Woman who couldn't stop itching

Last night I listened to a New Yorker podcast interviewing Atul Gawande, author of an article in the latest issue about itching. It's fascinating.

“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.” For M., certainly, it did: the itching was so torturous, and the area so numb, that her scratching began to go through the skin. At a later office visit, her doctor found a silver-dollar-size patch of scalp where skin had been replaced by scab. M. tried bandaging her head, wearing caps to bed. But her fingernails would always find a way to her flesh, especially while she slept.
One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night–and all the way into her brain.

Read "The Itch" | Listen to interview with "The Itch" author Atul Gawande

Mark Frauenfelder is the founder of Boing Boing and the editor-in-chief of MAKE and Cool Tools. Twitter: @frauenfelder. Come and hear Mark speak at the ALA conference in Chicago on July 1.

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Haldor

What would be really fascinating is if the part of the brain that was causing the itching was the part of the brain damaged by the scratching.

That part of the brain was defective so another part of the brain tried to get rid of it by causing the itching.
Antinous

Okay, how about the guy with chronic headaches? They did fluoroscopy (real-time x-ray) on his head. Apparently, he had been on a tropical vacation and picked something up, because they could actually see some wormy looking parasites swimming around his brain like it was a coral reef. God only knows how they got up there.
rane

B.S. nd L.B.

Tw rsns why try (kywrd “try”) t nt vst bngbng nymr.
Takuan

just google images “brain worm”. Don’t say I didn’t warn you.
Tim

When I read this in the magazine yesterday and got to the part where they realized she had scratched through to her brain, I actually had to put the magazine down and walk away. And yes, those calling shenanigans should have first read the article to see how it was possible: It happened over many months, involved scabbing and loss of feeling, and she habitually scratched in her sleep.

Interestingly, the sensation of itching is unique in that someone talking about itching, or a bug crawling on their skin, can cause you to feel an itch, whereas the same is not true of pain or pleasure.
buddy66

Thanks, Ross. I needed that.
queensissy

I have to second (and third and fourth) the comments noting that reading the article will make you itchy. I read it last night and was completely tormented.
igpajo

UNICORN CHASER!!!!!
strider_mt2k

I was…ahh…going to make a silent “B” joke, but that’s just awful. Ewww.

Hope she’s okay.
Ceronomus

I’ve read the article and I’m still trying to figure out how a person could scratch their way through their skull without using some sort of implement. I find it hard to believe that human fingernails would be up to the task.

Yes, this seems to be filled with reputable sources, but even so… I’m not about to simply believe everything I read. I’d like to know HOW she scratched through her skull. That is the stumbling block in the story for me.
Antinous

I’d like to know HOW she scratched through her skull.

Clearly someone must perform a noble experiment. Please report back to us if and when you regain the ability to type.
CANTFIGHTTHEDITE

I was gonna recommend wearing oven-mits, keeping them on with good amount of gorilla tape, but that’s hard to do by yourself.

And wouldn’t your fingers hurt ALOT after scratching through your own skull?

Solving this problem is a real head scra… nevermind.
Lauren O

After reading that, my scalp will not stop itching. Crap.
The Joey B

I call shenanigans. I have a hard time believing she scratched through her skull which is generally about a half a centimeter thick.
hkedi

Nifty article. It reminds me of the books that Oliver sacks wrote in “An anthropologist on mars” and “The man who mistook his wife for a hat” on some of the weird things that the brain can throw up if it gets damaged in a particular way.

As for scratching through the skull, I can see how it would be easy to use your fingernails to wear a hole through the skull given enough time and patience. Fingernails grow a lot faster than bone can repair itself, plus the constant state of infection an inflammation would help in weakening and breaking down the bone itself.
gabrielm

I am not a medical doctor (IANAMD?), but want to call shenanigans on “all the way into her brain”.

Unless she was wearing adamantium press-ons, there is no way that a fingernail is going to dig through solid bone in one night!
Anonymous

If I had to make a guess, I’d guess that the etiology looks like this: scratching –> wound –> osteomyelitis of the skull –> purulent osteoporosis –> total collapse of the regional bone structure –> necessity of debriding th area and removing infected bone.

