APHC #11 Rotterdam-Scotland-Norway-Rotterdam

[doctork]

I have decided that this will be a "current event" so I'll try to post about the cruise here.

The website has our itinerary:

www.aphccruise-eminj.com/ScotlandNorway2017/itinerary.html

And if any of you are having some last minute change of heart, the website shows at least one cabin is still available!

In preparation for departure, I am collecting the items I need, laundering, packing, and cleaning up the house a bit while Howard is at his college reunion, then visiting the kids near DC and then our house in the Blue Ridge. Our pet sitter Bruno will move in on Tuesday to hold down the fort until Howard returns.

My co-worker Ellen has given me many helpful hints about some new and different things to see and do in Oslo, as I realized this will be my 4th visit there (two cruises plus one Star Mega DO) so I have seen many of the usual tourist sites. (Some of the unusual ones as well, as I recall the Mega DO - a talented SAS flight attendant out on the wing of a Boeing 737 singing "Fly Me To The Moon.") I will visit her dad at the hospital in Oslo while we are there, and I am trying to think of some appropriate memento of western Washington to take there as a little gift.

I'm working in the clinic tomorrow and then flying out on Tuesday. So far, DHS and TSA haven't banned laptops, but if they do, I am hoping to evade the ban by traveling from/to Canada.

[BoatBabe]

Oh, do have a great time, Doc! I know that your gentle spirit and kind heart will be appreciated by Ellen and her dad in the hospital. We look forward to your postings as you are able. Bon Voyage!!

[jspnrvr]

Have a great trip, doc. Say "Hello" to Thomas for us. Safe travels!

[Jane]

Sounds wonderful! You must be their best customer. Has anyone else been on all the cruises?

[doctork]

Yes, there are apparently quite a few people who have been on all the cruises. And I haven't been to all of them, as I missed the first one. Most cruisers have been on "several" cruises, but occasionally I meet someone on their first cruise.

I heard a rumor that GK meets with the "every one of the cruises" group to discuss possible destinations before announcing the next one. John and Sandy, the blind couple from NC have been on all of the cruises. I invited them to come up and visit for MerleFest, which they would love to do, but this past year they were in the midst of a move and couldn't come. Maybe next year.

[BoatBabe]

Doc will come home with her pockets stuffed with stories. I can hardly wait.

[doctork]

Surprise! A spare hour or so before the ship sails and I have cellphone coverage. I been taking notes and will post when access is easier. We leave Oslo very shortly and tomorrow is a sea day - packed with activities! Home on Saturday but in the air during the show.

[BoatBabe]

Welcome Almost-Home, Doc!

[jspnrvr]

Looking forward to you being home safe and sound, with lots of stories.

[doctork]

I am home in Bellingham safe and sound. All my travels went smoothly today - ship to airport via bus, good exit row seats on both AMS-LHR and LHR to YVR flights. Vancouver is a really nice airport with quick throughput at customs and immigration, friendly staff, no traffic problems (it is Saturday when traffic is usually lighter) and only about 5 minutes wait at the border crossing. About 22 hours overall, but so much easier traveling west during the day, instead of going east overnight.

This cruise was two full weeks, June 10 - 24, and it felt just the right length and tempo. Three of the last 4 cruises have been two weeks long. The Baltics in 2014 felt a little too long, like we were limping along to the finish line the last couple days; perhaps this was a reflection of the fact that we visited 8 very different countries - UK, Denmark, Germany, Estonia, Russia, Finland, Sweden, and Norway. Last year we went to Alaska and Victoria, BC in Canada, the latter stop being due to an obscure federal maritime law requiring a foreign stop on any round trip cruise from a US port. So most of the cruise was great but since we were in Victoria only 100 miles from Seattle, the last night didn't have the traditional closing show and closing party in the Crow's Nest.

The "in-between cruise" of 2015 was to the Eastern Caribbean and it was only one week because GK said that one week of sun and warm weather in the winter was all that anyone needed so there was no indication for a cruise of 10 days or longer. While many or most people cruise specifically for sunshine, warm weather and beaches, Garrison clearly prefers northerly, cool and cloudy destinations, and we all go along with him - and the cast and the performers and the other cruisers - regardless of the destination. If the destination is one we have been wanting to visit, that is a bonus. A few days ago Rich Dworsky related a story about shopping for some items to prepare for the trip. When he told the salesperson he was going on a cruise, he was asked ""Where are you going?" and he answered honestly "Actually, I don't know, I can't remember."

