A Hidden World Under the Skin

Florida, spring 1980

I was in for a surprise on that warm central Florida afternoon. I had just returned from a trip to Canada with numerous black fly bites on my face and neck: large, painful, bright red bumps impossible to camouflage. In this deplorable condition, I entered the examining room in my office.

A couple of patients in their sixties, small and plump, sat holding hands. She had her silvery hair in a long braid flowing down her shoulder and tied with a rubber band. So did he. They were dressed in long-sleeved plaid shirts and overalls. Wore baseball caps and leather boots.  In one word, they had the typical country-folk looks. I sensed in them a nervous anticipation.

The woman checked my face, turned to her companion, and said with a surprised look, “Honey, it seems like the doctor has them too.”

“That’s life, my dear,” he said. “If you live long enough, you’ll see they strike everyone. Them little stinkers.” They gazed at me with sympathy. I shook my head, trying to cover my forehead with hair.

“Black flies got me,” I said, and giving my voice a professional tone, I asked, “So, what brings you here, Mr. and Mrs. Smith? What skin problems?” I had both of their charts in hand.

“You’ve been highly recommended by our neighbors at the trailer park. You’re our last hope, Doctor.”

“But what is the problem?”

“Doctor,” answered the man, “we’ve been suffering with this awful curse for over twenty years.”

“Yeah? Tell me about it.”

“It’s a long story. One day I felt something crawling under my skin. In time, my wife began feeling the same. Well . . . Now, after all these years . . . decades, we still have them.” The patient looked at his wife, who nodded.

“We’ve been to every dermatologist in Maryland and to the university in Baltimore,” he continued. “Had scrapings, cultures, and biopsies. Used all kinds of salves. They’ve told us it’s all in our minds, but look at these bug bites, Doc.”

Mr. Smith unhooked the shoulder straps of his overalls. He unbuttoned and opened his shirt, rolled his sleeves all the way up, and extended his arms in front of him. His wife did the same. Two-inch, strikingly bright orange circles of painted iodine surrounded oozing crusts and sores on the couple’s pale skin, chests and arms. Numerous scars of older lesions were also present.

With my clinical experience of almost twenty years and based on the patients’ history, signs and symptoms, I determined my diagnosis. I’d seen quite a few cases of delusion of parasitosis, or Ekbom syndrome: the belief in non-existent infestation by insects (a deep psychosis practically impossible to cure). But never had I observed it in a husband and wife, or folie à deux (madness between two).

Nonchalantly, I asked, “Did you bring samples of the bugs?” I knew that surely they’d say yes.

“Here they are,” replied Mr. Smith triumphantly, handing me the characteristic zip-lock pouch with a neatly folded paper napkin inside. It revealed tiny pieces of lint, skin scabs, and other debris. I knew it would be useless to examine them under the microscope and say, what bugs, where are the bugs? There would be a hundred excuses.

“Have you ever been referred to any doctor other than a dermatologist?” I avoided saying ‘a psychiatrist,’ knowing I would alienate the patients.

Mr. Smith laughed wholeheartedly. His wife echoed him. “You mean a shrink? Yeah. Several times, against our will, of course. It was completely useless,” he said. “We know the bugs are eating us. Mercilessly. It’s worse at night. During the day they hide. So every morning we dig them up with tweezers or a dull knife and disinfect the skin afterwards with iodine.”

“But the creepy-crawlies manage to stay alive and vicious.” The patient raised his voice as he continued. “Our lives are miserable. I repeat, you’re our last hope.” His eyes moistened and his nose reddened.

I sat down and thought for a moment. No point in referring them to another therapist. I knew I couldn’t cure them, but felt compelled to at least treat the visibly self-induced, infected, bloody crusts on their skin. How could I disappoint them? I spent the next fifteen minutes chatting with them, and asked them to stop the iodine, that I had a better treatment.

“That’s what we was hoping for,” Mr. Smith said. They both drew long breaths of relief.

“I’ll definitely try to help you,” I said, “but you must follow exactly what I tell you.” The patients stared at me without blinking, devouring my every word. So much hope shone in their eyes! I understood how much they had suffered. I can’t make them any worse, I thought, and came up with a plan to dispatch them with prescriptions for an oral antihistamine and an antibiotic cream.