– ACS
dove

unicorns, PLEASE?

there should be a warning before reading these sorts of articles (“unicorn chaser may be necessary after reading”)
cisco

fwiw, a finger nail is a 2.5 on the mohs hardness scale. but 2 minutes looking for the moh value of human bone didn’t yield any definite number.

i blame my short attention span on
andbigdaddy2

What do you say to the woman who did this besides you are superhuman. You have the ability to scratch through your own skull in one night and not bleed all over your sheets when you hit the blood brain barrier.
Razzabeth

Teehee. I don’t know why, but I <3 reading about people’s hideous neurological disorders. Does this make me a creep?
manicbassman

not a hope in… this must be an urban myth…
noen

This story is absolutely fascinating. I believe that she managed to scratch through her skull and infect herself. There is a tendency by some to arm chair analyze things based on second and third hand hearsay. The author is a highly reputable person and the presence of hospital records weigh in favor of the account being true. Semantic quibbling over ambiguous phrases is such a lame pastime.
lectroid

http://youtube.com/watch?v=hkqqMPPg2VI

not a unicorn, but a good andedote.
Anonymous

Wow, I’m really scared now. My whole life I’ve had a very frequently (though not constant, thank god) itchy scalp. It is not caused by dandruff or any other skin condition my doctors have found. It seems to have gotten worse in recent years, and it was especially itchy today, even before reading the article. Was quite embarrassing, since I was in an important business meeting.
ill lich

“Doctor. . . my brain hurts.”
acx99

Was there a cup of tea on her bedside table in the morning too?
jacord

Anyone else thinking of “How to Get Ahead in Advertising”? Replace boil with scalp-scab….
beep1o

I think you naysayers didn’t read the article carefully. This woman didn’t have any nerves left to feel the pain in that area, and scratched away for years. She worked her way down through the skin and skull a little each day and finally broke through to her brain.

It’s entirely possible and believable and reading carefully will show you this.
Dirk

Before calling shenanigans on the woman scratching all the way through her skull, some of you people should take the time and actually read the article. As #10 said above, the author is highly reputable. Plus the New Yorker fact checks its article.

The article also mentions a man who accidentally killed himself by scratching his neck all the way to his carotid artery.
IWood

Yeah, shenanigans.

Except for the part where she’s, you know, partially paralyzed due to the brain injury which the not-doctors say she can’t possibly have inflicted upon herself.

See, also:

Gawande, Atul.
gabrielm

@ ROSSINDETROIT

I didn’t know that this was the thread to show baby duck pictures! Here are mine.
Cupcake Faerie

There was a young belle of old Natchez
Whose garments were always in patchez.
When comment arose
On the state of her clothes,
She drawled, When Ah itchez, Ah scratchez!

(O. Nash)
squirrelgirl

how in the hell would you not notice that you were scratching through you skull? i mean seriously. i think you would notice this before you managed to get all the way to you brain.
davebarr

Sounds like an episode for Mythbusters that everyone will enjoy!
mcdonough

This woman didn’t have any nerves left to feel the pain in that area, and scratched away for years.

Just curious: why was she scratching if she didn’t have any nerves in that area? Don’t you need nerves in order to itch?
squirrelgirl

ok sorry no, i didn’t read the article becuase the brief description was nasty enough. yeah if she had no nerves left in the area and did it every night for years, i suppose it’s possible. still i think you might see the patch of bare bone, or something. i think you either need to be pretty unobservant or in incredible denial not to realize you were doing something terrible to yourself.
Lady Katey

Wow.

Another good reason not to do heroin (aside from the possibility of getting nasty stuff like Hep and HIV from needles) is that most of it is bullshit and not truly diacetylmorphine, but rather chock full of codeine compounds that will make one itch like a madman, yet lack the self awareness to stop scratching before ripping big holes in one’s self.
vincentpants

Oh man, this is first post where I’ve needed a Unicorn Chaser, and none in sight. Desperate times calls for desperate measures!

cute bento-ness for the masses
minTphresh

mmmmmm, deliciouss brrraainzzz!
phoenix21

I cannot stop picturing scenes from the movie Cabin Fever. Ick, ick, ick. True or not, that is GROSS.
Antinous

I worked in a hospital for twenty years. You have no idea what people will do to themselves. How about an enema with boiling hot coffee that cooks your colon? Forgot to remove the potato that you used as a pessary until you noticed a vine sprouting between your legs? No, I have no idea why there’s a section of stereo wire in my bladder. Decided to do your own nose job at the bathroom mirror and replace the cartilage with a leftover piece from last night’s chicken dinner? You have no idea.
LeSinge

Campfire story FTW. Jesus. It was a dark, dark night, in a dark, dark house……SHE HAD SCRATCHED THROUGH TO HER BRAIN!!!!!
Anonymous

Infection can weaken and soften bone.

And the CSF may not have been leaking. Dura mater is tough stuff. Again, infection could make pretty colors.
Secret_Life_of_Plants

This article was totally fascinating — truly in the spirit of Oliver Sacks’ own brilliant essays. Atul Gawande is an excellent writer.
Antinous

Don’t you need nerves in order to itch?

