Patient Itches a Hole into Her Head | Chicago Med | MD TV

Keegan and I have been neighbors for a few months. Since I moved back. I'm only here because Vicky talked me into it. At this point, I've given up on doctors. Whoa, whoa. No, no. No more scratch. I can't help it. It's been three years. Three years never stops. It started with the MRSA infection. Oh, the antibiotics to treat it. Linezolid. Side effect was pureitis. Bad itch, huh? The worst. Everywhere. And I mean everywhere. But the reaction went away when she stopped taking the pills. Except for right here. And it is killing me not to scratch it right now. Itch never lets up. In the shower. When you're sleeping. Never. I've used toothbrushes. Pencils. Even steel wool once. Nothing stops the itch. Easy. Keegan. I know it's hard. Just try not to scratch. All right. I'm going to clean it out. And apply some steroid cream. Should help calm it down. That won't do anything. I've tried creams. And antihistamines. Acupuncture. I've seen dozens of doctors. Dermatologists. Allergists. Nothing helps. I just can't stop. Don't. Doesn't that hurt? All I feel is the itch. It's all day. Every day. Please just find it and cut it out. Okay. Let's get a full set of labs. And go from there. Keegan. I'm Dr. Charles. How you doing? Of course. The shrink. Look. This isn't because of feelings. And it's not OCD. I don't have delusional parasitosis. Or a conversion disorder. The itching didn't start after my dad died. Or my boyfriend left me. Look. I'm not insane. My head just itches. And I want it to stop. Okay. Well, let's try to make that happen. Really? Usually, docs will write me a referral. So I'll leave. You came to us for help. So we're going to help you. Just for now, though. You think you'd keep your hand away from the wound? Can't help it. Okay. So Dr. Joy told me that you've tried OTCs, prescriptions, host of home remedies. How about bupivacaine? What's that? A local anesthetic. Five mil should do it. I'd like to apply a little bit to the area. If it provides relief, it would suggest that the problem might lie in your cutaneous nerve endings. And that would help suggest a treatment plan going forward. Then stop talking and get to it. You're going to feel a pinch. Do it. Ooh. Okay. Feels different. Different how? Better. I mean, it tingles a little, but it itches less. Hmm. That's a good start. Yeah. I'll check on you in a bit. So anesthetic should provide relief for, like, three or four hours. Itch doesn't come back. Set her up with some topical patches. Take home. Sounds good. Damn it! Call Dr. Charles. He can stop. Don't scratch. It's back and it's worse than before. You have to stop scratching. Then you have to tie me down. Five milligrams of diazepam. On it. I can't live like this anymore. I'd rather be dead. What happened? Oh, God. She scratched through to her skull. That's a new one. Usually I have to cut them open myself to get to the brain. So what do you think? Well, for whatever reason, the cutaneous nerves in that part of her scalp went haywire. It makes them always feel itchy, so she keeps scratching. Better fix? Yeah, surgery. Sever the nerve. No more feeling, no more itching. And no more scratching. Yeah, and possible serious irreversible side effects. Facial paralysis, blurred vision. Worst case, she ends up in a wheelchair. I'm not cutting her open in an alley, Daniel. The risk you're describing are dwarfed by the reward. Yeah, we hope. What do you suggest? Twice a week counseling sessions? Of course, we have to put a cone around her neck to keep from scratching. Sam, all those years of scratching, those nerves are shot. There's nothing left to go haywire. Dr. Charles, if that were the case, Keegan shouldn't feel anything, let alone an itch. If those nerves were active, that anesthetic would have provided relief for hours. It didn't. You only used five mil, it wasn't enough. I agree, the anesthetic didn't work for long, but it did work. Proves the nerves are involved. Great, we have a majority. Not that I care. We done? Sam, all I'm saying, I don't think operating's gonna do a damn thing. Thanks for your input, but the last time I checked, I was the neurosurgeon. Put her on the schedule. Isn't surgery supposed to be the last option? Dr. Charles, she scratched into her skull. It's all this. It's an experiment. For what? Well, you don't think that Keegan can experience her itch without cutaneous nerves, and I do. I think I can prove it. Have a seat. Okay. So, can you take your left arm and put it on the other side of the partition here? Thank you. So that's like a magic trick? Yeah, kinda. Okay, so, I'm gonna start to brush your real hand and the fake hand simultaneously, but I just want you to look at the fake hand, okay? Whatever you say. So, amputees sometimes still feel the missing limb, right? Yeah, a phantom limb. The nerves are transmitting confusing signals. Or do amputees still feel missing limbs because the brain is just assuming that it's still there? Because if that were the case, the nerves would be irrelevant, right? So you're suggesting Keegan's got a phantom itch? Her brain is telling her it's there even though it isn't? Yeah. Just like amputees perceive a limb that used to be there, Keegan still perceives an itch that she got three years ago from a drug reaction, when the brain's basically playing a trick on her. Interesting theory. Where are you going with all this? That's not your hand, right? But the more you stare at it while feeling me brush your real hand, the more your brain might start to blend them together. I guess I can buy that. Yeah. Very powerful, the connection between what we see and what we feel. But Dr. Charles, I still know which one's my arm. Do you? Ah! Ah, for a second there, I... You felt the hammer. Yeah, I did. Well, then we both know there aren't any nerve endings in this thing, right? Amazing the tricks the brain can play on us. Keegan! Keegan, wait! I've changed my mind. I don't think you should have surgery just yet. Oh, here we go. What crazy ideas did Dr. Charles talk you into? It may not be a nerve problem. It could be a perception problem. In fact, I'm not sure your itch is real. Not real? Are you too serious? Look at me. I have to be tied to the bed so I don't scratch a bigger hole in my head. If surgery will work, I have to do it. But what if it doesn't? What if you wake up and nothing's changed? It has to work. Because I can't live like this anymore. I want my life back. Surgery will give it to you. All right, let's go. Hey, Keegan, wait, wait. The brain can change in response to experience. It's called neuroplasticity. Three years ago, a drug reaction created a chronic itch that you can't seem to satisfy because it rewired your brain. No surgery is gonna fix that, trust me. Daniel. Please, please, Keegan, let me try something before you go under the knife. It's been three years. What can you do for me that no other doctor has tried? A trick. What do I do? I don't know how long I can go without scratching. Okay, I want you to look at your reflection and scratch the non-itchy side of your head. In the mirror, the image is gonna be reversed. It's gonna look like you're actually scratching the itchy side. Oh, I see it. But how is scratching this side of my head gonna make the itch go away on the other side? Keegan, trust me, we know that you've been feeling this thing, but I just want you to consider the possibility that maybe, just maybe, that this itch isn't real and no amount of scratching is gonna satisfy it. But then what the hell am I doing? Giving your brain new visual input to override the experience you had three years ago so it can begin to rewire itself. Okay, you're losing me. By feeling yourself scratch one side of your head while you're seeing yourself scratch the other, your brain will be tricked and realize something's not right. Now, hopefully, that experience will force you to perceive a new reality. A reality in which the itch doesn't exist. So you say, but nothing's changing. And I feel stupid. The exercise is designed to confuse your brain, so don't worry about that. Just keep scratching. Like this? Harder? Softer? Just like you're doing. Be patient. Give it a chance. Keegan, we'll be just outside. You're doing great. How long are we gonna let her keep scratching? She's been dealing with this for, what, three years? I mean, honestly, Ethan, I don't know how long it might take. If it takes. The phantom itch theory makes sense, but it's still just a theory. I certainly don't want to give her any false hope. Dr. Charles, something's definitely happening. The itch, it's less.