Destiny’s Doc

Destiny waits for no man…

AMERICAN WINDSURFER: How does one get a job like this?

Bill Cmikoski: The truth is that after I finished my residency in emergency medicine, I decided to reward myself and take a year off and just play. I’m not really into studying real hard, as I’m more of a person who enjoys his free time and doing a lot of sports like windsurfing in the summer and skiing in the winter.

It was about June of 2000, and I had just taken a cruise with my parents for the first time. We had a really good time and I thought, wouldn’t it be interesting to get the contact number for becoming a ship’s doctor and just look into that. Maybe that would be a fun job to have. I took the number and gave them a call a couple months later.

The person I spoke with said they would really like to have American doctors and the specialty they like the most is emergency medicine. Being American and being trained in emergency medicine, they were really excited. They needed a doctor right away on this particular ship; The Carnival Destiny, and asked if I could start in two weeks. At the time I didn’t have any other commitments. It was right before the time I headed out to Oregon to windsurf. So I talked to the guy in charge and suggested a try-out.

I wanted to make sure that I didn’t get seasick, number one, and number two, you hear about all these nightmares stories in the medical community about cruise ships and how the infirmary is full of patients, and that doctors are working all the time and not as glamorous or fun as it’s cracked up to be. That was the rumor. So I told my boss, “Listen, I’ll do one month because you need someone right away and if I don’t get motion sickness and I like the scene, then I will extend my contract for a full contract,” which is six months.

So I did the one month and immediately loved it. Didn’t get motion sickness at all as the ships are huge. The Carnival Destiny came out just a couple years before I joined the ship, and at the time it was the largest [cruise] ship in the world. Even now it’s one of the five largest cruise ships. It hardly ever rocks. And as far as the patient population goes, most of the people that come on this particular cruise are younger, single, active people. I had very few serious emergencies.


AW: Any to speak of?

BC: We have occasional major heart attacks and medical evacuations, but for the most part, on a routine basis, there aren’t a lot of people that have critical problems on the ship. As an emergency physician, we’re used to dealing with several critical patients at a time and several not too critical patients. So at any one time you might be taking care of seven or eight people in an emergency room but here, even if you have a critical case, it’s just one patient you’re taking care of. The work is never overwhelming, and as far as the lifestyle goes, it’s really incredible. Just touching on the services that are provided for you, you get a really nice cabin—which you can see here. The cabins on the other ships are equally as nice. You get instant prestige and respect as a physician. You are at the rank of senior officer.

AW: You sound like a recruiter now.

BC: Yeah, the ship can’t sail without two people: a physician and a captain. The only two people who can turn the ship around are the captain and the physician. If the physician feels like there is a medical emergency or some problem that warrants turning the ship to the nearest port, then we make the call and the captain either speeds up the ship to reach a port in front of us or turns the ship around to reach a port behind us.

Carnival really doesn’t put a price on people’s health. If we have to turn the ship around, which we’ve had to do before, then we do. I remember on one occasion, I had to turn the ship around for a sick patient and we didn’t arrive back in San Juan, our home port, until later that evening.

We were supposed to arrive in the morning and we didn’t arrive until twelve hours later. Carnival had to put up everybody who missed their flight home. They had to get new airline tickets and a hotel room. Usually we’d drop people off in the morning and pick up a whole new batch of people. So the new batch of people also had to be roomed at a hotel. When you consider a ship like this can carry over 3,000 guests, turning the ship around for that one patient was a big deal. I knew ahead of time it was going to be a big expense, probably cost Carnival in and around $150,000 in extra expense just to turn the ship around.


AW: That’s a huge responsibility! Are there any guidelines to help make that decision?

BC: Well anything that’s either life or limb threatening is basically what you’d consider a critical emergency situation. Most of the time it’s a major heart attack or it’s when a patient is unstable, who needs some other definitive care. Or it might have been an acute abdomen, which means that he has so much abdominal pain that he might have a perforation or an obstruction that needs immediate care or immediate surgery.

AW: Any unique cases you’ve come across?

