A Medical Adventure at Sea

A Medical Adventure at Sea

An excerpt from "Adventures in Medicine" - Coming Fall 2010:

     Don’t listen to Dr. Milt Waldron. I did not kill the Captain. Everyone knows Milt as a semi-retired orthopedist. Milt is also a physician recruiter for Semester at Sea, teller of tale tales, and part-time stand-up comedian. He often plays doctor lounges near you. Known to stretch his stories on occasion, Milt has gone too far this time implicating that I was the accomplice to the Captain’s mistress. This medical adventure needs little embellishment. It’s not giving the story away to say that the actual cause of death was too much “Zorba” in the Greek Captain. 

     In between his own voyages as the SAS Ship’s Physician, Milt often haunted the ER’s picking up the latest tips from the emergency physicians.  At times, he used these visits to recruit ER Doc’s for the Semester at Sea Voyages. From what I can figure out, he has a de facto, rather than official, title for this. His entertaining slide show on his voyages certainly hooks any qualified physician to wish to do it.  Besides, what is more adventurous, exotic, and challenging than being a ship physician cruising around the world with a boat-load of college students and professors?  The only drawback is the time commitment and loss of income.  So, I signed up after I retired from emergency medicine, taking my wife, Mary, and son, Ryan, as a student for the 2005 Summer Voyage. The staff boarded the beautiful MV Explorer in the Bahamas and became oriented to our roles and positions while cruising to Halifax where the students met the ship. We ultimately visited the following ports for five days: Reyjavik, Bergen, St. Petersburg, Gdansk, Antwerp, LeHavre, Dublin, Bilboa. After steaming back across the Atlantic Ocean, the cruise ended two and months later in Ft. Lauderdale. Milt Waldron went along as my “medical assistant,” to enjoy the voyage primarily as an adult student. It was really a ruse to watch over his wife, Betty, the adult social coordinator, his grandson, Dan, and, of course, me. The fact that the SAS CEO was also on board didn’t make any difference according to him, but I knew Milt did not want any screw-ups.

     A month into the cruise I had earned my ship physician’s sea-legs taking care of the usual stuff like sea-sickness on the rough Atlantic crossing and a few unusual diagnoses like Lyme Disease. Milt had made only a few “suggestions” about my running the medical clinic. I spent several hours in an ER in Iceland trying to expedite x-rays and fractured passengers. Norway was spectacular and uneventful, the beer being too expensive to consume excessively. Having rounded Denmark, we were festively sailing in calm and warm Baltic waters toward Russia on July 4th.  Our Greek Master Captain joined in celebrating the American Holiday on the back deck of the ship. The crew had decorated the area with patriotic flourish intermixed with tables laden with momentous spreads of hot dogs, hamburgers, and potato salad.  To the beat of an impromptu, rag-tag band, the gregarious Captain line-danced with the students waving at everyone as the group snaked through the appreciative crowd and the tables piled with food.  Normally known to be a stern, albeit fair taskmaster, looking after his Number-One Lady, the Ship, he revealed his “Zorba” side that afternoon with dance and frolic. Later, many observers thought he appeared rather “gray around the gills” as he excused himself early to go to his cabin.

     As the campus settled into the ship’s amphitheater a few hours later for the evening entertainment, there was an announcement over the PA system, “Code Blue in the Captain’s Quarters…this is not a drill.”  My first reaction was disbelief.  Then, the message was repeated, prompting the SAS Medical Team to head for the exit. Crewmembers escorted us to the Captain’s quarters.  Pre-resuscitation dread mixed with performance anxiety filled me as I descended the ship’s main staircase to the ship’s officers’ quarters. The door of the Master’s suite was already clogged with the crew’s medical team. Like so many other times at codes during my emergency medicine career, the bystanders parted before me without a word, relieved to place the responsibility on me, the old ER Doc. I doubt Milt will ever admit it, but my old buddy, the orthopedist, a glint of terror in his eyes and sweat flowing off his brow, looked like he could have kissed me at that moment as he kneeled on the floor over the cyanotic Captain doing Basic CPR. In the midst of everything, as usual, he had been alerted directly by the crew’s physician, a psychiatrist, and her code blue team. Both physicians gladly deferred to me as I took over the code, obtained the immediate history, and intubated the Captain. He was an unwitnessed arrest, last seen thirty minutes before, found down…fully clothed…by one of the ship’s receptionists, a fetching twenty-seven Latvian lady, who I later learned was his mistress. His pupils were fixed and dilated. His rhythm on the Life-Pak showed asystole. We worked him for twenty minutes anyway, hoping, quite honestly, for a miracle from Neptune. The Captain should only die when he goes down with the ship. Alas, futility brought clearer reasoning. With the command of the situation came the responsibility to make the decision to stop the attempt of resuscitation. As the minutes passed…fleeting for the code team and dragging by the distraught bystanders, I sensed the ambivalent emotions to stop or not boring down on me. My experience told me from the start that we would not be successful. Our hope demanded a valiant effort. When I asked whether anyone objected to stopping the code, no one did. 

