Between leaving an emergency department where I had been working for nine years and starting in a new one, I had the luxury of having two months off, from May to July. This meant that I would get to really enjoy an extended summer break and recharge my batteries. It is fair to say that some degree of burnout and moral injury contributed to this change, and this was a much-needed break in many ways. The new place was also much closer to home, had better hours, and a population that was more in line with my clinical interests. I planned on getting some time in on the outdoor deck, catching up on reading and relaxing on my hammock before returning to the often-stressful environment of the emergency department. It also meant that I could take a shot at something I had always wanted to do: work as a deckhand on a whale watch boat.
In Boston, the whale watches are operated by one company with a fairly large fleet of boats that also do ferry trips, historic harbor cruises, sunset cruises and of course a speedboat that zips around the harbor. The whale watch adjacent aquarium provides a naturalist and an intern to narrate the trip, collect data, and do research. The job of a deckhand is akin to that of an ED tech. You do all the background tasks that are below the pay-grade of everyone else, from securing lines (the nautical term for rope), cleaning bathrooms, emptying trash, pumping the bilge and of course cleaning up any vomit. The vomit clean-up duty, in particular, was one that as a nurse practitioner I got to pass off to techs and nurses for that all-too-often occurrence in the ED. Now I was the guy with the towels and the wet-vac.
To do this job, I had to learn a variety of terms; port, starboard, galley, head, bow, and stern. I had to learn to tie a clove hitch and bowline. I became familiar with how to tie a figure eight around a cleat and staying clear of the snapback zone. I learned to fill the freshwater tanks, refuel, and how to check the generators. We got to practice man-overboard and fire drills. There was also the opportunity to learn more about the harbor, the history of the harbor islands as well as an array of important landmarks. I got to soak in a lot of information about the fauna we saw, including minke, fin, and humpback whales as well as bluefin tuna, sharks and the myriad of birds. Best of all I got to share almost all of this information with our passengers.
Answering questions, while not the primary responsibility of a deckhand, was something we did often. We were among the most visible of the crew, so people came to us with their questions. “How long is the trip,” “What type of engines does this boat have,” “How fast does this boat go,” were among the most common. This was closely followed by “what seafood restaurants do you recommend?” We got a lot of questions about the harbor as well, and I was always glad to point out some of the cool features to our passengers. We also got some questions about the animals we saw, and as the husband of a marine biologist who studied whales and who is also an amateur bird nerd, I was happy to answer those too when I could.
What started as just “something I always wanted to do,” actually became a real lesson in the delivery of healthcare. It wasn’t the medicine piece. Sure, knowing how to operate our AED, the microbiology of seal-hand, and my diatribe on shark bites made me a curious artifact on the whale watch boat. But it was more the customer service side that I got to see from a different perspective that allowed me to grow as a practitioner.
Akin to the whale watch boat, people in the emergency department ask a lot of questions. This used to be a real low-level annoyance for me, and one that could escalate quickly to “difficult family in room 5” levels. We often get questions we consider ridiculous like whether or not the patient with active abdominal pain can have a sandwich. Or ones that are “beneath our station” like “when does the valet parking close” or “what type of soup is the cafeteria serving today?” These can be annoying and often detract from other important duties. They seem to surface more often than important questions that patients should be asking about their healthcare delivery. But these are the questions we hear most often.
I think I better understand now why people ask these questions. They detract from the real questions and worries that they have. It is often idle talk just to pass the time or to allow them to not have to think about the worry of what the CT scan will show or what the blood tests will reveal. I started to recognize that a lot of the questions we fielded about boat speed and engine types were often from people who were just a little bit nervous to be at sea. It was a way for them to engage in conversation that allowed them to not think about getting seasick.
As providers, like on the boat, we get bombarded with questions that often times seem ridiculous. In truth, however, it may be an opportunity to start a conversation and then delve into more details about the patient’s feelings, anxieties, and fears. Sure, some people simply want to know what we are serving for soup that day. But for others, it’s an opening – an opportunity to start a real conversation with patients and their families and for us as providers to sit and listen.
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