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The Good, The Bad, and the Ugly of Cruise Ship Medicine

Richard A.(Rick) Fort, MD

!Hola!

I am just back from a month serving as a cruise ship physician. It is always a nice change of pace, sailing to the tropics and visiting an exotic foreign land. But after a month I’m happy to be home again.

As more cruise ships are being built this adventuresome opportunity for physicians trained in Emergency medicine, family practice, or general internal medicine with extensive emergency department experience is increasing. It’s an inexpensive way to see the world, but it is not exactly a paid vacation!

On most cruise lines you will be provided round trip airfare to the ships port. You will receive a small remuneration of between $50 - 100 per day while on board the ship. Your spouse or significant other may accompany you aboard the ship and stay with you in the small "doctors" cabin. You both may eat either in the passenger dining room or in the crew’s mess as you desire. But the cuisine in the passenger’s dining room is superior. Many cruise destinations have scuba diving trips or shore excursions that you and your spouse may sometimes participate in, although the physician generally must be within 30 minutes of the ship, so you cannot go on distant excursions. However, your spouse can avail themselves of these opportunities. Water sports activities, like sailboats, kayaks, windsurfing, waterskiing are available if the passengers are not using them. Touring the local coastline on the ship’s zodiacs is also fun. All the ships have small to medium sized pools, hottubs, and exercise rooms which can be used on an as available basis. The cruise ships have satellite pickups for CNN and play recent run movies. The large ships have large entertainment productions nightly and discos. The smaller ships have a couple of musicians with a small lounge. Sometimes the best part is just finding a quiet spot just to read, soak up the sun or gaze at the stars as the sea rolls by, or lying in a hammock under a palm tree on the beach.

As the ships physician, you hold clinic morning and evening for three to four hours total each day. After regular scheduled clinic hours you carry a radio and may get called a number of times during the week with after-hours passenger medical problems which you will need to attend to and so must always be within 30 minutes response time to the ship.

On the larger ships there are three permanent staff nurses who take care of most of the administrative duties. They have the equivalent of small ICU’s, 3-4 hospital beds, x-ray and laboratory capabilities and thrombolycitics for MI’s.

The smaller ships have essentially a small clinic, no x-ray or laboratory capability save dip stick urinalysis and a glucometer. You have a monitor defibrilator which doubles as your 12 lead EKG machine. On the smaller ships you will have a number of administrative duties including keeping a running inventory of medical supplies and reordering each month. You autoclave surgical instruments, do daily checks of the defribulitor and bimonthly refresh the batteries. Weekly you inspect and restock first aid kits around the ship, complete documentation on all patients seen, accidents, diarrhea cases, and the weekly controlled substances count. Diarrhea cases are tracked very closely and generate extra paperwork.

Crew and passenger accidents occur often and in addition to caring for the injuries require a three page report, telexes to the company risk management office, notifying the hotel manager and the Captain and sometimes arranging transfer os passenger to shore medical facility. . Crew lifeboat drills along with various training including firefighting, operating fire and watertight doors or man overboard drill occur weekly. On small ships you give the immunizations, place PPDs on all crew, perform drug and alcohol random analysis, give all IM injections, start IVs, give nebulization treatments and train the crew on the medical response team. In the event of a trauma or medical code most of your assistance comes from the sports team..

Some of the most difficult medical problems I have seen are the ones passengers had before they came aboard. These passenger develop a medical problem a week or two before the cruise and come anyway, because they know medical care is available on board. Of course, they were seeing a specialist before they left who had an armamentorium of diagnostic capabilities and you are left with history and physical exams! Your drug formulary on board is limited and you frequently don’t have the same medicine they lost or forgot to pack. Supplies of reordered medications are supposed to arrive in a month but in some more isolated places may take 3-4 months. You frequently need to buy medicines for the ship at the local foreign pharmacy which, if they don’t speak english, can be almost comical!

On cruises in Europe or Alaska you are generally only a day from a port where good medical support is available at ashore hospitals. On the more remote cruises shore side medical care can be very poor to nonexistent and doing an emergency disembarkment of a passenger with serious illness or injury to a large city or stateside can be complicated and protracted. You may find yourself on a hot isolated beach intubating a passenger who has fractured their neck while body surfing, bagging them for 4 hours while waiting on an ambulance to a small airstrip to airevac the patient to one of the larger central american city hospitals.

On the larger ships passengers are generally older and because there are more passenger and crew you will see more patients daily in the clinic and after hours, but you have a pretty good ICU, Lab and x-ray capability and a nursing staff. On the smaller ships, the passengers are generally younger with fewer passengers and crew to care for. But when something serious does happen, It is just you and your limited supplies and equipment to stabilize them for the hours or days needed to get them to a good ashore hospital.

I have served cruise ships from Alaska to Tahiti and from Costa Rica to the Mediterrean Sea. My spouse and I have seen whales, dolphins, sailfish, and sea turtles in the open ocean. Although the cruises are not stress free, all things considered, we feel the sea beckoning us again next year.

 


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