Hospital Medicine and Critical Care; Obesity, Nutrition, and Bariatric Surgery: 2024 Update

Vancouver, British Columbia - Vancouver is one of the few world cities where a major metropolis feels seamlessly integrated with the wilderness. The cruise terminal at Canada Place puts you directly in the heart of this stunning landscape, with soaring mountains and the Pacific Ocean framing a vibrant, walkable downtown. This prime location means many of the city's best experiences are immediately accessible, allowing for a rich and varied day ashore. A short walk or bike ride along the waterfront leads to Stanley Park, a 1,000-acre temperate rainforest that is the city's soul. Its famous seawall offers breathtaking views of the harbor and North Shore mountains, while inland trails lead through towering cedars and firs. Don't miss the collection of First Nations totem poles at Brockton Point, a powerful and accessible cultural landmark. For a dose of history and modern style, explore Gastown, the city's oldest neighborhood. Its Victorian architecture, cobblestone streets, and iconic steam clock now house independent boutiques, Indigenous art galleries, and some of Vancouver's most innovative restaurants and cocktail bars. A quick, scenic ride on a False Creek Ferry or Aquabus takes you to Granville Island. While popular, its Public Market is an authentic sensory delight, bustling with local artisans, bakers, and fishmongers. It’s the perfect place to sample local smoked salmon, grab a coffee, and watch the city's maritime life unfold. For those with an interest in art, the Vancouver Art Gallery, housed in a former courthouse, features a significant collection of works by British Columbian artists, including the renowned Emily Carr. Vancouver's culinary scene is a destination in itself, celebrated for its exceptional Pacific Northwest seafood and diverse Asian influences, from world-class sushi to authentic dim sum in historic Chinatown. It’s a city that rewards exploration on foot, offering a sophisticated yet refreshingly unpretentious urban experience.

Alaska Inside Passage - The Inside Passage is not merely a route between ports; for most travelers, navigating this protected waterway is the definitive Alaskan experience. Unlike open ocean crossings, this journey takes you through a narrow, calm corridor flanked by the massive Tongass National Forest—the largest temperate rainforest on earth. The scale here is humbling, with thousand-foot granite cliffs plunging into deep fjords and mist clinging to the hemlock and spruce canopy. This is a day for active observation. We strongly advise securing a position on deck or a private balcony well before approaching major highlights like Glacier Bay, Hubbard Glacier, or Tracy Arm Fjord. The silence here is profound, often broken only by the 'white thunder' of tidewater glaciers calving into the sea. The visual impact of the 'glacial blue'—created by dense ice absorbing red light spectrums—is startlingly vivid against the grey skies. Wildlife viewing requires patience but offers high rewards. The nutrient-rich waters are prime feeding grounds for humpback whales; look for the telltale mist of a spout or the fluke raising before a dive. Orcas, Dall’s porpoises, and harbor seals are common sights, while bald eagles are nearly ubiquitous on passing ice floes. On the shoreline, keep a sharp eye out for coastal brown bears at low tide. Practical preparation is key to enjoying this passage. The weather is notoriously changeable; expect rain and mist, which actually enhances the dramatic, moody atmosphere of the fjords. Dress in waterproof layers and, most importantly, bring high-quality binoculars. Relying solely on the naked eye or a camera lens means missing the intricate details of this untamed wilderness. This is a time to disconnect from shipboard distractions and immerse yourself in one of the planet's most magnificent natural corridors.

