The crossing

"Come quick, Doc -- I think he's dead!"

MJA 1997; 167: 630-631  

I had not been looking forward to this trip right from the start. If you've got to spend a night in an aircraft seat, it's preferable if the seat is in an aircraft, not on the Liverpool-Dublin ferry. But the crossing had to be made, so I had asked my nearly-new Irish bride to book a cabin to make the journey almost tolerable. But she forgot. This led to an interesting discussion on the gangplank, during which she accused the medical profession in general, and me in particular, of bullying helpless midwives (surely a classic oxymoron?), whose only aim in life was to please their God-like masters. I refrained from pointing out that this view was somewhat different from the one she had been known to postulate on other occasions. We put our names down, with two hundred others, for a cancellation, but only a fool would have held any hope. While some passengers went to the bar for their sleeping draught, I took a couple of orange pills. By midnight, things were settling down in the "aircraft" area, with the significant exception of the two-year-old boy sitting next to me. He appeared set on staying awake for the night, and keeping me entertained too. Fortunately, his mother had no problem sleeping. I tried negotiating with him, but he seemed to share the Midwife's reluctance to concede any ground. Soon the pills overcame my homicidal instincts and I drifted off, despite the increasing motion of the ship. The next thing I knew an eyelid was being prised open and a voice a million miles away said, "Wake up, they're looking for a doctor!" She seemed to be confusing me with someone else. I muttered something about "only a medical student", but then the fog lifted. That was last month -- this month I was a doctor, albeit one with just two weeks' experience on the wards. I dragged the brain into gear. Already I was learning the knack of answering silly questions five seconds after being wakened. Irish explained patiently (she had had considerable experience in speaking slowly and clearly to half-awake doctors) that the ship's public address system was broadcasting the names of several doctors, obviously taken from the passenger list. I took her point: if I rendered some sort of service to the ship, they were bound to find us a cabin. So, trying to look both wide-awake and widely experienced, I set off for the Purser's office. I guess I failed in my attempts to rearrange my demeanour. "Are you looking for a doctor?" I asked the Purser in his little booth. He looked me up and down suspiciously, and conceded that he was. "Do you know where there is one?" he asked. "Well . . . actually, I'm a doctor." Frank disbelief crossed his face for a moment, then the solution dawned on him. "No, no, son -- a medical doctor, not music or anything." He seemed reassured when I told him I was tone deaf, and that I also had a first-aid certificate. We moved into his office, where he explained that the Captain had insisted that he get a doctor to look at a steward who had burnt his arm some days earlier. The Purser gave the impression that he was only following orders by getting medical attention. (I was later to see the same look on the faces of senior non-commissioned officers as they marched young men into my office -- several of whom were saved from the charge of "wasting the medical officer's time" only by urgent surgery.) The steward had a full thickness burn, badly infected. I thought I made a reasonable stab at cleaning it up and dressing it, although the Midwife clearly felt there was room for improvement. I wrote a note for the Mater casualty department in Dublin. Then I said that a good start to clearing the infection would be some intramuscular penicillin, if there was any on board. By this time the Purser had recovered his good humour (with the help of a glass of Jameson's Irish whiskey). "We've got the standard Board of Trade Medical Kit on the bridge, Doc. It's got everything you can think of -- even a big book that tells you how to use it all." Obviously, Irish's helpful critique during the dressing had rekindled the Purser's interest in my musical prowess. "I'm sure it'll have some penicillin," I said. And so we climbed six pitching ladders to the bridge, where the Navigating Officer unlocked the drug cupboard, and the first thing to hit the deck was a Webley .38 pistol. ("Well, where else would the Captain keep it?") A quick glance through the cupboard revealed the Board of Trade's thoroughness-- there were remedies for all of mankind's known ailments, even including some penicillin for injection, as well as penicillin tablets. Resisting the temptation to take the easy way out (I was very young), I lifted the penicillin G and some sterile water and started to look for syringes and needles. I found a bottle of Primaquine and couldn't help myself asking, "Good heavens, man, why have you got an antimalarial aboard the Liverpool-Dublin ferry?" The Navigating Officer looked me straight in the eye and said, "Well, to be sure, Doc, if we miss Ireland the next stop's the West Indies." I eventually unearthed a case of glass syringes, and asked for some place to sterilise them. (I didn't, at that stage of my career, have an anaesthetist's concept of asepsis -- that a wipe with an alcohol swab kills all known household germs.) Everyone looked a bit nonplussed at my request, until the Purser had an idea. "I know, we'll speak