Cruising Around in Circles
Feb 15, 2014 | Dr. X | Dr. X
image by: Striderv
To think that Dr X would just be cruising, carefree, around the Gulf and the Caribbean betrayed a profound ignorance of the seriousness of the job I had signed onto
This was my first cruise assignment after my orientation and I had most of my training certificates already, for safety, crowd control, fire drills, man overboard. So I envisioned a carefree cruise with plenty of spare time to meet the guests and my fellow crew. I was in search for something new in my life, some adventure.
I knew the ability to improvise would be at a premium since we haven’t many of the tools we’re used to ashore: CT scan, ultrasound, armada of blood tests. And the ability to keep a broad base of knowledge current is constantly tested due to lack of consultants and slow communications to shore. We can transmit x-rays and EKGs and get some input from specialists, but it’s still the maritime physician who makes the final call.
Maritime medicine is serious, deadly serious. People die, injure, and abuse themselves and others on a boat just as they do on land. And as I developed the skills of my new-found specialty as ship’s doctor the annoying safety drills and inspections I complained about at first suddenly became more reassuring and serious to me. Emergency medicine, which I practiced for thirty years onshore is similar to maritime medicine in that the entire range of illness and injury can present in a flash, and so many of our cases have a finality to them.
As I waited on the dock at the crew boarding area, Sunday, my first day, I saw a long black bag being wheeled right past me, on a type of cart all too familiar to me after my years in the ER. It was a mortician’s cart carrying a body bag and a group of very sad people were gathered about it. Ahead of them, parked next to the curb, a Hearst.
I learned later a young man had collapsed while playing basketball on Day 5, Thursday, and died. He had been resistant to all resuscitation efforts and the medical team was unable to revive him. I learned later he had a sharply demarcating line of blue, from the nipple level up and surmised he must have had dissected a congenital aneurysm of his aorta.
My original light-hearted introduction that I had written the day before was suddenly too simple and superfluous. Naïve would be the perfect word. Having trained as a psychologist, I always had an interest in human behavior and motivation, and this series of cruises gave me plenty of opportunities to observe and sometimes analyze what makes us human, what makes us good, and what makes us do bad sometimes. More than five thousand new personalities to chose from and study, every week.
I had come out of retirement to re-evaluate myself. I had nothing to do except try to enjoy retirement. Did I still have an identity, a purpose? As others have noted, a true story can easily be more exciting and instructive than fiction. I will meet many people, hear many stories. People open up and talk about themselves on a boat, like strangers on an airplane. I wanted to learn of their hopes, their fears, and their dreams.
Join me as I share my story of sometimes small, sometimes big adventures. As I journey, looking for adventure but also, looking for myself. You have my promise that all written here is true, except for the names of the people and the name of the boat...
It was Sunday. The traditional embarkation day for this particular cruise that I’d signed onto. And it’s the usual confusion; lots of people, forklifts, people zigzagging all over, somehow ending up in their right places.
Takes three hours to disembark five-thousand passengers, four hours to clean the rooms, then another four to load the next group. In between the unloading and loading a lot of housekeepers are cleaning and straightening at a furious non-stop pace. They’ll work for 14 and sometimes 16 hours to get the new group in their rooms so we can embark the voyage on time, 6 P.M.
My home office had told me I would be guaranteed early boarding so I could have time to settle in and meet my new crew. So there I was sitting on the dock on a wooden bench, saying hello to everyone that passed by, wondering if anyone besides me knew about my boarding status. “It doesn’t say ‘early boarding’ anywhere Doc,” says James, my security guard, studying my Letter of Employment for the third time. “Sorry.” I remembered James from my orientation cruise. “That’s okay, James. They’re not going to leave without me.”
By international maritime law, any commercial boat with more than 12 passengers must have a doctor. And, amazingly to me, it doesn’t need a captain! Many an overbooked cruise ship has asked the captain to disembark so his cabin would go to a paying, registered passenger.
There are actually a lot of people who can captain boats. Wherever they need to go, into harbors, across the ocean. I took care of an accountant-crew member once, who had premature cataracts. And during casual conversation he told me, “I’m certified and current to captain any boat, even this big one. I just found accounting more suitable for me.” I strongly advised getting the cataracts fixed before he started driving the boat around. If a captain becomes sick or unable to carry out his duties there are many others who can master the ship. This would prove to be all-too-important in my final and greatest challenge.
Five minutes later I was walking across the gangway. And I am struck with the enormity of the ship. Fourteen decks, hundreds of feet long, it carries four-thousand passengers and nine-hundred crew. It was enormous. It had 8 restaurants and 13 bars. I was leaving terra firma, where I’d been my whole life, for 10 weeks. Leaving my family and friends behind and I’ll have minimal contact: no phones, a very slow internet connection, a whole new set of people in my life. And we’re all depending on each other for one thing or another. If I have a bad shift or a conflict with nursing, I can’t go home and shake it off, ready to come back the next day. We’re all on this little island of people, together, for weeks, no escape.
