A Medical Adventure in the Caribbean

A bonus adventure story that didn’t make it into Adventures in Medicine and Redemption in Hospice.

I knew I was headed for high seas when my new shipmate, a dentist originally from Brooklyn, said, “Ya gotta help me out, here, with my wife, you know, ‘cause I don’t know nothin’ about down there,” demonstrating with the sweep of his hand the pelvic region. Neither does the doc on the ship, so I’m countin’ on you to tell me what to do.” And what I wondered as he related his dilemma on the sleek vessel‘s deck was how I managed to be in the midst of this medical adventure while plying the Caribbean Blue? “Ya Mon, don’t worry, be happy,” was the order of the day for this sailor, not medical consultation. Only this time it was without a local license, valid consent, or malpractice insurance. I wasn’t even sure whether they had these things in “da islands,” and I wasn’t going to ask the dentist’s high-powered, lawyer wife her legal opinion if I had to delve “down below.” My inclination was to swear ignorance of the feminine area rather than my “Oath” to heal. My obligation as a physician to listen and facilitate the situation to a humane end won out. As I braced myself for the gale, I only hoped this Good Samaritan wouldn’t have to “walk the plank” if things didn’t go well.

Windstar Cruises’ brochures described voyages of “casual elegance” on their computerized sailing ships, large enough for all the usual cruise amenities while small enough to languor in exotic, small ports for intriguing adventures on land and sea. Having only one hundred pampered passengers per voyage, the well-appointed ship provided an atmosphere much to my wife’s and my tastes with as much socialization as we desired while avoiding the herding mentality of the behemoths of the sea . Our previous Windstar Cruises to Tahiti, Malaysia, Thailand, Greece, and Turkey had lived up to the billing, especially when we brokered affordable two for one specials which included airfare. Oo, La, La, the times we had, and the places we saw…c’etait tres magnifique! We had made a few casual friendships with other couples on these trips, but nothing as intimate as this one eventually became.

Rather than dining by ourselves, we decided…or should I say my wife, Mary, decided, she, being the nursing administrator enjoying socializing and me, being the aloof clinician preferring solitude at our own table…to spread our best boating cheer to other passengers on the second evening out. It’s not that I didn’t like to mix with other people in these situations. It’s that I found that anonymity was not necessarily a bad thing. As in this case, I usually wind up agreeing with her that having a little dinner party with others can spice up an evening. We sat with three other couples of our era from Southern California, each spinning stories about their various professions and interests. We especially hit it off with an academic dentist and his wife, a high powered feminist lawyer, both, originally from New York City. He recounted even better dental than ER stories that I could muster that evening with his sideline work at the LA Zoo. I mean, how many people extract teeth from lions and tigers and do root canals on elephants and hippopotami using a garden hose for irrigation? “See,” Mary said, while giving me a poke in the ribs on the way back to the cabin, “wasn’t that better than eating by ourselves all the time.” “Yes, Dear,” was, of course, the only answer.

Two days later I got up early to work out at the ship’s fitness center before docking in Martinique. After a good spin on the exercise bike, I cooled off on the forward deck hanging out over the railings, my sweat flying off in macro-drips to the sea as the ship approached the harbor. Transfixed by the azure sea as the waves whooshed under the bow, I didn’t hear the approach of my new, best friend.

“I’ve been lookin’ all over for ya’s,” he said, his Brooklyn accent crushing the moment. “Figured I find ya workin’ on yourself… tryin’ to be some kind of athlete,” he commented as if chastising me for my lack of availability, then, losing his harshness, he pleaded, “ ya gotta help me out, here. My wife’s got a problem down there, ya know,” illustrating the area he was meaning with a wide stroke of his hand pointing to his groin. Don’t know anything about that part of anatomy.”

My immediate thought was that I hoped he knew a little.

I had to admit, besides the medical issues, I did wonder what kind of help he needed “down there” with his wife. I was able to keep a poker face as I inquired to the problem. He explained that his wife had developed swelling and pain the past forty-eight hours over one of “lips,” a good dental term, of her external genitalia. She had seen the ship’s doctor the previous evening, who had given her Tylenol with Codeine and started her on ampicillin. Not feeling comfortable taking care of the problem further, the doctor had also called ahead to a medical clinic in Guadeloupe and had made an appointment for a gynecologist to see her that morning. They would be the first off the ship to take an hour taxi ride to the specialist for definitive treatment.

That sounded better than good to me, but the dentist didn’t seem too happy, grumbling that “ya never know what kind of creeps ya gunna find in these far-flung places in the boonies.” I sort of understood that although I wondered whether that included all the fly-over territory between New York City and Los Angeles for him. It only looked like I was off the hook as I watched her painfully shuffle down the gangplank with her husband’s support to an awaiting taxi on the wharf. She was definitely in trouble.