to Sean in the engine-room -- you could use his steam hose." By this time I was only too aware that the bridge was the furthest point from the ship's centre of gravity and that the Irish Sea was beginning to get angry. I succumbed to commonsense and took some penicillin tablets to give the patient. Once the needful had been done with the tablets, the Purser remembered his manners. "You'll be having a dram with me, Doctor -- and your good lady," he added hastily, as she subjected the poor man to most probably his very first feminist glare. So we both joined him in a very large Jameson's. As a Scot, I had never been able to take Irish whiskey seriously, but this didn't seem to be the time to discuss the finer points of "the water of life", as our host was obviously one of Jameson's better customers. I knew my "good lady" hated spirits of any sort, but there was no way she was going to let it show in front of what she now saw as a veritable pack of male chauvinist pigs, so she downed her drink (with tears in her eyes) as she broached the subject of a cabin for us. It seemed that all the cabins were genuinely taken, but our new friend offered us the use of some crew quarters when the watch changed at 0200. This was a great improvement on the aircraft seats with built-in toddlers, so we gratefully accepted. As he showed us to the quarters -- desperately needed now that the whiskey had combined with the sleeping pills -- my last conscious words were, "Well, you know where to find me if you need me again." Hence my rude awakening at 0415. As I groped for my shoes, I mumbled to Irish, who was already heading for the door, "I'll bet he was allergic to penicillin; I forgot to ask. Did you?" She gave me one of her withering looks in reply, and I ruled out anaphylaxis as a cause of death. I followed the Purser, swaying now with what I hoped was the ship's motion, along the corridor to the gents' toilets, where a large crowd was forming. Irish came too. Never one to stand on ceremony, she followed me into the toilets, where customers were using the facilities, washing, shaving, etcetera, as though nothing had happened. Mind you, there was some hasty zipping-up at her arrival. The Purser, who was showing the effects of a serious heart-to-heart with the Jameson's while we had been asleep, pointed to one of the stalls. "There he is, Doc -- looks pretty dead to me!" I couldn't fault his clinical judgement. The toilet door was closed, but from the eight-inch gap underneath it bulged a deeply cyanosed face. "It's not the boy with the burn!" I said to my wife, with relief in every word. "You're right," she replied. "Did you treat anyone else on this boat when I wasn't around?" What do you do with a body found face-down in a toilet stall on the Liverpool-Dublin ferry? Could it be foul play? Were we on the "high seas"? Did my Defence Union cover this? Had they even got my cheque yet? We were helped by a burly Irishman who had his ten-year-old son with him, but didn't see that as any sort of handicap to dislodging trapped bodies. We managed to open the stall door. Perhaps it was the position of the patient (he had fallen forward off the pedestal with his buttocks skyward) that made me think of my forensic lectures and the need to take the victim's temperature to establish the time of death. "Don't suppose the Board of Trade included a low- reading rectal thermometer in its box of tricks?" I muttered, more to myself than to anyone in particular. "What's that, Doc?" asked an increasingly confused Purser. "Never mind," I replied, when I saw the scathing look on the Midwife's face. Bang went my ambitions to be the young coroner. I assured myself that there were no bullet holes, assegai wounds or bottles clearly marked "poison" on the unfortunate man. We extricated him from the plumbing, restored his modesty and called for a stretcher. This gave the Purser something to do other than shake, and allowed Herself to take over traffic control at the door. I heard one or two interesting discussions between her and some potential patrons, intent on gaining access. I put it down to the Guinness, and the fact that Herself didn't acknowledge desperate men. None gained entry. The Purser returned in a few minutes with one of those terribly useful (in theory) stretchers that looks like a cricket pad on steroids. With help from the Irish father, I managed to lash the body into this, although it protruded at both ends, like a hot dog. We each took an end and, half-carrying, half-dragging the horrific-looking corpse, made our way through what seemed to be the entire passenger complement. "Next time, Irish, let me sleep," I warned. "Even a night of toddler-taming in the aircraft seats is easier than this." "Let this be a lesson to you," she replied, totally illogically. Before I could remind her whose idea it was to "volunteer", an agitated-looking man with a red face pushed through the crowd. He rushed up to her as she walked alongside me, and asked, "Is he a doctor?". Although the novelty of being the young doctor's wife was wearing thin, she nodded. "Well, I wonder if he could have a look at my wife -- I think she's gone into labour." Irish's face lit up, despite the long night with little sleep: "Now what would you want a doctor for? They know nothing about babies -- what you want is a good Irish midwife." And she strode off with him to run her own show at last. Douglas N Gow Specialist Anaesthetist, Valley Heights, NSW