Jumping Ship:  A Cruise Junkie Explains Why Doctors Should
Think Twice Before Booking That Week at Sea

by Ross A. Klein and Kathleen M. Halley
 

We began taking cruises a number of years ago.  Being recently married, I had little awareness of the problems faced when a physician is placed in social situations.  With each cruise, my wife’s aversion to cruising increased and her tolerance of the cruise experienced waned.  At the same time, my understanding deepened about her need to be anonymous about her professional life.

My first real understanding of why one would want to keep their identity as a physician private came on our seventh cruise.  We were seated at the captain’s table for dinner and it slipped out that my wife was a doctor.  The remainder of her meal was filled with having to hear the medical history and medical problems of the Hotel Manager who was seated to her right.  At one point during the meal he even pulled up his shirt to show her the scar from his appendectomy.

A couple years later, it again slipped out in conversation at a captain’s table that she was a physician.  As we were having lunch the next day, a guest we had met the night before approached our table and asked for advice on how to treat her hemmorhoids.  In a controlled voice, the woman was advised to visit the ship’s doctor.  I was ready to suggest that she pull down her drawers and we’d have a look right then and there, but I was cut off before I could get it out.  And so it goes.

There are other stories to tell.  None would come as a surprise.  Most would mimic your own experience.  However there are also cases where her identity as a physician has become known and was useful.  Though I have been trained to help her slip out of conversations that are focused on medicine, on a recent cruise my attempts were ignored.  She was being told about a passenger who had been using patches behind the ear to control seasickness.  Because he didn’t think they were working, he used a different patch each day; by day four he wasn’t feeling well. He went to the infirmary, complained of abdominal discomfort, and was advised by the nurse to take a laxative and sent on his way.  When told of the situation, my wife pointed out the possibility that he had an overdose from the scopolamine patch.  The symptoms were compounded by the fact that he was also taking Ditropan.  That night at dinner his table companions told him what my wife had told them.  He went to the infirmary immediately after dinner, saw the ship’s physician, and was catheterized.  Letting her identity slip out in this case was for the better.
 
Sexism is alive and well

Being a physician is one thing.  Being a female physician is something quite a bit different.  Though she occasionally considers saying she cleans houses for a living, or that she is a “woman of leisure”, normally my wife responds when asked “what she does for work” with an innocuous statement indicating she works in health care and quickly changes the topic.  When the person asking is being generous, the response is “you must be a nurse.”

Contrast this with how I am treated.  As like most PhD’s, I unabashedly use “Dr.” when asked for my title.  When I am introduced with that title the questions asked assume the highest possible status.  I may be asked what is my specialty, or a similar question that conveys unconditional and immediate reverence and respect.  This is something that is not accorded women using the same label.

Sexism rears itself in other ways as well.  We have been listed on a ship’s manifest by our travel agent as Dr. Klein and Dr. Halley, and have received an invitation to a VIP party or a captain’s table addressed to Dr. and Mrs. Klein, or Dr. Klein and Mrs. Halley.  It is the exception that my wife is addressed with the correct title.  Even when she is acknowledged as Dr. on an invitation, the status accorded her at the event immediately reverts to Ms. or Mrs. She is not viewed as a professional in her own right; but rather is seen as an extension of her husband.  And so it goes.

To Cruise………

Despite all of this, there are some reasons why a cruise would still be an attractive choice for a vacation.  There is nothing like a day at sea – waking up and going to bed with nothing in sight but the horizon, and spending the day reading novels with no redeeming value or just nodding off into gentle slumber in the warm sun and the surrounding sound of the waves.

A cruise is also attractive for other reasons.  It provides an immediate and total escape from the reality of patients and paperwork.  It provides a choice of activities if that is what you want, or no activity at all.  It provides one’s partner with things to do, that s/he can do on his/her own and yet still share the vacation experience.  And finally, a cruise provides anonymity.  No one knows who you are, there is no fear of turning a corner and running into a patient, and you can be who ever you want to say you are.

…Or Not to Cruise

Perhaps one of the greatest aversions to a cruise is that there are people everywhere.  After seeing person after person in one’s work, the last thing you want to do is be surrounded by people on your vacation.  The degree to which this is problematic obviously varies from ship to ship.  One with 3800 passengers presents a different setting than one with 200.

