by Juliet Rose

At the walk-in health clinic, the nurse practitioner asks, “What brings you here today?”

 

I offer her my skin. The small bumps that dot my hands, arms and feet have begun to form into scaly patches of red the size of small quarters. They are oozing something colorless like rain. Despite this wetness, my skin remains dry and burning, flaking off in layers like forgotten glue.  The stiffness sticks. I try to scratch around the welts but I keep bleeding.

 

Hives usually begin with red, itchy patches of skin and develop into a raised welt with clearly defined borders. It is caused by an abnormal immune response.

 

 “Hives,” the nurse says. “The body responds to an allergen and releases histamine to fight it off. The histamine dilates the blood vessels and they release fluid. This is known as weeping. When did this begin?”

 

“Three days ago,” I tell her. “I noticed a few on my hands at first. When I woke up this morning, there were more, and now they are spreading and scabbing.”

 

As I say this to her, I am scratching at my forearm. The band-aids I have covered them with to prevent itching loosen their sticky grip.

 

“You have to try not to scratch them, they will spread. Have you had bandages on them for a while? You need to leave them uncovered.” 

 

She asks if I have any allergies, have I taken any new medicines, have I recently changed my soaps or shampoos, have I used a new detergent on my clothes, have I recently eaten any new foods.

           

While this typically occurs as a result of an allergy to food or medicine, there are non-allergic causes.

 

I tell her that I don’t have any allergies, and I haven’t used any new soaps or detergents. This is only half-true. I am allergic to strawberries, but I do not tell her this. I am scared that it will only complicate a truthful diagnosis. I want to know where the hives came from. Besides, I haven’t eaten anything in over a week.

 

She seems confused at the unknown cause of my skin’s swelling. She returns to her clipboard, flipping up papers as if she missed something important in my file.

 

“Alright, I’m going to prescribe you some steroids to help with the hives for now. I want you to keep note of what you eat and what soaps you use over the few days. We’ll schedule another appointment and I will see you in a week. If it gets worse, or you have difficulty breathing at all, go to the emergency room right away.”

 

She writes me a prescription for a steroid cream and prednisone, offers me instructions to fix my skin. “Take five for two days then four for two days then three then two then one. If you mess this up, the problem will flare up and only get worse. Remember not to scratch, they will only spread.”

 

Most individual hives fade quickly, but new crops may appear every 24 to 72 hours if the person continues to be exposed to the environment or substance that triggered the hives. Patients should avoid known triggers, if possible.

 

I make a note of this countdown on my phone so I don’t forget the math required to stop my skin’s leaking. As I walk out to my car, I spit into my fingers and press myself back into my skin. Just some moisture, I think. For now.

 

*

 

I do as I am told, but I don’t see results from the steroids. For a while the swelling seems to go down, but then the hives reappear in new places. They continue to leak something clear and strange. A wet film sits atop my skin like glass, glistening.

 

Tips to reduce the irritation caused by hives include: wearing loose-fitting clothing, avoiding hot water, avoiding scratching, using mild soaps, using a cool compress on the affected area, avoiding known triggers.

 

My feet have taken the brunt of the welts; dried blood hardens a red halo around each one. I walk around my apartment barefoot and careful. The hives need room to breathe. They need room to continue their crying, to release what they must release.

 

*

 

One morning I wake and cannot open my eyes. They are heavy and hardened like dried clay. In the mirror I study the splotches that seem to have gathered over night. The hives have swollen each eye two sizes bigger than normal. My eyelids replaced with a raised bulging, a shade of pink that screams. It spreads underneath, the hollow semicircle of socket where tiredness sinks the skin is now raised and stiff to the touch. I place a finger on my tear duct and push down; it stings.

 

My roommate is worried when she sees me. She assumes, rightfully, that I have been up for the whole night crying. She crawls into bed with me and sighs. We lay in silence, me unable to cry, and her unable to help. She has tried to help before but does not know what to say. I feel bad for this. She had been nagging me about my medicine, making sure I took it. Now that it is finished, we don’t know what else to do. She is mad at me for not eating, but she has stopped nagging me about trivial things as food. Besides, there are bigger things to worry about. The reaction gets angrier each day.

 

She researches hives online, reads me different possible causes.

 

Examples of known triggers include: medications;  foods; bacterial infections; intestinal parasites; extreme temperatures or changes in temperature; pet dander; dust mites; cockroaches and cockroach waste; latex; pollen; some plants, including nettles, poison ivy, and poison oak; insect bites and stings; some chemicals; chronic illness, such as thyroid disease or lupus; sunlight exposure; water on the skin; scratching; exercise.

 

 

It is unclear what my skin is trying to fight off. The cycle is deadly: the patches burn until I scratch them, then they bleed and dry into harder patches that hurt more when I try to scratch.

 

I resort to hot showers, a heat I control. As the water needles into my skin, I imagine it blistering. When I step out of the shower, my feet are the color of strawberries. The redness grips me long after I am done showering. A shade of red I can trace, a sunburn. But always the dryness comes back, angry. I think maybe I am allergic to water.  My skin refuses to drink.

 

In over half of all cases of hives, people never find the exact cause.

 

*

 

When I am actually able to sleep, I dream of my father, sitting at the kitchen table, reaching a hand up to the side of his face. My mother told me about the strange faraway look in his eyes and how his mouth hung, as if it would slip off. I was not there when it happened but my brain imagines this scene over and over again. I dream of his nose and eyes falling off; his skin as I remember it red and peeling. When I wake in the middle of the night I am bleeding on my arm and have been scratching in my sleep. My sheets are streaked copper brown.

 

We later learned it was blood in his brain, something ruptured. On the scans a growth had spread like a long-legged spider; the source of the bleed buried deep. There is not much room for an inflamed brain to swell. It just pushes against the skull until it can’t anymore. He died the next morning.

 

*

 

It has been two weeks, and the hives have not gone away. I feel heavy and drained, a wrung-out sponge.

 

My roommate sends me a screenshot of an article offering another cause of hives, anxiety:

 

When the sympathetic nervous system is revved up, it causes histamine release which results in hives. Cells release histamine in response to injury, and in response to allergic and inflammatory reactions.

 

I decide to call my mother on Facetime. When she sees me, starts to cry. Why didn’t you tell me sooner? Her voice peeling away like a blister on the skin, urgent and hurting. She tells me to take some Benadryl. Why haven’t you already? She reminds me of my strawberry allergy. She is insistent of my avoidance of all fruit, even apples; that I should be taking Benadryl three times a day.  Our connection is interrupted. I watch her face shatter into fragments until the screen turns black.  Later, she texts me: It has been hard for me too. 

 

*

I return to the doctor, this time a psychologist. I fill out a questionnaire of my history of mental health, medications, sleep patterns, substance use, and recent events in my life. She reads this over as she looks at me. She does not ask me what brings me in. Instead, she asks “How are you holding up?”

 

For the first time in a few weeks, I cry.

 

I am tired of not knowing, I tell her. I just want them to go away.

 

She tells me that hives can sometimes be a physical manifestation of anxiety, the body’s way of communicating stress. In this case, the allergen, the suspect I was searching for, is grief.

                                                           

*

The old English word for grief, “heartsarnes,” literally translates to soreness of the heart. The very definition of a severe emotional state including a physical marker of pain. Soreness. I can’t stop thinking about this as I hold a hard bag of ice to my eyelids.

 

 

Italicized lines taken from article “What Are Hives-Urticaria” https://www.medicalnewstoday.com/articles/157260

 

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