Atul Gawande writes in this week's New Yorker about the science behind itching. Timely, for me, as my leg, encased in the cast for several weeks now, has started to itch with a vengeance. Any area of my leg that can be reached by a disassembled wire coat hanger has been explored, but there are areas that are not reachable in this tight cast.

Is it preferable to the pain I felt earlier? Perhaps, for relief can be had, however briefly, by scratching. But I'm reminded of this Montaigne quote from the article:

Scratching is one of the sweetest gratifications of nature, and as ready at hand as any, But repentance follows too annoyingly close at its heels.

Many a moment at work or at home, I attempt random mental exercises designed to distract myself from the itching, but meditation backfires. It clears the mind and leaves nothing but an blinding spotlight on the itching.

Two Thursdays ago, I visited the doctor to have my cast reset again. This time, Carl, the male nurse who specialized in the business of adjusting and replacing the casts of patients at this orthopedic office at UCLA, was going to try to bring my foot up to a neutral 90 degree angle with my leg. My foot was about 20 degrees off. If he could get me to 90 degrees, I'd wear this cast for an entire month before my shift to a soft boot. If he couldn't get me to 90 degrees, I'd have to visit again in two weeks for another recasting.

The previous recasting was excruciating. This time my foot was so close to neutral already that I hoped for an easier go of it. To keep myself in a positive frame of mind, I tried engaging Carl in cheerful small talk as he sawed off my cast. I asked him about the history of Achilles tendon repairs, trying to give him opportunities to share his expertise.

Dear reader, you will either be filled with a joyous schadenfreude or consumed with empathic terror when I tell you that it was to no avail. When Carl placed a board on my foot and then leaned against it with all of his 300 pound weight to pry my foot up, I experienced what I am near certain was the most violent, unbearable pain of my life. I screamed and nearly flew off of the table on which I lay on my belly. It felt as if my Achilles tendon tore again.

For those who don't know what that feels like, the closest analogy I can summon is that if you were trying to do the splits but could not because you were not flexible enough, and Shaquille O'Neal came along and jumped onto your shoulders and caused you to drop into the full split position with a sudden tearing of your groin and leg muscles, that comes close to simulating the pain I felt as Carl threw his weight into that board again and again.

Carl, who had seemed mildly pleasant during small talk, reverted to the unsympathetic brute I'd come to know my previous visit. As I grunted in pain, he grunted in mockery and chided me, "Stop squirming away."

So once again, I had to call on friends to drive me home as the pain was unbearable. This time around, Carl warned me that with these last twenty degrees, I'd experience not only several days of pain but occasional muscle spasms.

"If I were you," he cautioned, "I'd take my pain meds regularly, and I don't recommend missing a cycle."

Before heading home, and even once there, I popped Vicodin like they were breath mints. This cured none of the pain but left me with an overpowering nausea that caused me to throw up in the afternoon.

A day later, I was on a plane to Chicago for a wedding. Thankfully, the leg spasms left me after one night. However, I do not recommend flying coach when recovering from an Achilles rupture. Actually, I don't recommend flying coach in general, it is one level above traveling as cargo, and I mean that literally, as your luggage is beneath you in the plane's belly. It may be that there is more leg room in the cargo hold, and more than once I thought of asking if that was a possibility.

As for right at this moment, why am I up at 2 in the morning the night before the work week begins? Because of an itch I can't reach in my cast. I was going to note that this should be an add-on circle to Hell, but it turns out it's already earned a spot there.

Itching is a most peculiar and diabolical sensation. The definition offered by the German physician Samuel Hafenreffer in 1660 has yet to be improved upon: An unpleasant sensation that provokes the desire to scratch. Itch has been ranked, by scientific and artistic observers alike, among the most distressing physical sensations one can experience. In Dante’s Inferno, falsifiers were punished by “the burning rage / of fierce itching that nothing could relieve