Pruritus

Nonfiction Contest Winner


BY J. D. SCHRAFFENBERGER

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The Lord will smite thee with the botch of Egypt, and with the emerods, and with the scab, and with the itch, whereof thou canst not be healed.                                   Deuteronomy 28:27

On the right side of my abdomen, on a patch of skin the approximate size and shape of my hand, a field of pink dots blooms, slightly upraised, some of them gathered in little semi-circle islands, some having glommed together to form major and minor continents, and a few scattered here and there by themselves on the great white ocean of my belly. On my left side, a more modest three-finger archipelago. Every day the geography shifts slightly. The pink dots redden, blanch, dry, crust, swell.

***

Every other night at bedtime I read to my two daughters, three and five, books of their choosing. Lately, they’ve both been interested in old baby books we should’ve given away long ago—Peek-A-Who?, Barnyard Dance, Goodnight Moon—but I don’t mind. At the end of a long day, a short book is a blessing. The girls have also lately been asking me to pretend that they’re babies, to hold them like babies, rock them like babies, give them imaginary bottles. I don’t mind this game, either. Each in turn lies in my arms, enormous, scrunching her eyes shut like she’s asleep, and then opening them suddenly with a big pretend fuss. They ask for their wottle, their wanket, their wacifier. I play along and put this or that invisible thing in their hands. They goo and gaa, big beautiful cartoon babies in my arms.

***

I slather my abdomen with lotions, ointments, and balms of all kinds. The patch of red dots gets better, it gets worse, sometimes it seems to be going away, but it doesn’t go away. Rubbing the lotion, the ointment, the balm on my skin, running my hands on the contours of my belly, I can’t help but notice how fat I’ve gotten in the past few years, how flabby fatherhood has been so far. I am a never-really-been-in-shape, out-of-shape forty-year-old fat guy. My shape is blossoming, ovoid mid-section, curvaceous gut, I am the inflationary universe. I’m fucking pregnant.

***

Scratching puts us very much in our animal bodies. I enjoy a good scratch as much as a dog or cat enjoys it. When my scalp or my beard is dry and I indulge in a vigorous bout of scratching, I am fulfilling a grand procreant urge. Some scholars believe that by scratching themselves and each other, our ancient pre-human ancestors removed potentially harmful parasites. Scratching, like sex, is evolutionary—the pleasure of our species. Our bodies still speak the language of itch.

At night, always at night, I’m woken by this insistent evolutionary itch. I wriggle and shift. I try hard not to scratch. WebMD says itches are always better left untouched. But the more I think about it and roll over and reposition and concentrate on my breathing or the darkness or some task I have to accomplish in the morning, the more intensely it itches. Sometimes, half-asleep, I scratch and scratch. In these dreamy moments, I am all dog, happy and unashamed. I am four-legged. I purr.

***

The girls have brushed their teeth. Their hair is wet from the bath. The older one is wearing a satiny turquoise nightgown with a glitter tulle skirt and the pale Nordic face of Elsa adorning the chest. The younger one has put on her equally satiny pink nightgown with a glitter tulle skirt and Hello Kitty’s expressionless face stamped on the chest. I sit on the floor cross-legged and lean against my five-year-old’s now-too-small toddler bed to read The Cat in the Hat, the girls stationed on either side of me. Then I read a book about Strawberry Shortcake becoming a mermaid. My older daughter tucks her legs into her nightgown and says look, now she’s a mermaid, too. Her legs have been transformed into the scaly tail of a fish, and she rolls on the carpet as though swimming. The younger one jumps on top of her and they roll together, screeching, laughing, tickling each other. Now the mermaid king decrees that it’s time for all young mermaids to swim to their seaweed beds, to close their eyes and go to sleep.

