Holy smokes has it been a voyage.
I’m grateful that Emily and I had a moment to get to know each other before things really hit the fan. Sure we had a flu epidemic, sure we had TD and UTIs and a few broken bones, but over the final month of our voyage we had some major challenges and it was great to face these with such a pleasant and competent partner.
We had pyelo and two presumed bacterial pneumonia (pneumoniae?), couple of dog bites (and therefore a couple of rabies series). Then we had several ER visits in South Africa, including a college student who suffered a scaphoid fracture, an orbital fracture, a radial head fracture in Cape Town, presumably the result of a late-night assault (I say presumably because for him the details remained fuzzy). Amazingly these injuries happened the first night of the port and he was able to have surgery on his scaphoid and sail on with us, completing the voyage. Mercifully, Ghana was pretty quiet. Then a couple ER visits in Morocco including a devastating dominant hand injury following a car accident in Casablanca.
The most dramatic medical issue for us on board the ship, however, was a helicopter evacuation off the coast of West Africa. We had a voyager who presented with unilateral facial swelling a few days after Ghana and was diagnosed with bacterial parotitis (we considered mumps, many parts of Africa being places this diagnosis would not be unheard of but in this vaccinated college student with unilateral swelling preceding fever, it was thought highly unlikely). She was not responding after 48 hours of parenteral (IV) antibiotics (with excellent staph coverage including IV vanco as well as good anaerobic coverage - thank you ENT and ID consults back home!). Her left-sided facial mass continued to grow, she continued to be febrile (39.7!) and that morning she started complained of throat symptoms (“like there’s something I have to swallow past”) and was having obvious anterior neck fullness. We became concerned about development of an airway issue and on a clear blue Wednesday morning in April we decided to airlift her off the ship, opting to get her to a facility where she could safely be intubated if need be (we have the capability to intubate on the ship, certainly, but it would bag-masking for hours AND we do not have the tools or expertise for a difficult airway. Also just writing this makes me sweat).
Dr Grace (crew MD, originally from Columbia) and the rest of our medical team agreed and after that, things happened pretty quickly. Grace and I made the call to our captain. Our dean was aware that an issue may be developing and we let her know it was a “go.”
We spent an hour or so on the phone and computer with our insurance and medical evacuation company. I have mixed reviews for this company in general, but in this instance they were able to act fairly quickly to evacuate our voyager and our “medical swing” person and that was pretty amazing (the medical swing position was filled by a lovely psychiatric ARNP, the girlfriend of our voyage librarian, who had signed on pre-voyage to be an extra pair of hands if need be — though it wasn’t clear she knew she had signed on for dangling from a helicopter cable).
While Emily continued the conversation with the insurance company and kept our patient’s family up to date, Dr Grace and I went up to the bridge (this was cool for sure - I have toured the bridge and was up there a few times to watch the ship take off or for a meal in “the Captain’s garden”, but most passengers don’t get to spend much time up here and this was a pretty fascinating meeting).
Captain Kostas (MV World Odyssey’s captain for many years, originally from Greece) had his detailed radar maps up on the computer. We looked around at our options “Western Sahara is directly to our east. We could get there by sea fairly quickly and more quickly still by air, but once you get there…” his voice trailed off. This is a country I had never heard of, much less ever wanted to ask to back us up medically. It quickly became clear to me that we did not want to drop our patient there, we’d much rather keep her on our ship and take our chances than choose option A. So the next closest bits of land to our current position in the eastern Atlantic Ocean, were the Canary Islands, part of the country of Spain. A fancy resort town definitely has good medical care and our medical insurance company was in the process of agreeing as well.
[A quick note about Western Sahara - a web search reveals the following: “Western Sahara is a disputed territory on the northwest coast and in the Maghreb region of North and West Africa, partially controlled by the self-proclaimed Sahrawi Arab Democratic Republic and partially occupied by neighboring Morocco.” When you google “heathcare in Western Sahara” this is the first thing that pops up “Prevention is the key to staying healthy in Morocco.” But I digress, Gran Canaria it was.]
