I know I shall miss the scratching. My middle right-hand finger, its nail clipped as close as a surgeon’s, furrowing the skin on my shoulder. The sound it made in the night, a crackling like tyres on gravel. Something silver in it. And in the morning the flakes of skin washed off in the bathwater, which turned greyish-green like the mineral baths I swam in as a child. Where, I wondered, did all the flakes of skin go, because there was little enough room under the nail?
It was on my shoulders, it began. In the little hotel in a city I was visiting for the first time. Outside my window a line of pink flowering cherries looked like dresses on a rail that a hand might whisk away at any moment. I drew the net curtains and looked at them, and at someone walking on the opposite pavement. Then I looked at my shoulders in the full-length mirror propped against the wall in the hallway. I sat on the toilet seat and noticed the purplish colour of my thighs. There were spots on my arms and a band on my stomach, but the latest and most aggressive, crust-topped, were on my shoulders. I ran a bath and put on trousers and a V-necked top with long sleeves. I went into breakfast and looked around, hopefully, for other authors.
I walked to an area behind the hotel where a market was held three days a week. The market was closed; only a liquor store was open. I felt immensely tired and feeble. Two women approached me, looking for a cooking school. Then I slunk back to my room and lay on the bed. I ate a chocolate bar and a packet of crisps; then, thinking it might be medicinal, I drank a miniature brandy.
Later in the afternoon I took a cab to the university and found the seminar room in which papers were presented. A line of students sat on plastic chairs, reading prose poems. The department had produced over four hundred prose poems that year. Some would be published as chap books. A poet I knew and loved came up behind me and hugged me. Soon we were sitting together on a sofa and my opinion of academics and prose poems softened. A group of us went to a bar and ate tapas and drank too much wine.
In the morning, the spots were still there and a few more had snaked down my arms. I got into a new morning routine: avert my eyes, wear cover-up clothes. All my energy was expended on appearing vivacious. My appearance was a prose poem; the real poem was deep inside.
When I arrived home, a ridge had formed on my arm. In the airport shuttle, pulling my sleeves down to cover half my palms, I made a tunnel and surreptitiously inserted my hand and scratched. Take Itchy and Scratchy to the doc I wrote in my workbook beside the computer.
My wardrobe became very curtailed. Long sleeves that came to the base of my thumbs – if they slid up I furtively pulled them down – a narrow V-neckline because now the spots had reached the top of my breasts. Trousers in a cotton blend. When unsightly swellings appeared on my feet, I re-arranged the straps of my sandals to bisect them the way a belt bisects a waist.
One day, something zipped into both breasts mere seconds apart. Whatever it was – obviously not Cortez – had discovered a new land, a better quality of flesh. I felt the rush, the stinging, almost the exultation. A few days later, as the invasion continued – I imagined the leader or the general had got the breast – I was informed I had scabies.
‘Most people have ten or fifteen’ – that’s eight or thirteen, excluding the pair settled in the breast apartments – ‘but you have thousands, hundreds of thousands,’ I was informed when the test results were in. A rare autoimmune disease was suspected until a second punch biopsy came back. I had been given the wrong medicine and the pin-like creatures, and their burrows and eggs, had proliferated. At night, I scratched and tossed, and tiny black corpses were deposited on the sheets.
Once when I was in London, staying with a friend whose flat overlooked the Middlesex Hospital, I visited the chapel that was at its heart. The Middlesex, which in former days had legless men in wheelchairs lined up on the pavement who called out endearments like ‘pet’ and ‘love’ as I passed, was being demolished. Soon, from my friend’s sitting room, I could see a great hole in the ground and the isolated chapel. Hordes of rats were rumoured to have fled. No one questioned me – the corridors were full of hurrying nurses and doctors in white coats carrying pieces of equipment. Against the wall lay long pieces of piping. The chapel itself was dark with Roll of Honour boards and memorial plaques. An image of Keats and the butcher he worked for came to me. Bowls of blood, covered with cloths, bandages with seeping blood, groans and shrieks. Small wonder he equated truth with beauty. By now I was thinking of the passages in my own body, coursing not just with blood and oxygen but – ‘It could even be millions,’ the doctor had said, taking care not to pick up a piece of paper I had left on his desk – of invaders. When I left, he might have used tongs to drop the paper in the wastepaper basket. Later when I went to a dermatologist, members of her team, at a discreet signal, donned surgical gloves.
