The Solitary Practice of a Ship's Physician

Since I was a child, the lure of sailing the blue seas has fascinated me, but medical education and emergency practice became my priority. Later in my career, however, an opportunity arose to be a ship’s physician. A local physician acquired the contract to staff a small cruise vessel and asked me to become involved, so I jumped at the opportunity.

Since I was a child, the lure of sailing the blue seas has fascinated me, but medical education and emergency practice became my priority. Later in my career, however, an opportunity arose to be a ship’s physician. A local physician acquired the contract to staff a small cruise vessel and asked me to become involved, so I jumped at the opportunity. The vessel was a 100-passenger expedition-type vessel travelling to exotic destinations.

Cruise Ship in Chilean Fjord with view of Andes Mountains.

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My involvements were 3-4 week sessions providing medical care to the passengers and about 50 crew members, with the reimbursement being free passage for myself and my wife. The main difficulty was trying to find enough time off from my hospital’s ED schedule so as not to disrupt the schedule too much for the rest of the group. The other issue and expense was obtaining malpractice coverage, as this was not provided, and required considerable effort.

Over the years our expeditions ranged from the South Pacific, where islanders rowed out to greet us, to the Amazon River, where villegers gave us a similarly warm welcome. Other destinations included Antarctica, with its unequalled scenery of ice, water and sky, the coast of Norway, the smaller islands and remote coast around Great Britain and the various islands of the Mediterranean. Overall, no doubt these were beautiful cruises and destinations.

However, I was the Ship’s doctor and the first thing one learns on such a small ship is that anonymity is impossible. The ship’s doctor is often involved in providing medical consultations, usually at the dinner table, about ailments in the passengers, friends and relatives. Part of my non-medical duties aboard the ship included hosting a dinner table every evening, and at times being the truce mediator as marital and political arguments erupted. On such a small ship and longer voyages, all get to know each other quite well – at times too well.

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Medical duties included treating the usual viral, respiratory and heat skin infections, cuts and bruises, as well as the prevalent sea-sickness. This was a small ship without stabilizers, and on the open ocean the vessel felt like a cork bobbing on the water. When the seas become rough, I kept a fanny pack strapped to my waist that was stocked with anti-nauseants, from oral to rectal to parenteral, depending on how sick the passenger was, and went from cabin to cabin. With the waves came the injuries from falls, as passengers tried to get through shifting doorways and walk down stairs while being tossed about. Thankfully, my stomach is quite sea-worthy, but I have heard of ship’s physicians who were more seasick than their passengers.

The challenges and worries occurred with the sicker cases and their disposition in remote locations. There was the crew member who fell from one deck to another, leaving him in a semi-comatose state with a large scalp laceration. Was this his alcohol intoxication or a surgical intracranial injury, and should one request the ship to turn around with major disruption for the captain and passengers? There were atypical chest pains. After one figures out how to use the EKG machine, the EKG is invariably not totally normal, and again critical decisions have to be made as to whether this is ischemia or indigestion from the excessive food. There were the displaced fractures with debate as to whether to reduce now, even without X-rays, or wait for the next medical facility. There were vague abdominal pains that one observes and hopes are not localized to the right lower quadrant. Decisions have to be made based on the location of the ship and condition of the patient. An additional decision point is whether the resources at the next medical facility are even more limited than the capabilities on the ship. As mentioned before, there is the major decision of re-directing the ship. Then, once in a larger port, one has the unpleasant task of insisting that a passenger and spouse or family end their cruise to be evacuated for such a medical emergency. These passengers paid dearly for the cruise, and did not want to leave, irrespective as to how ill they were. These situations, until resolved – which could take days – caused me a few sleepless nights.

Then there were the hours spent in the infirmary, counting and sorting medications and supplies, completing the next supply order (I did not have a nurse), filling out the Infectious Disease Forms if too many passengers had diarrhea, showing the port inspectors the medical facility, and attending crew staff meetings, most having little to do with medicine.

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Cruise Ship in bay of island of Rapa Iti, in Austral Islands of French Polynesia in the South Pacific. 

But all the while, there were unique destinations and the beautiful scenery that one sees from a ship. Slowly approaching a country and town by sea is so much more romantic than landing on an airport runway. There were the local and friendly people who rarely see tourists. There was the grandeur of the open ocean and the waves, the sense of isolation and awe, when the small ship is the only sign of civilization. There was the experience of working in a different and at times challenging environment, rather than the usual ED, with a large hospital and facilities as support. Then finally there were the passengers, all intriguing in their own way, some of whom have become life-long friends. Again, I must say that my involvement was on a small expedition type vessel for short periods. This experience may well be different from larger vessels, different itineraries, and longer time spans or for career ship’s physicians.

Was this a holiday? It depends on one’s definition of a holiday. It is not sitting on beach in total relaxation, with no responsibilities. If one’s definition of a holiday is relief work in Haiti, then such a ship’s position may well be. As a final question, am I glad I did this? The answer is a resounding “yes.”