Lately my daughters have developed a few standard bedtime stalling techniques. They have to go to the potty. They need a drink of water. They sing and dance nonsense songs to entertain me. “We can’t go to bed until we finish the dance!” Over the last few days, they’ve been styling my hair with doll combs and brushes. “We can’t go to bed until we finish your hairstyle!” They’ve also begun scratching my back. They poke through the clutter of their toy bins for a tool to scratch with, settling on half of a plastic Easter egg or a Lego person or pinwheel straw. “We can’t go to bed,” they say now, shedding their tails and rising from the sea fully human, “until we scratch your back.” I don’t let them lift my shirt because of the rash, but they scratch through the fabric and on my bare arms, and it feels good, as it always does when someone scratches your back. “Finish up,” I tell them, even though I don’t really want them to.

My older brother and I, when we shared a bedroom as children, used to scratch each other’s backs at night when we should’ve been sleeping. We’d draw pictures and write words and make the other one guess what the pictures or the words were supposed to be. When it was my turn to be scratched, I experienced a pleasure I was unaccustomed to—not exactly affection or attention. It was something elemental. Sometimes the scratching was so hard, as I fell asleep I could still feel burning on my skin the glimmery outline of a castle or a military tank firing on a jet plane, or written in stiff block letters my brother’s goodnight commentary: D-U-M-B.

***

Itches are real. They’re not metaphors. They are things. They’re not just temptations or desires. They’re not cravings. They’re not “all in your head.” They’re on your skin. They’re in your skin. And to scratch an itch is to fulfill a tangible need. We should all be pardoned for such weakness of willpower. The more I try now to not scratch, to ignore the unrelenting itch on my abdomen, the more I need to scratch.

What is the need? The need is for things to stop, for calmness to settle over my body, for stability, for equilibrium, for resolution. An itch is scratched, and the world is as it should be—until the next itch. The need is to get to the end of it, the bottom of it—even if there is no end, no bottom to it at all—imagining even before my fingernail touches skin what it will be like to no longer feel this way.

***

Growing up, I would get a wicked poison ivy rash every summer from exploring the woods behind my suburban southern Indiana home. My skin became a pink patchwork of calamine lotion. I took oatmeal baths daily. I radiated itch. During baseball games I felt the constant sting of sweat on the rash under my rough polyester shirt and pants. The blisters would break and ooze and bleed. I’d stay in the bathtub until the dingy water cooled. I’d lie absolutely still in my bed, spread-eagle, trying not to think of anything but baseball, the game we just played or the upcoming game, pitching the ball, feeling the muscles of my body move in concert, the pivot, the coil, the kick and release, energy rising from my feet up through my hips and into my shoulders, until my whole body was flung irresistibly forward. I didn’t know it then, but I had invented meditation. Even now, when I’m having trouble falling asleep, when I need to calm my mind, I think of throwing a baseball. I massage the red-threaded ribs of the ball’s seams, vinaigrette sweat steaming from my skin. I hear the bullet pop of the catcher’s mitt. I do it again.

***

On the frontispiece to Samuel Hafenreffer’s 1660 book on skin diseases, two lepers are depicted with large papules on their legs and arms. One stands with his foot propped on the head of a sleeping lamb. The other brandishes a leper’s clapper in one hand and a crucifix in the other while a dog licks a sore on his knee, like the parable of Poor Lazarus. Between them hangs the skin of a flayed man, his head drooping Christlike, the ribbons of his arms draped over pegs holding him aloft. Across the flayed man’s skin is printed the book’s title, Nosodochium: in quo cutis affectus traduntur curandi (Hospital: in which skin affections are healed). It’s a gruesome scene, but the image expresses the dual symbolism of flaying in the premodern mind: as a method of torture and as a means of acquiring medical knowledge. What could be a more extreme form of capital punishment than flaying? At the same time, how will the burgeoning field of anatomy progress without removing a person’s skin to see what hides beneath?