BC: I’m asked that question about the ER too. Everyone wants to know the interesting ER cases and I really don’t have too many interesting cases. It’s really the run-of-the-mill, stuff you’d see in any ER. Like the heart attacks, the abdominal pain, asthma attacks. We see a lot of run-of-the-mill urgent care-type simple cases like the colds, the sprained ankles and the lacerations and cuts, bumps and bruises-type things.

I guess the more interesting cases we see are when people go berserk on a ship. When I say berserk, I mean people that have mental problems and/or have alcohol or drugs on board. Sometimes those can be a little interesting because the patient might be tearing down the halls or running around naked and doing some crazy things. I guess those are usually the more memorable cases.

AW: What are your medical capabilities on board?

BC: We have all the same medications and all the same interventions here that you could do in an emergency room in any large city or any average emergency room but with the exception of doing surgery like angioplasty and things of that nature. That’s usually the times when you’ve got to get someone out sooner when they require angioplasty or immediate surgery. We can’t do that but we can do everything else.

We have all the life-saving medications, we have the life-saving defibrillators, we have the ventilators, the breathing machines, we have all the simple life-saving procedures that you would have at any emergency room and we can stabilize. It’s like a miniature intensive care unit. If you’re going to have a heart attack or a major serious problem, you’re better off having it on a ship than anywhere on land. On a ship, you’re never more than five minutes away from the infirmary. We’re on call twenty-four hours a day. We can give specialized attention quickly and all the latest medications and treatment are available.


AW: You say the Carnival Destiny is your favorite ship. What are the perks?

BC: I’ve worked on many different ships because I do a lot of fill-in work. All of them are excellent and all of them are fun. However, there are certain runs that go through islands that are very conducive to windsurfing or kiteboarding. The Carnival Destiny is the ship that I’m on right now; it’s also the ship that I was on during my first contract for seven months.

At that time, San Juan was our home port. We didn’t leave until ten o’clock in the evening. So for that day, it gives you a full day of excellent windsurfing or kiteboarding. The next port would be St. Thomas and then Martinique, which is a very windy, beautiful island, lots of windsurfing and kiting available there. Then Antigua, which is very famous for kiteboarding. It’s becoming a major kiteboarding location. They also have great windsurfing there too. There was a person there that used to rent out windsurfing gear and it used to be a windsurfing destination resort. Not really a resort but a windsurfing destination, it was very nice. And then, of course, Aruba would be the next port, which is famous for windsurfing and then back to San Juan. Barbados, which we stop at now, is also a windy destination. The following week we would change ports and visit Dominica and Guadeloupe, which is also a great place to windsurf and a very beautiful island.

So, in a two-week span, I would visit four or five different islands that are all very excellent for windsurfing. I was having a varied experience and it made it really fun and exciting, I never got bored.

Now the Destiny’s run has changed a bit. When I first arrived here, the first month and a half, we did San Juan, St. Thomas, Martinique, Barbados, Aruba, and San Juan. So we had San Juan, which was awesome, and Martinique, a very good spot for windsurfing as well. Then Barbados, which in my opinion was the best because it’s got great wind and waves. Aruba, which was famous and then back to San Juan. It was an absolutely incredible itinerary. They often changed the itinerary. The itinerary changed about two weeks ago and instead of Martinique, they are doing Dominica, which isn’t quite as good for windsurfing or kiting but you never know if they’re going to switch back to Martinique or change things up. But we’re still left with Barbados which is excellent, Aruba which is excellent, and San Juan, the home port which is excellent. St. Thomas and Dominica—it’s a little iffier as to whether you’ll get sailable conditions. But the chance of it happening still exists and it makes it exciting and something to look forward to on those windy days. So that’s one of the nice things about the job. It’s the beautiful different islands that we go to on a weekly basis. You never get bored at the same spot. There’s always something to look forward to.


AW: Tell me about life on the ship.

AW: Well the nice thing about this particular ship is that there are two doctors on board. So with two doctors on board, we share the workload. Clinic hours are 8-11:00 in the morning and 3-6:00 in the afternoon. And then on home port day, on Sundays in San Juan, we only have one-hour clinic from 5-6:00.