Ketchikan, Alaska - Ketchikan is often the quintessential introduction to the Inside Passage, serving as a potent concentration of everything travelers seek in Alaska. Known as the "Salmon Capital of the World," the town balances a gritty industrial history of fishing and logging with the profound heritage of the Tlingit, Haida, and Tsimshian peoples. Visitors should be prepared for "liquid sunshine"—this sits squarely in a temperate rainforest, and the frequent rain is an atmospheric element of the destination, not a deterrent. For a relaxed day, the town is highly walkable. The centerpiece is Creek Street, a historic boardwalk built on pilings over the water. Formerly the city's notorious red-light district, it is now a charming, albeit busy, collection of galleries and local shops. In late summer, looking over the rails offers a front-row seat to thousands of salmon fighting their way upstream; the nearby fish ladder provides a fascinating, close-up view of this biological struggle. To engage with the region's history beyond the souvenir shops, we recommend the Totem Heritage Center. Located a short walk or quick taxi ride from the bustle of the port, it houses an unparalleled collection of original 19th-century totem poles retrieved from deserted villages. Unlike the brightly repainted replicas found in parks, these are preserved in their natural, weathered state, offering a somber and powerful insight into Native artistry. While the town is engaging, the true grandeur of this stop lies in the surrounding wilderness. If logistics and budget permit, a floatplane excursion to Misty Fjords National Monument is the definitive Ketchikan experience. Soaring past sheer granite cliffs and cascading waterfalls provides a perspective on Alaska’s scale that ground tours simply cannot match. Whether you explore the boardwalks or fly into the fjords, Ketchikan delivers a dense, accessible dose of the frontier.

Juneau, Alaska - Juneau is a paradox: a state capital accessible only by air or sea, where the wilderness doesn't just surround the city—it defines it. As a port of call, it offers perhaps the most accessible high-adventure opportunities in Alaska, though managing expectations regarding weather and crowds is essential for a quality experience. The Mendenhall Glacier is the undisputed centerpiece. While the Visitor Center offers a solid introduction, the glacier has receded significantly in recent years. To truly grasp the scale of the Juneau Icefield, we recommend a helicopter excursion. Landing on the glacier or dog sledding on the ice cap is a significant investment, but it provides a visceral connection to the landscape that a distant view from the visitor center cannot match. If you prefer to stay grounded, the hike to Nugget Falls offers a powerful view of the glacier's face and a roaring waterfall without the flight costs. Juneau’s waters are among the most productive feeding grounds for humpback whales in the world. Sightings in Auke Bay are exceptionally reliable during the cruise season. If you have not booked a wildlife excursion elsewhere on your itinerary, this is the place to do it. Downtown Juneau is compact and historic, though South Franklin Street can feel congested when multiple ships are in port. For a sophisticated cultural break, the Alaska State Museum is outstanding, housing world-class exhibits on Native Alaskan heritage and Russian history. The Mount Roberts Tramway, located right at the dock, offers sweeping views, but we advise purchasing tickets only after assessing the cloud cover; the view is spectacular, but non-existent in heavy fog. For a culinary finish, skip the generic tourist traps and visit Tracy’s King Crab Shack for genuine local flavor. Juneau is a wet city—it lies in a temperate rainforest—so dress in waterproof layers to enjoy this spectacular intersection of civilization and wild frontier.

Skagway, Alaska - Skagway operates as a living museum of the 1898 Klondike Gold Rush, situated at the northern terminus of the Inside Passage. While the town’s year-round population is small, its historical footprint is massive. The downtown district is part of the Klondike Gold Rush National Historical Park, featuring meticulously restored false-front buildings and wooden boardwalks. It is undeniably tourist-centric, yet the preservation is authentic enough to transport you back to the era of prospectors and con artists. You can easily explore the core of Broadway Street in an hour or two, perhaps stopping at the Red Onion Saloon or the National Park Service visitor center for context. However, we advise viewing Skagway primarily as a staging ground for the wilderness beyond. The town sits in a narrow, wind-swept valley, and the most dramatic scenery requires leaving the immediate port area. The definitive experience here is the White Pass & Yukon Route Railroad. This narrow-gauge railway is an engineering masterpiece that climbs nearly 3,000 feet in just 20 miles, offering vertiginous views of gorges, waterfalls, and the Sawtooth Mountains. It is not merely a train ride; it is the most efficient and spectacular way to understand the geography that challenged gold seekers. For a different perspective, Skagway is the premier port for flightseeing. Helicopter excursions to nearby glaciers—often combined with dog sledding—provide a sense of scale that ground-based tours cannot match. For those preferring to stay closer to sea level, a float down the Taiya River or a hike to Lower Reid Falls offers serenity away from the busy boardwalks. Ultimately, Skagway rewards those who book a specific adventure rather than wandering aimlessly.