I had a fantasy. There was a Queen of the Scabies, resident of one of the breasts. Into this chamber she was led by her retinue. Something like the scene in Brideshead Revisited where Lord Marchmain, returned to die, is set up in a vast downstairs reception room which servants transform into a bedchamber. A huge bed is carried in, screens, lamps, plants in tubs, bedside tables, chairs. Soon the room is dressed. Maids carry vast armloads of linen, pillows, eiderdowns, dressing gown and slippers. Lord Marchmain is not in residence for long, just time enough to drag out the sign of the cross with a near-useless arm.
I thought the other breast was occupied by a trusted factotum, someone bringing reports of the invasion and each day’s strategy. When the correct medicine was found, it was the task of this official to appear optimistic. With so many troops, burrowing and laying eggs, how could they fail? The annihilation of a few burrows just above the ankle or the shoulder blade signified very little. The Queen in her lush apartment, surrounded by an endless supply of rich food and space for new chambers, should she desire them, need not be disturbed. It puzzled me that never again, despite rapid changes in other parts of the body, did that zipping rush, almost accompanied by a hissing sound, recur. Still, I imagined some reports reached the Queen; some decisions were taken. She would be sealed off, barricaded from the poison which was paralysing the nervous systems of her followers and then, in a follow-up dose, destroying whatever eggs had hatched in the interim.
At night, when I was in bed, I held up one arm at a time and scratched. I had given up on self-control. I thought there was something in the blood that must die down first. The heat in the blood would abate and the imperative to scratch fade by degrees. Perhaps a lot of virtues are like this: we claim a false superiority when the method is really out of our hands. I held my arm out in the dark and ran my nails down its sides. I imagined skin flakes flying. Afterwards my arms felt hotter than ever and I could not sleep. But I couldn’t give up the scratching either. I saw it as a reward for all the concealment I practised: high necklines and long sleeves, the forced cheerfulness. At night I became a primitive, an animal in its lair, miserable and licking its wounds. If I slept it was towards morning, a heavy unsatisfying sleep that left me bleary-eyed and pessimistic.
I am not a believer in visualisation therapies; they require too much energy. Imagine on waking you were to visualise yourself as the leader of an army or the supervisor of a team of hackers. A gull breasting the air near a cliff face or a rally driver who starts with a handicap and then pulls ahead. Another burden when lethargy might be better. Sleep is a good curative if you can get it. Alcohol drunk the way our great grandparents used it: a medicinal reward at the end of a day: whisky or brandy with a finger of milk. Followed by the fall into sleep on a feather mattress, the head on a feather pillow. But I did try, remembering the Middlesex Hospital’s strange bullet-nosed chapel, to think of the body as having its tasks, its circuits. What today we would consider teams and team leaders. The team that deals with digestion and waste products, the circulation team, the respiratory team. Just as I had imagined the Queen of the Scabies housed in my breast, in the best tissue, I imagined the essential teams my body possessed going about their business. Coming on duty into what seemed like a ruin, conferring and then going about their routines. Stepping over pipes and tubing, flasks and Bunsen burners, to ensure their accustomed tasks were accomplished. I imagined, as dawn arrived, and the patient woke, that they crept back along the corridors again, satisfied that the bowel was still functioning, that the threat of diarrhoea was averted, that their section, at least, was under control.
