Academy of Family Physicians’ copy, as well as that of Medline Plus, and the British Association of Dermatologists; the Cleveland Clinic prefers "cheese-like." Other descriptions: foul, malodorous, smelly. Doctors are fairly used to ghastly smells, I’d reckon. But I think something else is driving the faux-neutral word choices here. "Foul, cheesy odor" sounds distant; it's not descriptive but it's authoritative. It's vague and official-sounding at the same time. It doesn't make you imagine the doctor ever experiencing the stench first-hand, that's for sure. From experience: "foul" does not even begin to describe that stink, which I hope never to smell again in my life. As a word choice, "foul" is inadequate to the task. "Cheesy" doesn't really cover it either — try "Limberger from hell" and we're getting somewhere.

I certainly understand not wanting to alarm patients — my perfectly accurate descriptions are possibly alarming — but I would have liked a chance to prepare myself, perhaps by drenching a bandanna in Shalimar and wearing it over my nose and mouth the entire time. In the interest of offering future patients some kind of guidance on cysts, I have put together some suggested descriptions for the smell: putrescent, noxious, shocking, repugnant, fetid, rancid, stinking, revolting, sent from hell itself… Or to keep it clinical, you could try this: nausea-inducing.

Really, though: the surgery itself was quick and mostly painless — I only needed aspirin for the soreness after. I'm done with my antibiotics, the skin now lies flat again, and my stitches come out Monday. The procedure itself was so minor that the smell is really what stands out.

My doctor, at least, tried to warn me. She told me she’d once seen a nurse faint at the smell. Nurses are among medicine’s hardiest creatures; if the stench can fell a nurse, you know it’s hellacious indeed. I realized what she was trying to tell me too late, I'm afraid.