Hafenreffer’s portrait hangs in the gallery of professors at the University of Tübingen, where he was a well-regarded rector. His face seems dyspeptic, like he’s suppressing a burp behind his elegant white Van Dyke beard. In one hand he clutches what looks like an egg, and in the other he presses a book against his chest, perhaps his own book, Nosodochium, in whose pages the medical term for itching first appears, the Latin word pruritus (proo-RIGHT-us), defined by Hafenreffer rather commonsensically as an “unpleasant sensation that elicits the desire or reflex to scratch.” The book includes descriptions and treatments for many skin ailments. He discusses itch mites and scabies. He reprints a signed affidavit of one of his examinations to verify that a woman was free of leprosy. He even reproduces a piece of folk music to exorcise the uncontrollable impulse to dance, believed to be caused by the poisonous bite of a tarantula.

***

We’ve advanced quite a bit since the seventeenth century in our medical knowledge of human skin, but we still don’t know much about itching itself. We know very well the sources of itching, both internal and external: infections, infestations, inflammation, even liver disease and renal failure. Depression and anxiety can produce itching. And itching can be a symptom of different kinds of cancer: an itchy nose might mean brain tumors, continuous itching in the lower extremities could be lymphoma. The itchy swaths of pink inflammation on my abdomen today might presage something truly dire, a disease surfacing from inside my body somewhere.

We also know that cooling reduces itching and that warming intensifies it. We know that itching follows the same neural pathways as pain, that pain reduces itching, and that the inhibition of pain enhances itching. But itching is still a mysterious sensation; it is the shadow, the echo, the phantom of pain. When we scratch an itch, when we rake our nails across the outer layer of our skin, we don’t remove the itch: we inflict a bit of pain to overwhelm it, a river roaring in to flood a narrow creekbed.

***

The summer after my first year of college I worked as a plumber’s apprentice. The clean logic of pipes and fittings appealed to the mechanical part of my mind. The rules were easy to follow: cold is always on the right, shit flows downhill, Friday is payday. A house, my boss told me, is like your body. According to him, the walls of a house are your bones, wires are nerves, air ducts are your lungs, pipes your arteries and veins, and so on. It’s just plain physics, son, he said. Simple as that.

I mostly did grunt work that summer, digging long ditches in gravel foundations where new homes would soon dot the cul-de-sac spirals of another suburban development. Blisters puffed up on my hands, splitting and then oozing tiny drips of watery pus onto the handle of my shovel. With every load of gravel, my hands stung. I spent entire days in the sun, my bare back and shoulders turning pink and then red, the skin tightening as we carefully laid new PVC pipes into the ditches to connect to the water main at the curb. At home, the skin blistered and then peeled away in tender patches that soon began to itch. In the cool shower I felt my skin sliding from my shoulders as though flayed, slipping down my back like molting snakeskin. I slept on my stomach. I could hardly stand putting on a shirt. My boss bought me a tube of sunblock at the gas station on our morning breakfast stop. He tossed it into my lap in the truck, and I almost spilled my coffee. It’s like how you paint your house, he said, to protect it from the elements. I was thankful to have learned a lesson.

***

My doctor has never struck me as an intelligent man. He’s a bit bumbling, the one nobody wants to get stuck talking to at a party, who laughs at jokes he doesn’t really get, a person on whom many things seem quite lost. But he’s not condescending the way some doctors can be, he isn’t uninterested or distracted, and he’s a pleasant enough human being even if I wouldn’t choose to have a drink with him. His beard is neat, his glasses clean. I lift my shirt to show him my abdomen, and almost immediately he tells me what I’d already entertained as a possibility: it’s tinea corporis, ringworm.

I think of tiny worms crawling in and on my skin. I imagine them writhing in furious microscopic coils. I feel them burrowing deeper into my pores, multiplying, spreading out in colonies across the vast frontier of my belly. I see lice, mites, maggots, bedbugs, chiggers, ticks, fleas. I see clutches of eggs hatching. But that’s just my imagination. Ringworm is not actually a worm at all. It’s an infection from a fungus that lives on skin, nails, and hair. The fungus grows its web-like filaments and feeds on the nonliving outer layer of skin tissue. Microscopic pictures show sleek segmented heads the shape of a cockroach with crisscrossing tangles of threads trailing behind, swimming together in the warm, humid ecosystem of our bodies.

