Thuy-An Tran
Skinned
1. Skin [skin] noun
a person’s complexion
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My sister’s hands are much more beautiful than mine. I imagine that in the womb, she grasped all the nutrients for hands and left none behind for her future siblings. Her hands are soft and smooth as cotton, unblemished and perfect, with no wrinkles or scars. I often hold her hands to feel the softness of her skin against the roughness of mine.
Fifteen years ago, in each room in my house, a sign hung on the wall bearing the words, “NO SCRATCHING.” The signs were my mom’s 53rd best idea on how to get rid of eczema. The bilingual signs were written in bold red letters for me to read in English and in cursive blue Vietnamese so any extended relative could get in on the scratch-free zone. A few months later, these signs became personalized, as if I would forget that I was the only itchy person in the house.
I stuffed my hands under my pillow at night, trying to hide them from my mother. They always looked worse than they did the night before when my mom meticulously slathered medicine on each cut. As my mom tucked me into bed, I kept my hands and arms outside of the blankets in order to make sure the lotion didn’t rub off. I bent my elbows, suspending my hands in the air, ready to catch anything my dreams threw at me. Nothing would touch my hands at night.
“She sleeps like a zombie,” my mother says to her friend as they gossip over jackfruit chips. “Her arms look like they’re ready to pop her out of her coffin.”
I listen to the pair of them giggle from the bathroom. My hands are soaking in lukewarm water. I have been here for only three minutes, but it feels like I’ve been standing here for an eternity. I’m not really sure how I got here – the doctor mentioned something about ten-minute water soaks, but my mom misheard that as twenty. Maybe she thought doubling the dose would be more effective, the same way she piles on an extra layer of lotion each night. By now I know how my skin will react to the water bath – after five minutes, grey flakes of skin becomes soft and white. After ten, the tough, worn skin on my fingers turns completely white and raw. Right before the twenty minutes are up, my hands begin getting itchy again – the water soaks, like every other remedy the doctors throw at me, never work. When the timer goes off, I sneak in a few good scratches before my mom appears at the door with a towel to dry off my hands. She thinks the skin flakes in the basin are flakes that came off through the soak, that they mean success in washing out the eczema; she doesn’t realize that I just furiously scratched them off not two seconds ago.
At home, my grandparents blend avocados into my milk and force me to eat butter, because my uncle said it would help my skin. On my grandmother’s right hand, her middle finger can’t extend – when I ask why, she tells me that as a child, she scratched her finger so much that it became permanently fixed in that position. I am terrified.
“Can’t you fix it?” I ask.
“No,” she says. “I am too old, but you are still young.”
I hide my hands behind my back to scratch an itch on my hand, but my grandfather sees.
“If you keep scratching like that and never put on lotion, your hands will become permanently stuck like your grandmother’s.” He folds his hands into fists.
I am used to my grandparents’ scare tactics; on a daily basis, they threaten to leave and go back to Vietnam each time I refused to eat my vegetables. But this time, I am petrified because they have proof. My grandmother’s finger has been stuck for as long as I remember. I resolve to stop scratching, but by nighttime, I can’t take it anymore.
My hands spend most of their days with little exposure to air – lotion, water, lotion, and more lotion. I don’t like touching things because I leave little smudges everywhere and those smudges mean lost lotion, lost effectiveness in healing my cuts. If I am honest with myself, I hate lotion because it gives my skin less friction, friction that is necessary for basic things like grasping a doorknob, swinging on the monkey bars, and scratching an itch. I end up using any other rough surface to satisfy the itch – the rough patch on my jeans, the scratchy wool on my grandfather’s coat, a spikey hairbrush, the carpet. Sometimes, I hide from my mother in the closet and rub my hands against wool; sometimes I don’t hide at all and pretend to be drawing invisible people in the carpet when I am actually scratching furiously.
But at night, I can only hide my hands under my pillow and my mom finds them there anyway. Usually by nighttime, I can’t stand the itching anymore, and do nothing but scratch and scratch. If any healing occurs during the day, the new cuts hide it, despite all the efforts against it. My mom purses her lips as she inspects my fingers. As I watch her turn my hands around to trace my palm for broken skin, I see her eyebrows cross as she counts the number of new cuts that had formed that day. But every night, when she looks up at me, she smiles and says, “That’s my girl. Your hands are becoming more beautiful by the day.”
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2. Thick-skinned. Adj.
