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F%@* cancer

Tattoos and personal connection

June 2017

THE WORDS grab your attention. They certainly caught mine the night I admitted JT* to our hospital medicine service.

JT was a stoic, cachectic man in his mid-50s with advanced esophageal cancer. As I placed my stethoscope on his thin chest wall, I noticed the two words tattooed in inch-high block letters along his left inner forearm. In a nod to propriety, a skull occupied the place of the letter “U.”

JT’s wife had called 911, and he was brought to our ER. For days, he had refused to see his primary care doctor in spite of worsening throat pain and confusion. Although his wife had alerted EMS to come to their home and bring JT in, he was alone in the emergency room.

My training taught me that patients don’t want to know their doctors’ problems.

I have had my own experience with a cancer diagnosis, although not as serious as JT’s. So I silently applauded his tattoo, and I imagine that almost every cancer patient at some point would agree with his profane message.

Holding back
But I didn’t share my emotional response to his tattoo that night, nor did I tell him my personal experience. I held back because of my clinical impression that JT was delirious. I recall that, in that moment, I also had the feeling that the tattoo didn’t require explanation: F%@* CANCER. Enough said.

Some might scold that questions about tattoos are gratuitous or odd; certainly, not a doctor’s business. When I looked to the medical literature for guidance, I found little to go on. A search of the keyword “tattoo” on pubmed.gov returns dozens of articles describing the medical complications of tattoos but little else.

JT’s lab results showed dehydration causing acute kidney injury. His emaciated appearance suggested further progression of his cancer, which was already known to have metastasized widely. Because I was working an overnight shift when I met him, my contribution to his care was limited to providing his admission orders, treating his dehydration and hypernatremia, and referring him to the inpatient palliative care service.

I never saw him again, but I remember his withered figure and the glowering skull on his thin arm. What is more powerful, however, is my sense of opportunity lost: for connection, and for a chance to help him—and perhaps myself—in a small way.

A personal connection
Why hadn’t I taken a small risk and stepped out of my role to commiserate with JT? Why didn’t I choose to spend some moments sharing in his anger over the menace of cancer and acknowledging our human fragility?

My training taught me that patients don’t want to know their doctors’ problems. Ours is a service profession, and service implies a focus on the patient, even as we keep our own difficulties out of sight. Of course, professional distance can be a euphemism for aloofness. And no one wants an aloof physician.

In contrast to JT’s inked-up forearm, my own is unadorned by a tattoo, as is the rest of me. That is beside the point. I am no anthropologist, but it is clear that tattoos, in their increasing variation and popularity, say: “This is me. To see this tattoo is to know me.”

So, a simple question to JT—”Tell me about your tattoo”—may have created an empathetic bond. In the time-pressured inpatient environment, personal connection is a rare commodity, but has immense value. Next time I will ask.

*Identifying characteristics altered for patient confidentiality.

O'doyleThomas J. Doyle, MD, 
is an internist who practices hospital medicine in Massachusetts. Send him an e-mail at tjdoyle7@gmail.com.

Published in the June 2017 issue of Today’s Hospitalist
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