As I passed into the bowels of the ship I felt a twinge of anxiety. I tried to remember why I was doing this. Was this really my idea? Maybe I couldn’t resist my sense of adventure? Suddenly, I couldn’t remember. There were easier ways. Actually, my brother-in-law had worked for a cruise line as a steward many years before and he told me, “Maybe you should be a ship’s doctor. From what I could see they didn’t need to know that much. Plus they drank a little too much.”
Well, no time for second thoughts now. I’ll be in charge of the health of five-thousand people at one time or another and they’re going nowhere without me. No backing out. I gave my passport to the purser, per protocol, and noticed the Medical Center sign a few feet away. The door was open and I walked in to meet Brianna, the nurse on call for the unit.
The first person I met was in charge of the unit when I checked onto the boat. Her name was Brianna and she was a 50ish woman from Glascow which means she talks like a Scot, no consonants, all vowels. We know one main difference between humans and the other primates is the ability to use consonants in speech. Fifty-thousand years ago, Brianna’s particular evolutionary group missed out somehow. It’s “R, U, E, U, O, R?” for “Are you the new doctor?”
“Why, yes I am.” We chattered some small talk and then she showed me to the usual places one goes to check in for an assignment. The purser clicked my photograph and issued me my I.D. tag. Next I dropped my bags off in my quarters. The cabin was more spacious than my last one. Two rooms and a larger bath. The main room was about 20 by 10 feet, the bedroom a little smaller, the bath was a boat bathroom: about a 12 square foot economical use of space.
It had been a long day but my co-doctor for this trip, Dr. Velasquez, wanted to have a staff meeting at six so we could get to know each other. We gathered in the Medical Center and each t00k a turn at “Who am I.” I introduced myself and noted my past practice experience.
Then our new Lead Nurse, or supervisor, who had boarded with me in Galveston, introduced herself. Her name was Marly. She was a drop dead gorgeous Canadian with perfect skin. About thirty. Well trained with experience on cruise liners, she was a veteran cruise ship nurse. She talked about her philosophy of leadership: I’m easy to work with as long as we’re doing it my way. Hmmmm, I told myself. I was just about to talk about leadership theory; one of my favorite topics in my MBA program years ago, but somewhere inside I heard an inner voice: “Danger Will Robinson, danger.”
She ended, crushingly, by saying, “Gee, I thought, well they told me I was getting an experienced ship’s physician. I worked with an emergency doctor once and he didn’t know anything.” I love nurses; they’ll say anything at anytime. Love them, even married a couple of them.
So, of course, that means all emergency doctors know nothing, Marly. Great, a crisis on my first day. I decided we could have private chats later. It just wasn’t worth it on this first day. She went on, far more than necessary, then finally she was done. Brianna talked about herself and somehow ended up talking about the AIDS epidemic in South Africa.
She had, earlier in the day talked about her experiences with Christian Bernard, the world-famous South African heart transplant surgeon, while she was in South Africa. I asked her to share some to the group. To her eye he was a disagreeable person. “He had this screeching voice and was always yelling at everyone.” The she tried to imitate his voice, sounding like a marauding eagle, actually, to me.
Elena was a 30 year old Columbian nurse on her first job since school. Cute as a bug, she had a thick accent. She was a doll, literally also, about 4 feet 10 inches tall. She would be no problem getting along with. She was young and insecure, would need lots of support and “good nurse, I’m proud of you” sorts of things.
Clancy was another South African with better consonants than Brianna. She was in her 60s, had been on this assignment for about 10 months, and showed all the signs of burnout: negativity, hostility, belligerence, and labile emotions. Nothing got processed before it came out, what she felt, came out of her mouth. No filters, no modifications, no edits. She went on and on talking about this experience, that patient, this coworker.
She had also worked with Dr. Bernard and shared Brianna’s opinions. “Actually, his voice sounded more like this.” She proceeded with her rendering, sounding much the same as Brianna’s. Clancy has a big red X on her, a big Caution sign. But burned out nurses I can handle using my long-held, ever-reliable rule number 1 for getting along with nursing: Just say, “Okay, well, why don’t we compromise and do it your way?” I’ve never had anyone question the rule because all they hear is “do it your way.”
Marly, I wasn’t so sure. She’s only recently inherited this position and the previous crew left a mess, particularly with what they call GI logging. Careful records must be kept on crew or passengers who get diarrhea, every GI patient fills out a questionnaire regarding this symptom or that. If the records aren’t immaculate, the Coast Guard can fine the entire fleet. She’s understaffed and doesn’t need a rookie physician to slow her down.
Once, she announced without warning, out of the blue, “I think I’m going to have the physician’s do their own vital signs,” Dr. Velasquez and I looked at each other, then nodded, saying nothing, perplexed to silence. Warning, loose cannon.
And finally Dr. Velasquez introduced herself to the newcomers. An obviously intelligent Columbian, recently trained M.D. who had specialized in Intensive Care medicine before she decided to see the world as a ship’s doctor. She required careful listening skills also due to her sexy, yet still thick, accent. She cared about her work. We would get along fine, I decided. And she’s gorgeous, but very serious.