Insensitive to criticism or rebuffs; not easily upset or offended
The monkey bars give me ugly blisters and calluses, but they are nothing to the eczema. My friends think I have a contagious disease. I don’t correct them, because I don’t know what “contagious” means. Ring around the rosie, we all fall down, but I remain standing because no one wants to hold my hand. As the girls in my class skip to lunch hand in hand, my best friend lets go of mine because she’s disgusted and afraid. “Your hands look like glue,” she says. “They’re ugly.” I run around the playground with my hands balled into fists so I can hide most of the eczema. My friends never want me to be “it” because they’re afraid of my hands, so I convince them that tag is a stupid game. I take us to the playground to swing on the monkey bars, where the blisters are a welcome change from the itch.
I spend most of my days staring at my hands. When eczema takes hold, my skin becomes white, scaly, and peeling, offering hours of distraction. When my dermatologist promised that my eczema would be gone by adulthood, I remember wondering how on earth I would deal with a boring situation if I could not sit and quietly peel the skin from my fingers.
I am the most intimate with the outermost layer of skin on my hands. The epidermis, or “outer skin,” is the layer of skin that falls off when I scratch and the layer that I peel when I’m bored. Our epidermis sheds millions of dead skin cells per day, leaving invisible trails of us behind. The epidermis is also where itchy nerve fibers end, firing up when they detect something they don’t like, creating an itch sensation and its complement – an irresistible urge to scratch. My epidermis is particularly touchy – it doesn’t like many things, like polluted air, dust, or soap, and swells when it doesn’t get what it wants.
On the worst days, my hands are red, swollen, and ugly. They are rough to the touch, and make a sound like grinding concrete when I rub my hands together. The joints of my fingers swell with tiny blisters that itch intensely until they have been broken by my scratching. Flakes of skin fall into the air like dust when I scratch, leaving raw, broken skin behind. Some days, I cannot properly hold a pencil because it rests on my fourth finger, where a cut opens again and again. On my left hand, cuts form where my fingers bend, and playing the violin constantly reopens these cuts, so that they never heal and practicing is painful.
But even on the worst days, I find endless fascination in my hands’ ordeals. Like an inconsolable child, my skin throws endless tantrums at the slightest touch, but it is nothing my mothering cannot fix. I nurse the cuts with steroid creams and lotions, and obsessively watch over them as they heal, like a worried mother. After scratching off my itchy skin, I revel in my body’s ability to heal almost all on its own, and finally peel away the loose skin to reveal new, unblemished skin underneath. Some days, I need Band-Aids, but I hate Band-Aids because then I can’t watch my skin knit itself back together.
When most people see my hands, they give me a familiar look of disgust, pity, and veiled curiosity. At school, my popular friends don’t want me to touch them or their belongings, so I content myself by chasing after boys with my zombie hands, swinging on the monkey bars, and playing jump-rope with the other oddballs. Yes, my hands are quite ugly and I would be scared to touch them too. But did you know that an eczema cut of half a millimeter in width only takes two hours to close back over if steroid cream is applied on time?
But the steroids that give me instant relief from the itching also come with the scary side effects of thinner skin and brown spots. My hands spend almost all my waking hours covered in steroids. After many years of treatment, my skin has thinned. I didn’t notice the changes in my skin at first, but then the healing process that I trusted and treasured failed to work as quickly and my cuts broke open again and again. My doctors’ promises that my eczema would go away never came true. I took such pride in my skin’s ability to heal itself that I always assumed it would eventually cure my eczema on its own. Now, I realize that my skin was never equipped to cure eczema, only to heal over unquestioningly, again and again, any injury it suffers. To this day, my hands have never failed to heal from a bout of eczema, never failed to fight the cause of itchiness and the scratching. The skin on my hands may be thin, but I am thick-skinned enough not to care.
My hands are my soldiers, fighting raucous wars against eczema every day. They bounce back despite having seen the worst. My hands are not beautiful, but to me, they are perfect.
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3. Skin [skin] noun
the tissue forming the outer covering of the vertebrate body; it is mainly protective and sensory in function.
Our skin is designed to protect our bodies from outside enemies. Our skin can sweat to cool us down and can stretch to allow us to grow. It can heal quickly and continuously without question. It gives us the sensation of pain, of hot and cold, and of precise, minute touch. Our skin is our first barrier to the world without which we cannot survive.
But sometimes, the skin tries too hard to protect us from nothing.
