Jumping ship: I treated 600 STDs during my 6-month deployment

It was 1986, and my post-graduate training in the Navy was interrupted by an operational tour in the Mediterranean Sea. Technically, I was qualified to practice independently as a medical officer at sea—however, I had my doubts.

Ready or not

I was told that alcohol abuse and psychiatric disorders would be my most frequent encounters. This turned out to be true, and managing those patients was interesting, challenging, and professionally satisfying. 

Because of the timing that my internship ended and the required training before being shipboard certified, I missed ship’s movement. My ship had completed the 10-day transit from her home port at Norfolk Naval Base in Virginia to begin a 6-month deployment in the Mediterranean, but I caught up with her in Rota, Spain.

Smooth sailing? Not exactly...

As I scaled the ship’s ladder, I prayed that I was ready. Day 1 saw us steaming through the Straits of Gibraltar, and I was invited by the Commanding Officer (CO) to join him on the bridge. We were quickly surrounded by small fishing boats, the captains of whom apparently wanted an up close-and-personal view of a massive US Navy ship. I expressed my concerns of a collision at sea, but the CO chuckled and reassured me, “Gross tonnage has the right of way.” I remember thinking, ”Whew, 168 more days and a wake-up, and I will be back in the hospital with a chief resident watching over me!” 

We encountered heavy seas on Day 2. My shipmates quickly tested my abilities by lining up outside the Medical Department, complaining of seasickness. 

I ordered my shipmates to their racks, or beds, to recover. Soon after that, I met the First Lieutenant. At 6’6”, he dwarfed me, and his misshapen nose intimidated me. (I later learned that he declined surgical repair following a number of bar fights, lending to the unconditional respect he received from the young sailors under his charge.) He put his arm around me, and in a surprisingly gentle voice told me, “These men do not need to be in their racks; they just need a paper bag and fresh air.” 

Taking his advice—and, later on, diagnosing his myeloproliferative disorder while in an early stage—cemented a relationship that has remained intact to this day.

Occupational hazards

As a supply ship and “gas station at sea,” our ship provided supplies, jet fuel, and diesel fuel to the carrier group. The shipboard work environment can be very dangerous, especially with all the moving parts during an underway replenishment, with the carrier port-side and a destroyer to starboard tethered together by 6-inch fuel hoses while steaming at 12 knots.

On Day 3 of my 180-day cruise, a very experienced sailor sustained a severe crush injury to the neurovascular bundle in his foot during one of these replenishments, necessitating amputation without the benefit of general anesthesia. 

It was difficult for me to amputate his foot, not only because I had never performed an amputation before, but because I knew he would have to be discharged from the military after 18 years of service. Fortunately, there were no complications.

‘You’re a surgeon, aren’t you?’

After 30 days at sea, I was more than ready for “liberty” in Toulon, France, with dinner at a French-American League event in Marseille. Unfortunately, dinner was cut short when one of my shipmates was arrested by shore patrol for intoxication. He required a medical disposition, as we were due to get underway in 12 hours, for another 30 days. He was difficult to arouse and had a near-lethal blood alcohol level of 0.38%, but I deemed him to be stable. 

As he began to emerge from his fugue state 24 hours later, he complained of severe scrotal pain. The pain was so severe that it was difficult to perform a meaningful examination—that is, I could not determine if there was a mass (ie, torsion) or inflammation (ie, infection). I didn't even have access to ultrasound or CT machines—it was just me!

Although my shipmate denied any recent sexual encounters, I had already treated numerous STDs and was understandably skeptical.

His medical record had very few entries, despite his 18 years of service, so I did not consider him to be a malingerer attempting to get out of work. I appraised the CO in the morning report that I felt he either had an STD or a testicular torsion. If the former, he would show signs of improvement on empiric antibiotics within 24 hours. The CO asked what treatment would be required for a testicular torsion, to which I replied “surgery.” The CO said, “Well, you’re a surgeon, aren’t you?” 

Fortunately, my shipmate recovered fully with a short course of antibiotics.

Shipboard success

It wasn't easy, but I felt proud when the tour was over and my tenure as a medical officer at sea had been successful.

Mastery of the biomedical sciences in the preclinical years, experiencing the full spectrum of core clerkships supplemented with electives in the clinical years, watching residents in action, passing the licensure examinations, and the incremental increase in patient management under the supervision of attending physicians during post-graduate training—all of these together are an effective recipe for independent medical practice. 

James Anderson, MD, is a retired OB/GYN, with 45 years of medical writing, editing, and peer review experience.