My situation is not completely abnormal. Nearly 30 million people (9%) in the United States suffer fungal infections, and it’s the fourth most common disease worldwide, affecting more than 980 million people (14%). Nor is it unusual to find fungi on a human in the first place. About 80 different kinds of fungus live in our skin. Millions upon millions of fungi are currently thriving on your head, in your ear, your nose, on your feet, your heels, your toenails, between your toes, on your chest, your back, your groin, all over your body, propagating, growing, generation upon generation living their lives on you.

***

I have to quit drinking, for now at least; the antifungal pill I’ve been taking has elevated my liver enzymes, and I still have another two weeks to go. In the meantime, the rash has spread, the itch deepened, and I’ve begun to think I might have to live like this forever. The itch is always there, beside me, on me, in me, the bumps spreading, overtaking each side of my torso, and I picture them coming together, a quivering pink corset I can never remove.

At first, the itch was a thing I had. It’s starting to feel like a thing I am. And in a way, the fungus, the rash, the itch—it is all a thing I am. If half our bodies are not us—our skin, our gut alive with other organisms—then it’s all us. We are they. And I become the universe of flora and fauna in and of this thing I call my body.

***

The doctor actually called it tinea corpis rather than tinea corporis, a minor error in the declension of a Latin noun, which I would usually forgive without mention—I’m no pedant—but details matter in medicine. And after an entire month, he wants me to continue taking the antifungal medication that’s burning through my liver even though the rash has shown no signs of abating. He claims it might take many months more for it to go away altogether. He said we should fight the fungus from the inside and the outside at the same time, so he’s prescribed an additional antifungal topical cream, Nystatin, which has been proven in clinical trials (I checked) to be ineffective against tinea infections. I don’t want to be the difficult patient who thinks he knows everything after browsing a few pages on WebMD, but I also don’t want to be a passive schmuck unwilling to advocate for himself. I need a second opinion.

***

Skin defines us. It’s a boundary, a thin sheath that separates me from you, me from the world, that marks the difference between us. It is a protective wall keeping the outside from invading the inside. We often think of skin as an enclosure, like a house (just plain physics, son), a container for our true selves sheltered within—our hearts, our brains, our souls—a covering rather than something essential: husk, shell, rind. But skin, we have to admit, is more than just a surface. Touch, pain, itch, warmth—these sensations and perceptions are profoundly human phenomena both physically and metaphorically. Inside and outside come together through these experiences on and in and of our skin.

My white skin marks me socially, just as brown skin marks others. These marks are inscribed so deeply and violently into the pages of global history that it’s difficult sometimes to imagine them being read and interpreted differently—self and other, us and them, good and bad, white and dark, man and woman. Whiteness has formed and informed my identity in ways that I remain only dimly aware of but are nevertheless real. Skin color is both a meaningless construct and a deeply meaningful code we all live our lives by.

I think about the highly charged, allegorical passage in Ralph Ellison’s The Invisible Man when the narrator has an accident at the factory he’s working at and white paint boils over and burns his skin. He wakes up in the hospital: “Suddenly my skin itched, all over. I had on new overalls, strange white ones.” Later, as his skin is healing, it peels away: “My side began itching violently and I tore open my pajamas to scratch, and suddenly the pain seemed to leap from my ears to my side and I saw gray marks appearing where the old skin was flaking away beneath my digging nails.” He suffers physical pain alongside the psychological, the emotional, the symbolic.

***

The dermatologist prescribed a topical steroid. It’s probably just a little bit of eczema, she said. I told her I didn’t trust my doctor, that he seemed incompetent. I listed all of his mistakes and oversights, wanting her to tell me that I was right—and that I was right to leave him behind. General practitioners, she said with professional equanimity, they know a little bit about a lot. We know a lot about a little. The depth and acuity of her knowledge reassured me. She smiled and crossed her legs. She wore chunky red patent leather Doc Martens. She was cool, not unfriendly, but utterly self-possessed, the kind of person at a party you’d be happy to strike up a conversation with. To be sure that my rash wasn’t fungal, though, she needed a biopsy. Would I like to do that now? Yes, of course I would.

