Patient TS

“This is what the patient wrote in his letter.”

It is the obvious metaphor, and therefore may be a little bit bland.  But sometimes, perhaps in most cases actually, unusualness and eccentricity should take a backseat to simplicity, especially if those characteristics are employed for the sole sake of being exciting and add nothing in the way of substance. I hope that a simple metaphor that stays true to the message will evoke at least some of the emotions that plague me every day and night.

It is as if a really mischievous mosquito flew up one of my nostrils and started an itch in my mind that could only be scratched indirectly in the most illogical of ways – a gruesome snap of the head or a loud grunt to clear a throat that is not blocked at all – those are just two examples.  This is what it feels like; these feelings are what really underlie everything:

It is an itch that not only causes a certain spot to itch, but also heats up all the body parts that are involved in the Scratching process. Keep in mind that I use the word “Scratch,” capitalized, to mean any action that I take to try to alleviate this itch.

At times, either because it is really gone, or because your attention is focused elsewhere, the heat and itch do not bother you at all.  But all of a sudden, often triggered by some kind of random thought, you feel the urge to redirect your attention to that itchy brain and burning back neck, or right shoulder, or right eyelid.

The urge to Scratch is not entirely autonomous, as you can suppress the most blatant actions when you think somebody might notice, but doing so often causes a deep discomfort in a region behind your sternum, somewhere between your lung and heart, and only adds to the discomfort caused by the pressure built up in the itchy body part.

Sometimes you can find a more discreet way to Scratch.  Your vigorous head-shake might devolve into the subtle tightening of some muscles on the right side of your neck, and for a moment the itch will be gone.  It is never as satisfying as the real thing, so once you think you are alone you have a cathartic release of heat and pressure with a rip-roaring whip of your head.

Sometimes, only when you are alone, you go on a long streak of head-shakes until you have performed just the amount that feels right; then you feel content.

This aspect of the itch, namely its desire to be Scratched in a manner that is just right, is an integral part of the issue.  At times the itch seems to be playing a never ending game with you: the more you think about it and try to perform the perfect Scratch, the more precise become the actions that the itch demands.  Your urge to Scratch increases, because you are stressed and frustrated, but sometimes you just repeat the same mistakes over and over again, leading to highly repetitive actions, as mentioned above.  At the same time a pitiful obsession over getting the Scratches quantitatively just right forces you to continue Scratching until each action’s deviation from the perfect Scratch is compensated for by an opposite deviation by the subsequent Scratch. It often takes more than one extra Scratch, and in such cases the brains behind the itch calculates the average of all the Scratches using some sort of internally logical arithmetic and compares it to perfection.  You don’t stop until the average gets reasonable close to the ideal Scratch. Once you feel relief, it is how you imagine a pressure cooker might feel after the plug is removed and internal and external pressures finally equilibrate.

N.B. You tend to care a lot about multiple parameters of the activity as well.  For instance, you might shake your head too hard, then shake again softer by the perfect amount to compensate, but if the second shake happened to overstretch a tendon on the right side of your cervical vertebrae and create an unacceptable lateral imbalance of tensions, you must continue shaking to fix that problem, which is independent of “strength of shake.” Ultimately you keep going until you neutralize all parameters that characterize the shake.

Add to all that the possible need to use more than one type of action in your Scratch, in a specific serial combination of shakes and sounds maybe, and I seem to be describing a life afflicted with such a heavy burden as to not be worth living.  But it is bearable because I have learned to control it in the presence of people and it does not bother me too much when I’m alone.  My most important adaptation is that I usually don´t pay much attention to the, largely unconsciously performed, Scratching ritual anyway.

“I have good news. Patient TS has responded beautifully to early rounds of treatment.” Everybody in the room nodded in approval.