Reflections on the human side of maritime medicine, by Dr. Emily F. Luza, Ship Physician, VIKAND
Every Antarctic expedition begins with excitement. Guests arrive carrying binoculars, waterproof boots, cameras and dreams they have often spent years planning. For many, it is the journey of a lifetime.
Before the first iceberg comes into view, however, the medical team asks a very different question: Is everyone truly ready for the journey ahead?
Some of the most important decisions we make in expedition medicine happen before the ship ever leaves the dock. This is one of those moments.
A concern worth pursuing
On embarkation day, a member of our ship’s staff contacted the Medical Centre with a simple concern. One of our guests did not look well.
It could easily have been dismissed as fatigue after a long journey, excitement or simply the rush of embarkation. Instead, someone trusted their instincts and spoke up. That simple observation changed everything.
When we assessed her, she smiled warmly and reassured us that she was fine. She admitted to experiencing some recent shortness of breath on exertion but did not think it was anything serious.
Fortunately, we decided not to leave it at that. Further assessment revealed an abnormal heart rhythm that appeared to be new and required hospital evaluation and treatment before she could safely continue the voyage.
On many cruise itineraries, there may be opportunities to seek medical care in a nearby port if needed. An Antarctic expedition is different. Once the ship sails south, advanced medical care becomes increasingly difficult to access. Weather, distance and the remoteness of the region mean that decisions made before departure carry far greater significance.
A difficult recommendation
As her condition remained stable, we worked closely with our shoreside medical team to determine the safest course of action. It was another reminder that caring for patients at sea is never the responsibility of one person alone. Medical judgement and careful planning must come together to achieve the same goal – keeping our guests safe.
The recommendation was not easy. Physically, she felt well enough to continue. Emotionally, she wanted nothing more than to begin the expedition she had spent so long looking forward to.
We explained why we believed leaving the ship was the safest decision – not because we wanted to end her journey, but because we wanted to protect her health and give her the opportunity to enjoy more voyages in the future.
She was understandably disappointed. No one expects an expedition to end before it begins. But after we talked through the reasons together, she understood. Before the ship sailed south, she was safely transferred ashore for further evaluation and treatment.
Before the ice
As I watched her leave, I could not help but think how difficult that moment must have been. The gangway everyone else crossed to begin an adventure became, for her, the path back to shore.
Thankfully, she received the care she needed at a shoreside medical facility. I hope she will one day return to complete the journey she had dreamed of. The ice will still be there, and our responsibility is to make sure guests are able to return and see it.
One of the things I have come to appreciate about practising medicine at sea is that patient care does not always begin inside the Medical Centre. Sometimes it begins when someone notices that a guest does not quite seem themselves – and takes a moment to speak up.
On board, we all look after one another. And sometimes the most important medical decision is made before the ice.
