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Posted by Dr. Sushrut Jangi February 27, 2014 04:16 PM
One night, I woke up itchy. It was around 2 a.m.
What a strange thing. Ordinarily, I'm blessed with a capacity for deep slumber and can sleep through everything: rain, thunder, police sirens, and if there were earthquakes here in Boston, I would probably sleep through those, too. That's what made this night particularly odd. The itch started on my legs like toothy insects nibbling at my skin. Then it rose up until the sensation enveloped the rest of me, my stomach, my arms, my face, my scalp.
I wasn't an atopic kind of person; never had eczema or asthma or dermatitis to wrist watches, shampoos, or lotions. So I let it go for awhile. There's a book that describes how monks can will away discomfort by accepting it as a neutral sensation. I tried that for five minutes, then started scratching like a gray-back ape. Blissful was the sound of excoriation. Cells were coming off like steel wool abrading the last remnants of debris at the bottom of a pan. For awhile, my body was content. But soon after I stopped, the sensation came back in a wave. The clock read 3 a.m.
I stood up and got out of bed. This was ridiculous. There had been other occasions where some symptom - nausea, even unhappiness - had overwhelmed me. But the fact that an itch was causing me distress on such a dramatic scale bordered on the bizarre. I walked to the window and threw it open. The cold winter air rolled in and floated over my skin. In the bathroom I found a tube of moisturizer that I squirted on and rubbed in, but there was no soothing effect.
Could I have cried? I could have. I wanted to call someone and tell them what was happening. Everyone - at least in my pocket of the world - was asleep. But I was awake, blundering around the house in search of exfoliating cream, a strong light, and a comb for nits. I actually studied my arm in the mirror, looking for little bugs, at least a culprit to name.
We have a word in medicine for such itching: whole body pruritis. But could these words even begin to reflect how potent that itching was? How I wished to set my skin afire to burn the feeling away? How in the depth of the night even a simple discomfort like this could summon clouds of uncertainty and precipitate near existential anguish?
We've made a lot of advances in medicine. A doctor can put a tiny stent in your heart and stop a heart attack; we have precise chemotherapies for cancers that were once undefeatable. Yet surprisingly, the most basic elements of the body's suffering - pain, nausea, and in my case, that night of nocturnal itching - remain mysterious, their mechanisms vague and still relatively undefined.
Let's take a look at pain. Even though we have the capacity to quantify much of our physiological innerworkings, thus far we have no practical instrument that objectively measures pain. The best we can do is ask a patient to estimate how much pain they feel. In the case of nausea, despite new ways to control this symptom, it remains a much feared side effect of medications, causing patients to drop out of vital chemotherapy regimens, antibiotics courses, or HIV treatments. Itching, described in Atul Gawande's fascinating account of the symptom as "among the most unpleasant physical sensations one can experience," can cause patients such distress that they actually inflict bodily harm on themselves from their relentless scratching.
Part of the reason such basic afflictions remain undeciphered has to do with the nature of these feelings themselves. During the course of human evolution, pain, nausea, and the itch became the signals of revulsion from dangerous or toxic stimuli. They are our allies and have been at our sides for thousands of years.
Consequently, the circuits that run the programs for these symptoms are deeply and redundantly buried in our brain and body; the ability to manipulate or treat them is far more complex than going after a single target. As a result, many of the diseases that remain relatively intractable to management in our current era - any kind of chronic pain, irritable bowel syndrome, fibromyalgia, cyclical vomiting - are the outcomes of these complex circuits gone awry. Patients that I've seen with such syndromes often sit in the office at their wit's end looking for a solution. Western medicine doesn't yet have it. How can we treat such disorders when we still don't understand their roots - the simple sensations from which they arise?
That night, I finally took a hot shower, almost scaldingly so. And while that didn't take the feeling away entirely, somehow sleep came to me. I closed my eyes just as the sun was coming up. An hour or so later, my body felt like my own again. The itching was gone. I've never figured out a cause. And while I've been far sicker than that night, it has left in me a sensitivity that even the most simple and common symptoms - those that we will all at some point experience - are the ones that can be the hardest to explain, to treat, and can leave us the most unhinged.
"I'm sorry I've called you in again," a patient told me one night on the cancer ward, after I had been paged to her bedside twice already. "My arm won't stop itching," she said, near tears. "Of all things," she wondered. "It's so silly, isn't it?" she said.
The nurse brought in another round of Benadryl. I crossed my fingers.
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About the authorSushrut Jangi is an internist at Beth Israel Deaconess Medical Center and an editorial fellow at The New England Journal of Medicine. More »
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