To work while traveling has always been one of my dreams. I never imagined that the way I would actually manifest this dream would be as a cruise doctor. I had recently returned from a one week contract with Carnival Cruise Lines to help cover their physicians so that they could attend an annual medical conference on maritime medicine.
The trip began from New York to San Juan, Puerto Rico. I got aboard the ship as many passengers were about to leave there the ship after completing their 7 days cruise. This ship began in San Juan and cruised the Western Caribbean and had multiple stops including Saint Lucia, Dominica, Saint Thomas, Antigua, and Barbados. I was joined by another physician from San Francisco and we had a staff of 3 nurses, who ironically were all from South Africa.
The role of the physician is to not only take care of the passengers during emergencies, but we were also the primary care physicians for the crew members, who were from all over the world and had all sorts of medical problems. This made creating a differential diagnosis tricking since you had to consider the origin of where they grew as part of the possible etiology for their illness.
The patients were relatively straightforward and the other physician and I would alternate days in the clinic and we would see approximately 10-15 patients per day, over a 7 hour work day. The nurses saw many patients on their own and could make the decision to treat without seeing the physician. This was much more liberal than one sees when practicing in the United States, however, I must admit that it was a model that I could appreciate considering how busy physicians are.
My first clinic day was interesting to say the least when the nurse answered the phone and indicated that the captain would like to speak to me. I picked the phone and the captain mentioned in his Italian accent that his son was complaining of abdominal pain. I immediately asked him to bring him down. He came within 5 minutes with his wife and child, who both only spoke Italian. I was relieved to see that he did not look terribly sick and after the history and exam, I was able to diagnose him with strep throat. I thought back to my combined internal medicine and pediatric residency, where I would make this diagnosis routinely in the pediatric emergency department at Rainbow Babies Children’s Hospital in Cleveland, Ohio.
There were many interesting patients and one who I almost had to airlift via the Coast Guard off the ship back to Puerto Rico, which placed a burden on my mind since the family did not purchase travel insurance and would have to pay the $8,000 Coast Guard travel fee on their own, in any case, the patient was fine the following day and she did not require any emergent transportation. However, the really interesting thing about such a trip is that you have full continuity of care with the crew members that may last as long as you stay on the ships and they remain employees of the cruise line and in regards to the passengers, you had a transient continuity of care in which you became their primary care physicians for one week only, however, I found myself routinely running into the patients on the cruise ship as I walked along the ship.
So in the end, I was off 3 days, worked 3 days and was able to see parts of Saint Thomas, Antigua and Barbados, yet I was not really on vacation. It was a great opportunity and I look forward to doing more often during my vacation time. I since have learned about many other opportunities to work as a medical doctor for other Cruise Lines, even one that sails out of Antartica.
