Doctor turns tide of illness at sea

A sick passenger on a Caribbean cruise discovers that its medical team can dispense more than aspirin.

By SI LIBERMAN
Published February 6, 2005

The cruise ship doctor's bill was $1,328. It was a fantastic bargain, though, because the physician may have saved my wife's life.

Dorothy, a vitamin junkie and exercise-prone health nut who rarely got sick, last year mysteriously had developed high blood pressure, a chronic urge to cough, a rapid pulse and occasional palpitations. Medications didn't help, so she stopped taking them.

Also tossing aside her internist's recommendation that we postpone or cancel our 12-day Caribbean cruise on the Crystal Harmony , she declared, "I'm all packed, and we're going."

And so we did.

What a mistake, we soon found ourselves admitting. The palpitations had become more frequent, walking short distances caused her a shortness of breath and she had no appetite. Worst of all, my wife couldn't sleep lying down without experiencing severe stomach pains, palpitations and labored breathing.

Seven days into the cruise, Dorothy reluctantly agreed to see the ship's doctor.

A blood pressure reading, chest X-ray, electrocardiogram and blood test, all done within the ship's three-room infirmary with a nurse's help, indicated that there was fluid in Dorothy's lungs, apparently resulting from hypertension and an irregular heartbeat.

Dr. Yves Kercoff, a Swedish-born physician with a studious demeanor who looked older than his 56 years, offered three options:

"We can try electric shock, an intravenous injection with a beta blocker or you can take Coumadin, an anticoagulant that might take several weeks to produce any results. Intravenous and electric shock could bring your blood pressure and pulse rate down right away."

"If she were your wife, what treatment would you favor?" I asked.

"Intravenous" Kercoff replied. "It generally works 80 percent of the time, but there's no guarantee."

That's the route Dorothy took.

After nearly three hours in a hospital-type bed with an IV needle delivering medication, and hooked to an oxygen tank to facilitate breathing, her blood pressure and pulse rate dropped into the normal range.

And it has remained there, aided by three medications the doctor gave her: a beta blocker, a diuretic and potassium pills.

"You're lucky you had a good doctor on that ship," Dorothy's internist back home observed after examining her and studying a detailed account of the treatment sent by Kercoff.

The American College of Emergency Physicians has recommended specific guidelines for cruise ship medical care, facilities and medicines to have handy, but there are no enforceable standards. Most ships have an infirmary staffed by an English-speaking doctor and one or two licensed nurses. They are expected to be on call 24 hours a day.

As for a ship doctor's credentials, the emergency physicians group recommends that he or she have an active practice with at least three years of postgraduate clinical experience in general and emergency medicine or certification in emergency medicine, family practice or internal medicine.

Kercoff, we learned, had received his medical training in Sweden and France and is a staff member of the 800-bed Norrland University Hospital in Umea, Sweden, assigned to the intensive care unit.

He began doing contract work on cruise ships in 1990, he told us, usually working two or three months at a time.

It's a change of pace, Kercoff explained, because it involves just three or four hours a day seeing patients, though he is always on call for emergencies. The cruise work also takes him to different - warmer - places during Sweden's winters, which he said are long, dark and bitterly cold.

Common colds and nausea are the most frequent passenger ills he has handled. However, twice he has performed emergency appendectomies at sea. And occasionally he has had to arrange the transfer of a gravely ill passenger to a hospital.

"Once, off China, I attended an elderly man who was having a heart attack, then had him taken to a hospital in Beijing," Kercoff recalled. "The man received excellent care there and survived."

Though he most frequently dispenses Primperan to relieve nausea and seasickness, he said, "We have access to about 400 drugs and extensive facilities on this ship. In difficult cases, I can call experts anywhere in the world to get advice or help."

His shipboard consultation fee was $56. Special tests, treatments and medications are extra, and, as we learned, are not covered by Medicare or by some health insurance companies if administered outside the United States.

Freelance writer Si Liberman and his wife split their time between Palm Beach and Interlaken, N.J.

[Last modified February 4, 2005, 11:03:08]