We all learn about the importance of a good history and physical in medical school, but to really understand what makes a patient tick, you have to be curious about the patient’s life outside the office. Patient tattoos have always interested me, and this sometimes leads to unexpected discoveries. It’s hard to explain what makes one tattoo interesting, while another one is ho-hum. I’ve seen plenty of older men, (that is, anyone older than me) with naked women tattooed on their arms. Presumably these tattoos are souvenirs of their wild youth. I don’t ask about these, but I can’t help but wonder how they would reply should their grandchildren ask them about these racy images.
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Tattoos are a common sight these days and can be quite revealing about a person's life and outlook.
For a while, it was fashionable to have "love" inscribed on the knuckles of one hand and "hate" on the other hand. I’ve had a few patients with these tattoos, but the most memorable was a patient that everyone said looked like Charles Manson. He was probably harmless, but people didn’t spend any more time with him than they had to, and I doubt anyone asked him about his tattoos.
One of my less sinister looking patients has a Celtic cross of protection on his right upper arm. I asked him about it once, and he told me he used to be a cop. He felt more secure with this image permanently on his arm. I’ve seen a number of biblical verses too, some of them positioned in less than modest places on the physique. I wonder if it is still called a "tramp stamp" if it comes from the good book?
Some patients have fearsome looking tattoos, but they are very insecure people. Among my patients is one large muscular man with huge tigers on his arms who looks like the kind of fellow you would not want to meet in a dark alley. He recounted vividly the story of his first cardiac catheterization. He was on the table when he spied the cardiologist bringing over a tray of instruments. He sat bolt upright to flee, but someone held him down, and he got an extra shot of diazepam. The person holding him down must have been pretty big too.
Flowers and butterflies are generally passé, but foreign language tattoos are interesting. Oriental calligraphy can be lovely, but Hebrew can be tricky. I’ve seen a few tattoos that had problems because either the tattoo artist, or the tattoo recipient, or both, didn’t know that Hebrew goes from right to left, creating an unintentional tattoo dyslexia. It’s not written in stone, but correcting a typo written on flesh is almost as difficult.
Another one of my patients has a picture of a heart pierced by a dagger dripping blood. I made some benign comment about this frightful image. He told me that this was a Mafioso tattoo, and he assured me that it was "real." He seemed rather pleased explaining this to me, and I didn’t ask for any documentation of his right to sport this symbol.
He used to consider me a miracle worker because his arthritis improved so nicely with methotrexate and prednisone. He often embarrassed me by referring to me as "Dr. God." In general he was polite to the point of being deferential. We got along quite well, but there were some notable exceptions.
His wife, a middle-aged smoker, was also my patient. The Mafioso called the office one day and demanded that his wife be seen right away because she was short of breath. My schedule was full and the nurse offered her an appointment with a nurse practitioner. He became increasingly loud and nasty, yelling at the nurse. He was on the phone because his wife was too short of breath to speak in full sentences. The husband informed my nurse that he was bringing his wife to our office for immediate attention. He told the nurse he’d take his wife to the hospital ER across the street if she didn’t get immediate attention
As providence had arranged things, Dr. God had a convenient cancelation at the same time the don and his gasping wife arrived. After I took one look at his wife, I wished he had taken her to the ER. She was gray, dyspneic, weak, and quite drowsy. She had lost 25 pounds since I last saw her, and her husband informed me that she still smoked two packs a day. I was worried about congestive heart failure, pulmonary embolus, and stroke, but quickly decided this was most likely emphysema. I was concerned that she might have a respiratory arrest while I was going about the bureaucratic admission process.