Permanent Ink

I can remember as a teenager having my mother tell me repeatedly that decisions that I made came with consequences. This continued through college as she reminded me on a weekly basis that only I was responsible for my actions. In light of this, I was often not a spontaneous person, and in some ways, this has continued into my adult life. Take tattoos for example...

I always thought about getting a tattoo. The fun was in trying to decide what to get and where to put it. I remember in the first season of "Road Rules" one of the contestants who was a pre-med student got a tattoo of Kermit the Frog wearing a stethoscope on her hip. I thought that was kind of cool, especially when I got into med school. But then, I started thinking... what would that tattoo look like when I was 80? Would that still be cool?

I trained at the V.A. during med school, so I had a great reference of tattoos as the WWII vets were mostly my patients. Following them, the Korean War and Vietnam Vets. A lot of them tattooed. You get to see the effects of time. So I continued to ponder.

As a fourth year medical student working one of my first shifts on my E.D. rotation, I remember a patient who came in. She was in her 80's and as I examined her, I noticed that her tattoos seemed especially bright. I commented to my senior resident, and they too wondered how the tattoos could have stayed so bright all of these years. Finally, before discharging her, I asked her about her tattoos. She smiled as she held out her arms. She told us that she had always wanted to get a tattoo, but that her husband had always been opposed. She said that when he died, about a year later she got her first tattoo. She now had her second. And, this had been within the last two years.

I was thinking about my own permanent ink fancies recently when I had a young female patient who came in with a complaint of "bloody urine." After a few minutes of discussion, "bloody urine" turned into abdominal pain, then she got teary as she described that she was really having pelvic pain. As in most cases, I asked about her sexual activity, and she admitted that she had a single boyfriend but that they didn't use protection because she was trying to get pregnant.

I went through my usual abdominal exam, noting a fresh new tattoo that started above her bikini line and wrapped around her waist. I then explained that I would have to do a pelvic exam because she could have an infection causing her problems. She became more teary as I performed the pelvic, and it became clear that she was having cervical motion tenderness, one of the signs for pelvic inflammatory disease, a process most often caused by an STD.

She started to cry as I explained what I felt was causing her pain, what medications I would be giving to her, and further instructions for her care. She then admitted that her boyfriend had cheated in the past, and she was feeling very stupid because she had just gotten the tattoo. That's when I took a second look and noted a name as part of the design. It's not my place to counsel patients on how to lead their lives, but I silently hoped that the ink would be the only consequence of her relationship with this other person.

I still think about tattoos from time to time... maybe when I'm 80. Now, where would I put it?? Where are yours?