Let’s call her Lydia, not the name on her chart.  I knocked on the door of the exam room and entered to see this otherwise strikingly beautiful young woman seated with legs crossed nonchalantly and with hands busy texting at hyper speed. When I spoke her limbs unfolded.  I could then view rising above the horizon of her halter top a vivid color image of a dying Christ on the cross, His arms spread eagled across her entire upper body. The unfinished portraiture was so remarkable I had to restrain my curious nature to address the actual medical problem for which she came to the clinic that day.  I later learned the reason for the incompleteness of this prodigious display of ‘body art.’  When the tattoo artist began work atop her tender breast bone, this ultra slim young lass found the pain quite unbearable. She called a time-out, then decided to come back and try it again another day.   

Before our visit was over I simply had to see the whole thing. The crucifix extended from the base of her neck all the way to her navel, Jesus’ toes pointing in the direction of a metal bar pierced through her belly button.  And I could only ask her, “Why? Why?”

Her answer, “To get the message across to the world.”  I wondered if it was necessary for one’s entire skin to be martyred in the name of Christendom.  When back at my desk I began to ponder that any man that someday becomes intimate with her will also by necessity come to know Jesus Christ as his close personal Saviour.  I marveled at my imagined vision of how bowlegged Jesus would appear when someday distorted by the ninth month of gestation.  I then pondered how pitifully the Lord might seem to fade and sag a half century or so in the future.

What’s up with this exploding modern day tattoo phenomenon?  It seems more than just a passing fancy to me, something more along the lines of a basic societal shift.  As a family practice physician, I see more of folks’ skin than the general public is privy to. From my observations it appears that about half the 18-35 age group have at least one tattoo. The tattoos seem to be getting larger, bolder and less discrete.

Why do so many people of seemingly normal intelligence want to get tattooed?  When you ask them (and believe me, I do ask them) the responses vary:

 “I wanted to pay tribute to the most important things and people in my life.”

“It shows that I am really Me and in control of MY body.”

“Man, I don’t remember…I was wasted, I guess.” 

“I just think they are SOOO COOOL! Tattoos rock!”

“I just wanted to be different; I wanted to be really unique.”

 The sad contradiction is that in that masochistic attempt to be somehow seen as ‘special’, these young people are simply running with the herd. Sadly, fads and fashion change, but like it or not, tattoos will go on forever.

Tattoos are not a new or isolated phenomenon and their history is nothing short of fascinating. From Paleolithic Japan to Pre-Christian northern Europe, we humans have been applying tattoos for various reasons for tens of thousands of years. One example, Otzi, the mummified Neolithic Iceman who dates back to the fourth to fifth millennium BC, sported approximately 57 tattoos scattered over his body.  The Alpine Iceman’s simple carbon tattoos were primarily a series of dots and lines adorning his lower spine, left knee and right ankle. Anthropologists speculate that Otzi’s tattoos were applied as a form of healing ritual because their appearance closely resembles the acupuncture patterns we see today.  Like the tattoos themselves, it seems that people have been suffering from low back pain and arthritis of the knees throughout the centuries.        Amazingly, the islands of Great Britain even take their name from the practice of tattooing, with the term ‘Britons’ literally translating as ‘the people of the designs.’  The British people continue to be the most tattooed folks in Europe.  And throughout world history, people have been forcibly tattooed for identification purposes in every culture that practiced human bondage.

Dermatologists by necessity have a vested interest in tattoos and today classify them into five basic sub-groups.  There are the ‘amateur or homemade tattoos.’ Examples of this risky, unsanitary and disfiguring practice can be seen in ex-convicts and wannabe gang members. Often they are of a ‘teardrop’ configuration (which is said to mark a death or murder) and are done with cigarette ashes or ink salvaged from pens.  The most mainstream group these days are the ‘professionally applied/ artistic tattoos’ which may range from a simple butterfly or star on the ankle to the very large, vividly ornate themed tattoos displayed on multiple body parts.  Thankfully most are now done under hygienic conditions in trendy tattoo parlors.   There are the ‘post-traumatic tattoos’ such as can be seen from a remote encounter with asphalt (road burn) or the common grade-school scuffle which leaves permanent pencil lead marks.  The two final categories, the ‘cosmetically applied tattoos’ (permanent facial make-up) and the ‘medical tattoos,’ are applied by professionals in clinical facilities.  

As a med student, I first encountered serious tattoo art in my VA hospital rotations, veterans bearing permanent mementoes of tours of duty from every military theater since the turn of the century.  They were particularly de rigueur among the Navy men.  They were casually observed and remarked upon as identifying features of the physical exam and no negative significance was attached to them or the men who bore them. Big grey battleships, colorful US flags, and the ubiquitous naked pin-up girls were the norm, all serving to tell the story of my patient’s former incarnation.

Thirty years ago I recall inheriting my first tattooed female patient in private practice.  She was 98 then and was languishing in our local nursing home, stricken with advanced dementia. In stark contrast to all my other little old ladies, she had several god-awful, washed out tattoos on both her arms…undecipherable names and unrecognizable symbols. I wondered when and under what circumstances she had acquired these frightful markings, but never learned their origin. She never had any visitors, and her vocabulary consisted of two words repeated endlessly, “Kah, kah, kah-meer….kah, kah, KAH-MEER!”

Interestingly, the Latin word for tattoo is ‘stigma’ and indeed that is what this elderly woman’s markings implied to me. Her mysterious history became a constant source of speculation as I tried to envision the rough and rowdy ways of her past lifestyle back around the turn of the century.  Had she been a drug-addicted prostitute? Had she done prison time?

These days the sheer volume of “body art” that I view daily has desensitized me somewhat, but for the most part I still find that people are sadly stigmatized by their mostly ill-advised tattoos. There is nothing cute, classy, sexy or macho about having more tattoos than you do teeth.  I strain to be open-minded but find it almost impossible not to feel consternation when someone with a 400 buck “tramp stamp” on her tush moans about not having the money to buy her diabetes meds.

Though I have seen plenty of patients with intriguing tattoos in medical practice, I have only very rarely met a ‘tattooed lady.’  One dear older friend of mine recently called my attention to her tattooed-on permanent eyebrows, almost indistinguishable from the real thing. She had them done when after years of fashionably plucking them “my eyebrows just seemed to disappear on me.”  Most recently I saw a tattooed lady whose story piqued my interest, a 40ish African-American woman who had just undergone a complete mastectomy and breast reconstruction asked if I wanted to see her new tattoo.  My eyes must have displayed some disapproval for she immediately said, “Oh, but you will really like my tattoo!”  She then proudly displayed for me her newly acquired aureola on the reconstructed breast. Her plastic surgeon did a marvelous job for it was a perfect match to the nipple of her healthy breast in size shape and color.

The most singularly memorable tattoo I have encountered throughout my medical career…a ghostly blue series of six numbers on the forearm of an elderly German woman who was branded by the Nazis in an Auschwitz prison camp. Now there was a tattooed lady.

Truly there are as many types of tattoos are there are personalities.  The fascination for those of us unadorned has to lie within the life stories they evoke, whether they are expressed to us audibly or simply inferred from observation.  When I named my patient Lydia I was paying homage to a Groucho Marx song in the wildly funny “At the Circus.”

Lydia, oh Lydia, say, have you met Lydia?

Lydia the Tattooed Lady?

When her muscles start relaxin’

Up the hill comes Andrew Jackson

Lydia, oh Lydia, that encyclopedia

Lydia the queen of tattoo.

For two bits she will do the mazurka in jazz

With a view of Niagara that nobody has

And on a clear day, you can see Alcatraz

You can learn a lot from Lydia!

My patient, my Lydia, accomplished her goal that day in the clinic.  She captured my rapt attention and shared the take-home message of her life story with me. I learned a lot from Lydia. 

The tattoos of life.  Everyone has them. I possess some very special patients with tattoos. My rapidly diminishing World War II veteran population bears what I term ‘progressive tattoos,’ a hybrid of those acquired 60 years ago overlaid and disfigured by the ravages of time and ill health.  Most of the guys are on blood thinners that cause their crepe paper skin to bruise at the slightest bump. I touch the wrinkled thinning hide of these my heroes and have to fight a teary eye. I watch their eagles and anchors mutate and mottle over time through a succession of blue and purple shades. That lovely blonde bombshell tattooed on an upper arm now appears to have a good case of varicose veins.  Many of the old military emblems once worn so proudly have finally evolved into an unidentifiable rusty brown conglomeration, altered by stains caused by the iron in his blood, a testament to a half-century of manual labor. These are the tattoos of a hard, but well-lived life.

Then I realize that we all acquire tattoos sooner or later...tattoos that bear witness to the slings and arrows of our outrageous misfortunes.  My older brother had a big blue-black tattoo on the crown of his head. While playing as a child he was accidentally struck by a hatchet. Our grandmother staunched the rapidly bleeding scalp laceration by putting fireplace ashes in it. This old country remedy stopped the hemorrhaging, but the ashes and soot never left his scalp.  I remember last noticing my brother’s ‘tattoo of life’ some 30 years later on the day he was buried.  

I inspect my skin for my own tattoos of life. I am acquiring a veritable constellation of them. There is a rusty scar on my calf from an encounter with a barbed wire fence.  There are brown spots and white stretch marks that came with pregnancy and never quite went away. There are some permanent radiation burn discolorations on my neck, a residual from cancer treatment. I have one blue leg vein which for all the world resembles a topographical map of the Mississippi River.

Our bodies are already something of a masterpiece, a truly one of a kind piece of artwork. These tattoos of life are the indelible souvenirs of our fantastic journey on this planet. The tattoos of our lives make us unique, make us special, make us ‘cool.’ They tell our stories like nothing else can. And they come to us soon enough in life.  There is no need to pay extra for them.

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