My dad’s favorite pastime is swimming, a trait he passed onto me. Everyday, my dad and I swam laps in the local pool, ending with a two-lap race that I always won. But my dad truly came alive in the ocean, where the salt water and fierce waves were thrilling and refreshing and where my dad was not confined by the boundaries of a pool. At the beaches in Hawaii, California, or Vietnam, he swam far out into the vast expanse of the ocean, ignoring warnings of riptides and sharks, to be where he felt most at home.
When I was twelve years old, my dad suddenly and mysteriously developed a skin condition more serious than mine. Deep, red sores appeared on his legs that soon developed into a full-body rash. Unlike my eczema breakouts, which came and went every few days, my dad’s skin condition was continuous and unyielding. The constant, stubborn itchiness kept my dad from completing mundane everyday tasks, gave him insomnia at night, and stopped him from being able to swim each day.
The simplest explanation for itchiness is that nerve fibers designed specifically for itchiness fire up when they detect something that shouldn’t be on the skin, like insects or poisonous material. Yet beyond this explanation, scientists have little idea as to why people itch, especially in extreme skin conditions like eczema and psoriasis. Histamine, a key protein that causes itchiness, is a player in the immune responses to cuts and abrasions on the skin, yet the itchiness it causes during the healing process would reopen the cut if scratched. Itching is not so much the problem as the scratching that opens up the skin and exposes it to toxins. I have never understood why humans are engineered to instinctively scratch an itch if it is ultimately detrimental to our wellbeing. My dad and I could no more avoid scratching an itch than a dog could avoid eating a platter of cake set in front of him. And yet, scratching only made us itchier.
For me, I knew exactly what triggered my eczema and caused me to scratch, so I could avoid the triggers, at the very least. My hands hate heat, moisture, and pollen, and my eczema fires up when I am stressed. But for my dad, these triggers were impossible to untangle because they kept changing. A meat and fish-free diet would bring relief for a few days, only to come back a few days later. The only clear trigger was swimming, although whether the chlorine, the sun, or the physical exertion intensified the itching, we could not know. Because he could no longer swim everyday and was constantly itchy, my dad’s normally even temper became erratic and difficult. His nightly cocktail of sleeping pills went from four pills to eight to a precarious sixteen when the itchiness made sleep impossible. While driving, eating, or working, my dad’s hands would scratch frustratingly at his rashes while disregarding the tasks at hand. The itching and scratching began to take over my dad’s life.
My dad was determined to knock his skin condition out of commission for good. Throughout ten years of multiple dermatologists, countless remedies, and a long emotional roller coaster, he never stopped looking for a cure. He took to the Internet overseas lotions enriched with vitamin E and K and void of FDA approval, medicines laced with fish oil and flax seeds, and pungent herbal teas with a pervasive smell that made him gag. For me, my eczema was manageable without changing my lifestyle, so I resisted excessive suggestions from family members and strange doctors to do half-hour full-body water soaks, drink disgusting herbal cocktails, and change my diet. But my dad’s constant itchiness cut into his lifestyle so much that he had no choice but to continue looking for the next big medicine that could cure him.
After ten frustrating years with no lasting cures, my dad was finally diagnosed with an autoimmune disorder and given immunosuppressants to treat the itchiness. Finally, the medication began to work and slowly, my dad was cured. The dermatologist concluded, after many misdiagnoses of psoriasis, eczema, and, at one point, lymphoma, that my dad’s immune system was simply too robust and enjoyed attacking itself with itchiness, causing the full-body rash. The cure came as simply and swiftly as if the answer as just hiding around the corner. The problem was not in my dad’s skin but in his immune system, a system designed to protect the body from harm.
Doctors believe that the rates of skin conditions like eczema and psoriasis are increasing because infants are born into a cleaner world. They no longer have the same exposure to allergens as they used to, creating an immune system that is constantly fighting toxins it was never trained to fight. If our skin and immune system are designed to protect us, if itching is a natural response to our body’s natural security system, then why did my dad’s turn on him so suddenly and cause so much anguish? In these cases, the skin seems to do more harm than it protects us from. As I watch my dad absentmindedly rub his hands over his scarred skin as he steps into the ocean for the first time in years, I wonder if our skin’s mechanism of itching is outdated and imagine what life would be like if we could strip ourselves of itching for good
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4. Skin. [skin] noun
the outer covering of a pearl
On the first day of gross anatomy class, the cadaver lay on a table in the middle of eight eager students in bright blue scrubs. I was excited about dissecting a cadaver to see the muscles and organs and to learn the map of the human body. But when we got into the anatomy lab, I was not prepared for what I would see. The cadaver had a small frame, wearing a meshed mask to cover her face. Her skin folded into an unnatural heap where the embalming fluid had settled unevenly, leaving dips and curves that seemed unfamiliar from the dips and curves of a living, breathing human body. Her hands were tinged purple and green and seemed ready to grab at me.
