A recent New England Journal of Medicine letter gained national attention by describing an emergency room visit by a patient with a tattoo on his chest, “Do Not Resuscitate.” The article told how the emergency room physicians, who had not encountered this issue before, contacted their medical ethics specialists to make sure they were complying with their state’s informed consent law.1
I had a similar experience after we opened the then-new University of Arizona College of Medicine Hospital in Tucson, a half-century ago. The first physician in charge of our “Emergency Room” was a tough, “crusty,” and beloved veteran, who had served in a Mobile Army Surgical Hospital unit in the Korean War. At that time, the “Emergency Room” was a subset of the Department of Surgery. When there was a cardiac arrest, a “code blue” was announced over the hospital loudspeaker. On those occasions some of our house staff—and during the day I—would often run, often down several flights of stairs, to help with the “code.”
This “Emergency Room” physician eventually had a baseball cap embroidered with the title, “CODE CAPTAIN”; and whenever I or another cardiologist showed up, he would slap that cap on our head so that he could continue running the “Emergency Room” while we ran the “code.” He was a colorful character, who had a tattoo on his chest that implied, “DO NOT DEFIBRILLATE.” His tattoo showed 2 defibrillator paddles, surrounded by a red circle and diagonal line, the “international prohibition sign” for not doing something! This was before the days of written “advanced directives.” In fact, decades later he did come into our Emergency Department with cardiac arrest. None of his academic colleagues defied his tattooed “advanced directive.”
This experience emphasizes the importance of having a written official advanced directive, so physicians do not have to relay on interpreting the presence or absence of a tattoo.
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-Gordon A. Ewy, MD, DSc
This article originally appeared in the June issue of The American Journal of Medicine.