As regards size, smaller is not always better.  On any cruise, once you embark you are there for the duration.  If service is poor, if the staff is rude, or if things are not as they are advertised you either endure or you take the loss and get off at the first port.  At a land-based resort you can just leave and go someplace else; on a ship you are captive.

This fact was made abundantly clear on two recent cruises aboard small “ultra-luxury” ships.  On one, a bartender became passive aggressive after we complained about rap music blasted around the pool.  Because his passive aggressive behaviour escalated, we reported it to senior management.  The result was further escalation.  After returning home, the company’s CEO essentially said “that’s the way it is.”

On another, a ship noted by Stern’s 2001 Guide to the Cruise Vacation for its “impeccable service, the finest cuisine, and unparalleled personal attention,” we complained to the Hotel Manager about lax service, poor etiquette, and bad attitude.  Things did not improve.  Service personnel were given our feedback and told who had made the comments, and they took the retribution.  It culminated on the last day of the 14 day cruise with being subjected to a five-minute tirade in a raised voice from the assistant maitre ‘d as we sat down to lunch.  After dinner that night we received a threatening telephone call when we returned to our suite.  The company’s CEO excused the behaviour of his staff because “according to them, you are difficult passengers.”  One week before the CEO described the ship in a press release as “the best of the best.”

Cruises rarely live up to the expectations they set for themselves.  Brochures are filled with superlatives.  Every ship is purported to be the best, and every cruise line says it has the best cuisine.  The reality:  don’t expect what they promise.  The food is generally good, but don’t assume that because the company is using the name of a Michelin starred chef to characterize their food that the food would even be allowed in a Michelin starred restaurant.

One other reason to avoid a cruise is that you may be asked to help.  Take the case of a 38-year old cardiologist who went on a four-day cruise.  On day three he attended to a fellow passenger who suffered an asthma attack, fell off a raft, and nearly drowned.  He got the man breathing and stayed with him until the med-evac helicopter came and went.  Before dinner he received a request from the ship’s nurse – the ship’s physician could not be found and the nurse did not know how to put in an IV – to assist with a woman who was having a seizure.  He spent the next two hours with the woman.  At 10:00 PM he went to the bar, ordered a martini, and heard a voice over the ship’s loudspeaker:  “Dr. V to the medical centre! Stat!”  A woman was in respiratory arrest and the ship’s doctor needed help.  He was there until 2:30 AM. The ship docked in Miami five hours later.  Dr. V. wrote to the cruise line.  He indicated he worked for more than 10 hours providing critical care medical treatment for its passengers and asked for a refund or an “alternative solution.”  The company’s response:  the company already showed its appreciation – the ship’s captain sent him a thank-you and a bottle of wine.  And so it goes.

Survival techniques

If you decide to take a cruise, there are some survival techniques that we have learned from experience.

Avoid admitting you are a physician.  If you must be honest, then use a line we have seen that works quite well: “I’m a doctor, but I only do research.  I’m not in practice.”  No one wants to talk to a researcher.

Arrange for a table for 2.  Assuming you are on vacation to get away from people and to spend time with your partner, arrange to have a table by yourselves.  Most cruise lines will accommodate special requests made in advance.  Put it in writing, send it to the corporate dining room manager, and have your travel agent confirm your request at least twice before the cruise.  If the request is not honoured, then simply do as a friend of mine does.  He goes to the maitre ‘d and explains that he’s quite willing to sit with others, but he is sure that the others would not want to sit with him – do they really want to hear about surgery and MVA injuries while they are dining?

Avoid the temptation of a physician get together.  As tempting as it might be to respond to an opportunity to meet other physicians on board, keep in mind the risk.  Your vacation may be intruded upon by requests for you to work. As with Dr. V., you can’t assume that your efforts will be appropriately appreciated.

Consider booking a cabin with a veranda.  If you value privacy and if you want to avoid unexpected wrinkles, splurge and get a cabin with a balcony (especially with newer ships which have less outdoor public space).  You will likely be better off paying for the top accommodation on a mass market or premium cruise line than paying for the bottom of the line accommodation on a premium or ultra luxury cruise line.  There is absolutely no substitution for space, quiet, and being people-free when you want to be alone and just want to soak up the sounds of the sea and the rays of the sun.

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Ross A. Klein, PhD, teaches at Memorial University of Newfoundland.  His book, Death by Chocolate: What You Must Know Before Taking a Cruise (Breakwater Books) will be available early-Summer 2001.

Kathleen M. Halley, MD, is a general practitioner in St. John’s, NF.