The last event of the day: Dr. Velasquez briefed me on the nuts and bolts of the department. We will rotate On days. The On doctor is responsible for the unit for twenty-four hours which means he attends clinics from 8AM to 11AM and 3 PM to 6 PM and then takes call till the next day. There are two physicians on the larger boats and the Senior goes to the various meetings: Captain’s Saturday meeting, the weekly Safety Committee, the Monday night Captain’s dinner, the drills, more drills, and the orientation meetings for new crew.
She was a very good communicator and used her talking time efficiently. She was very likable and at the end of my orientation she said, “Since you are so handsome and smart, I’m going to give you a promotion right away to Senior Doctor in the department. Which means also that I go to fewer meetings and read fewer memos. Let’s go to dinner. Tomorrow you can tour the Medical Center.”
The ship had 4 eating areas, just for the crew, and they were all Deck O-crew only level. The medical center was on the same deck and it was a short walk to the officers’ mess. Dr. Velasquez meandered through the buffet line, studying the fare, then nodded toward a table, saying, we’ll sit over there. At the table was a tall handsome Russian-looking engineer–they all wear white overalls–she sat beside him, then quickly kissed him full on the lips–we’re in the cafeteria–then moved to her side and kissed him some more. After watching the shameless groping and kissing, including tongue I concluded Dr. Velasquez and Gorgo were in love, or something. About forty crew-diners, perhaps used to it, didn’t notice, and ate away.
Gorgo, a Serb, was the engineer for the fifty foot video screen on deck eleven. That’s his only job, keep the screen going so the crowd won’t riot if the Cowboys game doesn’t come on; he and his crew of six. So instead of sitting at home, drinking beer, and watching television, our guests pay a couple of thousand dollars to be on a boat, drinking beer, and watching a really big television.
Picking through the buffet to find food that would make my cardiologist happy is a challenge. But I did the best I could. It was an easy choice, everything was fried and/or starchy. As I walked to our table I looked up and saw the two lovers still kissing and groping. In a flash I knew why Dr. Velasquez had promoted me. And it wasn’t because I was so smart and handsome, though she persistently insisted I was. She was in love with Gorgo, easily determined by watching them cling to each other for a few minutes. Definite attachment signs, a psychologist would have concluded.
As we ate, Dr. Velasquez started detailing to me the committees I had to go to as Senior Doctor. There is the Captain’s meeting every Saturday morning, the two or three safety committees held for each cruise, any emergency meeting if a risk is identified, like when there’s too many people trying to get through a certain hallway or something. Hmmm.
I wished her well. After all, what better feeling is there than being in love, especially for those first few weeks, maybe months, with that meshing of body and mind and when you want to physically be a part of each other. It’s a physical and spiritual bonding of mind and body. There’s the terrible pain when you’re apart that fades when you’re together again. The irrational, crazy, enjoyable things we do when we’re in love. What a rush. I thought I remembered what it felt like. And then it can come crashing down around you in a few seconds, and you can’t go back.
I started to remember and understand why I was on this boat with all these new acquaintances, going to all these new places. Having lost both parents and a wife within a year, then both of my dogs, I hadn’t loved or been in love for a very long time. Here I was, starting a new life where I hoped I could be of service to people, drink less Jameson’s and get to know what it’s like being human and happy again.
After dinner with Gorgo, we toured the medical center itself. It was quite large compared to the one I had on my orientation cruise last month. Walking through the door there was the nursing desk to the left, and a small 8 place waiting room. A large doctor consultation room was behind the nursing station. It had a desk, the slit lamp for eye examinations, and an examination table. And a clock on the wall that was always ten minutes fast.
There was a fairly large Code Room for critical patients, then two other basic exam rooms. All the meds were prepackaged. We were in international waters, under a Panamanian flag, so this is life without governmental regulation. For those of us in health care, no Obra, no Cobra, no HIIPA, no EMTALA. I fancied I could see a patient, spend most of my time with patient care and counseling, dispense meds, talk about side effects, do my charting and have a turnaround time of less than 5 minutes. And it worked out that way as time went by.
It was late, so after a glass of wine and dinner with my new crew-companions I called it a night. Dr. Alvarez had the night watch so I was free to organize my living space, check out the Wi-Fi, and assay the cable for “Walking Dead” and “Dexter.” Alas, no such shows, just CNN and some old movie channel. The computer connection to the mainland is extremely slow because it bounces off a satellite and is therefore serial, not parallel, and much slower, I was told by our computer guru staff.
Conjuring up ways to download Dead and Dexter from onshore Wi-Fi’s, I fell asleep quickly as the powerful engines below me droned on and my new home rocked from side to side. It had been a long day.
About the Author:
Come aboard as Dr X's Private Sea Journal reveals with great story telling and wit the practice of medicine on the high seas including some of the deep dark secrets of maritime medicine, as well as Dr X.
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