This year we gathered in Rotterdam after many of us had a few days socializing and sightseeing in Amsterdam and other locales in the Netherlands. We sailed to two ports in Scotland (Edinburgh and Inverness), then on to 5 different ports in Norway before returning to Rotterdam. Since the last day was a "sea day" (no port stop) from Oslo back to Rotterdam, our final day was packed with wonderful music, an outstanding Prairie Home Companion show, and then the Closing Party with dancing and music in the Crow's Nest. Just like Goldilocks, I thought this year was Just Right.

Except. This year GK did not end the cruise with an announcement of next year's cruise dates and destination. He had given hints throughout this cruise that there might be another one, but the reliable rumor mill didn't give any clues, and GK himself made no commitment. Each edition of the daily "Cruise News" included an interview with "random cruisers" and one of the questions always asked was "Where would you like a future cruise to go?" The Greek Islands and South America seemed to be popular suggestions. We'll see. And I will write more about the cruise later.

[jspnrvr]

Welcome home. Congratulations on your latest adventure!

[doctork]

Tonight Rick Steves is featuring a show about Oslo. It's a nice reminiscence of some of the places I've just been, and a couple of sites that I remember from my first trip to Oslo 10 years ago, but didn't visit this time. Norway is such a beautiful country, and the city of Oslo is marvelous, with so much to see, and an easy public transportation system so you can get all around to see it.

That said, one of the things I did was not a typical tourist activity, as I've found sometimes those non-touristy, or surprise things that you weren't planning, or that time you got lost, turn out to be the best outings of the trip the trip. At work in late May, I said hello to one of my co-workers and commented that I hadn't seen her in a while. No wonder - she is Norwegian-American and had just returned from Oslo, where her father had suddenly taken quite ill so she had needed to "go home" to see how he was doing and to help her mom and siblings. I was surprised and said "Oh! I'm going to be in Oslo in 3 weeks, would you like me to visit him (in the rehab facility) and see how he is doing?" That is what anyone would do, right, as that was karma, not coincidence. Especially if you are a doctor and your RN co-worker is obviously terribly worried about her sick father 7,000 miles away, because you can give a more nuanced report of dad's progress.

Ellen was apologetic because her brother couldn't come to the ship to pick me up and drive me to the facility, but that was really no problem at all. All I had to do was show the address to the nice lady at the Tourist Information office, and she told me where to get the bus that would take me right to Mr. S's facility in the suburbs. It was easy and inexpensive, and I enjoyed the scenery along the way, and the opportunity to talk with "real Norwegians." The bus stop was only 2 - 3 blocks from the rehab facility, in a residential neighborhood that was classic Norwegian. The houses so pretty and well-kept, so many flowers in bloom, quiet streets criss-crossing up the hill (leading to some spectacular views) and friendly people who usually spoke English. It was even sunny and warm, which is not necessarily so common in Norway.

Ellen had told me that her dad didn't speak much English, but actually he is a lovely gentleman who speaks English quite well, and was very glad to have a visitor come all the way from America to visit him! One must work hard in rehab, but it still is a boring place for folks who are used to living an active life outside a "facility." I had brought a couple of our tribe's weekly newspapers so he could see pictures (of the recent pow wow, and the war canoes practicing for the upcoming Canoe Journey) and read stories about the place where Ellen and I work. Happily, he was doing very well clinically and has made great progress from when Ellen last saw him when he was so critically ill in the hospital. I was able to take some iPhone pictures and send them to her, and it was a big relief for her to see her dad looking so good.

There was a night aboard the ship which took a medical turn also. About 0030 (12:30 am, or shortly past midnight) I was wakened from a sound sleep by an overhead loudspeaker announcement requesting that anyone onboard who has a blood donor card and is type A positive or O negative and is willing to donate for a life-threatening emergency please report to the Explorations Lounge. This is very unusual on a cruise ship. Though Holland America and GK/APHC both attract an older demographic who are prone to medical issues, they usually try to keep medical emergencies under the radar screen. I woke right up, though I am neither blood type, so not a potential donor. I called downstairs to the front desk and asked if the medical center needed the extra hands of a board certified FP with emergency experience. It can take a lot of hands in an emergency, but they said the medical team was handling everything OK, though they appreciated my offer.

Once my adrenaline got going I couldn't just go right back to sleep (I never can). So I headed up to the Lido midnight buffet and - surprise - ran into some friends. We "snacked" on buffet goodies and chattered about what must be going on, given that announcement. I listened uneasily for the chopper. My friends noticed that I was "really wired." Earlier, Jen had asked me "How do doctors stay awake and work for 24 or more hours straight?" I told her "Now you know - adrenaline." Just ring that bell and I'll start salivating, or more precisely, announce the medical emergency and I get into gear. I suppose once a doctor, always a doctor, even on vacation.

I never did hear a chopper, but about an hour after the announcement, the captain hit the gas pedal and we moved from lollygagging along at about 10 knots right up to warp speed, about 22 knots, the cruise ship's max. We docked 3 hours early and the patient was off loaded, but I had gone back to sleep once the emergency was over. The patient was stabilized sufficiently that no chopper was needed, they could just move along to get to land and a hospital a little early.

[gailkate]

Great story about Ellen's dad!

Is there a sequel to the midnight emergency tale? did you ever find out what happened and did the pt. go home with you?

[BoatBabe]

Excellent story, Doc, and look how technology expedited your comfort and reassurance to Ellen. Here in Washington State, up pops a picture of her mending Dad, who is half-way around the globe, courtesy of her work-mate.

The speed of change has increased.

[doctork]

I agree, the speed of change has accelerated, and this is one time that it is beneficial. From the pictures, it was immediately obvious to Ellen that her dad is much better, so that was a huge relief.

I never did find out anything more about the midnight patient. Sometimes Garrison will say something at the evening show, but this time, no word. There had been 3 days in a row in which a patient was off-loaded for a medical emergency, but the midnight request for emergency was by far the most dramatic. I can put together a few pieces to make some sense. I surmise a patient had a bad GI bleed (heavy bleeding in the digestive tract (ulcers, ruptured blood vessel, something like that) to a level that was clearly immediately life-threatening, requiring several units of whole blood, or else they would never have made a public announcement. They would have just gotten eligible crew and staff donors.

It's rare in the modern era to transfuse type-specific blood; in a hospital they use typed and cross-matched blood only because there are other less common antibody factors than ABO and Rh that can cause a transfusion reaction. The ship medical center is like a mini-ER so perhaps they have the facility to do a basic cross-match.

Whatever, I guess it was successful in stabilizing the patient enough that continuing on the ship at a faster pace was satisfactory. The ship doesn't have a helicopter pad so transferring a patient by chopper usually entails the chopper hovering while a basket is dropped down, loaded and the passenger brought up in the basket and then into the chopper - dangerous for a sick person.

I usually do not have great curiosity about "the rest of the story." One hears and sees so much in a decades-long career that sometimes you just want to do your part and then put the story away. Had I been directly involved - gathering donors, hooking up transfusions, talking with patient and family - I'd maybe have wanted to know that the patient got safely to the hospital and survived. I am fairly sure that the patient did not return to the ship. A person who survives such an incident (as is likely in this particular situation) would likely require at least a couple days in the hospital, then a discharge to take it easy at "home," in close proximity to a hospital, perhaps staying in Bergen or Oslo until it's safe to fly to wherever the real home is.

It's late and I am working tomorrow's Saturday clinic, but after that I have a 3 day weekend. I'll write more then.

[gailkate]

So the Saturday clinic is over, and K's probably sleeping in. Maybe she'll check in or just snooze away her lovely holiday. 3 days of peace and rest probably look heavenly.

I'm amazed that there are so many medical emergencies. How many people on the ship? Are they mostly old? I think of the ship's doctor as sort of a camp boo-boo fixer. I didn't watch the Love Boat often (honestly, I didn't) but wasn't there a sort of amiable doc who very occasionally had something serious to take care of?

I love oddball facts, so I googled "medical emergencies on cruises." All kinds of things came up, including this:

www.consumerreports.org/cro/news/2014/04/7-things-you-need-to-know-about-medical-care-on-cruise-ships/index.htm

[BoatBabe]

Ouch. That is not a comforting article about ship board health care, albeit possibly true.

[gailkate]

No, it isn't. Just imagine the misery of the original Legionnaires' sufferers and the exhaustion of the limited medical staff. I don't remember how long that ordeal lasted. No doubt there are some vivid accounts.

[doctork]

You guessed right, gk. I've just been relaxing, sleeping late and taking naps. Get while the getting is good, I say.

HAL's Rotterdam carries 1400 passengers (and 900 crew members), HAL is known for its older clientele, and fans of Prairie Home Companion definitely skew to an older age group. And they are all going to new places and having lots of adventures so illness and injury are not unexpected. Thinking back, there have been medical emergencies on most of the cruises I've been on, though not as dramatic as emergency blood donations/transfusions in the middle of the night. As noted in that article, they usually have crew members donate when necessary, which is why I discerned that patient must have had a fairly massive bleed - more than the crew could accommodate.

The other emergencies on this cruise - one person with a broken ankle (falls are common, as noted), and one person inconspicuously offloaded in port for some unknown reason. And of my 10 APHC cruises, I've gone twice to the ship's doctor - once with my sprained ankle (X-rays were done - no fracture) and once for industrial-strength steroids. I cleaned out the ship's entire supply of prednisone though I am sure they restocked in port the next day. The doctor visit was reasonable - $90 and my travel insurance reimbursed me, the steroids were at cost, and the ankle X-rays were at no cost to me because my injury occurred during an official HAL cruise.

IME, the docs on HAL ships are ER or family practice docs, and "board-certified" or equivalent. They are running an urgent care type environment, not a hospital emergency room or ICU; I can't imagine why anyone would think otherwise for a cruise ship. I think that article is probably fairly accurate, except I think that a Coast Guard chopper can't get more than 200 miles out from shore, not 500. OTOH - most nations have their own version of Coast Guard, and as far as I know, they do not charge for their services in medical emergencies.

Norovirus is widespread in schools, nursing homes, and most any place where there are lots of people in enclosed spaces. Mosquito borne illnesses are common on land as well as sea. IIRC the initial outbreak of Legionnaire's occurred at a conference at a hotel in Philadelphia. The avain influenza that nearly toppled Toronto hospitals began in Hong Kong with an infection acquired on land. Death rates are higher in rural America than in cities due to delayed access to care. And I know I have regaled you all with my tales of mid-air medical emergencies! Life is dangerous and nobody gets out alive. (depending upon one's spiritual orientation of course)

One of the most important aspects of travel in general, and cruising specifically, is getting good medical evacuation insurance. The kind that takes you from you initial medical facility to your preferred hometown hospital and doctors. I usually do get my travel insurance through insuremytrip.com, as mentioned in the article. I'll self-insure for the cost of the trip and the minor stuff, but when it comes to the 5 and 6 figure sums, I buy the insurance.

On the medical aid trips to the Third World, the agencies provide insurance coverage, including the political kind, such as abduction by Taliban or whatever - they used an Israeli firm for that, like those Entebbe guys. Not needed for a HAL cruise to Norway :-)

[BoatBabe]

I don't know . . . some of these old Scandahoovian salty, sailors/fishermen we have around here (who call Norway home)
are pretty darn scary, if you ask me.


Uff Da!!!


;-)

[doctork]

Maybe they got wild when they got Out West. They seem pretty civilized in Norway today. That reminds me of this song that GK wrote, set to the tune of "This Land Is Your Land." I only remember the chorus:

This land's not your land, this land is Norway
They do things their way, and it's not your way.
From downtown Oslo to the Arctic Circle
This land, it welcomes you and me.

And you know, they really did welcome us!

[gailkate]

Great song. Good ol' GK.
"What do you mean there's no pontine, no sriracha curly fries, no Mountain Dew?"
"Stores are CLOSED on Sundays?!!"

[larky]

Hi all here! Heard the blood donor issue was someone who'd been on chemo, had a bleed, got stabilized and off ship, as you described, Doc. The other was a fellow who couldn't get his heartbeat under control, but after a hospital stay he was back on board in Bergen. Just like life at home, stuff happens. I tripped on the stairs near the Crows nest (sober, I swear) and hit the deck, but just a bruised knee.

[BoatBabe]

Jul 8, 2017 18:05:08 GMT -5 larky said:

Hi all here! Heard the blood donor issue was someone who'd been on chemo, had a bleed, got stabilized and off ship, as you described, Doc. The other was a fellow who couldn't get his heartbeat under control, but after a hospital stay he was back on board in Bergen. Just like life at home, stuff happens. I tripped on the stairs near the Crows nest (sober, I swear) and hit the deck, but just a bruised knee.

Stuff happens on a ship. Ships move. Glad to hear that it was just a bruised knee. So sorry to hear that you were sober!