So if you split that time in half, I only work every other day or sometimes we’ll split the day, where I’ll work in the morning and he works in the evening. If that’s the case, I’m only working for three hours that day. And we share the schedule. We are on-call every other day. So it’s really not a lot of clinic work or doctor work that we need to do. We just need to be there.

Our meals are all prepared for us. There are multiple venues to eat. We never have to go shopping and we never have to do the dishes. All my clothes I just put in a pile and my cabin steward makes up my bed every day, cleans my room and my room as you can see now can get really sloppy. I have a lot of people over all the time. I have a huge cabin so this is the place where most people come to hang out later in the evenings.

We’re all pretty active but in the evenings, this is the place to kick back and it does get really messy. My cabin steward makes it beautiful every day. The laundry’s all done; ironed and on hangers. If you want to go listen to any music or go to any clubs or lounges, there’s actually—I think we counted them one time because every once in a while people will do a pub crawl where they go to the different lounges—and I think there’s fourteen different places or bars on the ship. And about five or six different lounges that have different musicians that play. Everything from classical trio to salsa to rock and roll bands, there’s disco, and there’s a jazz trio.

So at any time, you don’t have to go get into your car and go drive anywhere, worry about drunk driving or just leaving your house. We’re five minutes away from all these excellent varied lounges to hang out. People are on vacation, so everybody is in a good mood, everybody’s friendly. It’s very easy to approach people and see how they’re doing; find out where they’re from.

Every single week, there’s a couple of very nice Las Vegas-style production shows which the company puts a lot of money into, so they are very big productions. They’re really as good as most similar type of Las Vegas shows, and then in addition to that, we’ve got comedians that come on, we’ve got jugglers, and we’ve got different types of entertainers that sing. Every week it changes and every week we have new people that maybe have never been here before. So that makes it really interesting.

We get a Carnival Caper which is a newsletter delivered to our door which has the night’s activities and who’s playing in which lounge and what not. I usually check that out and if it’s a comedian I haven’t seen before or a show, I’ll try to find time to go do that. There’s so much to do all day long. So many different things to do that it’s very hard, you’re always running around. I’m always running because I actually like to do a lot of these things. I guess a lot of crew members, people who are here for a long time, probably don’t go out and go to the shows, go to the lounges as much as I do. And that’s fine. You know, there’s something for everybody. But for me, I’m here specifically because of the lifestyle and because I have friends that are loungers.

It’s really very interesting when you’re going to listen to a rock and roll band or a jazz trio and you are good friends with the musicians or you are going to go see this big dancing production and you are good friends with the dancers. These are your friends. These are the people that really love to perform for other crew members. They get really excited when other crew members come to watch them. They actually try to do a little bit better. It’s really interesting to know these people on an intimate level and then to be able to go and watch them do their thing.

AW: Tell me about the crew. I see they are from all over the world.

BC: It is interesting to me how the demographic make-up is different in different departments. The steward department or the housekeeping department, we have a lot of Philippinos and Thai-Indians. In the food and beverage department, we have a lot of Eastern Europeans and Romanians, Phillipinos and other make-ups. The staff, which entails people like the dancers, the gift shop folks, spa people, are mostly from South Africa, Australia, lots of English. There are very few Americans actually, but a fair amount of Canadians.

Interesting thing is that there’s probably at least seventy countries represented at Carnival at any one time. It’s really interesting because it’s one thing to go visit these countries or to get to know people for a short period of time who are visiting, let’s say the states, and you run into them and you meet them for a few days or you meet them for a few hours. We live and we work with these people from all over the world on a daily basis for several months at a time and you really get to know and learn about different cultures.

