Illness and injury on the high seas

Editor’s note: Eric Forsyth is not a medical doctor and the following account is not intended as a medical guide. Forsyth recounts some medically-related incidents he has experienced in more than 40 years of deepwater sailing to illustrate the kind of situation any sailor can run into. It’s important that in any medical situation you get professional help as soon as you can. The development of satellite phones, SailMail and Winlink can provide a means of getting medical advice to sailors on the high seas with a modest investment in equipment.

All the incidents in this article occurred while I was cruising aboard my Westsail 42, Fiona, since retiring in 1995. Whether the boat is at anchor, tied up or under sail, accidents can happen at any time. Fortunately most of the accidents I have encountered have been fairly minor, an adhesive bandage and some Neosporin ointment usually fixed most of these. Illnesses have been rare; I think living on a boat at sea is quite healthy. Despite the fact that the cleanliness in the galley would shock the average land-based chef, tummy troubles are uncommon and most of my crew have had a hearty appetite, unless they were sea-sick. Perhaps it helps the immune system to stress it a little. Many of the accidents I shall discuss happened to me; it may seem that I am a walking disaster area, but they occurred over many years and over many sea miles.

When a bandage is not enough
I have cracked several ribs during my voyaging career. The symptoms are unmistakable: intense pain and initial breathlessness. It is usually difficult to lift one’s arms and sleep comfortably. Doctors worry that the lungs may have been punctured, but I have never experienced that. There does not seem to be any useful treatment except taking it easy and possibly swallowing pain-killers. One of my ribs got cracked as Fiona approached the Falkland Islands on the way to Antarctica. I was sitting on the refrigerator, a favorite perch, talking to the crew about the heavy weather they were experiencing in Port Stanley when the boat gave a sudden, violent lurch and I catapulted across the main cabin. I came to an abrupt stop by colliding with an upright pole. As soon as I slid to the cabin sole I knew from the pain in my side what had happened. I could not raise my arms above shoulder height, which made it impossible for me to open the main hatch. I wandered off to the hospital in Port Stanley when we arrived, but the doctor could only x-ray me to check that my lungs were okay. My crew was not impressed and vetoed pushing on further south to Antarctica, which was probably wise. Instead I picked up a couple of local charts and we had a very pleasant time cruising the Falkland archipelago.

Another time I was chugging a beer in the old yacht club at Colón in Panama when a torrential downpour started. I remembered that the aft cabin hatch was open, and I dashed across the dock to shut it. I tripped on something and landed on a large cleat going full tilt. Goodbye to another rib! This time I was suspicious of the local hospital and I simply nursed myself as we sailed to the Galápagos Islands and beyond.

A few years later I had another painful accident at an old medieval dock in the Baltic. We were safely tied up inside the massive stone jetties as the wind piped up to about 25 knots. Comfortably ensconced in the cabin having afternoon tea and listening to the wind and rain I felt smug because I had got the boat into the harbor just in time. Suddenly I saw through the port a powerboat pass close by. It was a large German boat with just an elderly couple on board. The captain had become concerned about the chop further down the harbor and decided to move. The woman was standing on the foredeck holding a heavy mooring line, gesturing for me to take it. I climbed onto the dock and passed the line through an iron ring bolt. I took an extra turn, but the captain suddenly panicked and engaged full reverse. I could not hold it and let go. As the line spun through the ring, the end of the rope, which had a large knot tied in it, flailed back and struck me on the hand, almost knocking me into the water on the other side of the jetty. The back of my left hand was split wide open and bleeding profusely.

The crew dashed to my aid with lots of paper towels and duct tape and got me in a taxi to the hospital. A charming Greek lady doctor stitched me up but did not x-ray my hand. Months later an orthopedic surgeon looked at my hand and opined that a bone had been broken; it took more than a year to fully recover. My crew at the time consisted of a couple of ladies of a certain age who were not very strong. I was the winch operator for the main halyard. That was now out of the question so we sailed very circumspectly using engine and jib towards the Kiel Canal, where I managed to sign up a couple of Scotsmen for the trip across the North Sea to London.

These incidents happened at or near land, but one of the most frightening accidents occurred when Fiona was far from land in the boisterous southern Indian Ocean en route from Cape Town to Australia. We were running in heavy seas with a reefed mainsail and reefed jib boomed out on the whisker pole. The staysail boom was sheeted midships, but the vang had worked a little loose and the sail was banging around. I asked one of the crew to go forward and tighten things up. As he crouched near the staysail boom it swung over and gave him a good crack on the head. He flopped to the deck, momentarily unconscious, and I yelled for the other crewmember to give me a hand. I left the boat in the capable hands of the Aries wind vane as we both struggled to get him through the companionway and into the main cabin. Blood was pouring from his head. The boat was rolling violently. We wedged him into a dinette seat and I decided I would have to shave the hair off near the wound. The other crewmember hung onto a couple of poles and pressed himself against me so I had both hands free.

After cutting as much off as I could with scissors I also used a disposable razor. The wound was a couple of inches long and looked quite deep, but I didn’t know if his skull was cracked. I decided the main thing was to get it covered and anointed with Neosporin. My late wife, who was an MD, had cautioned me years before not to attempt stitching in such a situation. I pulled the skin together and used butterfly strips. The nearest land was more than 1,000 miles away; Kerguelen Island, which I knew possessed a French research base. It took us eight days to get there. The doctor examined the wound, pronounced it okay, changed the dressing and urged us on our way to Australia.

On another occasion I stumbled on the foredeck and suffered a deep wound in my knee from a protruding cotter pin on the forestay turnbuckle. We were cruising in the West Indies and the same day I went to the local hospital where an efficient French doctor inserted a few stitches. He told me to get them removed in a week, but we were not near civilization after a week and I delayed getting them out. After about 10 days the wound turned inflamed and painful. We tied up at a port in Puerto Rico and I took a bus to San Juan. The doctor at a hospital tut-tutted at my negligence and put me on a course of expensive antibiotics. There is a lesson there. I have, in fact, removed stitches myself when professional help was not available. I boiled the scissors and tweezers first and the patient survived.

House call
I was once able to help a female crewmember on another yacht anchored nearby. As I dinghied by I noticed that she was weeping copiously. It turned out she was suffering from abrasions on her breasts when she got caught by the mainsheet during an accidental gybe as they came in to anchor. By chance I had a little green box on board containing the product known as Bag Balm. I rowed across with it and suggested she should use a liberal application on the affected area. The next day her captain (also her boyfriend) brought the box back and reported it had helped the pain. I didn’t tell him that the balm had been a joke gift from a farmer friend and was used for cows with sore udders.

Hidden from view
Once when cruising in the far Arctic I had to lift up the Aries self-steering gear. This is a fairly heavy piece of equipment and I had to bend nearly double over the aft rail and heave it up. Something inside let go; a few days later I became aware of a curious lump on my left side about two inches below the level of my navel. I had a hernia; a break in the abdominal wall through which my gut was squeezing out. It was not painful and I knew the main danger was if the blood supply to the extruded gut was cut off and it became infected. I felt it every day as we sailed to Norway and then on to Ireland and Portugal. Nothing seemed to be changing, so I resolved to defer seeing a surgeon until I could get back home. I took a short break when we tied up at Lisbon and flew to the United States. A surgeon was able to stitch me up a couple of days after my arrival. A week later I had to see him for a final check-up and to have the external stitches removed. “Just take it easy for a while,” he advised. I did not have the heart to say I was about to leave on a double-handed jaunt across the Atlantic to the Caribbean.

There have been times when I’ve had to make an unplanned stop to disembark a crewmember. It happened on a passage from Terceira in the Azores to Nuuk in Greenland. We were a week out and well north of the Azores when a woman crewmember developed severe internal pains and found she could not urinate. We called her doctor on the Iridium satellite phone, who suggested getting her to medical attention as soon as possible. Easier said than done when you are literally in the middle of the Atlantic. He suggested using a catheter. Fortunately, I had a couple of dozen sterile catheters in sealed plastic packages in the first aid kit. She took off her pants, but at this point my courage failed and I suggested she insert it herself. This she managed to do and she emptied out.

Luckily, from then on she did not need help from a catheter. She went on a regime of antibiotics recommended by her doctor based on the selection of medications I had in the first-aid kit and the pain was alleviated by very hot water compresses on her stomach every few hours. For a few days she laid in her bunk as the two of us sailed the boat to St John’s in Newfoundland. She flew back to the U.S. and had surgery.

Sea-sickness
More than half of any new crew initially show the classic signs of sea-sickness: fatigue, nausea and loss of appetite. Usually they find their sea legs in two or three days. Not all of them actually vomit, but for the ones that do the trip becomes a nightmare. I have noticed that the effectiveness and side-effects of the common cures such as Dramamine and patches vary widely from one individual to another. If the vomiting continues for more than a day, the victims often stand down from watch-keeping and retire to their bunks clutching a bucket. Getting water and nourishment to stay down can be very difficult; I usually try dry crackers and bananas. On several occasions I have had crew who became so sick that they left the boat at the first chance. Sometimes a sailor can recover from sea-sickness if the boat continues on a run, but then becomes sick again if the boat changes to another point of sailing, such as a beat. I try to be sympathetic to crew suffering from this malady. I suggest lots of sleep and when they have recovered from a bout of vomiting I try to get their assist their body chemistry with juice, fruit, vitamins and mineral supplements.

Resources
I carry quite a good amount of prescription medications. I keep them in a roomy fishing tackle box, every couple of years a doctor friend goes through it to discard expired items and write prescriptions for replacements. I also carry a number of over-the-counter medications such as aspirin, pain killer, Dramamine, treatment for diarrhea and constipation. I have ointment for burns and Preparation H is useful for scrapes. In the same first-aid locker are several water-tight plastic boxes with bandages, Band-Aids, sterile dressings, cotton wool, etc. The boxes also contain scissors, a thermometer, tweezers, alcohol, etc. I always offer the crew vitamins and mineral supplements on longer voyages. I have a supply of catheters in sealed packets because many of my crew have been older men who run a risk of prostate problems. For medical reference I use International Medical Guide for Ships published by the World Health Organization. I also carry a small manual on common first-aid procedures.

Contributing editor Eric Forsyth is retired from Brookhaven National Lab and is a CCA Blue Water Medal winner.