sophiejane said:
Cruise ship doctor might be fun once things in rural medicine get boring...
On that note, I just ran across this article on that subject from NYTimes.com:
April 11, 2006
The Doctor's World
Doctor of the Deep: The Challenges of Shipboard Medicine
By LAWRENCE K. ALTMAN, M.D.
ABOARD THE ZUIDERDAM, in the Caribbean As a cruise ship physician, Dr. Gary Razon's most harrowing moments are when passengers and crew become injured or seriously ill hundreds of miles from shore.
Sudden life-threatening emergencies like internal bleeding, heart attacks, strokes and broken bones can leave little, if any, time to divert a ship to the nearest port. The challenge for a ship's doctor is to stabilize a patient until the ship reaches land.
Not long ago, untrained crew members aboard passenger-carrying freighters followed radioed instructions while doubling as ship doctors in responding to medical emergencies. Now, with the growth of the cruise ship industry, many ships have staff doctors and nurses aboard who work in well-equipped infirmaries.
Through the Internet, the doctors have access to telemedicine to send difficult-to-interpret electrocardiograms and X-rays, and they can consult specialists about problems that occur aboard the ships, which often carry more than 2,400 people. But the doctors do not perform surgery.
In extreme emergencies, helicopters transfer patients to hospitals on land. But with no helicopter pads on most cruise liners, such transfers "are quite hairy and downright dangerous," said Dr. Razon, who has conducted five such transfers in his three and a half years as a ship's doctor for Holland America.
A helicopter may have to hover over the bow of a vessel pitching in high seas and buffet stiff winds, while parajumpers lift a sick passenger into the craft, said Dr. Razon, who is certified in two specialties pediatrics and emergency medicine in the Philippines.
In the infirmary, Dr. Razon, 43, recalled some cases, amusing and serious.
One man nearly bled to death from a common bowel disorder, diverticulitis, on a run from San Diego to Hawaii last year. The man suddenly became anemic from a loss of red blood cells, his blood pressure fell and his heart rate quickened.
"We got very, very worried for him and we searched for blood donors" while his team injected saline intravenously to stabilize his circulatory system, Dr. Razon said.
From a data bank, he found that the man had an uncommon blood type, A negative, and that only the captain had the same one. Dr. Razon transfused a unit of the captain's blood, and the man's condition improved.
He went to a hospital after the ship docked at Hilo nearly two days later. (If the man had needed more blood aboard ship, Dr. Razon said he would have asked for donations from crew members with O-negative blood, which allows them to be universal donors.)
"That was one of the hairiest cases I ever had," Dr. Razon said.
Two weeks later, when the ship returned to San Diego, the captain happened to look down from the bridge and spot the former passenger claiming his luggage at the terminal. The captain went down to the pier where, according to Dr. Razon, the man said: "I am in the pink now. You saved my life."
While the ship was sailing in 35- to 40-foot seas off the Norwegian coast in 2004, a toolbox fell on an engine room worker's head, splitting his scalp. Dr. Razon was seasick, and each time he threaded a needle in the lurching ship, the suture fell out. It took him an hour and a half to do a 15-minute procedure.
Dr. Razon also checked the man's neurological functions every six hours until an M.R.I. scan could be performed ashore in Norway. It showed no brain damage.
Last year, a woman broke her hip in a storm between Hawaii and the mainland. "A really wide lady came down the steps trying to find a seat in the darkened show lounge when the ship lurched and she fell, landing between a railing and a wall," Dr. Razon said. Summoned to the scene, Dr. Razon found that "she was literally wedged in, screaming in pain."
The show stopped. In a test of the crew's agility and ingenuity, Dr. Razon supervised the eight stewards it took to dislodge the woman and carry her to the infirmary. Dr. Razon said he "was so scared because the ship was bouncing and feared she might be bleeding from the hip fracture."
Two days later, surgeons repaired her hip in a hospital after the ship arrived in Seattle.
During a Mexico run, an elderly man came to the infirmary, desperately seeking Viagra. "Buy some when the ship docks tomorrow," Dr. Razon said he told the man, who replied: "No, you don't understand. I can't wait. I need it now."
Dr. Razon responded: "Sorry, we don't have any."
Some incidents reveal how cruel some people can be, even to their own families.
On a Valentine's Day cruise in 2003, stewards called Dr. Razon in his cabin at 2:30 a.m., asking him to see a screaming woman who was stretched across the floor of a lounge.
"She looked at me through her demented eyes and said she had a rare neck disease and there is nothing bleep bleep you can do about it," Dr. Razon recalled.
Dr. Razon agreed and walked away. But, he said, "the woman got up and chased me, saying, "Wait, wait, you have to listen to me." He did, and she ranted about "a roommate from hell."
Then the crew put her in a vacant cabin to allow others to sleep. The next night, the woman put on a repeat performance.Meanwhile, he said, "We discovered that she had been discharged from an institution, lived alone in California and that her nephews flew her across the United States and left her on her own with us."
Dr. Razon could not reach the nephews. From other calls, he learned that the passenger's mother also was also demented. Her nurse provided the name of the woman's psychiatrist, who was skiing. Dr. Razon could not reach the covering physician and sent the woman to a hospital after the ship docked in Nassau.
On most embarkation days, many passengers come by to seek prescriptions for drugs they left at home and can describe only by their color and shape, not their names. Some passengers call their doctors to solve the problem; for others, the ship's medical staff has to play detective to determine the identity of the drugs.
"Our pharmacy is not a CVS, but does have a representation of every class of medication," he said. He tells passengers that "we can provide replacement for a few days and write a prescription so you can buy your medication at the next port of call."
The ship carries about 7,000 meclizine pills for seasickness. But the supply ran out on a recent charter where a vast majority of passengers were on their first cruise, and many became quite sick, Dr. Razon said. So he had to ask nearby ships for additional pills.
Outbreaks of norovirus, an infectious agent that can spread rapidly, have caused serious problems for cruise ships. On New Year's Eve, Dr. Razon said, he had to deal with 144 cases of illness from norovirus. He stopped it by following Holland America's manual on dealing with such outbreaks, which includes "shutting down many facilities and having a specifically trained team of stewards serve affected cabins."
He said he had never needed to exercise his authority to order the ship to turn back, make an unscheduled stop or overrule a ship's captain because of a medical emergency, though he has sought a captain's support to order a sick passenger to leave ship, when a passenger suffered a heart attack on a Mediterranean cruise, but repeatedly refused to go to a hospital in Athens, saying he preferred to die aboard rather than be treated in a Greek hospital.
"He's got to go," Dr. Razon said he told the captain, who gave the man that message.
The man went to the hospital.
While growing up in the Philippines, Dr. Razon said he was expected to follow his three older brothers into engineering but chose medicine in part because his math skills were not as good as theirs.
He became a ship's doctor after a colleague, who was one, whetted his appetite about the chance to see the world while practicing medicine. Dr. Razon said he had traveled to many areas but with less time ashore than he had expected. Still, Dr. Razon said, "Being a ship's doctor is an offer I cannot refuse."
He is divorced. He earns a salary but does not pay for food, rent, clothing or utilities. He usually works aboard ship for about five months and then has about three months off.
On returning to the Philippines, where he is now, Dr. Razon said, he visits his son, Calvin, 8, and wants to "forget work for a while because being on call 24/7 takes its toll."
But then he takes courses to keep up with new advances and covers other doctors' practices for brief periods to renew his skills in everyday land-based medicine and get ready for the next voyage.