It was probably a neuro glitch in the first place and could have worked like phantom pain from an amputated limb.
Agent 86

ew… I’ve been scratching my head lately, after a harsh haircut, and have had scabs for the last week…

Time for oven mitts!
beep1o

Squirrelgirl you get the prize for not reading the article. If you had you’d know that they whole point is that the brain makes up illusions of pain and itching and other things to make up for input it expects but isn’t there. She lost 99% of the nerves, and then 100% when they surgically cut them. Guess what…she still itches.

It’s likely her brain originating the itch. But seriously, try reading the article rather than asking for the info to be spoonfed.
Agent 86

Oh, and Tak, if you want some real gross factor, youtube ‘Hydatid Cyst‘ (My new personal nightmare)
nehpetsE

shouldnâ€™t this story be filed under
â€œPornography-Desensitized Populace Demands New Orifice To Look Atâ€
?
Takuan

@12: there ya go, Ill
http://www.posterplanet.net/images/mybrainhurts.jpg
minTphresh

brainfucker?
beep1o

squirrelgirl, you must enjoy showing your ignorance. people with OCD wash their hands till their bloody and they are right in from on their eyes. Her scalp likely was bloody and scabbed all the time and I doubt you could see much. She did do this every night. People do amazing things and it isn’t because they are “unobservant” or “in denial”.

Again, the whole point of the article is that your brain may not give you proper sensory information about the outside world.
Teds Famous Kickin Chicken

Some of the commenters above really have to read the article to understand. It describes a radical reevaluation of how the nervous system works: so, you’re right, the woman could not literally sense the itching as we normally think of it, but because of how perception works, even after the nerve endings were destroyed, she continued to feel the sensation of itchiness–and for so many years that she eventually wore her way through her skull.

A great parallel Guwande made was to amputees who could still feel their lost limbs. They expect their leg to be there, so they “feel” it there. And right now this second I bet you could make your eyelid itchy just by thinking about having an itchy eyelid.
Jerril

Aaugh aaguh aaugh I shouldn’t have finished reading the blurb…

I’ve got psorisis, on my scalp and around a very-slow-healing surgical wound. Severe itching that I wasn’t allowed to scratch (such as around said wound) has driven me to writhing around like I was in agony; lucky for me taking far too much Benadril eventually calmed it down.

I’m going to have nightmares about this woman, I can tell. *shudder*
Maurik

@#36,

Cool.
GregLondon

weird.
starbreiz

*shudder* I have chronic urticaria. I previously tested positive for a number of food allergies, and mysteriously, my new doctor says I’m negative for all allergies and simply itch for no reason. The mere fact that it’s possible to itch through to ones’ brain makes me shudder. Especially since I too, itch all the time. I still fail to understand how she scratched through the bone of the skull though.
Takuan

LADY MACBETH
Here’s the smell of the blood still: all the
perfumes of Arabia will not sweeten this little
hand. Oh, oh, oh!

Doctor
What a sigh is there! The heart is sorely charged.

Gentlewoman
I would not have such a heart in my bosom for the
dignity of the whole body.

Doctor
Well, well, well,–

Gentlewoman
Pray God it be, sir.

Doctor
This disease is beyond my practise: yet I have known
those which have walked in their sleep who have died
holily in their beds.
AHH

Of course it’s true. The New Yorker fact-checks its articles extensively, far more than any other U. S. magazine. They would never run a story like this without verifying every detail. Never, never, never.
gnosis

If you are interested in reading the article in the print addition, I don’t advise it as bedtime reading. I read it two nights ago in bed and not only stayed up hyper-aware of every (perceived)itch, but last night as well!
Avram

Warning: Reading the article will make you itch.
The Joey B

Hey Dirk… I did read the article. Nowhere does it say that she scratched a bloody hole in her head over a period of years. It says that the internist noted her propensity for scratching a particular area. Over some unspecified period of time her scratching produced an area devoid of hair that would occasionally bleed. Some (again unspecified) time later she formed a scab. Then the kicker:

She had scratched through her skull during the nightâ€”and all the way into her brain.

Perhaps the problem isn’t with my reading, but rather with the ambiguous writing.

And frankly, if she was slowly but surely burrowing her way through her skull over a period of years while being treated by an internist, the internist needs to have a malpractice suit brought against her. That would be a serious wound. At some point during her treatment the extent of her scratching should have been noted and treated a little more aggressively, rather than let her continue her nocturnal labors until she reached the sweet, sweet reward of her cerebral cortex.

