Dr. Mo scurried into the hotel lobby like a ferret on speed. As he approached, it was impossible not to notice his odd appearance. Standing five foot five, and slight of frame, his untidy jet black quiff towered above his head. With a perfectly matching stick-on moustache, brown fuck-off shirt collars and agonisingly short fawn slacks, Carnival Cruise Line’s Medical Director was a dead ringer for a 1970s streetwise undercover TV cop. He even sported the obligatory cigarette in hand, on which he inhaled deeply at worryingly short intervals.

Dirk and I  had already spoken to our new boss several times over long distance telephone calls, but we remained apprehensive about meeting him for the first time. His gently persuasive tone combined with his Mexican bandit accent made him sound a little quirky, perhaps even eccentric, which only added to the enigmatic picture we had of him. 

And what sort of name was Doctor Mo anyway?

“Hel-lo boys,” sleazed Mo, shaking our hands in turn. 

“Dirk. Paolo. Welcome to Miami. Nice to finally meet you! You must be tired after your flight from London. But we’ve got to catch the next flight to Orlando straight away. The minibus will take us from there to Port Canaveral, where the ships will be waiting for you.”

“Paolo, Guy will meet you on the Carnivale and give you a handover before he leaves for the Tropicale. Dirk, you’re on the Mardi Gras. Your friend Pete’s currently at sea on the Celebration. He’s very happy there! You know, you two are lucky to have such good friends like Pete and Guy. They told me so many wonderful things about you both, I couldn’t wait to get you on the ships too!”

It was an extraordinary turn of events. Friends since medical school, the four of us would now be simultaneously zig-zagging our way across the Caribbean as Carnival Cruise Line’s first ever British doctors. We were 25 years old. But there wasn’t a moment to reflect on the cavalier year book ambition that started it all.

“Oh my God, look at the time! We have to run for the plane,” declared Mo, lighting another cigarette.

Airborne on the way to Orlando, our new boss was certainly in full flight. Barely pausing for breath, Dr Mo smoked a whole packet of cigarettes while chatting up all the air hostesses and simultaneously explaining everything we needed to know about being cruise ship doctors. 

“Before you sail, check the manifest for passengers with complex histories - wise to be prepared. If you're going to do any surgery, try to avoid high seas. I’ve performed a million haemorrhoidectomies! ”

“As the ship’s physician, you read every crew members’ health records and therefore know all their sensitive medical information. This gives you great professional power to make decisions about fitness for work, organise hospitalisation in port and order evacuations at sea - decisions that not even the captain is qualified to make or overrule.” 

“And the doctor is the only person onboard with the power to diagnose the captain as clinically insane and unfit for duty!”

Dirk and I looked at each other incredulously.

“Yes, you have tremendous authority,” Mo continued. "Some of your patients will become your friends, maybe even your girlfriends. Learn true or false motives quickly; some staff will be needing favours, others are there to guarantee you don’t upset the status quo.”

It was clear that behind the sartorial and cigarette smoke screen was a remarkable character with an uncanny ability to read people and complex situations. We liked him immediately. Mo lit another cigarette before delivering his pièce de résistance: a parable about power, privilege and hierarchy derived from the decade he’d spent climbing the ladder from ship’s doctor to Medical Director for one of the world’s largest cruise lines.

“You must play The Game. You see, I have worked on these ships for many years and I know what kind of people you will be dealing with. Make friends with the Chief of Security at your first opportunity. Slip your room steward something when you get paid. The captain always tries to surround himself with friends and loyal officers. If you don’t agree with the captain, don’t tell him, tell me. He likes quiet, well-behaved crew. The Captain’s Mob will see your unique power as a threat and will view you with enormous suspicion until proven otherwise.”

He lit another cigarette before shifting his eagle-eye from the hostess to Dirk. Tall, slim and permanently tanned, with blonde locks and a big nose, Dirk was Sheffield's very own version of Barry Manilow. Women saw his captivating charm and overt sexuality as utterly irresistible. Music and passion were always his fashion, and he never failed to exploit it.

“Oh my God, I can see now that I’m going to have trouble with you! Stay away from the passengers - you can screw the crew as much as you like but don’t let the Italians know, they get very jealous. For sure, have a great time; party, meet lots of women, but don’t forget: ship’s doctors are their main target. All American mothers tell their daughters to marry a doctor. So be careful. And remember who is the boss. The captain is the most powerful person on the ship. If he is after a certain woman that maybe you like also, let him carry on. There will be many others. Be discreet. Trust no-one.”

Dirk rubbed his hands with glee, convinced that the Caribbean and its cruise lines were made exclusively to accommodate his Copacabana good looks.

