Cruise Ship Doctors

You’re on a 3-week cruise somewhere in the South Pacific and you suddenly suffer an acute appendicitis. They take you to the ship’s doctor and he confirms your appendix is infected and is likely to burst within 24 hours.

I assume that normally they would try to get you off the ship as quickly as possible, but you are at least few days from the nearest port and sending a helicopter to pick you up really isn’t an option.

Is a ship’s doctor normally trained, and is the ship equipped, to do minor abdominal surgeries such as an appendectomy? We’re talking about a normal cruise ship, not the biggest nor smallest one.

I don’t think an appendectomy is considered “minor” when it comes to shipboard surgery. This site pretty much covers the basics when it comes to being sick at sea.

According to that link, "The staff will be able to perform advanced life support practices, emergency cardiovascular care and minor surgical procedures. " Would an appendectomy be considered a “minor surgical procedure”? An if it’s not, what is?

Good luck, chum.

:smiley:

I would imagine, minor surgery is going to consist of draining an abscess or suturing up a bad cut, something you would see a walk in medical clinic or typical hospital ER do without forwarding to a surgical team.

So my question stands. You suffer an acute appendicitis in the middle of the South Pacific and evacuation really isn’t an option. The ship’s medical staff gives you pain meds and antibiotics and watches you die? Isn’t there something they can do to stabilize you until they reach a port with a hospital? We’re not talking about open heart surgery here.

Given the size of modern cruise ships the chances of someone getting serious ill and requiring abdominal surgery isn’t all that unlikely.

Will you be cruising to Alaska?

In your other thread, someone pointed out that appendicitis can take days or weeks before it’s critical. Assuming that’s correct, the cruise ship would likely reach port somewhere before the situation became dire.

But given the routes of modern cruise ships, the question isn’t likely to come up. The catch is that most cruise ships actually stay rather close to civilization. Take a look at this itinerary for a South Pacific cruise:

http://www.pgcruises.com/destinations/itineraries/society-islands-cook-islands-tonga-fiji-13-night-cruise/itineraries

There are only 3 days spent at sea - passage between Bora Bora and the Cook Islands (about 1,000 km or 600 mi), passage between the Cook Islands and Tonga (about 1,500 km or 900 mi), and passage between Tonga and Fiji (about 800 km or 500 mi.)

That is the extreme - very few cruise ships actually ply routes that far from civilization. If they can stabilize you for half that time (turning the ship around if they need to), they’ve got you in a place where helicopters can reach you - you’re never more than 12 or 14 hrs or so from a port, helicopter, and airport. So even if you are likely to need emergency surgery, most cruise ships don’t ply routes that will put you in that position.
Now say for some reason, you are in that situation - say someone has decided to sail a cruise ship on some long-distance route (it probably won’t be very popular with passengers, since most (but not all) tourists like to be able to pull into an exotic port by lunchtime, not sail day after day at sea.
I’m not a doctor, but I suspect that if it were impossible to get the boat or yourself into a place where emergency medical attention was available, they would do the best they could with whatever tools there are on hand. Part of wilderness medicine is improvisation - and they’ll do what they can - even surgery - if the situation is life-threatening and there are no other alternatives.

Fair enough. It must not be an issue since people take these cruises every day and other than heart attacks most people who get sick live long enough to reach a port with a hospital.

I was thinking about my parents who took a cruise from Hawaii to Tahiti, which is over 2600 miles. I don’t know what’s in between those two sets of islands, but getting a helicopter to a cruise ship that is half way in between can’t be easy.

Actually heavy doses of antibiotics can sometimes resolve an appendicitis without cutting, just depends how far along it is. I am nowhere near well enough versed in surgical stuff (I was an EMT). We would need someone more surgery savvy as to options for surgical anesthesia with a limited pharmacy and or surgical team. I don’t see it as unassailable for a confident MD who has even minimal surgical experience, but I can see them not wanting to unless all other options were exhausted.

I’ve seen enough Love Boat episodes to know that a visit to the ship’s doctor can quickly turn uncomfortable. I’ll take my chances with the appendix.

Top speeds for many cruise ships are in the range of 20-30 knots and they run 24 hours a day. At the halfway point 1300 miles assuming a top speed of 25knots, they should be in helicopter range in around 40 hours assuming something like A USCG MH-60 Jayhawk flying out to meet them.

Granted at that speed the rest of the passengers are NOT going to be happy.

A friend of mine, a doc I used to work with, became a cruise ship physician, and she told me about a few things she did.

First, as to appendectomies: she definitely did not want to do them aboard. Minor surgery means incision and drainage of boils, repair of lacerations and maybe a tendon or two, and perhaps an emergency thrombectomy on a hemorrhoid. Entering the abdominal cavity is not minor, and shouldn’t be done outside of a licensed surgical center.

Secondly, a ton of geriatric care, as a whole lot of the elderly set went on the cruise and either skipped or lost their maintenance meds and blew off their diets and ended up in acute CHF, decompensated COPD, diabetic ketoacidosis, etc.

Emergencies were air-lifted out whenever possible. She’d stabilize a patient as much as she could, and even intubated one chronic lunger who couldn’t keep his oxygen levels up on his, own, managing his ventilator for a few days, before the Chilean Navy could evacuate him.

ETA: A suspected appendectomy will be evacuated as soon as possible. Medical management would be a harm reduction measure until that could be done. And a bold primary car doc *might]/i] be willing to enter an abdomen to do an emergency appy if there was no medflight rescue in sight, but most would think about it long and deeply before doing so. I sure would.

I would assume that if the choice were to remove the appendix or the patient will probably die they would be able to take it out but that would be only the most extreme circumstances.

And, just to be clear, the absolute need for surgery in uncomplicated appendicitis may, in fact, not be absolute.

My cousin is, right now, on a cruise that left Vancouver. Next port of call is in Russia, after seven days at sea. (I thought they were going up the Inside Passage to Alaska, but apparently not.)

So evidently some cruises have extended times at sea.

A part of the general answer here is that on a cruise ship you are further in distance and time from high-tech medicine than many first-world people are when at home - which implies a somewhat higher risk that certain medical conditions will have a bad outcome.

Anaesthesia is no small matter, surgery isn’t just cutting. Even if an anaesthesiologist happens to be on the cruise, I doubt all the necessary equipment and cocktail of drugs to put a person under and keep then alive is just sitting in the medicine cabinet.

No, it’s in the bar. :smiley: