This Is the Captain Speaking
Naples, Italy, 1990
While traveling I usually do not reveal I am a physician: it often steers the conversation toward ailments and pseudoscience and requests for opinions I’d rather avoid offering. Most cruise ships have a doctor or nurse on board, but this time we were on a ship with a capacity of about 100 passengers, too small for a ship’s doctor.
We had just returned to the ship from a shore excursion when a voice boomed over the ship’s intercom: “This is the Captain speaking. Any available physician please call the bridge.” I called, expecting to be one of several docs on board, but I was the only one. The Captain gave me a stateroom number and asked that I meet him there to examine a woman. “We can’t wake her up,” he said.
I found the Captain and First Officer in the room with two elderly women, both of whom I recognized from the dining room. One lay abed, apparently asleep, the other stood nervously by the captain and volunteered she’d just returned from a separate day-long shore excursion to find her roommate still abed.
“When I got up this morning she stayed in bed,” she said. “I imagined she was tired and wanted to skip our outing, so I didn’t wake her. When I got back a few minutes ago I found her just like I left her; she hasn’t moved an inch.”
I pulled back the bedcovers. She was wringing wet and her breathing was rapid, with a forced, mechanical quality; not the placid excursions of someone asleep, and she could not be roused, even to a knuckle dug deep into her upper breastbone. She was deeply comatose. But why? I told the Captain to summon an ambulance and asked her friend if she was diabetic. She was not. I asked for a list of medicines she was taking. Three stood out: two for irregular heartbeat, and Coumadin, a widely prescribed blood thinner. A picture formed immediately—this combination of drugs is often prescribed in patients for a common type of irregular heart rhythm (atrial fibrillation) commonly found in older persons. I asked if she had fallen recently. Yes, she had, just the evening before while climbing the stairs to dinner. She slipped and banged her head against the handrail. All she got from it was a sore spot, no bleeding, headache, or other consequence, and continued to dinner and an otherwise uneventful evening.
That was enough. I told the Captain I was reasonably sure she had an acute subdural hematoma, a variety of intracranial bleeding that occurs over the surface of the brain beneath the skull but not in the substance of the brain. Subdural hematomas are a hazard with a minor head injury in patients taking anticoagulants. For certain anatomic reasons the blood usually accumulates slowly, sometimes taking weeks to cause symptoms, and doesn’t produce the dramatic, sudden symptoms of a stroke. In her instance, however, a symptom, coma, occurred quickly while she was asleep.
An ambulance arrived and she was whisked away to a hospital. The ship continued on its way. After returning home I called the cruise line and asked what became of the patient. She had a subdural hematoma, which was successfully drained by an Italian neurosurgeon.
English