In 1971 I was the chief surgeon on the P&O ocean liner Orkney. I was coming home from Australia time. 24 hours out of Freemantle in the middle of the night there was a radio room summons for an urgent medical consultation with the captain of an unidentified ship. It was his chief electrician who had been repairing electrical wiring on top of one of the ship’s boilers; he had received a severe blow (the boat was running on 480 volts) and had been catapulted backwards and fallen at least 20 feet. He was still alive, but the Captain feared that he was dying and needed more help than he and his crew could provide.

It quickly became apparent that he was in a great deal of pain, and the captain needed advice on the proper dose and frequency of morphine that the ship was carrying in its medical supplies. The nature of the pain suggests anterior and posterior chest wall injuries and possible spinal damage in the lower thoracic and upper lumbar region. The two most pressing concerns were that he was urinating blood and that by the hour he was getting paler and sicker. This strongly suggests internal injury to at least one kidney and possible internal bleeding due to injury to other organs, such as the liver or spleen. He would probably need surgery and soon he would definitely need blood, both ships were a minimum of 2 days from land in either direction. There is a common myth that anything serious that goes wrong on a ship can be corrected by sending in a helicopter, this is rubbish now and it certainly was in 1972. The range of a helicopter is quite small with only 2-3 hours. sailing, most ships were out of range unless they came close to shore. We had found out the name of the ship, it was called Berge Istra, but our Lloyds list had no information on it.

She was a monster, a huge long green monster. As she got closer, our relative sizes became apparent. We were a big passenger ship, 28,000 tons or so, but we could have been a lifeboat for this one; she transpired that at that time she was the largest ship on the planet. In an astonishingly short time, a tiny-looking little red lifeboat was lowered, the injured man strapped to a wrap-around stretcher, named after its designer, Anderson, and secured as tightly as possible. The lifeboat rocked at full speed.

We had our patient on board and took him to the hospital when the first problem arose. He, like his ship, was huge. So huge that he was too long for our hospital beds, he was 6 feet 8 inches tall. We made him comfortable on one bed while the Ship’s Carpenter cut off the foot of the other bed. He was pale as a ghost, but he could talk and his English was good even though his nationality was Swedish. His pulse was thin and fast, his blood pressure low and he was in agony every time he urinated due to blood clots in his urine. On closer examination, it appeared that a left lower rib had been torn into the left kidney, more ominously it appeared that he also had a ruptured spleen. His abdomen was taut, exquisitely sensitive, and his muscle hardened at a light touch. This was probably due to blood in the peritoneal cavity, but could indicate intestinal rupture.

Overall, his chances of making it to Durban didn’t look too bright, and the first priority was getting him some blood and keeping his pain as controlled as possible. This was not easy at the time on a passenger liner, we could not carry blood stocks and the blood substitutes available at the time were not very good. The cross comparison was primitive, done with a series of blotting papers, a methodology devised by a Norwegian, who ultimately saved a Swede from a Norwegian ship. There was a little book of blood groups of crew members who were prepared to donate blood in an emergency.

After the second pint, it really started to get better. Her blood pressure stabilized, her pulse finally began to drop below a hundred, her temperature dropped, and, perhaps most importantly, she began to think that she could make it. With 24 hours to go, her condition worsened. We really thought we were going to have to operate this time. We gave him a large dose of morphine and a sedative to knock him out and those of religious belief prayed, he squeezed half a pint more from the only member of the crew with the correct blood type. So he arrived in Durban, where the ambulance and surgical team were waiting for him. In fact, he was even more damaged than we had thought. Both kidneys were damaged, his liver capsule was torn and oozing internally, and yes, his spleen was ruptured. They removed his spleen and 1/3 of his left kidney and gave him another 6 pints of blood, but he made it through and within 3 months he was back at the Berge Istra.

For a few years he sent me Christmas cards with small details of his life, at that time I was a family doctor and listening to the radio one morning while making my visits there was a news bulletin reporting the tragic loss of one of the largest ships. in the world, yes you guessed it, the Berge Istra. She had sunk with the loss of all hands in the South China Sea. It was later learned that the cause was probably inadequate cleaning of the holds of flammable gases before loading a full cargo of iron ore in Japan. There was an explosion that caused the hull to rupture and she sank like a stone. At Lloyds of London they classify the Lutine Bell.