“Wash your sores gently with soap and water three times a day and apply this topical medicine. No digging! I’ll see you in two weeks,” I said, with encouraging farewell pats on their shoulders.

After two weeks, the couple returned, radiating happiness.

“We’re cured,” they hurried to say, their round faces flushed.

“We did everything you told us,” Mr. Smith added. “You’re a miracle worker.”

“I see your bugs are gone too,” Mrs. Smith said, checking out my face up close. “Here, we brought you fresh catfish. Yesterday’s catch for the good doctor.”

“Thank you kindly.” I accepted the package, wrapped in newspaper.

“We will recommend you to everyone at the park.” They both spoke at the same time. They showed me their chests and arms, dotted with bleakly pink areas of healing skin. Much improved. No signs of iodine.

“The bugs have finally left our skins! Never have we been so well before. Thank you, thank you.”

Against all logic and my experience as a dermatologist, naïve, I caved into the allure of victory. My chest rose with pride. Is it possible that my persuasion had cured the incurable? But how?

After I expressed my gladness, the patients got up and approached the door—gallantly, swaying playfully, smiling. With his hand on the door handle, Mr. Smith stopped abruptly and turned around.

“Yes?” I thought they wanted to thank me again, since they approached me as if in a rapture, while feverishly whispering something to each other.

“It’s really not worth mentioning, Doc, because they don’t bother us anymore. Honest,” Mr. Smith said. “But . . . now they have moved to our throats.” They opened their mouths wide, the blessed orange iodine circles glistening on the backs of their tongues.

“See?  That’s nothing comparing to what we had before.  No one can see them now. We don’t have to be ashamed anymore.”

“Oh, no,” I babbled, but Mr. Smith continued talking in a happy tone.

“We’re going up north, but when we return from Maryland in the fall, we’ll see you again. Just to say hello.”

“Wait a minute. Don’t go. I know the bugs don’t bother you much anymore,” I said, coming to my senses, “but please do not smear your tongues with iodine, or, over time, you will damage your thyroid glands. Too much iodine is toxic, even if it’s used without measuring to disinfect the water during camping trips.”

I had to think fast.

“I’ll give you a script for a special disinfectant solution that can be used safely in the mouth. I concocted it myself. It’s very powerful. It will kill the little critters for sure.”

What else could I do? Life presents us with impossible tasks. In time, we dare to enter the psyche of fellow humans, even if it has drifted from the norm, from all logic, and from reality. My compound prescription was just a palliative potion for diminishing the pain of canker sores, not an insecticide preparation like the one we use for scabies, or for lice.

“God be with you, my dear people. Stay healthy,” I said, as they were leaving arm in arm, content, trusting me—children in my eyes.


Eduvigia (Junia) Ancaya is a nonfiction writer who has taken creative writing courses at USF and numerous courses at OLLI. She has published two nonfiction books honoring her parents’ saga during WW II :  Struggle for Freedom: Marta’s Courage—A Memoir  and Stefan’s Journey on the Road of Sorrows.

A native of Poland, who escaped Communist tyranny in 1946, she immigrated to the U.S. in 1963. She is a retired physician.


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11 Replies to “A Hidden World Under the Skin”

  1. This story, rich with descriptions, is nicely written, moves at an enjoyable pace, drawing the reader into the drama of the consulting room. And the reader is left with the deliciously ambiguous question: who is the possessor of wisdom: the doctor or the patients?

  2. Ha—a funny/sweet tale, Junia in fine form. I’m with the couple. The less you know the better–gimme a placebo, and I’m outa here.

  3. So easy to empathize with the patients and with the patience of you as an empathetic doctor….I’d see you to cure me of my ills, whether real or imaginary. Wonderful writing.

  4. Thanks Bob and Sara. It’s so easy to drift from reality, seduced by human imagination! Thanks for sharing with me this enigmatic world…this nebulose…

  5. What a WONDERFUL story, Junia! WHen I used to teach a course in the Diagnostic and Statistical Manual of Mental Illnesses, I taught about this psychotic disorder, but I never saw it. You were a very wise dermatologist to recognize their shared psychosis and to give them a “medicine” to cure their disorder!!!!

  6. Thanks, Peter. I know you’ve had much experience, through Terry, with the body’s “command centers” and their malfunction. I find it the most fascinating aspect of medicine….

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