July 2005

Having finished a number of cruises, things are falling into place a lot more and I feel much more settled.

The medical work has been busy, but also very rewarding. As previously mentioned, one of the junior doctor's main responsibilities is to the crew, as effectively you are 'their' GP.

Most of the crew really appreciates what you do for them as many have not had the ease of accessibility and this standard of medical care before. I even had a carpenter going out of his way to fix something for me as a thank you! However it is important to remember that you are on call for the crew 24/7.

Although most conditions have been minor ailments, there has been a lot of interesting pathology. In the last couple of weeks I have had to refer 11 crew ashore for specialist opinion. These ranged from suspected hernias (which require crew to be debarked), a breast lump that turned out to be an angiolipoma and numerous dental problems. These cases can be a challenge, but you usually have a bit of time to look things up about them in a book or on the internet.

The speed at which cases can be treated is amazing too. From presentation, to seeing a surgeon, to excision and biopsy and result of histopathology, the breast lump case took two weeks in total - not something you would see in the NHS!

As I mentioned last time, learning about life on the ship is a task in itself. I wasn't prepared for the whole array of uniforms that are required for different occasions. I will not bore you with the details of each 'rig' or uniform you have to wear, but let's say that generally it is not me that keeps the ladies waiting when I dress to go out. However on a recent formal night, when I had to wear my mess kit, it was me that made us all late! (see photo of mess kit). I was not sure what button went where and had to rely once again on the ever sage nurses to act as my mother.

Unless you have worked in the military, or done similar jobs on ships, arriving onboard and immediately being a three strip officer is quite overwhelming. If I were to say that you were in the top dozen most important people in your hospital, you'd expect to be the head of your department with tens of years of experience and education to get there. Amazingly, this is what you are as soon as you step aboard. People appreciate your skills and knowledge, which is why you are rewarded with such a high status. But the position is not to be abused or taken lightly.

Also, the crew can hold you with much respect and reverence which one can find daunting or peculiar. As was said in the Spiderman film, "with great power comes great responsibility" (sorry sad film buff!). You therefore have to set an example, but I'll talk more about the responsibilities of a ship's doctor next time.

This cruise has been touring the Eastern Caribbean region visiting ports such as St. Vincent, Grenada, St. Lucia and Martinique. It has been great to have time to visit parts of them on the afternoons I have managed to get off (see photo of me on a bike up hill at St.Vincent with Sun Princess in background).

Using the medical centre bikes has been ideal for getting away from the crowded port and seeing other parts of the islands. Another way to see things in the short amount of time available is to go on an organised tour. The ship organises tours for passengers, and if you volunteer to go as an escort and write up a report of the trip, you can go for free. I managed a snorkel trip in Martinique for an afternoon.

Well I'm off to enjoy a beer in the crew mess now. At least it's tax free and cheaper than in a pub in the UK!