Sabby, tell your husband not to faint!! I managed to go out and vacuum, armor-all, window clean, and wash my car. Hopefully the windows aren't streaky on the inside. If they are, I'll have to try your trick! Maddie (my 13 year old puppy) supervised, so I'm sure they will be fine!
So... I have a few minutes to write about my cruise ship work.
I was assigned initially to a ship with the capacity for 3,000 passengers and 1,050 crew. The itinerary included the western Caribbean-- Belize, Costa Maya, Roatan, and Cozumel and was a 7 day cruise. We had a good mix of old and young passengers with the average age in the 40's. Most common complaints were MI's, asthma attacks and upper respiratory infections. I worked with two other nurses (one from South Africa and one from the Philippines) and two doctors (one from South Africa and one from the Philippines). My initial cabin was below deck and so small that I could barely turn around (which says a lot given that I'm 5' tall and 100lbs soaking wet). I hated not being able to see if it was day or night, but thankfully it was a single cabin. The staff captain (there are actually two captains on each ship-- a captain that over sees the operational side and has ultimate responsibility, and a staff captain who over sees the personnel but is equally as trained and capable as the captain) was not the most pleasant person and believed that the crew, regardless of their rank, did not belong in any of the passenger areas-- including the promenade deck. This combined with the fact that none of the crew areas had windows, I could go several days without seeing daylight when we had at sea days (not in port). The work schedule was 12 hours on and then 24 hours off from the end of your shift. I worked an average of 40-50 hours per week with plenty of opportunities to get off the ship while in port. After a month, one of the nurses went home, and I was able to move up to a true officer's cabin (nurses are 2-stripe officers) which had a small porthole, double bed, love seat, desk, and large closet (same tiny bathroom). Several weeks later we completed a re-positioning voyage that was going to put us on a wonderful itinerary including Bermuda. The day before we entered port, I was told that I had to pack my belongings and I was going to transfer to a short-staffed ship. Agghhhhh!!! I had finally started to feel comfortable with the layout of the ship, "ship life," and my job.
The second ship was a little smaller-- 2,500 passengers and 1,000 crew. The itinerary is what we called the "Booze Cruise"-- 3 and 4 day cruises to the Bahamas. This brought the average age down to the 30's and alcohol became the biggest problem. The staffing level should have been the same as the last ship, but I made the second nurse with two doctors. Being that there were only two nurses, we had to work 24 hours on with 24 hours off. The rule was that I had to be in the clinic from 8a-8p with an our lunch break, but the paperwork portion of my job usually wasn't complete until ~2am and I almost always got pages and phone calls roughly every 30 minutes due to passengers wanting to see the doctor (Why do they need to see the doctor at 3am for UTI symptoms? They wouldn't do that at home!). If we were on the private island, one of us nurses would have to go over and sit at the first aid stand. That meant that If I worked the previous 24 hours, I had to then go sit on the island for 9 hours. Oh, yeah... 33 hour shifts were frequent!! The captain and staff captain were amazing-- very supportive of their staff and treated them like family! The atmosphere on this ship was much more relaxed and enjoyable even though I worked my tail off.
In total, I worked/lived on board the ships for 4 months. It was my first time away from my family and friends, so not having a phone or free internet was a difficult transition. I saved phone calls for when we were in an American port and I had to pay $20 for 220 minutes of internet time which I used for quick facebook postings and skype. The majority of the crew members were from the Philippines. I think I was one of about 3 Americans on each ship. Everyone was very welcoming to me-- I couldn't go anywhere on the ship and not hear "HI NURSE!!!" I have never before and probably never will feel as well respected as I did on the ship (at least from crew members).
I learned to use my "crew status" to my advantage! I was able to see some Mayan ruins for free-- a $300 excursion normally. I also was able to go to Atlantis for 1/2 price. While I didn't otherwise venture too far from the ship because of time constraints and the high cost of cabs, I was able to see so many beautiful places that I otherwise never would have. I made friendships with crew members that I will hold near and dear to my heart (most don't have any way of keeping in touch). I am so thankful of the medical resources that we have here. There is nothing quite like telling an active STEMI that they will be in good hands in the Costa Mayan hospital when the EMS personnel show up without oxygen or a cardiac monitor. Instincts and good assessment skills go far!
It was not only working on the ship, but I had to learn so much about how to LIVE on a ship. There are so many safety regulations and emergency equipment that all crew have to know. Each and every crew member had a role in every type of emergency. We practiced weekly fire/hazmat/ship damage/evacuation drills in addition to the life boat drills with each new voyage. We also had monthly man overboard drills. Medical emergencies, or code alphas, were routine occurrences. As a nurse, I had to respond to all codes at any time of the day or night. This meant that I was not allowed to be "under the influence" at any time and was on the zero tolerance list for alcohol (not allowed to consume alcohol on or off the ship at any point during my contract or it was immediate termination).
The majority of what I did was office work. There were so many reports that had to be submitted to the CDC, USPH and Coast Guard as well as data that headquarters wanted tallied. Patient wise, the majority of the work involved crew members. We ran two clinics per day and dealt with mostly primary care complaints. Many of our crew were hypertensive and/or type II diabetic. Any maintenance medications had to come from us. If you think about it, most of the crew members were on board for up to 10 months. They also were not allowed to "call-out" from work. The physician had to determine if they were sick enough that they needed off work.
As far as what we were capable of... pretty much anything except surgery. We had an iSTAT machine that could run basic labs like Hgb (no WBC or Hct), CMP, coags, and ABG; urine dipsticks for UA and pregnancy (yup... told a few ladies they were +!!!), legionella, strep, flu A/B (had a few +). We had an EKG machine, basic (and I mean BASIC) ventilator, x-ray machine (digital!!). We had two inpatient beds as well as an ICU room with IV pumps and cardiac monitor. Our medication supply included routine meds as well as antibiotics-- both PO and IV, ACLS drugs, and many ICU drips. We had a procedure room with sutures, casting supplies, nebulizer. We did have a two-person morgue (thank goodness we didn't ever have to use it).
War story... The worst patient I had: Gentleman ~60 years old with no medical history is escorted by wheelchair to the medical center just prior to going home (we were docked in FL) with the chief complaint of diarrhea overnight and just "generally not feeling well"... as he is rubbing his chest. I start asking more about this not feeling well and rubbing his chest, and he says that his chest "just doesn't feel right." My instincts were telling me this wasn't good. I got a quick set of vital signs which were not too abnormal-- BP was a tad high, but not alarmingly so. I walked around the wheelchair to push him into the room with the EKG machine, and he went limp. I called the bridge and had them call a Code Alpha. I pulled him to the floor and started compressions. The rest of the medical team and the stretcher team (the crew members assigned to respond for medical emergencies-- they bring all of the medical supplies to the location and assist with bringing them down to the medical center) showed up. We shocked x4, lined, drugged x6 rounds, and intubated. Because we were docked, 911 was called. ~45 minutes later, EMS took him off and we were told the hospital called it as soon as they arrived. Very sad for the family.
Ship lingo for when you go on your next cruise:
- Forward-- front of the ship
- Aft-- back of the ship
- Starboard-- right side
- Port-- left side
- Midship-- middle of the ship... duhhh
- Alpha-- medical emergency
- Bravo-- fire
- Delta-- ship damage
- Papa-- hazmat
- Oscar-- man overboard
Ok... I think I wore out my keyboard. Hopefully I wasn't too willy-nilly and all over the place in what I wrote.