Optimism and pessimism, I find, are the worst. I swing between them, announcing to myself the cure is in sight. Then the symptoms worsen, my temperature rises, I have frightful dreams. I open my eyes in the morning and a dark crab shape appears on the wall. Sometimes it has holes in the centre but there are always legs hanging down, legs like those of a rag doll. It appears and disappears, usually three times. Such patience is required, even when recovery has begun. Especially then, because I am expecting a miracle cure. I want an absurd care I can no longer claim, like someone wanting a shop to be open and fully-staffed after hours. Someone to switch on the lights and boot up the computer. We all want to be special. Hardest of all is to remain engaged, thoughtful, attentive in company. I long to drive home, listening to classical music on the car radio. I turn the air conditioning to high and cold air washes over me. It feels like ointment, one of those salves that is not really effective but the application soothes. Once I watched a TV documentary about a Cistercian monastery. A very old monk had ointment smoothed on his wasted arms and shoulders by a young novice. The motions of the young monk were unhurried. His hands travelled the length of the arm, paying attention to the underside. This is what I am doing: paying attention to the underside.
Each morning when I woke I looked for little black spots on the sheets. Tiny lines and pinprick spots: corpses and eggs laid at the ends of burrows. And in the night, after a bout of scratching, I pushed the hem of the sheet the very short distance it would go under my clipped nails. The house of skin, I said to myself, but I wasn’t thinking of anything profound, like a bildungsroman. I was thinking of skin flakes in the air when I shook out the sheets, cascades of flakes of skin falling on the carpet, the dressing table, on the covers of books. A mountain of flakes falling over a lifetime, flakes from millions of human beings inexorably burying civilisations in the manner of snow falling. I read that those who cannot stomach a religious funeral can choose a naturalist’s one in which the comfort is not of the afterlife but the eternity and endless circling of all that was attached to them in life. Its thesis: nothing is lost since there is nowhere for it to go. You might be breathing in the dust of a dictator or a mass murderer. The after-life seemed infinitely preferable. What use vacuuming the carpet, dusting the furniture?
My body seemed to have divided in two: on one side the depleted but still functioning teams of the Middlesex Hospital and on the other the invaders laying eggs and extending their burrows with the determination of Romans putting through a road. But I was learning things about illness too. My scratching was deplorable and yet the healing had its own overriding timetable. My skin might be crossed by burrows that ended in tiny cul-de-sacs, the way a flask in a laboratory has a rounded base. I could see the logic of the invaders: a chamber, a tunnel and a nursery. Wisely the chamber was at a considerable distance from the hatching room as if someone was keen to ensure a good night’s sleep.
Maybe the tunnel was stacked with waste products and supplies, like the alley behind a restaurant where bins overflowed and the kitchen hands came to smoke. Each morning I detected a little progress: a few of the nests and burrows were fainter. I tried to examine a particularly marked circle of blotches on the back of my calf but it was hard to turn my head. The air seemed to have a puff of dust hovering in it. I bathed and the water was faintly less grey and milky.
Being both patient and nurse to myself brought a curious division, something like a turning tide or the transition stage in birth. Or, more prosaically, the uncertain time when the day’s work at an office is finished and the person has not yet changed into the casual clothes and different demeanour of a homebody. That was a transition I always found to be accompanied by an irritability which seemed irrational. I was glad to be home and could feel myself relaxing long before I reached my front door, and yet, I felt edgy and confused at the same time. Nursing myself was even more curious. When I was a ‘patient’ I consoled myself and offered encouraging thoughts but when I changed into one of my other roles – nurse, housekeeper, maker of appointments, researcher – I had to become resolute, practical and, if someone called, almost lively. Then, when they had gone, I would lie on my bed and turn into a patient again. When I woke in the night I sometimes didn’t know which I was: a tired hostess who had loaded the dishwasher or a frail patient in a private room, waiting for the soft footfall of a nurse.
Of course in the end I recovered. But the recovery was as protracted as the illness. Even when the spots were fading and the Queen of the Scabies had left the building, my imagination could not quite relinquish the fear. Each morning I searched the sheets for pinprick black spots and tiny black threads. When there were hardly any to see I ran my fingers over the sheet’s surface feeling for something uneven. For months the burrows left long marks on my thighs; my palms and fingers felt hot and itched in the afternoons. For quite a while I thought the Scaby Queen might be hovering nearby, plotting a comeback. But the worst damage was mental. It cost little to realise I had limited virtues in illness – certainly I was no Job, observing a fresh crop of boils – I thought he might have had scabies as well, and desultorily scratched without bothering to add them to the list. It was the sway between optimism and pessimism that derailed me. The optimism of a good and hopeful visit to the doctor and the pessimism that came as I was walking to my car in the clinic’s parking lot.
