Alan Blum
Tuscaloosa, Alabama, United States

A century before reality TV, there were circus sideshows, and one of the star attractions was the tattooed lady. Betty Broadbent was the most famous. The 1939 song “Lydia, the Tattooed Lady,” written by Yip Harburg and Harold Arlen and performed by Groucho Marx in At the Circus, was a big hit.

I confess I never liked tattoos or felt that they make a good first impression. Moving to sports-crazed Alabama did not help. If you go to the Talladega 500 auto race in April, you will see some raunchy tattoos. One football fan I know has legendary coach Bear Bryant tattooed over his entire back. Not to be outdone, an English professor has one of poet Emily Dickinson on his back.

Trying not to reinforce my bias, I learned that over 30% of adults in the US (and 40% of those between 18 and 40) have at least one tattoo—slightly more women than men.

I never asked patients about their tattoos until I was examining a sweet elderly lady whose heart failure had dramatically and mysteriously worsened. Pulling down the bedcovers, I saw a tattoo of a skull on her swollen calf with the words, “Ride or Die.” I looked at her daughter in astonishment. “Oh, I forgot to tell you that Mom was a biker babe—lots of booze and drugs.” Never again would I ignore a tattoo.

Most references to tattoos in medical journals are to the health consequences: abscesses, keloids, hepatitis, lead poisoning. There is also research suggesting that patients with tattoos, especially teenagers, are negatively perceived by physicians and nurses.

But then there’s the healing power of the post-mastectomy tattoo. Women who have had a mastectomy often feel that they have been damaged by both the cancer and the treatment. The tattoo artist helps transform their sense of disfigurement and loss of control into feelings of beauty and self-esteem. “On a good day,” tattoo artist David Allen wrote in JAMA in 2017, “I can heal with my art.” The botanical imagery of leaves and flowers that he designs offers women “a sense of transfiguration that they’ve fashioned for themselves, having wrested control of their bodies back from their anxious tenancy with cancer and health care.”¹

There are tattoo artists who can make a facial scar undetectable and others who can create the illusion of fingernails on partially amputated digits.

As I read more on tattoos, I learned a surprising theory about The Iceman, nicknamed Otzi, the intact, carbon-dated, 5,000-year-old man found in the Alps. He has sixty-one tattoos in the form of lines and crosses—incisions rubbed with ash. Since they are located mainly over the joints of the hands that get the most wear and tear, it is thought that the tattoos were therapeutic, perhaps a form of acupuncture to treat the pain of the osteoarthritis that he was found to have.

Polynesian tattoos go back over 2,000 years. The upper part of the body relates to the spiritual world, and the head is the contact point to heaven. Face tattoos are about one’s family and one’s life journey. Analogously, when I started asking my patients about their tattoos, they were eager to open up about their own life journey.

Female mummies in Egypt, the cradle of tattoo art, with examples from 4,000 years ago, frequently have ornamental scarring around the umbilicus, which is believed to hold fertility-promoting and protective significance. Such scarring is still common in African women today.

Animals are popular subjects for tattoos. Throughout history, people have identified with the spirit of animals. “This is the winged horse Pegasus,” one young woman explained to me when I asked her about the tattoo on her upper arm. “But it’s also a do-over,” she added. “I was covering a Capricorn, which is a goat with a mermaid tail, but it didn’t look like a Capricorn. My Capricorn looked like a chicken, and a Capricorn is not supposed to look like a chicken. You do crazy things when you’re sixteen.”

Memorial tattoos, often marked only by initials and dates, are frequently revealed during a discussion with patients. As one woman shared with me, “I lost my baby ten years ago. They gave her the wrong shot. At first, I saw her lips were turning blue, and we got her back into the car to go to the hospital, but…Now her birthday’s coming up. That’s a hard day. I’m never ready for that.”

“Is your tattoo in memory of someone?” I asked another patient. “Yes, it is,” he replied. “Who?” I asked. “Me,” he said.

Asked about her memorial tattoo, a woman told me, “This one is in memory of people who died.” “In your family?” I asked. “No, just everyone.”

The Latin word for tattoo is stigma, a mark of disgrace that the Romans put on prisoners and slaves. In the English army in the nineteenth century, delinquent soldiers would be branded with “B.C.” for bad character. Today’s prison and gang tattoos could be said to continue that tradition. When I asked a formerly incarcerated patient about the significance of the tattooed number “13 ½” on the back of his hand, he replied, “Twelve jurors, one judge, and a half-assed district attorney.”

As patients talk about their body art, the tattoos become a way for them to see other people, and not just for others to see them. In recent years, I have noticed that more physicians and nurses have visible tattoos. As one resident told me about the delta sign on her wrist, “Because delta means change, and change is the only constant.”

Reference

1. Allen D. Moving the needle on recovery from breast cancer: The healing role of postmastectomy tattoos. JAMA. 2017 Feb 21;317(7):672-4.