Testing Telemedicine’s Limits
Early into the 645-mile race between Marion, Mass., and the island of Bermuda in 2009, trouble brewed aboard the C&C 40 Corsair. The bizarre situation that the crew of Corsair faced is described in detail in a 2011 article, “Lost at Sea,” written by Diane Kelly in Ocean Navigator magazine. It all began when the navigator, 75-year-old Ron Chevrier, started acting strangely.
At first, Chevrier’s mental lapses were subtle. His dead-reckoning position plots were far off their mark. He swore the boat was going nowhere, though the GPS showed the boat making progress. He shrugged when the skipper showed him the GPS and pointed out his error. “Just one of those things,” Chevrier said.
There were other signs. Chevrier hung his foul-weather jacket over the cabin table, instead of in the wet locker. A written watch schedule he had promised never materialized. He made no entries into the ship’s log.
The skipper, David Risch, was perplexed. “We knew something was wrong,” he said. “We just didn’t know what.”
On the third day offshore, the navigator began behaving erratically and hallucinating. He said he saw people without faces floating below.
The crew decided to quietly take over navigational duties. Chevrier, was a respected, veteran offshore racer. Although he seemed happy most of the time, he was acting more and more unstable. The captain and crew didn’t want to create any friction. It would be days before they reached Bermuda.
On the fourth day, Chevrier himself recognized he was behaving abnormally. He willingly relinquished his position. A junior member of the crew took over his duties.
The boat’s designated medical officer unsealed Chevrier’s medical history (submitted by each crew member, the records were sealed to be kept confidential, only to be used in an emergency). He made a satellite phone call to George Washington University’s Maritime Medical Access center, where doctors on call 24 hours serve sailors at sea.
Chevrier was taking medication, and the consulting doctor suspected a drug interaction. Chevrier’s behavior had become more erratic, sometimes compliant and happy, but other times fearful, even suspicious of the crew. He was having trouble sleeping. The doctor suggested trying a sedative to calm him down.
“We just wanted him to lie down and get some rest,” Risch said. “He was moving all around the cabin. We didn’t want him to hurt himself.”
By the time Corsair docked in Bermuda, the hallucinations had gotten worse. Chevrier was taken to a local hospital and then evacuated to Massachusetts General Hospital, where he was treated for a week and then released.
It took doctors in Massachusetts months to figure out what occurred. In the end, they concluded that a drug overdose had exacerbated an underlying, emerging dementia. The drug regimen was changed, and Chevrier’s condition improved.
In this month’s issue on telemedicine, we gaze into the not-so-distant future, examining a trend that will play a growing role in offshore cruising, especially for those crews who plan to venture to remote locations. Telemedicine technology is developing at a rapid pace, and although it’s no miracle-worker, it has fascinating potential. I can think of at least three occasions while my wife and I were cruising that having quick access to such a service would have kept me out of the hospital.
Nevertheless, as the Corsair case illustrates, much of the work to ensure a crew’s safety needs to be done before leaving port. Without a clear assessment of each crew member’s health before departure, and without a fully stocked medical kit to address any anticipated emergencies, having a remote doctor available to offer advice won’t make much difference. As it is with almost every aspect of cruising, preparation is name of the game.