In contrast, our carefree day was spent living “da Caribbean life” at the beach and shops near the wharf. Back on board the ship in the early afternoon, we lunched royally on the rear deck with a grand view of the Island. A familiar looking taxi rumbled toward our dock and screeched to a halt. The dentist hoisted himself out of one of the rear doors, flung some cash at the driver’s window, stomped around the taxi to the other rear door, and with as much gentleness that he could muster helped his wife out of the car and led her back toward the ship. She looked worse. From my distance, I could not hear the moans that she uttered with each step, but I winced with them anyway. Sweat splashed off his face to his already soaked tropical shirt while his beefy arms supported her upper body as they approached the gangway. Alert crew came to their aid to help her up the gangway and to their cabin. Just before they disappeared from sight into the ship, he peered up and scanned the ship as if looking for someone. When our eyes locked, there was no doubt that it was me.

Not knowing what had transpired, I felt it best not to intervene. My hope was that she was still groggy and waking up to post-procedural pain. I figured that he would approach me if he needed me. Finished with lunch, Mary went below. I stayed put and available. It wasn’t long before he confronted me with “ya really got to do somethin’ down there, now.” Then, he told me their medical experience on shore in beautiful Martinique.

The taxi driver had taken them on a bumpy thirty mile ride to the capitol city where she was to be examined by the Island’s gynecologist. It turned out that he was a rather unkempt general surgeon of uncertain nationality and training. As the doctor examined her, ashes from the burned down cigarette that dangled from his mumbling lips had fallen on her exposed abdomen. “Yeh, and all he does is, just flicks ‘em off her without an apology,” my new best friend adds. “Then, he says that he won’t do any surgery unless she spends the night…like I’m goin’ to let this creep operate on her anyway. So, here we are back to square one, and I’m asking you to help us out.”

“Ok,” I said. “I’ll examine her in your cabin, but I think it would be a good idea to get my nurse wife to assist me.” Mary had gotten me into this mess, and for lots of reasons I thought it would be best to recruit her to be the new nurse on board the ship. If this boat sunk, I wasn’t going down alone. My first mate was going with me. “We’ll be down to your cabin in five minutes,” and I was off to get Mary for our mission.

Ready for action and being the good mate that she is, Mary required minimal encouragement…not even, a pretty please…to come with me. I updated her on their miserable day on the way down to their cabin. Their door swung open before I could finish my knock revealing a very pale, diaphoretic woman in obvious discomfort on their bed. Despite being an awkward situation, I sensed immediately that he was right, I had to do “somethin’.” He told me that she was very dizzy and had a temperature of 101. With as little socialization as was necessary, we got down to business putting on our appropriate caps and exposing the patient. My suspicions were right. Even though she was in her 50’s, she had an orange size, pointing Bartholin’s abscess of the labia, seen more commonly in 20 year old women in the ER. She was septic and needed an immediate incision and drainage.

It took me a few moments to think through the problem and how to resolve it. Here I was on cruise ship pulling out of a Caribbean port headed for another backwater island…who knows? Maybe 3000 miles from where I can legally practice medicine…examining a woman’s pelvis, who also happens to be some hotshot lawyer in LA per the request of her academic, doctor husband, who also happens to be really sick and in need of my Good-Samaritan care since the physician on board does not wish to embrace the issue. I excused myself, found the ship’s doctor in the dining room finishing his nice lunch, and explained to him how the two of us were going to take care of this lady’s illness.

“But, I’ve never I&D’d a Bartholin’s abscess before,” the retired internist protested when I informed him of what he needed to do to make this woman better, or even prevent from dying tragically by his lack of doing “the right thing.” “I’ve given her antibiotics and pain pills that should pull her through until we get to Barbados in three days where they have a real hospital.”

“No,” I commanded. “This is something we can easily do together. I will borrow your wheelchair from your dispensary, bring her to the dispensary, place her on your examination table in stirrups, help you prep and anesthetize her, and assist you with locating the proper place to make your incision to drain the abscess.”

Reluctant, he still had to ask, “are you sure that she can’t wait a few more days?”

Feeling sorry for the old guy, not wanting to be in unfamiliar territory like me, I gave him sympathetic, “no, believe me I don’t want to be in this position either. It’s not that difficult. I’ll show you what to do. And we have no other choice under the circumstances.”

“Ok,” he agreed reluctantly like a chastised urchin. “I’ll meet you in my medical dispensary in ten minutes,” he said trying to regain some of his self-respect.

By ten minutes Mary and I had whisked the patient to the dispensary and were readying her for her procedure. The overbearing dentist backed off and did a good job of being the concerned husband at the head of the table held his wife hand, looked at her affectionately, and spoke to her softly and reassuringly. The cruise physician arrived looking about as pale as the patient, but in control. I sat him down on the stool between her legs and handed him a syringe filled with lidocaine. I pointed to the spot where her prepped labia appeared to be most tented and suggested anesthetizing that area. His gloved hands trembled so badly that I took the syringe and slowly injected it myself. I gave it a few minutes to numb up. Then, I handed him the scalpel. His hand wavered back and forth several inches as he tried in vain to control his body by focusing his mind on the target. I could see that it wasn’t going to happen. I took his clenched hand holding the scalpel in mine, and we stabbed the abscess in just the right place. Under tremendous pressure, pus shot out of the wound giving her some immediate pain relief.