One morning, the racing tracks on my thighs resembled a tree. A pale tree in winter. Did the scabies feel they were climbing, did teams of them make the branches which ended in something like a candelabra? It must have been a day on which I felt weak, on the verge of defeat. There were days when I seemed to sink into myself, like a person under siege. I did only the minimum number of things before going back to lie on my bed. I listened to music and dozed. Sometimes a book fell from my fingers and landed on the carpet. If the phone rang or someone called I gathered my last stores of energy to sound cheerful or look interested. I resented this, checking my face after a visitor had left. The energy drained from my face and I rested my hand against the wall to steady myself. Yet I know, were I to be returned to full-blown illness, the nights of scratching and sleeplessness, something inside me would break and I would whimper and beg to continue this slow recovery.
The great hole in the ground that was the Middlesex Hospital is now exclusive apartments and the chapel is preserved in the centre surrounded by grass and flowerbeds. An occasional passer-by, taking his sandwiches to eat on a green bench, is moved on by a janitor who explains that the residents do not want their view disturbed. Someone writes a letter to The Times but nothing happens. The amputees who used to sit in a line on the pavement, their stumps covered by red hospital blankets, puffing on their cigarettes and flirting with the nurses, are less than ghosts. Somehow they would not have expected this: limbs gone and then memories.
Long ago the Queen of the Scabies died and her servants, though some resisted, followed. Whatever repairs were needed to return the white cells to full fighting strength were done. Their uniforms were neat again, the floors polished; they walked in little bands through the corridors whose light bulbs had been replaced. There were new nursing stations and an urn for making tea.
Today I read something online that seemed like an answer. It was one of those question and answer interviews that are mainly potted autobiographies: my experience, my rash, my solution. I read only three of them but the last was by a nurse, chiding those who want to make every last symptom the manifestation of a disease: the last blemish, the last pimple. After the powerful treatments were over, she urged that the body be allowed to recover, to remove these last manifestations itself. Let it go about its own business, the nurse urged, citing twenty years’ experience in surgery and emergency rooms. We must learn to have faith in our own bodies. If the frailest times are over, it is natural that a little frailty should remain. I have noticed that having stitches removed is very different to having them inserted. What I resented most is that by opting for stoicism—of a low grade, not much higher than endurance, nowhere near the Spartan boy being bitten by the fox—I had excluded myself from any comfort. It seemed I still wanted a few words of praise so I could pretend it was nothing much. Compared to the mind, the body seems so much more admirable. The faithful servants of the House of Skin going about their daily chores, blackening fireplaces, filling coal scuttles, making smooth custards, roasting meat on a spit and at the end of a long shift, sitting down to a meal of leftovers, still with a tablecloth and cutlery properly aligned.
I have decided to measure my recovery in months. Not hours, days or weeks, though these shall play a part. A decent parcel of time that allows so many variations and changes of pace. And the mental characteristics that go with it: moods that are noble or petulant, often within the same hour, self-loathing and moments of hesitant self-praise. How hard it is to keep control of something we can hardly understand. Sometimes when I am bathing and preparing for the day I imagine there are people who dislike their bodies, not for the obvious reasons – the shape of a nose, one leg longer than the other, an undescended testicle, a drooping lopsided breast – but because they dislike its design and feel they would have done it differently. A quiet modest person approaching a maternity hospital in a lawn nightdress with lace at the neckline and cuffs. No intimation of the horrors to come. Or should I say mechanics, mechanisms, the way the child follows its own prerogatives. A petite Japanese woman was screaming the ward down when I was admitted for an induction. ‘She’s got no idea,’ I overheard a nurse say. ‘She’s only just started.’
If a beginning is slow and subtle, the ending may be the same. I draw the images together: Queen of the Scabies, re-christened Queen Mab, the cheerful amputees, the nights of no sleep, the mask I kept in place. The body has its servitors, just as we have our tasks. I look down at the arms I loved to scratch and notice the frail and flattened hairs are growing back.