     Even with the death of its Master, it’s not surprising that on such an organized society as MV Explorer, there is an immediate shift to practical matters…like what do you do with his body. No, he wasn’t wrapped up in sheets, placed on a board, and slid off into the sea. There were two, never-used, refrigerated, roll-out morgue lockers at the back of the clinic specifically for this purpose. The ship’s electrical engineer was called upon to figure out how to turn on the cooling system since no one had done it before. He conferred with the medical team on what the temperature setting should be for the next three days until we reached our next port, St. Petersburg. We didn’t think we should freeze him. As this was new territory for all of us, we settled for the same temperature as the ship’s food refrigerators. A select group of the grieving crew gently carried the Captain down the two levels to the back of the medical clinic, manipulating his limp body through its cramped, narrow hallway to the “cooler,” pulled out and ready for service. With a few adjustments here and there, he was placed on the cold metal tray. Gazing at him laid out unceremoniously on a slab of steel, everyone’s head drooped a little. Accompanied by a few mournful sighs, we pushed him into the dark cavern, the tray’s roller bearings whirred like a grand filing cabinet. The locker door was snapped shut with a smart click just as you would expect of its Germanic origins. It wasn’t stated, but I think we all got the “Willys,” none of us being familiar with this part of death protocol. At the same time it certainly seemed to bring closure to the episode. It wasn’t. 

     Even with the Captain’s death, shipboard life seemed to be returning back to normal as we approached Russia. We sailed through a calm Baltic Sea, finally experiencing the first warmth and sun of the cruise. Thoughts turned to life more than death. As in all the cities, the MV Explorer docked early in the morning in St. Petersburg to save a day’s worth of port charges.  Routinely, the ship cleared customs within the hour, and the passengers, then, were allowed off the ship. The process seemed slow that morning, but this was Russia after all. Rarely getting off the ship the first days, I hadn’t really considered the problem until I was summoned to the Officer’s Conference Room to meet the local authorities concerning the Captain’s death. “I’ve got nothing to worry about here,” I thought as I headed up the stairs. “I know I didn’t kill the Captain…I just didn’t resuscitate him…and I don’t think there was really any hanky-panky going on…but there was the issue with the young and beautiful Latvian mistress…he was fully clothed, right…and despite his clean medical records, he probably did smoke, drink, and lived life excessively…nah, I got nothin’ to hide.”

     I may have groaned a stunned, “whoa,” under my breath as I entered the conference room.  Seated at the table was the Latvian beauty handwriting her “confession” while an irate, black t-shirted Russian cop loomed over her, his short-cropped hair pulled forward in a malevolent frown. Four similarly attired, nasty inquisitors stood to my left arguing with the Armani dressed, nouveau-riche, port authority representative.  They noted my entrance with a sneer and motioned me to sit down with Milt and crew physician.  Even Milt looked contrite and, for once, without a good one-liner.   I sat down where indicated.  The next two hours consisted of the nasty thugs acknowledging our presence on occasion by asking a question through the nattily dressed interpreter.  “What caused the Captain’s death?…how does one die at age 59 with no record of medical problems on his records?…did the Latvian woman poison him?” Their minds made up.  They rudely turned their backs on us before we could finish the answer. They didn’t discriminate. They were inconsiderate to everyone. At times the scene was so surreal that I chuckled to myself. I was also wondered whether the new Russia still had Gulag’s for the innocent. I felt sorry for our Latvian Receptionist, who took the brunt of the wrath from the Russian cops, ironic that she was living again the abuse of the past Russian occupation. Unable to get a confession and tired of bullying us pansies, they seemed satisfied that we weren’t a group of conspirators. However, they demanded to see his body to make sure that there wasn’t any “funny business.”  The cops kept watch on us as we filed our way down to the morgue…like who’d want to escape into Russia after this.  We rolled the Captain out of the cooler. He looked just as dead. As the cops gruffly gyrated the poor Captain’s body about looking for bullet holes or stab wounds, they grumbled amongst themselves in probably not the nicest Russian. With their stubby whiskered jaws, buzz “do’s,” and muscle bulging t-shirts, they looked more like grave robbers. Unhappy that they didn’t find a crime, they stomped off without any apologies for our time.

     Later that day, the Captain’s Body was ceremoniously carried down the gangplank by his officers for his final journey.  Dressed in their best uniforms, the crew looked on from the deck, many with tears in their eyes.  When I asked one of the officers what kind of Master he had been, he answered that he had been an excellent, well-respected Master, always fair in his judgments as he looked out for his first love, the MV Explorer. My limited observation was the same. I also think that he lived life to the fullest. Possibly, he had too much “Zorba.”  At his funeral his Greek wife sat in the front row on the right, his Dutch wife sat in the front row on the left, and his Latvian mistress sat in the second row.  I don’t know what side.

coming soon

"Adventures in Medicine"