It’s great to keep in touch with them and be able to go visit them. If I want to go to, let’s say to Eastern Europe, I have at least one hundred friends out there from Poland, Russia, Czech, Slovakia, Estonia, you name it and that’s just one region in Eastern Europe where I can do a tour. If I were to go visit, I could just stay and visit all these different countries and have a place to stay and also, someone to show me around. I reciprocate as well, I have a very big place in Utah, and I love to have visitors. Every year when I’m on vacation, at least a few people come to visit. At least two or three different groups of people will come. So that makes it really nice, to be able to have these contacts in different countries and just to get to know so many different cultures. For me, this is the most rewarding experience of working on a ship. To be honest, working here, living here, it’s like being in college or going to summer camp. I guess going to summer camp would be a better analogy. Or it’s like going to college or high school without having to study; just the fun parts.

You’ve got a ton of friends. You don’t have to make arrangements with anyone, you can just head on out to the promenade deck, to the lounges. You’re going to run into some people you know. Even if you don’t know anybody, you’ll meet some passengers, or if you go to the crew bar — a local gathering area where a lot of the crew hangs out — you just show up and you’re bound to know ten different people there. It’s always a fun place to hang out, for a lot of people; it’s their social common room. You always have friends and people who want to do things. It’s really nice. As you get older, you kind of miss and look back on your high school and college years and all those friendships and people to hang out with. I feel like they pay me to be on vacation. I really do. I really don’t feel like I’m working here. Even when I’m seeing a patient that’s critical, then okay I see that patient, but you know for that time you’re back in an emergency room. But like I said, that’s not very often. So the rest of the time I really feel like I’m just cruising around on vacation and they pay me for it.


AW: I see you walking around a lot with your kiteboard and tell me, when did you get into kiting and how do you decide when to go kiting and when to windsurf?

BC: Actually, I don’t really kite, I just carry the board because it looks cool and it helps me pick up chicks.

AW: [laughing] It obviously works!

BC: [laughing] That’s the main deal, but I started kiting because when I first came down to the Caribbean, I didn’t realize what a great opportunity this was for windsurfing. But one thing that I noticed is that in the Caribbean as anywhere, including the Gorge and Maui, you don’t have strong winds all the time. This was three-and-a-half years ago, so there weren’t a lot of kiters out there. Obviously, the sport has been around longer, but it really hadn’t taken off at that point.

I knew if I showed up with a kite it would be the first time anyone had seen one. At any rate, I knew that you can’t really keep your surf equipment on the ship. There’s just not enough room for it. The mast, the boom, it would be too difficult lugging it around, getting a cab. Forget about it. If you’re going to windsurf you have to rent the gear on the islands. Whereas with kiteboarding, I’ve got one kite. You can have more kites but I have one kite that works well. I purposely got a bigger kite that works well in lighter conditions and one board. You can bring that in your cabin, it’s really easy to walk around with.

Basically, when I was home that two weeks, I took a windsurfing trip to Cape Hatteras. It stunk the whole week as far as the windsurfing goes, and I thought, you know, I have to learn how to kite before I get back to the Caribbean. I won’t be able to rent them down there, they won’t have any schools. Back then they didn’t. I’ve only got this one week here where they have a kiteboarding school and it’s an excellent place to kite and learn. I had to take a lesson.

I thought it would be such a cool to bring the kite on the ship and be able to kite anywhere down there. I wouldn’t have to worry about rental gear. So luckily on the very last day, literally two hours before sunset, the wind picked up. I called the shop and said, “You’ve got to give me a lesson!” I had actually been calling them earlier in the day saying, “Hey, if the wind picks up I need to have a lesson.” So we got out there and I told him to just give me the whole shebang in two hours. Even if I don’t get very far, tell me everything I need to know because this is my last chance, I was leaving the ship in one day.

The instructor, who I guess is a pro kiteboarder now, got me out there and taught me everything I needed to know. It was really simple; I couldn’t believe how easy it was. I wakeboard and I windsurf so obviously I know how the wind works. Flying the kite was a piece of cake, and then standing on the board was a lot like water-starting and even actually a lot more like wakeboarding, when the tow-rope pulls you up on the board from the boat. So that was really easy, I was able to go fine in both directions. I didn’t do it very well but I had the premise down. It got dark; I had my two-hour lesson. I knew the basics of what I was doing.

