'I can't believe you were a ship's surgeon!' The comment came from an old friend on reading one of my articles on COVID-19. The implication, perhaps, was that I had moved from uncreative to creative writing so, as I'm sure you are beginning to tire of my preaching about this awful cause of your and my confinement, here's the story. We have to go back a bit, to 1968.
Times were hard in those days. I had, after six different jobs and three house moves, achieved the top rank in junior doctoring, a senior registrar post in cardiology, together with a salary of almost £2,000 per annum. Taxes took most of it and a mortgage the rest. My rota involved on-call alternate nights and it was usual to be called in, as I was one of very few in Liverpool who knew how to fix pacemakers into people’s hearts at the time. One night recently I had found myself walking home at 2am from the hospital when someone had stolen my poor old Mini from the car park so we, my pregnant wife, infant child and I, were car-less too. On our evenings off we junior doctors frequently did surgeries for general practitioners at £10 a shot to make ends meet. Yes, times were hard, and the bank manager had started to ask about our overdraft.
We did get four weeks holiday each year and it was usual to spend part of that time doing locums as well. Some of my surgical colleagues had told of using leave to work as ships' surgeons. At the time I was trying desperately to finish off my research for a doctorate as well as fulfil my clinical commitments. It happened that only one other group of researchers in the world was doing similar research, in Montreal. There was a regular two-weekly passenger service by Canadian Pacific from Liverpool to Montreal, via Port Glasgow. This was before study leave was introduced so it occurred that I could use holiday leave for a meeting with Canadian colleagues, and also earn some extra cash. I managed to contact the regular ship's surgeon and arranged to cover his next trip as a locum.
The salary was a princely £100 to look after the crew for the 12 days, and I could also charge £1 or $2.50 per consultation with passengers. But there were problems, mostly relating to the fact that I was not a surgeon and might have difficulty with appendicitis mid-Atlantic. However, I was told, there's always a surgeon or two on board as a passenger who will help out. So off I went up the gangway wearing my uniform, borrowed from the regular doctor. The three gold rings were impressive, only the red background distinguishing me from the Chief Officer and Chief Engineer, but it was at least three sizes too big round the waist for me. I went through the passenger list and the only surgeon was an 80-year old eye specialist, with no other medical doctors. I received my bar allowance, substantially greater than my salary, but was told it was to entertain the passengers, and I was allocated a table to preside over in the first class dining room.
The medical staff of the ship comprised a nurse, a dresser who ran the sick bay and knew how everything worked, and me. Unfortunately, on arrival in the sick bay I found they had also taken leave and their substitutes were an elderly nursing sister whom I knew to be nice but rather scatty and a third-year medical student. We were all complete novices and the fate of several hundred passengers and crew depended on our skills. We discovered an x-ray machine and I decided to try it out by taking a film of the student's hand. I switched it on and 'Flash, Bang!'. I'd blown the tube. The long-suffering Chief Engineer explained the difference between AC and DC to me and the Captain arranged for a new tube to be made available when we reached Port Glasgow. Even so, we never managed to get it to work properly.
As we sailed out into the Atlantic the ship began to roll and, not being susceptible to sea sickness myself, I quickly learnt the benefits of this as we charged the standard consultation fee for the injection and this came to me. It was to be the only time in my life when I charged a patient for my services, but it was very welcome at the time. We ate very well in first class, way above my station, but the three rings gave me an air of authority and passengers would ask me nautical questions. The easiest related to directions on board, since whichever way you sent them, they would eventually reach their destination if they were on the right deck.
The outbound journey caused no medical problems other than minor stomach complaints and hangovers. I was caused some anxiety when I was told that should an American passenger die, I would be required to embalm the body, and I was shown an instruction booklet, but fortunately this didn't happen. And, most importantly, nobody got appendicitis. We reached Quebec then Montreal, where I met my Canadian colleagues who wondered who this strange Brit in an oversized sailor suit was doing there. I told them and we discussed matters relating to the distribution of blood in the lungs. I found that they, like my colleagues and me in Liverpool, tended to have their discussions over a beer at the end of the working day.
Back on board, things had changed. Some of the crew had misbehaved and been thrown into jail or come back severely drunk, enraging the Captain. Others had acquired nasty diseases that required my medical attention. The weather became rough as we left the St Lawrence and headed for home. After one day at sea, you were on your own until within reach of the British Isles, so there were three to four days when the passengers were at risk from an inexperienced surgeon. Luck was on my side. Not only was there plenty of income from sea sickness but also the serious problems fell within my competence. I told you that I was not a surgeon but was, at that time, a cardiologist. I had also some experience of orthopaedics as a house surgeon and thank goodness for that.
My first problem was an elderly lady who had got up in the night and fallen from the top bunk, breaking her wrist and dislocating her elbow. I filled a syringe with anaesthetic, put the needle into her good arm and instructed the student to inject it very slowly. As she fell asleep, I pulled the elbow back into place and then set her wrist and plastered it. It was something I had done several times before and both the student and patient were impressed. I told them about the Irishman, Dr Abraham Colles, after whom her fracture was named. Medical history was my hobby. The patient went off to her cabin with a sling.
My next patient was more difficult. He was overweight and had drunk a bit too much and fallen heavily, fracturing his ankle. It was quite rough, and the Captain kindly steered the ship into the wind to make the operation easier. The patient had another classical fracture, this time of the two ankle bones, named after a famous London surgeon, Dr Pott. I knew a lot about Pott and had seen colleagues set this fracture, but never been trusted to do it myself before. Again, the student gave the anaesthetic and I pulled the broken bones into shape and plastered his lower leg, sending him off with the nurse and a pair of crutches when he woke up. The student got a lecture on Percivall Pott, who had been the first person to describe a cause of cancer back in the 18th century, when he saw a chimney sweep with a tumour of his scrotum caused by soot.
My last emergency was a very wealthy businessman who sat at my table and on the penultimate night woke suddenly short of breath. He had acute heart failure, right in my specialty, and I had the drugs to treat him. He recovered quite well over the final day of the voyage. He asked me to send him my bill, but I declined as I quite liked him and had no idea anyway how much to charge. Nor did I charge the two injured patients as I was informed that they might otherwise sue the company for causing them to fall.
While these dramas were unfolding, I kept being asked to see patients with fever, and realised that we were importing the current influenza epidemic into the UK. This required the port authorities to be informed and they boarded us when we arrived, but there was nothing one could do as this was before vaccines were available, and the epidemic took hold across Europe. The two fracture patients went to the orthopaedic clinic and found their fractures were well positioned; a few crew members went to what we called the special clinic, a euphemism for the places they treated those nasty diseases, to be checked out. And a few days later a Rolls Royce arrived at my small house and a chauffeur gave a large parcel to my wife. She rang me excitedly in the hospital and when I got home, we opened it; it was a huge Stilton cheese from the cardiac patient! A kind gesture but I wished then that I had charged him. It was to be another 15 years and four more jobs and house moves before I got rid of my overdraft.
Those of you considering a cruise will be happy to know that ships' doctors nowadays are expected to have appropriate qualifications, so you only have sea sickness, Norovirus, and now COVID-19 to worry about.