All at sea with scalpel in hand

by Richard Arnot*

During an interesting six-month internship at the West Cornwall hospital in Penzance, Cornwall I looked for a berth on a square-rigged sailing ship with the intention of sailing round the world.  Fortunately common sense prevailed, and instead I joined P&O as junior surgeon on the SS Canberra, and set off from Southampton in August 1966.

It was a great introduction to life at sea - romantic, wicked, and a wonderful experience in life affairs. I rubbed shoulders with the great and famous, including Cary Grant and his wife Dyan Cannon, with whom I was on first name terms.

During that voyage I had one day ashore in Sydney, one of the very few during the trip around the world, and fell in love with Australia, lying on starlit Bondi beach.

My travels with P&O ended in tears after six months when, following my refusal to obey what I regarded as an unreasonable order from my senior officer, I was charged with mutiny; fortunately I’d the foresight to arrange a transfer to the Union Castle Shipping Company.

Early one morning after we docked at Southampton, I borrowed a trolley from the stewards, rolled my bags down the gangway, and up onto RMV Cape Town Castle, which just happened to be moored behind us.

The six months on that ship were some of the happiest and most adventurous of my life. My good fortune was greatly enhanced by having the vessel commanded by Captain Doug Southam. Doug was the epitome of the sea-going hero - cap worn at a rakish angle, piercing blue eyes that missed nothing. He had received a medal during WW2 for sinking a German U boat. Captaining an armed British merchantman in mid-Atlantic, his ship chanced upon the enemy conducting repairs on the surface. The gunner got off a lucky shot, striking the sub’s conning tower, and Doug promptly ordered ‘full steam ahead’, ramming the submarine amidships, and sinking it.

The Cape Town Castle did a six week round voyage between Southampton and Cape Town, and back, calling into St Helena and the Ascension Islands, and Swakopmund in German West Africa. I had a few days ashore at each end of the voyage.

It was during a stop-over in Cape Town when I met an orthopaedic surgeon who had fixed my broken leg while I was a schoolboy in Rhodesia, now a lecturer in Anatomy, and he offered me a demonstrator-ship when I left the navy to begin serious training for surgery.

One day, after leaving the island of Madeira, I was visited by a cabin boy with obvious early appendicitis. Despite IV tetracycline, the only antibiotic we had aboard, he developed peritonitis, and clearly required urgent surgery. The only other doctor on that voyage was an ophthalmologist who had not strayed into an operating theatre in years, so it was all up to me.

By good fortune, in 1965, while I was on call as the surgical intern at the Dundee Royal Infirmary, a 12-year-old boy had been admitted with acute appendicitis. My registrar, who had over-indulged at the bar in the hospital mess earlier that day, informed me that this would be my first operation, with a nurse assisting and he supervising. I am pleased to report my first laparotomy and appendectomy was a success.

We had a makeshift operating theatre on board, complete with a collapsible operating table, a Boyles open-ether anaesthetic machine, an experienced ex-theatre ships nurse, and a hospital orderly.

As both surgeon and anaesthetist I attempted to induce the lad, only to discover I was unable to pass an endo-tracheal tube. Reverting to a pharyngeal tube airway the orderly bagged the patient with a supply of oxygen and ether.

No sooner had I started the incision than the airway (which had a round cross-section, not the usual flattened one) rotated so as to become partially occluded, the poor orderly on the bag could do nothing to help, and the operation was performed with this stout young lad gasping for breath throughout.

I can still vividly recall the nightmare operation 52 years later, including being able to successfully locate and remove a gangrenous appendix

Towards the end of my time aboard, once again in mid-Atlantic, the captain’s ‘tiger’ (as his steward was known) tapped on my door early one morning, and woke me with “Doctor, the captain sends his compliments, and asks if you could join him on the bridge”.

Dougie fixed me with a piercing blue eye and shoving a radio report into my hands said ‘Good morning doctor, I am sorry to wake you, do you think we can help?’ The report stated that a merchant ship in mid Atlantic had a sick officer on board with suspected appendicitis.

The captain changed course to a rendezvous point in mid ocean, and about fours hours later a rusty little tramp steamer came into sight, and we hove-to about 400 meters distant. A life-boat was lowered from the other vessel and Budge (my new but slightly corpulent orderly) and I were transported across, while the crew cooled the engine with buckets of sea-water sluiced over it and bailed from the bilges.

There was quite a swell running but we managed the rope ladder without incident, and a brief examination confirmed the diagnosis. The young man was strapped into a Stryker cane stretcher, and carefully lowered into the lifeboat. Budge followed, but unfortunately missed the last rung on the ladder, and landed heavily on top of the patient who fainted from shock.

The ships rails were lined by excited passengers when we returned, and transferred the patient to our sick bay. This time I was smart enough not to attempt another general anaesthetic, but I had read somewhere about surgeons operating with only sedation and local anaesthetic, and this worked out just fine. 

The lad snored gently away during the operation with Budge supervising the airway, and as the peritoneum was opened, the appendix, which had been lying directly beneath, popped up out of the incision and it was the work of a moment to ligate the artery and the base of the appendix and remove it.

The captain offered to do whatever he could to make the operation less dangerous, and he assisted by slowing the vessel down, and changing course so that the ship was running with the swells that made the motion on board a lot easier to handle.

This time recovery was almost instantaneous. I ordered the young officer to stay in the hospital for two days, but next morning he begged and implored me to let him out early, explaining that he had been at sea in a male-only ship for many weeks, and the charms of all the lovely young ladies on board was simply irresistible.

Months later I received a card of thanks and the report that he had been able to return to “full duties” within 48 hours.

I remained on the ship for her final voyage before she was sold to a Dutch shipyard to be broken into scrap metal, thus completing the final circle – my parents had met on her maiden voyage to South Africa in 1937.

Before we finally docked at Southampton almost exactly a year to the day from when I had set sail on the Canberra, I had to ditch the contents of our pharmacy over the side. I did however retain one small bottle of Dovers Pills containing a mixture of opium and ipecacuanha, which I had discovered was a wonderful cure for flu in combination with a liberal dose of ship’s brandy.

That would not be the end of my seafaring life, for I later embarked on a series of Arctic and Antarctic voyages, more experienced and better equipped for any medical emergencies that might occur.

* Richard Arnot is a retired Northern Rivers-based surgeon. He was born in England and educated in southern Africa, and graduated from medical school at St Andrews University in Scotland. After a year in the merchant navy he began surgical training in Cape Town and later in Britain. He holds a Masters degree in surgery and is a fellow of the Royal College of Surgeons in Edinburgh and the Royal Australasian College of Surgeons.

He has been recently appointed to the Southern Cross University health clinic where he runs a bulk-billing general surgical clinic one day a week.