It’s well known that patients struggle to clearly communicate their end-of-life wishes to those calling the shots at critical moments—generally doctors and family members. But, in case anyone was wondering, tattooing your wishes onto your body does not clear things up.

Emergency medicine doctors in Florida struggled to figure out how to respectfully care for an unconscious 70-year-old man with a chest tattoo that read “Do Not Resuscitate” followed by what appeared to be his signature.

In a case report published Thursday in the New England Journal of Medicine, the doctors recounted: