SURGEON'S DIARY: Man develops acute gall bladder inflammation at sea

That night I slept fitfully worrying about the poor patient, developing a serious emergency at sea. ILLUSTRATION| JOHN NYAGAH

What you need to know:

  • Next on our itinerary was Grenada, a “picture perfect” island. Known as the Isle of Spice because it grows nutmeg, cinnamon and cocoa, their aroma hanging in the air, it reminded us of Zanzibar, our own spice island.
  • From there we sailed successively to St Vincent, St Lucia and Dominica.
  • With its lush valleys of coconut and banana plantations, golden sandy beaches and majestic mountains, known as the Pitons, St Lucia is a delight to explore.

Cruising has become more popular since we took our first cruise on the QE2, a luxurious ship named after Queen Elizabeth, in 1983 to celebrate our silver wedding anniversary. We have taken a few cruises since and have noticed that cruising has changed greatly.

It has become very competitive and therefore cruise companies have had to cut their prices. Cruising was the acme of gracious living but now as a result, it has lost some of its grace.

For example, there was a traditional British tea served in our first cruise every afternoon. No more, unless one pays extra! QE2 had tables for six in one dining room and there were only two options for dinner – early or late seating. In contrast, in the latest cruise we took in the Caribbean for two weeks with our daughter, son and his wife, there were six ethnic restaurants with extra charge, some of them hideously high. Despite that,  we had a lovely time, which I want to share with my readers in this column and then bring in the Surgeon’s Diary angle in the end. 

To board the ship, we were flown to Barbados but before the ship sailed into the calm Caribbean sea, we had a day in Little England as the island is known because of the great British influence which prevails in Barbados, even though it gained its independence from Britain in 1966.

Unlike other Caribbean Islands, it has been a British colony since it was discovered in 1627 and has therefore developed an endearing blend of West Indian and British cultures. Like Nairobi, its climate is holiday-maker’s dream, hovering between 24 to 27 Celsius and very low humidity.

The capital city, Bridgetown has a market town ambience, Georgian houses belonging to the rich of the world, who have a holiday home there, and neo-Gothic public buildings. The Heroes Square, the civic heart of the town, has its own Trafalgar Square, with the statue of Nelson in the middle, erected in 1813, in memory of the Admiral’s time on the Island, when he was in command of the British naval station in nearby Antigua.

One experiences some  American flavour on the island, when one visits George Washington’s house, where he stayed in 1751 as a 19 year old Major in the British Army when US was still a British colony.

The great American statesman and the first president of independent USA rented the house with his brother for £15, exclusive of liquor and washing!” Our tour-guide informed us. 

We visited St Michael’s Cathedral, originally built in the 17th century and rebuilt in coral rock in 1780, after being destroyed in a hurricane. We also saw Kensington Oval cricket ground, proving that the national sport in West Indies is cricket and the islands collectively form a formidable cricket team. Bridgetown has a Jewish synagogue and a couple of mosques, which make it a multi-ethnic city.

Our first stop after exploring Barbados was Curacao, which with its row of houses with their gabled roofs revealing that it was once a Dutch colony. The highlights of Curacao’s capital, Willemstad, apart from the Dutch influence are the Hato Caves with their dramatic collections of grottoes filled with stalactites, tapering structures hanging like an icicle from the roof and stalagmites, slanting columns rising from the floor of the cave and crystal clear pools, all centuries in the making. Next stop was Island of Aruba, where mother- nature has spread her charm, covering the island with beautiful landscape, rocky deserts, sandy beaches, colourful cacti and secluded coves.

Next on our itinerary was Grenada, a “picture perfect” island. Known as the Isle of Spice because it grows nutmeg, cinnamon and cocoa, their aroma hanging in the air, it reminded us of Zanzibar, our own spice island. From there we sailed successively to St Vincent, St Lucia and Dominica. With its lush valleys of coconut and banana plantations, golden sandy beaches and majestic mountains, known as the Pitons, St Lucia is a delight to explore.

We docked in its capital, Castries and visited its market, colourful fishing villages, magnificent rain forests, tropical fruit fields, rugged jungles, with wild orchids, giant ferns, bird of paradise flowers and finally the “drive in volcano.”

“St Lucia got its name because Christopher Columbus discovered the island on his fourth voyage on St Lucy’s Day, December 13 in 1502.” Our pretty Caribbean guide informed us adding “ Since then the island has changed hands fourteen times between Britain and France, after a brief occupation by the Spaniards, after its discovery by their explorer countryman, who also discovered America.”

Next we stopped in Antigua, which boasts of a beach everyday of the year with water sparkling in every shade of blue. Because of its 365 beaches it is known as a “Beach with an island in the middle.” The most famous attraction here is Nelson’s Dockyard in English Harbour, twelve miles from St John’s, the capital. It is named in memory of the great Admiral, who was appointed to the station in 1784.

The last island we visited on our delightful cruise was St Maarteen, with its dual personality, half Dutch and half French, each side trying to out-smile the other. As a result, it has two names, the smaller southern Dutch part is known as Sint Maarten and the larger land mass in the north, the French section is called Saint Martin.

“No one knows how the island was split, but legend has it that a Dutchman and a Frenchman divided it by standing back to back and walking in opposite directions from a certain point on the coast,” our guide explained.

“They promised to establish a boundary from the point they started, to a point they met again! The Frenchman walked fast, so the part ruled by Paris is larger, while the Dutchman was tardy but more selective, so the part under Amsterdam is smaller but contains the best part of the island with beautiful beaches and modern shopping. The boundary was incorporated in an agreement, signed by both European powers as Treaty of Concordia in March 1648, thought to be the oldest treaty between two nations and is still valid to this day.”

 Our ship docked in Philipsburg, the capital of the Dutch section and we drove to Marigot, the capital of the French part, with only a stone monument to indicate that we had entered the French segment of the island.

Of course the national drink in the region is rum, made famous by Harry Belafonte in his song, Rum and Coca-Cola and in St Vincent, we went to a rum manufacturing plant and saw how rum is made with a tasting session at the end. Two tourists with us became merry after sampling twenty varieties of rum and one went to sleep at the back of the bus and was woken by the driver when we returned to the ship!

To leave the travelogue and enter the domain of the Diary, I must add that at some point during the cruise, as usual, I went and introduced myself as a surgeon from Kenya to the ship-doctor in his office in the medical centre which included an improvised hospital with four beds, one of which was occupied.

“Good thing you are here,” he said after making me very welcome. “I could do with a second opinion on a passenger who was admitted to our sick-bay last night.”

“But I retired a couple of years ago and have neither renewed my license nor my medical indemnity.” I replied.

“Never mind,” the ship-doctor said, “once a doctor, always a doctor. Please examine the patient and give me an opinion.”

Feeling sorry, looking at the face of the young inexperienced doctor, I took the history from him and examined the very ill patient. 

“Have you ultra-sound facilities on board?” I asked at the end of my examination. “Clinically he looks to me like a acute cholecystitis with gall bladder blocked by a stone. I can even feel the enlarged gall bladder which is very tender,” I added.

“Yes,” replied the doctor, “I am glad you think as I do because suspecting an inflamed gall bladder, I ordered an ultra-sound of the man’s gall bladder and liver last night.”

“And?”

“Here are the images.” The doctor replied handing me the ultra-sound.

“I am not a radiologist.” I replied.”But these show an acutely inflamed and enlarged gall bladder.”

“Now that the diagnosis is surgical, what would you do for him?” The doctor asked the crucial question, with the expression of an orphan on his anxious face.

“Pluck his gall bladder immediately because it is likely to burst anytime and cause biliary peritonitis, which can prove fatal,” I replied.

After a thoughtful pause, to my relief, the doctor said. “We have no resources or personnel to remove an inflamed gall bladder. I better discuss the case with the captain.”

That night I slept fitfully worrying about the poor patient, developing a serious emergency at sea and the doctor at his wits end. Then I heard a helicopter hovering above us. Next morning I heard the captain’s usual announcement on the ship’s public system in which the captain started with an apology. “I am sorry that your sleep was disturbed last night. We had to evacuate an ill patient by helicopter to Montserrat, a nearby island, which has a fully equipped hospital. The surgeon from there has phoned me since and told me that the passenger underwent successful emergency surgery and is doing well.”