Glacier Bay - Glacier Bay is not a port of call in the traditional sense; it is a destination for profound immersion. There are no docks, no towns, and no excursions here. Instead, the day is dedicated to a slow, deliberate journey into the heart of a UNESCO World Heritage Site, experienced entirely from the decks of your vessel. As the ship enters the bay, National Park Rangers come aboard to provide expert narration, transforming a scenic cruise into a rich educational experience. Their commentary on geology, glaciology, and native Tlingit history adds invaluable context to the staggering landscapes unfolding around you. The 65-mile journey up the fjord reveals a world in constant, dramatic change. You’ll pass forested shorelines where brown bears and mountain goats can sometimes be spotted, and rocky outcrops where puffins and other seabirds nest. The true spectacle, however, awaits at the bay's terminus. Here, you will spend hours in the presence of massive tidewater glaciers like Margerie and Grand Pacific. The experience is multi-sensory: the sight of the impossibly blue ice, the crisp, clean air, and the deep silence, punctuated only by the thunderous crack of calving ice. Witnessing a skyscraper-sized block of ice shear off a glacier's face and crash into the sea is a humbling, unforgettable display of nature's power. Keep a keen eye on the water for humpback whales, orcas, and harbor seals resting on floating ice floes. A day in Glacier Bay is a meditative encounter with a raw, primordial world.

College Fjord - Located in the northwest corner of Prince William Sound, College Fjord offers one of the world's most concentrated collections of tidewater glaciers. Unlike other Alaskan scenic cruising days that may focus on a single massive ice face, this fjord presents a panorama of ice. On a clear day, you can view multiple glaciers simultaneously, cascading down from the Chugach Mountains. The water here is often filled with icebergs, and the silence is frequently broken by the "white thunder" of calving ice—a dramatic reminder of the landscape's active nature. The fjord's unique nomenclature dates back to the 1899 Harriman Expedition, a scientific voyage that included naturalist John Muir. Expedition members named the glaciers after the Ivy League institutions that funded their journey. As you cruise deeper into the fjord, a pattern emerges: glaciers on the northwest side bear the names of women's colleges (Smith, Bryn Mawr, Vassar, Wellesley), while those on the southeast are named for men's colleges (Yale, Harvard). Notably, Princeton is absent from the roster—rumored to be a deliberate snub by the expedition scientists. The experience culminates at the fjord's head with the massive Harvard Glacier. Spanning over a mile wide at its face, it is the dominant feature of the landscape. As this is a scenic cruising day with no disembarkation, we recommend securing a spot on the open decks or a private balcony with binoculars; the sheer scale of the ice against the mountains is best appreciated in the fresh, crisp air.

Whittier, Alaska - Whittier is less a destination in itself and more a dramatic gateway to the glacial wonders of Prince William Sound. The town is a fascinating quirk of Alaskan history, a compact, functional port where nearly all residents live in a single high-rise building—a remnant of its past as a Cold War military outpost accessed by a 2.5-mile, one-lane tunnel. The true reason for a stop here is to board a smaller vessel and venture into the Sound. These excursions navigate through deep fjords to the face of massive tidewater glaciers, such as those in Blackstone Bay or Harriman Fjord. The experience is auditory as much as visual, with the thunderous crack of calving ice echoing across the water. Keep a constant watch for abundant wildlife, including sea otters floating in "rafts," harbor seals hauled out on ice floes, bald eagles, and the occasional whale. While the town's unique structure is worth a brief look, the most rewarding use of your time is a boat tour into the pristine, glacier-carved wilderness that lies just beyond the harbor.