Ticket to Ride
Very few people read the small print on the back of their ticket. It is a little known fact that the captain can refuse passage to any person that they feel is a risk to the smooth operation of the ship. I nearly had to make good on this threat on only one occasion when almost all other means of conflict resolution had failed. Anyone that has met me knows that I am an easy-going and friendly sort of chap. Jim* and his wife challenged that.
We had just set sail from Vancouver on a forty day repositioning cruise at the end of the Alaskan cruise season. Once we left Alaska we were due to sail across the Bering Strait to Vladivostok then down around Japan to Shanghai, where we would disembark our adventurous passengers for their land tours. The average cost for this trip of a lifetime (40 days on board then another 40 or so on land) was around US$45,000 dollars.
It had been a rainy day in Vancouver so the usual warning placards had gone up advising passengers to take care on the slippery deck. Jim’s wife, Marge, was not so cautious. Within hours of setting sail she had slipped and fallen onto her right hip, unable to get up. When we got their it was obvious she had broken her hip – her right leg was shortened and externally rotated and she was in a great deal of pain. The stretcher party was summoned with the scoop stretcher and I put in a quick fascia iliaca block before we moved her onto the trolley and down the 12 decks to the medical centre.
A lot of people are surprised at the level of facilities available on board. The first ship I worked on had a wet X-ray system but these were phased out on the modern ships in favour of a PACS based system. The nurses or doctors would take the X-rays then load the cassettes for processing. They would then be emailed to a radiology department in the US that provided support for us. We would often have a formal report within four hours but we really didn’t need it in this case. Marge had a inter-trochanteric fractured neck of femur and would need a DHS. I’m pretty good at MacGyver medicine but this was stretching beyond even my capabilities. We would have to disembark her to the nearest, most appropriate, facility – Juneau, in two days time.
I set it up. I contacted our port agent and the captain to let them know of the plan. Then I told the passengers. Jim was dumbstruck. I had shown him the X-rays and explained that his wife would need an operation. She was only 56 so it was important that she had it sooner rather than later. He flat out refused to let us disembark his wife. He wanted her to remain, with him and us, on board in the medical centre until it healed (or we got to China, whichever came sooner). For once I was speechless. These were no uneducated hicks. Jim was an accountant and his wife was a retired physiotherapist. No amount of appealing to his common sense was going to budge his thought that they would complete their holiday.
So, in this situation when your opinion and that of the patient are diametrically opposed, what can you do? You can try coercion – threaten them with the full force of the captain, to forcibly disembark them against their will. This would just lead to bad press for the company despite the patient getting the treatment they needed. You could relent, taking the path of let resistance and avoiding conflict and let them stay on board, against your medical advice. Or you could, in the parlance of NLP, “seek first to understand”, and find out the real reason why they did not want to leave the ship. It wasn’t the unlimited food or the blackjack tables or the show-stopping extravaganzas. Jim and Marge did not have travel insurance. They had saved up for this trip for five years and by being disembarked they would lose all the money they had paid for their holiday, around US$90,000. Now I understood why Jim wanted them to stay on board.
How did we get resolve the problem? We both stuck to common ground initially, creating a shared mental model of the ideal outcome. We both agreed that Marge needed the operation and it would be best done in Alaska, where their US health insurance would cover them. We also agreed to let them back on board in Kodiak, in five days time, if the orthopedic surgeon agreed. The company lawyers drew up a mini-contract binding them to our medical decision in case they changed their minds.
When we arrived in Juneau, Marge was stretchered off to the waiting ambulance with an apprehensive Jim following with 80 days worth of luggage. Five days later they were both waiting on the quayside, Marge In a wheelchair this time, and Jim with the unpacked luggage.
Marge carried out her own physiotherapy on board and gave herself her own Clexane. The rest of their journey to Shanghai was, thankfully, uneventful. I met Marge and Jim three years later, sailing up the Amazon. Marge had had another fall a year after the first and had broken her other hip. She was no longer dashing across slippery decks. But she could still do the waltz and Jim and Marge were happy with that.
*some details changed to protect the stupid
Dr. Andrew Tagg left the shipboard life in 2009 to settle down and lose weight. He is currently an advanced trainee in EM working in Melbourne’s western suburbs. He still has the uniform. Contact him via Twitter @andrewjtagg