Nurses on ferries to and from Finland must be able to do everything, from sutures and drips to psychological care.
”This job is not for people who get stressed easily or find it difficult to make decisions,” says Hans Lind, nurse on M/S Galaxy.
Shortly before half past one on Tuesday morning, Hans Lind is woken. The guard on duty is on his way to the surgery with a 28-year-old woman, who is said to have difficulty breathing and chest pains. When she is brought into the sick bay in a wheelchair, Hans is already there to meet her. The woman is lifted over to the stretcher while her sister sits down in the visitor’s chair. Hans talks to the patient while he methodically checks her values.
”Blood pressure is 130/70, which is quite normal, and your oxygen value is between 98 and 99%. You certainly have a high pulse rate, but that could be due to alcohol. I can find nothing that indicates anything wrong with you.”
The patient looks at him, not pleased.
”I think you’re wrong there,” she says while she is helped back into the wheelchair. ”I know what I feel.”
She puts her hand on the left side of her chest.
”What do you mean?” Hans asks. ”Do you have pain in your chest?”
”Yes, what does it look like?” she says.
”You must tell him how you feel, he’s not a mind reader,” says her sister.
The woman is put back on the stretcher. She takes off her blouse and Hans attaches electrodes to her chest to check her heart activity. The results of the ECG show that her heart is beating as it should, which Hans tells her. Then he adds that there is not much more he can do.
”Can’t you pump her stomach?” asks her sister. ”She probably needs it.”
”No, we don’t have the equipment for that,” Hans explains. ”But we can put her in a private room and keep an eye on her.”
The woman protests and they decide she should be taken back to her own cabin instead. When they have rolled her out of the sick bay, Hans walks to the desk and makes a few brief notes in a book to enter in the computer the following day. ”Allowing the woman to return to her cabin was not a difficult decision,” he says.
”As soon as she came in I felt it was nothing serious, and that was confirmed by the medical examination. In her case, it was probably more that she wanted attention than anything else. But you can never be sure and I take every patient very seriously and carry out a medical check-up.”
The rest of the night remains quiet and Hans is able to sleep without any other interruptions. The next morning he opens the surgery at nine. By then the ship has turned around in Turku and started the journey back towards Stockholm. Hans has already been sitting at his desk for an hour.
”I spoke with the guard who was here in the night. The woman had apparently continued to party after they took her away from here, so she obviously wasn’t feeling that bad.”
The morning sun shines in through the ventilation grille in the sick bay while the ship glides between the islands and islets. During the ten days Hans is on board, he is on call around the clock and may have a patient at any time. In addition to being on call, he administrates sick leave, trains staff and is responsible for the ship’s first aid group. For two hours every morning and afternoon he also has the surgery, and that is when most of the staff come.
”At the moment there are a lot of colds going round,” he says. ”There are a lot of us living in a relatively small space and if anyone gets ill it often spreads to others. We try to contain it with cough medicine and paracetamol, but if it doesn’t work they have to go home. If you are working ten and a half hours spread over 24 hours, you never really get the rest you need to recover,” he says.
Shortly after nine, the first patient arrives. He works in the service department and is one of those with a cold.
”I have a cough and a headache,” he says while he drinks a mixture that Hans has prepared.
”Do you also have a high temperature?” asks Hans.
”I think so.”
Hans takes his temperature and notes that it is slightly high.
”They had a disco in the cabin next to mine last night, so I could hardly sleep,” says the man. ”I thought I would go to bed for a while now, if that is OK.”
”Talk to the others in the department first, that’s all,” says Hans. ”I have no objections, though.”
How much Hans has to do varies. On special cruises with many young people there is generally more to do than otherwise, as well as periods when many of the crew are sick. Hans also takes care of work-related disorders and RSI.
”The restaurant department is over-represented when it comes to sick leave, especially neck and back injuries. There is a lot of crockery and glasses to carry and a lot of other heavy lifting work.
We could probably prevent some injuries with more preventive work, which is something we have discussed starting up,” he continues. ”Prevention is really the best cure.”
All of the employees have a journal on board. It contains illness history, allergies and other information that may be required for medical treatment. The records are confidential and only the nurses on the Galaxy have access to them.
”When we take out a journal, we should be able to see straight away what has happened in the past and if there is anything we should know about the patient. We also document events with passengers and keep the notes in an archive on board. Sometimes other health centres ashore or the police want this information,” explains Hans.
The morning continues and Hans alternates between checking patients and taking phone calls about bills of clean health and sick leave. Just before eleven o’clock when the surgery is about to close, there is a knock at the door. In comes a cabin steward with two new employees, Rasmus Iveholt and Angelica Alderhed. Hans tells them about the surgery and how they can register themselves as sick. Before they leave, they also state whether they have any allergies and fill in some personal details. When Hans finally closes the surgery for the morning, it’s time for lunch. He hopes to be able to sleep for a while.
”When you look at the bookings, you get an idea of what the voyage will be like. On some special cruises there is very much to do. The record was last year, when I only slept six hours in three days, but that was exceptional. I am usually woken once or twice a night on each shift.”
Even though Hans and his colleagues are well qualified and the ship’s pharmacy has more than the Swedish Maritime Administration regulations require, they sometimes require support from land. In the first instance, Hans calls Radio Medical at Sahlgrenska hospital in Gothenburg and consults a doctor there. Sometimes it is necessary to evacuate a patient. Just a few days before SAN News came on board, there was a young Finnish woman who was taken to hospital by helicopter for treatment.
”She was allergic to citrus fruits and there had probably been some in a drink,” says Hans. ”But I spoke to her father the day after and by then she was feeling better.”
”Mental illness is the most difficult”
The most difficult patients are those who feel bad psychologically, according to Hans. He worked in psychiatric care for many years, but assessing someone’s psychological state is far from easy. He thinks some of the most difficult situations are when drunk passengers threaten to jump overboard.
”My first reaction to people who say they are going to jump is to lock them up. Although experience tells me that those who have really decided don’t say anything, they just do it. If they talk about it, it is more a cry for help. But you can never be one hundred per cent sure, and I don’t want to have anyone’s life on my conscience.”
Crew members who feel bad psychologically also turn to Hans.
”I usually start by trying to find out if there is anything at home or on board that is making them feel bad. Often it is a combination of things, and then I try to get them to the occupational health services as quickly as possible to avoid long-term sick leave.”
On the last afternoon before Hans goes home, he walks around the ship and fills up the medical cabinets in the various departments with plasters, compression bandages and headache pills. He begins in the mess on deck ten, continues to the bridge, then the spa department and restaurants, and finishes in the control room. Then it is time to open the surgery again before the ship comes in at Värtahamnen and new passengers come on board.