Once we had established the Canary Islands as our evacuation location, Captain worked to get the search and rescue folks to us and we continued to work with the the travel insurance company to get a plan in place for the receiving hospital and to guarantee coverage.
In the meantime, Captain increased our ship speed to get us as close as possible to the Canary Islands. By the time the pick up happened, we were 300 miles due south of the Spanish archipelago.
After another hour or so, we had one final meeting of the team up on the bridge as we planned our final steps for the coming sixty minutes - how we would get our patient up to the top deck, how we would craft the ship-wide announcement to let people know why we were being visited by an aircraft, where we would all be positioned when the helicopter arrived, etc.
As we looked out into the ocean to the north, the radio crackled. Our Ukrainian staff captain Vadym answered the radio and spoke with the dispatch. After a moment of back-and-forth, his brows raised high and he said in his heavily accented English, so the assembled group could hear, “Please repeat, please repeat, you are fifteen minutes out, that’s one-five, one-five.” The Spanish radio operator repeated back to him, also in English, “yes that’s fifteen, one-five, one-five!”
We all looked at each other and may have temporarily lost our cool. We sprint-walked from the bridge and scattered, everyone to their positions. While ship-side did their jobs with precision, we worked to do the same. Our residential life team did crowd control and the rest of the admin team offered moral support (and documented the operations with photos). Meanwhile, I descended the five flights again from bridge to clinic, taking the steps two at a time. Emily, Grace and I and the two clinic nurses had already bundled our patient and we took her back up via elevator from clinic on deck 3 out to deck 9. When we arrived on deck 9, the sound of rotors was becoming stronger. We watched it make its final approach, keeping our ill voyager sheltered and hopefully distracted until the last possible moment.
The helicopter hovered above the ship in a blowing wind, the pilot expertly keeping the craft over the edge of the ninth deck forward area (where people usually do yoga, not get strapped into stretchers). For a few seconds, this call I had made did not seem like a terribly good idea. Thoughts of all that could go wrong in the name of getting one person to a safer spot went flipping through my brain. But these thoughts were replaced by the image of watching over this patient for the night without an ICU in sight.
And this thing was in motion. In less than ten minutes, two paramedics (looking like frogs in their wetsuits and helmets) had lowered themselves onto our ship’s deck, care was transferred and our patient was on her way. This is what I remember:
Bright blue sky and sea with white caps as far as the eye could see.
Strong wind blowing, both natural and from the helicopter’s rotors.
Yelling a brief short-hand medical sign-out to the main paramedic.
Our patient, strapped into the stretcher on deck 9 and carefully raised up into the hovering helicopter with her backpack by her feet and rolled up poster made by her friends waving in the wind (it made it!). In a sweet moment that I didn’t appreciate until I watched the video afterwards, the frogman who was with her, dangling perpendicular to the stretcher, appeared to pat our patient’s forehead on the way up.
The cable was lowered once again, the chopper, hovering incredibly close to the ship.
Alice, our medical swing (lots of puns ensued after the lift about her title), attached and rising with the second frogman, dangling from a simple harness under her arms in her jeans, hoodie and tennis shoes, disappearing into the open door of the chopper.
Firemen (deck or engine guys probably, crew members with big jackets and hard hats) holding thick lines of fire hose on the port side, ready just in case.
A small grey plane circling the ship, came and left with the chopper (spotter? re-fueling? general support in case of the worst? We never found out).
Once Alice our medical swing person was safely in the helicopter, it left swiftly, heading north to the Canary Islands.
There were some high-fives and handshakes; then a formal and several informal debriefs. Then the day went on, remarkably, and we got word after an hour or so that our patient had landed safely in Las Palmas. It was about five hours from the decision to evacuate our patient to her arrival on land. Not like an ambulance to Harborview’s trauma bay from the general Seattle area, but still pretty good.
Our voyager ended up getting the care she needed (and the airway issues we wanted to avoid were thankfully avoided). Remarkably, she rejoined the voyage on the last day of Morocco, our next port and sailed the final week with her SAS community.
Patient lift
This takes “medical swing” to the next level!
