Commentary on “Word Tattoos”

Dr. Alexander Chessman’s poem “Word Tattoos” explores and exemplifies a number of traits that physicians (and those who teach them) should ideally bring to the doctor–patient relationship—especially the qualities of empathy, humility, openness, questioning, and a sense of humor. The poem reflects a key aspiration of the updated version of the Hippocratic Oath, which Louis Lasagna, the academic dean of the Tufts School of Medicine, wrote in 1964, that is used in many medical schools today: I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not.”1 Chessman’s poem presents the stories of two patients, both prisoners (either former or current) and both covered with prison or gang-related tattoos, and the interaction of each with an especially empathetic and reflective physician. Dr. Chessman is an academic expert on Balint groups, the clinical seminars developed by British psychoanalyst Michael Balint to better understand and improve the clinician–patient relationship.2 The cases in the poem are presented almost as they would be if opening a Balint group discussion in which the doctor briefly outlines the patient’s story and invites the group members to react to it. The poem opens with the narrator–physician examining a former substance abuser and ex-convict who might present both literally and figuratively as a pain in the neck. (“I saw a patient with abscess in the neck.”) He is truly at the Biblical level of “the least among my brethren” (Matthew 25:40), the sort of patient who might be given short shrift and processed as quickly and as efficiently as possible. Yet the doctor–narrator treats him with kindness and respect as the vulnerable, needy human being that he is. The gulf between the doctor and patient in age, status, experience, and economic standing could hardly be wider, but the doctor bridges the chasm, caring enough to ask questions and make observations that elicit a real human connection. This questioning is clearly an ingrained habit of empathy, since the doctor notes with obvious pleasure that about half the time a story is attached to the T-shirts he inquires about. The self-created prison tattoos that organically twine around the patient’s arm are the trigger for deeper “warmth, sympathy and understanding”1 because they tell a story. The doctor appreciates the tattoos as art rather than simply as science—and it is no doubt rare for someone from among the most underprivileged, poorly treated, and exposed group of people to be accorded such respect. The poem’s reflections on the structural seam in Frost’s “Birches” and on the chicken or egg conundrum further develop the theme of interconnection, but also reveal that some things are ultimately unknowable or simply do not make a real difference in the end (“Does it matter” … “Who cares”). These reflections allude to the importance in the clinical context of humility, questioning, and not being ashamed to say, “I know not.”1 The most lyrical passage in the poem (“My tattoos twist / Across my limbs only / In my mind and / My heart”) acknowledges the differences between doctor and patient, but also portrays how intimately these two are intertwined in the clinical setting. The tattoos are real for the ex-prisoner, and—although only symbolic for the doctor—they connect the two separate people like a hand in a glove, allowing both to share in the wins and losses of each other’s lives. This sharing requires a degree of self-abnegation for the doctor, of being truly attuned to the patient. The poem offers an idealized vision, but one that gets to the essence of the benevolence and altruism that a physician must aspire to. The final stanza presents an even stronger test of the doctor–narrator’s powers of empathy and connection: It describes a patient who is not only a convict and a gang member marked with razor tattoos, but who is seemingly so dangerous that he is shackled to the bed. (Dr. Chessman’s mother was a psychiatric social worker who was once threatened with a knife by a disturbed client.) The disarming sense of humor brought to bear by the doctor in noting that the prisoner must be “connected” and has “a group of folks who care about you” is topped only by the irony of the prisoner looking at the doctor as though he were the dangerously crazy one. And, of course, the doctor is the one who is very much at the head of the group who cares about—and thus is caring for—the prisoner. Appreciating the benefits that accrue to doctors from these deep interpersonal connections is equally important—not just the benefit of becoming more effective health practitioners, but of finding fulfillment in a profession that has otherwise become more and more distant from what initially attracted them to it. In an era when physicians’ time and attention are increasingly diverted from the doctor–patient relationship by electronic medical records, checklists, government and insurer paperwork, continuing education requirements, and—often—the running of complicated, medium-sized business enterprises, it is all too common to shortchange the elements of compassion and empathy that are essential to healing. Dr. Chessman’s poem reminds physicians of the importance of stopping and looking and listening to patients. The poem also reveals how sharing our human stories—those narratives that have marked us as prominently and permanently as tattoos—is as critical to health care as pills and imaging, if not more so.

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