Now I have a hole the size of a pencil eraser in my right side where the dermatologist punched out a chunk of skin to send to the lab. It looks like an eye winking its crazy eyelashes. I wash the snarling black stitches every day, apply an ointment, cover it with a quarter-sized adhesive bandage. The skin will heal, knitting itself back together, smooth, and eventually I’ll have a tiny shiny pink scar.

***

ScarScabScourScatheScoreSchism

ScissorSkewerScaldScorchScourgeScaly

ScabScrubScribbleScrabbleScrawlScribe

ScriptSkitSketchSkullSkeletonScrim

Scum Scroll Scruff Scalp Scrap Sky

Skin Skin Skin Skin Skin Skin

ScratchScratchScratchScratchScratchScratch

***

The lab results were inconclusive, but the steroid is working. The patches of pink and red skin have shrunken and lightened, and the accompanying itch is no longer seared into my daily life. The diagnosis of “just a little bit of eczema,” however, makes me inexplicably sad. There was some comfort in knowing I was up against a fungus—an entity colonizing my skin, a single external thing I could isolate and fight against. But eczema isn’t a single thing; it’s simply a description of a condition that triggers skin inflammation, no cure, no definite causes. It is the biblical “itch whereof thou canst not be healed.” Even if this itch goes away, another one will return somewhere on my skin. As with so many questions in our lives, there are no real answers, only temporary fixes and provisional accommodations. The underlying mystery remains somewhere inside my body.

But even the phrase “underlying mystery” suggests a truth that might be found at last, a finality to be reached if only we could pull the curtain aside, get behind the wall, under the skin of the problem. The mystery isn’t underlying, though. It inheres, inlaid. It’s skin all the way down.

***

I tell my daughters not to scratch my back tonight. The rash is nearly gone, yes, but the skin is still healing even if now you can barely make out its contours. They pull my shirt up to my shoulders anyway and dig their little toys into my skin. They giggle, a little sadistically. Does that hurt, Daddy? They also think it’s funny to see the waistband of my underwear. I’ve lost a lot of weight recently—stopped drinking so much, started exercising and eating more consciously. My nipples are showing just under my uplifted shirt. Why do you have nipples, Daddy? They roll on the floor laughing. Why do you have hairy nipples? They think nudity is hilarious even if they haven’t yet been socialized into modesty and shame. The words shame and skin, in fact, share the same linguistic root, which means “to cover.” They don’t care much about covering themselves, perfectly at ease in their naked skin in a way I can’t ever recall being myself. I pull my shirt down and tell them to choose a book from the shelf.

Their skin is only recently their own. As embryos they acquired touch, and their skin was their mother’s skin, too. As babies, they slept and nursed on their mother’s breast, the shared touch of skin to skin as vital as milk or sleep. Their bodies have been carried, washed, and handled by me and their mother for their entire lives. When the older one was born, a dark pink Rorschach splotch emblazoned the space between her eyes. When the younger one was born, she developed a bumpy rash and had a flaky scalp for over a year. They’ll experience plenty of skin maladies in their future lives—oily skin, dry skin, acne, rashes, sunburns, bug bites, scrapes, cuts, bruises. But tonight, their skin is still radiating heat from the bath, their hair soaking damp spots into the knit of my shirt. They’re hardly aware of their own creaturely bodies, curled next to me like tired kittens, happy, as I crack open the pages of tonight’s book.


J. D. Schraffenberger is the editor of the North American Review and an associate professor of English at the University of Northern Iowa. J. D. is responsible for two books of poems, Saint Joe’s Passion and The Waxen Poor, and his other work has appeared in Best Creative Nonfiction, Brevity, Mid-American Review, Notre Dame Review, Prairie Schooner, and elsewhere. He lives in Cedar Falls, Iowa, with his wife, the novelist Adrianne Finlay, and their two daughters.

 

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