I was wary of cutting the cadaver for many reasons, one being that embalming fluid would spill over my gloved hands and handicap me from scratching my face, a necessity in the wintertime dryness. But I could not separate the cadaver from the human who had lived within it. With her skin resting softly on her frame, I couldn’t help but think about who this woman had been in her life and what her thought processes had been the moment before she died or the moment she decided to donate her body to science. Based on her age at death and her size, I imagined that she must have been a feisty, strong-willed woman in life. As I stared at her body, I noticed one of my group members absentmindedly stroking her hand as he listened to the professor explain our goals for the day. Her pale, cold hands seemed both full of life and void of it.
The day’s task was to get to the heart. We were to remove the skin off of the cadaver’s chest, cut through the superficial chest muscles, then use a saw to cut through the ribcage, where the heart would be cushioned between the lungs. One of my brave group mates volunteered to make the first cut. I imagined that the skin would easily slip off of the cadaver, that the boundary between skin and muscle would be clear. My partner carefully used a scalpel to make an incision. He gently pulled the skin back, but the skin stubbornly stuck to the muscle underneath. After a few more gentle tugs, he gave up on being gentle and pulled the skin back with more force, but it still did not budge. Frustrated, he held the scalpel up. “Anyone want to take a stab at it?”
I grabbed the scalpel and bent over the cadaver, holding the skin and pushing it back. The skin felt moist and tough like wet leather and slipped through my fingers as I held it back. The skin was about a centimeter thick and I could see the fatty adhesions sticking to pink, striated muscle. I pulled back the skin and cut away at the adhesions. Surprisingly, the skin easily gave away, inch by inch, as I kept cutting. As more of the skin came off the body, it began slipping through my fingers. My professor peered over my shoulder and saw me struggling. He took the scalpel and created a small nick in the middle of the loose skin, creating a buttonhole through which he hooked a finger. This trick allowed me to stretch back the skin more easily to cut it away from the body. “That’s it,” he said. “A finger-hold for you.”
We soon realized that the skin was the most boring part. We cut through the skin without a second thought to expose the structures we were there to see, like muscles and the heart. Because the skin was attached so firmly to its scaffold, it was nothing but an annoying barricade blocking our way to the main show. We slowly peeled it back, cut it loose from bones and muscle, and unceremoniously threw patches of it into the biohazard bag. Without the skin, the cadaver no longer resembled a human being. It became an object to study and scrutinize, to excavate and examine, to record and memorize every minute detail like an explorer mapping out the world. Without the skin, the hidden intricacies and inner workings of the human body were revealed.
For me, skinning was the most exciting part of the class. There was something satisfying in removing large slabs of skin at a time. I was reminded of the idea I once had that I could one day remove myself from my skin and be eczema free. It was a simple and easy idea – unzip my eczema-ridden skin and exchange it for a new set that would be flawless and never itchy. I would never have red spots on my face and the skin on my hands would never crack and bleed. When I was younger, I wished I could unzip myself from my eczema-ridden itchy skin so I could show the world that I was not just a girl with eczema. Eczema was simply a façade, masking who I really was and stopping me from fully expressing myself. I believed my true self would show when my eczema was finally gone and I had new, perfect skin. But after years without a cure, eczema is as much a part of me as my skin, muscles, and bones are.
As I cut away at the skin on my cadaver’s chest, I realized that while removing the skin was difficult in life, it was surprisingly easy to do in death. I thought about the overused and frustratingly trite phrase, “Beauty is only skin deep,” as if removing the skin would reveal a better, more beautiful person. As my groupmates dug deeper into the cadaver’s chest and cut the heart free from the body, I realized that the skin was hiding nothing more than the organs that give us life. But it was doing more than just hiding our organs. As my partner passed me the heart, I held it aloft like a trophy. I imagined the heart beating restlessly throughout our lives. The heart was truly an amazing organ, encased and protected in our ribcage, giving life with each beat. But without our skin to protect the heart, it would not be able to survive. Our skin battles everyday poisons and toxins, protecting our bodies from the slightest harm, working relentlessly to keep us free from danger. With each cut it heals, with each sensation it allows us to feel, our skin gives us life.