In short, I’m not saying it didn’t happen, I’m saying it didn’t happen quite the way it seems to be portrayed in the article.
nanoquimico

This would justify the implantation of a metal skull pate. As a bonus she could dress as Terminator in halloween.
help i cant comfirm my username themelonbread

HOLY *****!!!!!!!

You should’ve put some warning about the last sentence. We demand a unicorn.
Maurik

What’s the green fluid then? I’ve watched enough of House to know that CSF is clear…
pollyannacowgirl

Antinous, I want to hear MORE stories. *delicious shudder*

Yeah, I have a hard time believing fingernails could DO that. But I grant that it’s possible over time. Possible, not terribly likely.
xadrian

I heard this on All Things Considered yesterday and could not stop scratching.

I scratch my arms in my sleep and have woken with series marks, but nothing this bad…obviously.
Antinous

I’ve watched enough of House to know that CSF is clear…

Not if it’s infected with Pseudomonas aeruginosa. That would make it bright green and is a common infectious agent.
Tavie

@33 Agreed. Reading this almost made me throw up.

Also, I’m worried for a friend of mine that has bad eczyma. She’s constantly scratching. When we’d have slumber parties I’d be soothed to sleep by the gentle scritch, scritch, scritch of her soothing her scalp.

Now I’m afraid for her.

PING Linn. PING.
Dirk

A large, mostly fiction and anecdotal story magazine.
You obviously don’t read the magazine, do you?
Anonymous

I would just like to say that this is definitely feasible. I work in a hospital and while I was on a neurosurgery service, we actually had a guy that did this and didn’t even realize it-pretty much the same scenario.
Takuan

couldn’t they have a little hatch surgically installed?
bardfinn

The point of the article is that for many people, their itch / pain / zap is a product of their brain trying to make sense of conflicting, malformed, or absent neural signals.

We are what we think. With our thoughts, we make the world.
help i cant comfirm my username themelonbread

I just read through the whole thing, and it is really fascinating.
Moon

It’s not the NY TIMES, people. It’s the NEW YORKER!

A large, mostly fiction and anecdotal story magazine.
Tenn

Unicorn, unicorn, unicorn chaser. This is creepy, but I have little trouble believing it. My dog got a staph infection at one point, because he scratched so badly he took off the fur on his ears, a spot on his nose, on his chest, on his stomach, and behind his ears. He scratched through the fur- and then through the skin. Lots of pus, sometimes blood.

That was awful to medicate. They’re not sure whether he got the infection after, from getting dirt in the wounds, or before. Anti-biotics and a lot of medicated cream and one of those cones, and still, a dog itching everywhere he could. We thought he was going to die. Rocky was an unhappy camper.

He’s presently healthy as can be and getting chased all over the place by his new adoptive brother.

Also, I’m worried for a friend of mine that has bad eczyma. She’s constantly scratching. When we’d have slumber parties I’d be soothed to sleep by the gentle scritch, scritch, scritch of her soothing her scalp.

My two best friends also have eczema. They like to commiserate and show me their latest battle wounds. It’s gotten better the older they got, though. Medicated creams help, (though it seems like it’s almost impossible to find a cream that works for the individual!)
Evil Jim

Damn. I gotta stop reading comments on this article. I’m starting to itch.
Anonymous

The skull-scratching story is apparently true. It was previously covered in the 2007 article http://www.sciencemag.org/cgi/content/summary/318/5848/188?etoc=, which includes the woman’s name, picture and a CT scan of her damaged skull. It took her 13 months to work her way through.
anthropomorphictoast

UNICORN CHASER PROVIDED.

http://www.candiecoded.com/Cute/cute-unicorn.gif
Jake0748

Hey Jim, you’re not so evil after all.
Takuan

luxury!
http://i61.photobucket.com/albums/h53/mocost/Scultetus.jpg
Strange Quark Star

Nothing is worse than having an itch you can never scratch.
ROSSINDETROIT

This calls for Pictures of baby ducks in a bathtub
Takuan

zombie unicorn… BRains!
http://farm1.static.flickr.com/53/135243175_1b39bd96fd.jpg?v=0
jso

After reading that, did anyone else get a small itch on the scalp?
Profession

What was even worse was when she mentioned the man in the bed next to her who died when he scratched through his carotid artery.

V.S. Ramachandran has a talk on TED where he discusses “learned paralysis” in phantom limbs, which was mentioned in the article. Good stuff.

http://www.ted.com/index.php/talks/vilayanur_ramachandran_on_your_mind.html
Takuan

no, but I did get the munchies
Tenn

Yes, Antinous. More horror, plz.