I bought the equipment from him that day and had it shipped to the cruise ship and then the adventures began. Which I can tell you about a little bit later. But let me just tell you why or how I choose whether I windsurf or kite.

I’m a windsurfer first and most, and I’ve been windsurfing for many years and I love it. I’m very comfortable with it. Kiting you know, even though I’ve been doing it for three years, I still only do it sporadically here and there. I’m learning new equipment now too. I’ve just switched to a twin-tip, which I’m trying to figure out. That’s not taking too long; I’m just still trying to get the hang of it. But the bottom line is kiteboarding is an adventure for me still, whereas windsurfing is great fun.

I’ll never give up windsurfing to kite. It’s like skiing and snowboarding. They’re both fun and I’ll always do both. So it’s really simple for me to choose which one to do because it’s harder for me to windsurf on-hours because you have to have more wind to windsurf and sometimes the rental gear is harder to find. So whenever the wind is heavy enough to windsurf, I windsurf. I try to windsurf as much as I can. Anytime the wind is light, I go kiting. That’s basically how I decide which one to do.

AW: How long have you been a cruising doctor?

BC: Most of the things that I’ve done in my life I’ve done for a maximum of two years. Then I moved on to different experiences. You know, life is so short and there’s so much to do.

When I came here, I was having a blast, an absolutely incredible time. I still continue to have a good time. I never thought that I would be doing this for more than one or two years and that’s only because, well, a couple reasons. One is that I wanted to do a sports medicine fellowship which I still want to do, and also, I figured from the amount of people I meet on the ships, both passengers and crew, I figured I’d have a serious girlfriend by now.

You can have a relationship with a person on a ship who’s working with you. We do that quite frequently. We usually date crew members because we’re here for a while. We meet so many beautiful people from all over the world. We do have romances, but if I were to meet a person on land or on a ship that I was serious about, there’s no way you could have a long distance relationship and work on the ship. There are way too many temptations. You would miss the person too much, and even if you didn’t stray, you can’t have a relationship and be apart from someone for several months at a time. I really do want to settle down at this point in my life and have a serious relationship. I would have thought that I would have found one by now. I’ve had some close calls. If I do find one, I’d like to hang out and get a real job in the states and do the whole house and family thing. I’d like to have kids soon. If I did that, it would be the end of my ship life.

I thought that would happen and it actually did almost happen. I was dating a girl for a while and I went away on a contract and she didn’t want me to, she made me promise never to do any more contracts. So then I said okay I won’t do any more contracts, but while I was still on vacation this past year, my boss would call me to fill in. If there was a crisis, he knew I wasn’t working on land; I usually just ski and snowboard all winter. I don’t like to work in the wintertime. He knew he could call me and I could fill in for him at a moments notice. I was doing a little of that. Just one week here, two weeks there, that type of thing. That kind of put a strain on our relationship. She didn’t like that. So then she said, “Okay no more of that either.” So I thought I’d really better not work on ships anymore so I was looking for a job in Utah. Then our relationship really became very tumultuous and we did break up. We broke up about two weeks before my boss offered me this job on the Destiny.

The doctor who was here before me resigned earlier than his contract called for. So they had a two-month period where they needed a doctor. I had just broken up with my girlfriend. It was right around Christmas and New Year’s, and I had been planning on spending Christmas and New Years with my girlfriend. This is my fourth year in a row that I’ve spent in on a ship, so I’ve never been able to spend it at home, and I was really looking forward to that. So I thought, now I’ve got no one to spend Christmas and the holidays with. On the ship, Christmas and New Year’s is the best time of year. Everybody gets together, it’s all family oriented, we just have a great time. It was very good to not sit home and sulk about a broken relationship.

I came back, and they offered me the Destiny. The Destiny is my favorite ship. It’s one of the only ships that has this excellent windsurfing itinerary, so I jumped at it and I’m here now. I guess I’ll do ships until I can either get the medical training that I’m looking for or until I can find a good girl to settle down with.

article and photos by John Chao

Publisher / Editor is a former photojournalist for GEO, National Geographic and Time-Life Magazines