 “Paolo, I’m certain you can be just as wild given the chance, but don’t let people take advantage of your good nature. Thank God you seem more steady,” he noted, right on target. “Some people will want to see you both slip up. Be careful and take a little time to find out how things work and who you can trust. I can see something in you guys, and I know you will enjoy this lifestyle just like Pete and Guy. They are both doing very well. I think that you two will do even better and be the best doctors we’ve ever had!” 

It seemed like skilful flattery, but Dr Mo was also basking in the glory of his recruitment triumph.

In charge of hiring and firing, Dr Mo encountered recurring problems attracting and keeping American doctors. They struggled with the ships’ basically equipped infirmaries, demanded high wages, and didn’t necessarily view the neighbouring Caribbean as a particularly glamorous travel opportunity. Casting his net further only proved that Central American doctors didn’t have a good track record. He began to wonder if doctors from the UK’s great and well respected National Health Service (NHS) might be better suited to meet the demands of medical practice on board a cruise ship. It turned out to be quite an astute assumption.

As a publicly funded healthcare system, the NHS offered free and comprehensive services to 50 million British citizens, and as such lacked the lavish resources of US private medicine. Unlike our American counterparts, there could be no over-reliance on expensive tests and technologies, and it was ingrained into our mindset that we should only order tests that were deemed absolutely essential. Plus in the US, patients were far more likely to sue their doctor, resulting in the widespread practice of defensive medicine, defined by ordering every test under the sun. 

British undergraduate training was far more clinical in nature, with an emphasis on taking a good history and physical examination in order to arrive at a diagnosis. UK doctors were also well-versed in the concept of Masterly Inactivity, an important clinical skill passed down the generations. The idea is that many things are minor and get better on their own, and over-investigating and over-treating can often lead to a worse outcome. Sometimes it’s better to take a step back and simply observe. The key to masterly inactivity is accurately recognising in a timely manner exactly when intervention might be required. 

This is the essence of the art of medicine, which I embraced whole-heartedly during my training. Indeed, the motto of the 160-year old Sheffield University Medical School that we all attended served to underwrite the fact that our profession is more than just the practice of scientific knowledge: 

Ars Longa Vita Brevis. Art is Long, Life is Short.

As the plane began its descent, I realised that the sparkling, dazzling Caribbean was a million miles from the rain-soaked grimy Yorkshire steel towns from which the seeds of our friendship had sprung. And we had travelled a long and winding road which led us to exotic Miami and the magnificent Dr Mo. 

I had first met Dirk on a 4th-year student secondment to Scunthorpe Hospital, 40 miles east of Sheffield, in late 1988. I’d always seen him around medical school in the preceding few years but we hardly knew each other. But all that changed after a Friday night trip from Sunny Scunny back to Sheffield with Dirk and his current muse, a Scottish occupational therapist called Lucy. It involved one fast car, a pepperoni pizza and a bottle of Johnny Walker Black Label, and ended in a dramatic crash into a police Range Rover. Our car ended up in a ditch. However, my negative breathalyser test kept me out of jail and helped to relax the cops, who happily joined the party, sharing our pizza to the tune of The Cult’s She Sells Sanctuary still blaring out from my car stereo.

This high speed collision ignited an immediate and intense bond between polar opposites; Dirk, the flamboyant extrovert, and me, the quiet introvert. 

It also sparked the creation of the notorious Bates Street Boys, after Dirk and I soon teamed up with two like-minded contemporaries, Pete and Guy. The four of us established a rock-solid fellowship as we managed the difficult transition from students to junior doctors in Sheffield. 

Yorkshire was certainly no Garden of Eden, but we were determined to taste the forbidden fruits that life had to offer.

In April 1990 the four of us took a holiday to the Greek island of Kos, home to Hippocrates. Did we visit his famous monument and the ancient tree under which The Father of Medicine taught his pupils? 

No, we invented the Kos Kocktail. This comprised a mix of drugs taken before we hit the bottle on our nights out: a Stemetil (anti-nausea), a Ranitidine (anti-acid), and a Doxycycline (anti-STI antibiotic). All washed down with a big glass of ouzo.

Shortly after our Greek odyssey the four of us moved into a shared house together on Bates Street in Sheffield, not far from our old university. This deepened our endeavours to take the world by storm, and we set the tone with a legendary November 5th Guy Fawkes Bonfire Night party. 

All was going swimmingly until Guy decided to emulate his 17th century namesake with his very own Gunpowder Plot. This DIY fireworks display climaxed in a spur-of-the-moment effort to incinerate twenty of our innocent guests. Seeing a tightly packed rabble on the small garden terrace, all clutching cans of Special Brew and half-baked potatoes, the trainee surgeon calmly lobbed a sizzling rocket into the crowd, while repeatedly head-butting a frying pan. Inevitably panic ensued, but fortunately the only casualty was the kitchen door which suffered extensive third degree burns and was pronounced dead at the scene. 

