In general, I worked harder than I anticipated on the voyage. And, as is often the case when hard work is involved, the whole experience was professionally more satisfying than I had anticipated as well. It was very much like being a doctor in a small town (if the small town was floating around the world). It made me realize how portable my skills are and how much I miss creativity in my daily practice - not to say opportunities don’t exist but in my resource-rich setting, there’s rarely an opportunity to manage my own fractures, map out an influenza outbreak or use electrician’s shears (this last one is probably a good thing).
Emily and I saw over 1300 patient visits from January 2 through April 21. During our final stretch of water from Morocco to Amsterdam we thought (hoped) we had seen it all but the night of the fancy Alumni Ball (only two days to go!) had a few more surprises in store. All of the injuries / illnesses were festivity-related.
It was past eleven and I had just (finally) laid down when there was frantic knocking on the door. Geoff got up and was about to go through his usual recitation of “clinic hours are tomorrow from 8-9am. If you think it’s an emergency, please call the front desk” when our daughter burst in: “XYZ [one of the ship kids, child of a faculty / staff member] was up dancing on deck 9 and now is having an allergic reaction!!!” As she was getting the sentence out, my pager went off and the phone began to ring. Guess it was time to get up.
I dashed down the hall (without appropriately supportive undergarments on and with a gang of concerned ship kids in tow) to XYZ’s room where she sat with her attentive parents, her face a perfect swollen circle, snot pouring from her nose and a lovely pink raised ITCHY rash all over. She said her mouth and tongue felt weird and had obvious voice changes. She had taken two Benadryl already and I hoped I sounded calm when I suggested that now was the time to use the Epipen (she and I were each holding one in our hands — though she had a nut allergy, she had never had to use hers before nor has Geoff who has a shellfish allergy and whose Epipen I had grabbed on the way out of my cabin).
Through tears, she dutifully said she couldn’t give herself the Epipen because she was supposed to go the hospital immediately after using it and there was no hospital nearby (this was indeed true since we were in the North Atlantic with France several hundred miles due east). I overrode that explaining that on this ship, clinic = hospital and it was right downstairs and we were doing epi NOW. I gave her the choice whether to give it herself or have me do it. She chose the latter. The needle was still in her thigh when she stopped crying and kind of smiled and said “That was not bad at all. What was I afraid of? I’ll do it next time.” Please don’t let there be a next time.
We moved down to clinic and Joyce was already up, starting to tend to a voyager with a bonk to the side of the face (that’s what the call to my cabin and page were about, not the allergic reaction but the timing was perfect).
Our nut-allergic voyager responded pretty quickly with a decrease in itching and resolution of her throat symptoms; her vitals remained stable. I gave her a dose of oral steroids and H2 blocker (mixed evidence on UpToDate (also thank goodness in general for UpToDate) but likely more helpful than harmful). Epi is the key remedy in any anaphylactic reaction and I was prepared to give another dose but thankfully I did not need to as she remained stable. We ran through her evening in reverse and figured out that the special ice cream cake she had eaten at the fancy dinner had indeed contained walnuts. She eventually fell asleep in clinic with her parents draped around her and only woke periodically for vitals checks.
The patient with the bonk to the face had also been dancing (vigorously I guess) and got a fellow student’s hard head to her general eye area. She did not seem to be concussed or have eye symptoms (except a subconjunctival hemorrhage) and she went back to her cabin with a heads-up that she’d have a beautiful shiner by the next day (she did).
While I was monitoring my post-anaphylaxis patient, yet another student hopped in to clinic with a friend on either shoulder. She had been wearing super high platform heals, dancing piggy back on her friend while he danced (there are lots of things wrong with this sentence) and fell off backwards spraining and possibly breaking her ankle. It was already bruised and oddly misshapen. With her inability to bear weight and tenderness at the inferior aspect of the lateral malleolus, she definitely warranted an X-ray (thank you Ottawa ankle rules) but no harm in waiting until morning considering the fact that it was 2am and we were close to… nothing in the way of additional care. She crutched up to her cabin, wrapped, iced, with plans to elevate until morning clinic. (The X-rays were negative the next day so we continued conservative care, made the crutches officially hers for her upcoming travels in Europe, with advice to follow up for re-imaging along the way if her pain was not resolving and function was not improving.)
We had probably a dozen more clinic visits in those final days (including someone squeaking in one more allergy shot who promptly fainted in the hallway waiting area — I was briefly alarmed that we were running a last minute anaphylaxis special but she did not head in that direction, perking up after a few minutes.)
We prepared for final disembarkation and as I handed off my pager the final morning and stepped on to the gangway, I sighed a deep breath of relief and gratitude.