An Ill-Fated Cruise

Not long ago, I was on an Indo-Pacific liveaboard, and while I don't intend to name it, I think my trip had some lessons to be learned, not only by divers but by liveaboard operators as well.

After making it through Customs, we were told that of the 15 divers expected, only two had made it to the boat; others had been stuck at airports. Our agent confided that one of the two onboard divers was a problem and had not wanted to wait to dive. The indignation it provoked in all of us was palpable, but it would not be the last time we would be disappointed.

Much to the chagrin of the Aussie diver on board, who had arrived on time, he had been labeled a troublemaker. The grievances leveled at him by the DMs were related to his questioning what diving would be available while waiting for the 13 stranded guests. For whatever reason, his questions and manner had profoundly irked the staff, and he was told that they would deal with the issue while insisting he desist from asking further questions. He shared this with us shortly after boarding; we were initially incredulous that a seasoned crew would deal with passenger concerns in anything other than a diplomatic fashion. Surely, he was merely overstating a misunderstanding.

Liveaboard diving is characterized by a vast spectrum of personalities and abilities brought together in close quarters. The potential for friction is immense, and if it occurs, it needs to be diffused early on by professionals committed to the discreet finessing of people of differing backgrounds.

Sadly, this did not seem to be part of the DMs' skill set. Indeed, the protestations of our Aussie friend were quickly verified when the DM verbally attacked the diver in public, an experience that was quite jarring. All the divers were deeply flawed in the eyes of the DMs, whose opinions were voiced publicly and repeatedly with tremendous ferocity. Eruptions were utterly unpredictable; for example, during a poorly planned dive characterized by a raging current, the DM became enraged, gesticulating her frustration when we were too overpowered by the current to swim against it and return to the reef.

Derogatory labels and opinions were expressed to all the divers daily:

• A diver with cold-like symptoms, earaches, a headache, and congestion could not dive and was labeled a "drama queen." As a clinician, I suggested that the diver be tested for COVID as there were obvious implications for the boat, crew, and passengers. And while the DM admitted to having the tests, she refused to do so; if positive, it would cause too much drama. And yet, as a nonmedical professional, she would otherwise freely advise divers on medical conditions. This led to inappropriate advice, such as offering antibiotics for noninfectious conditions.

• A diver was labeled as an "asshole" as he asked too many questions. Other divers were "incompetent, childish, arrogant, and crazy." Upon embarking on a dive, it was stated, "If you think you know better than me, then go ahead and do your own thing, but you'll be sorry."

• "I have a Ph.D. in marine life and tropical parasitology; don't argue with me," when discussing the local fish life.

As a result, rather than incur the mercurial wrath of the DM, divers tended to avoid interactions that could lead to any combustible situation; this led to a rather awkward dynamic onboard.

Of greatest concern was when an older diver developed an extensive, clinically threatening deep vein thrombosis and was offered antibiotics by the DM until the passengers requested our clinical review, at which time we made the diagnosis. The DMs then stepped up and took responsibility, which was commendable; however, while attempting to outline a possible medical strategy, they rapidly stepped back privately, stating their unwillingness to proceed: new guests were imminent, and they could do no more. They said they were "washing their hands of the entire episode." While I appreciate the pressures of the situation, this was in profound contradistinction to their comments that the ill diver remained their "primary concern and responsibility," and they would stay involved and committed to ensuring his recovery." Such hypocrisy was very unsettling. Additionally, trust in the DMs had been eroded by their behavior during the voyage.

Nevertheless, the ill diver was sent to the local hospital, where the appropriate therapy was unavailable. As beds were scarce, he was placed in a hotel despite confirmation of our diagnosis. Upon that discovery and a report of the symptoms progressing overnight, we recommended that he be evacuated by medical aircraft as a commercial flight would be hazardous. Prolonged discussion between his two insurers began regarding who had primary/secondary fiscal responsibility, especially since this was a medical condition rather than a diving-related emergency such as DCS.

The thrombosis developed into life-threatening necrotizing fasciitis, which was in part due to small skin cuts. He was evacuated to Australia and has done well after a prolonged hospitalization.

Upon review, we were left with much to consider. Among them:

• Divers must be fit before departing to some distant Third World paradise where medical care is difficult to obtain and the standard unknown. It is not unusual for divers to refuse to disclose pre-existing ailments that they fear may impair their ability to dive in the opinion of DMs.

• Divers should maintain a master list of medications and their primary doctors' contact details that medical staff can easily access in an emergency.

• Dive boats should have remote access to clinicians or other medical staff to advise on diagnoses and assist with or monitor therapy. DMs should never consider themselves surrogate clinicians who can make medical decisions. This cruise had doctors on board; however, with satellite communication, easy access to the internet, and video phone capabilities, there's no excuse for a liveaboard to be without access to established medical emergency protocols for discussion and diver safety.

• Divers must be adequately insured to cover serious unforeseen events. The coverage must be optimized for complex medical issues and potential evacuations that are not dive-related.

What recourse do divers have when zealous passion turns to brittle dogma, and the passenger is seen as an ill-informed liability and adversary?

The public displays of hubris and antagonism can never be justified, particularly when diver safety is a concern. Simple respect and understanding are not merely required but demanded.

This trip left me with a profound sense of disappointment and sadness that such experienced and knowledgeable individuals could so easily have altered the trajectory of the overall cruise through patience and understanding rather than the belligerent intolerance that was displayed.

- Max Weinmann, M.D. (Atlanta, GA)

P.S.: I've since learned that the two divemasters/cruise directors have been dismissed after a series of complaints to the owners of the vessel.