Five years later a friend and year of ‘89 classmate, Stevie B, told us how a junior colleague recounted the story of a wild bonfire night party where the house got pretty well trashed and the kitchen door cremated. The irony was not lost on Steve, who had in fact been the owner of 56 Bates Street when the party took place. While he had been none too chuffed at the resulting carnage, a different landlord might have seen Guy hung, drawn and quartered.

On any given night during those formative years in Sheffield, the four of us would invariably meet up at 3am at Napoleon’s Casino, a small private club over the west side of town, comparing stories. Dirk’s exploits always revolved around the evening’s conquest and a quick trip back to his place. Pete aka Lawsy would have a story of derring-do, that typically involved scaling a fifteen foot wall and braving barbed-wire and broken glass to visit a girlfriend in the nurses’ residence; only to break into the wrong room and be thrown out by security. 

As for me, I generally left the more boisterous behaviour to the others. I would have spent an hour asleep on the comfy sofa at some local dive, before waking up to the sound of good music and dancing my way through four different nightclubs on the way to our casino rendezvous. 

I was never the most dynamic of people, and always looked to do things with the minimum of fuss - there was no point in wasting precious energy on small-talk, animated facial expressions or propensities to flap about like headless chicken in the face of a medical emergency. In fact, I’ve always been guided by one of the most fundamental laws of physics - The First Law of Thermodynamics: The total energy of an isolated system is constant; and energy can be neither created nor destroyed. This is also known as the Law of Conservation of Energy, and for a person of limited energy like myself, it’s a great excuse for a siesta.

Overcoming my extreme shyness was mybiggest personal and professional challenge. My quiet and unassertive nature made me feel a little out of place amongst the many Type A personalities in the world of acute hospital medicine. I classed my personality as Type Z. Talking was not my thing, and I found it very stressful meeting new people, which of course included my patients. Even in the company of my closest friends, there would often be no words entering my conscious brain to deliver to my mouth. After a particularly quiet evening on my part, Guy once asked me in a light-hearted manner, 

“Paolo, are you a manic-depressive or something?”

“No, I’m a depressive-depressive.” 

At least I never missed the opportunity to crack a joke.

Although various 6-month postings across regional hospitals saw us move in and out of each other’s orbits, we all continued to exert a strong influence on the lives of our fellow Bates Street Boys. But it was Guy’s defiant, indomitable decision to kill a flock of birds with one lion-hearted stone that had the most magnetic effect on us all. 

Despite wanting to be a surgeon, Guy had always eschewed the norm: school, medical school, surgical career, retirement. By 1991, he was at the crossroad. Upcoming surgical exams and a study load to rival his debts would perpetuate the predictable journey. Guy opted for enlightenment, which he sought by carpet-bombing ads for overseas postings in the British Medical Journal: The American Hospital in Paris, the British Antarctic Expedition, a few jobs in outback Australia, and a Miami-based cruise company called Carnival. 

Pete was on exactly the same path, searching for anything that would afford him a year’s adventurous sabbatical and a high paying job that would clear his phenomenal debts and leave him time to study before jumping back on the surgical conveyor belt. They both held four Aces: six months of Emergency Medicine, excellent timing, chutzpah and a belief that the first response would be destiny’s choice.

Carnival was the first to reply.

Shortly after their interviews in London, Dr Mo called and asked if they could start urgently, in a mere three weeks’ time. So on the 8th of August 1991, Guy, dressed in his best shoulder padded suit, with slip-on lavender coloured shoes to compliment his jacket lining, and headed for Heathrow Airport with Pete, who wore a matching certainty that their distinguished and superior medical talents lay behind Mo’s quick and eager response. 

Only later did they learn that one of Carnival’s onboard medics had been found in his cabin with 54 empty bottles of vodka, creating an instant job vacancy that needed filling tout de suite. 

When Pete and Guy arrived at Miami International airport, they felt the blast of 90 degree heat for the first time in their lives.  And who knows, without their slice of timely good fortune, the Bates Street Boys could have ended up spending the next twelve months freezing our arses off in the South Pole.

A few months later, Dirk and I realised we held a similar hand. I was currently in an Emergency Medicine job in Bristol and had recently passed my primary surgical exams, which meant I had something tangible under my belt for when I returned. Taking a year out from surgical training to work in the Caribbean was certainly a career risk; the traditionally-minded surgeons in charge of my future employment would surely view it with disdain. But like Pete and Guy, I knew exactly what lay before me; hard work, long hours, more exams; and a career in which there was no turning back. None of that put me off surgery, but it fired a determination to expand my horizons and open myself up to the wider world.

The stars were aligned. The opportunity for adventure might never come again, and the excitement of not knowing what was around the corner was a real thrill. Dirk agreed. 

So in March 1992, we completed our long journey from Sunny Scunny to the Sunshine State and touched down at Miami airport, ready to meet Dr Mo. We had arrived.