Andrew Miller: What your tattoos may be hiding beneath the skin

Baring your body for strangers can be daunting. Even though I have been to the gym several times this year and have the physique of a non-marauding, bookish Viking, I find the dermatologist’s close perusal of my landscape a little unsettling.

At work I ask a lot of people to show me their arms, and bestow compliments on those who are in possession of good veins. “You should be in Vein Magazine with that fine basilic, or cephalic,” I tell them. Patients generally don’t mind professional confirmation of an underappreciated attribute. Hidden talents enjoy exposure.

Then there are those whose blood magically returns to their heart, not via any detectable vessel. Cold, pale and even a little woody, their arms are not revealing anything without a warrant.

Twice in one morning last week I surrendered and grabbed the gas mask before even breaching the skin. The anaesthetist’s privilege is having a machine that can provide 8 per cent sevoflurane in oxygen. In select circumstances it can transport your patient into the abyss with four or five deep breaths, while simultaneously making their veins dilate.

There’s always another solution. One very apologetic lady told me she knew I would have terrible difficulty, and she was booked in for multiple procedures over a few weeks. She was right about her arms, but as we chatted I became distracted by her wonderful external jugular veins. Bingo.

It’s curious how many needle-phobic people have tattoos. My mental library of interesting body art goes back decades.

One huge young man had beautifully intricate Pacific Islander art all over, except his right arm and back. He explained those were the places he could not reach with his right hand; he had done all that fine work himself. Terrified of me, though. Another needle-averse patient was a professional tattooist. She was known in her industry as “the girl with no ink”. It made her stand out from her decorated cohort.

My own hand tattoo is very small, having been inflicted unintentionally by a classmate wielding an HB pencil. Humble though its artistic ambition, I have never forgotten the mothball smell in the classroom or Malcolm’s eyes widening as my palm filled up with blood, like a pale communion cup.

My primary school tattooist ended up wholesaling mortgages, I hear. I don’t know what that involves, which is probably why he is now vastly richer than any doctor who puts in needles — good for him. He paid attention during commerce classes while I was making a peashooter.

Some tattoos are poignant, referring to loved ones now passed, while others bravely shout the name of a lover who will hopefully either go the distance or have a successor with the same name.

Some are calamitous, such as the infamous image of a certain COVID-era Premier, or one I saw that was very nearly an old truism: “you sow what you reap”.

Surviving servicemen tell tales of exotic ports where a smudged and patchy tattoo was inked on a hot night between deployments, when a little reckless behaviour was understandable with the shadow of death looming all around. When I ask, “Where were you when you had that done?” to distract from my medical intervention, their eyes sometimes tear up for their lost mates.

Should we ask, or leave it alone? A visible tattoo, like any other bodily feature, is not an invitation by itself. Since the eponymous project in 2013, the semicolon tattoo has come to signal survival in a mental health sense. The semicolon encourages us to continue our life story; it’s just a pause, that’s all.

Showing some unconditional care and kindness is all we can do. Whether it changes anything, other than in the moment, we may never know.

Even tattoos are impermanent. In the years that the ink is in our body, the pictures fade, smudge and sag with the skin. They are gobbled up by macrophages, a variety of white blood cell that responds to inflammation, crawling about like tiny octopuses under the skin collecting the foreign chemical pigments in body art. These cells travel to local lymph nodes, which are important organs in our immune system.

If you have a sleeve tattoo, your armpit lymph nodes slowly turn black.

This leads to questions about the occurrence of immunological cancers and the effectiveness of vaccines in those with heavy ink. The incidence of skin and other cancers is still being studied, but we already know that tattoos provide no sun protection and that melanoma detection can be obscured by the art.

If I ever retire, I might get a big old neck tattoo, copying Will Ferrell’s character in The Internship.

In very large type, that one said, “Make reasonable choices.