Bent But Not Broken -- a Personal Account
(forgive me Neptune, for I have sinned... its been 13 days since my last dive...)
Every diver learns about DCI when they get certified... how breathing air under pressure puts gas into solution in your blood... about how if you are down too long, too deep or come up too fast, bubbles can form in your tissues and bloodstream, causing tissue damage, pain and even death.
You never think it will happen to you.
At least, I didn't.
But on March 29th, I "got bent."
Amazingly enough, while my profile was totally innocuous, I did everything wrong. Including recognizing the symptoms.
So, I'm posting this account to share my experience. Because, even though I made some errors, they were things I'd done on other dives... things my friends do all the time. Things I did all the time. And before the reader conveniently assumes that I somehow "deserved"this hit... that I somehow "caused it" you should be aware that even the most perfect textbook dive profile can and has resulted in Decompression Illness.
Denial is a mighty river in Egypt.
On March 29th, I woke up early after about five hours sleep... I never seem to get enough rest the night before a dive day... I'm somehow not capable of getting to sleep before midnight and I usually wake up at 5 or 6 am for the two hour drive from San Francisco to Monterey. I drove down to Monastery Beach in Carmel Bay... just south of Monterey and Carmel. It was a gorgeous day and the vis reports were 40 feet... the sun was shining and I just knew it would be fabulous under the kelp canopy of North Monastery.The surf was kickin' pretty good though. If you've ever been to this beach, you know that its very steep... a little bit of swell can result in some big powerful breakers. I was eyeing those breakers as we assessed conditions... looked a little "sporty" as me and my friends call it. I was debating whether or not I wanted to dive the site, but three of my four friends who I met there were into it, so... I decided I'd give it a try too.
After suiting up, we walked to the beach... sinking up to our ankles in the course rock sand... Watching the breakers to time the sets, I was feeling a little dubious... I've had my face slammed into that beach too many times... its not a pleasant experience. I watched as C tried to get in... he got caught the wrong way and knocked over and spun about a bit... I dumped my gear and ran over to him and helped him out. J tried to get in and lost her fin... T&V got through fine and we waved them on... after watching C's struggle in the surf, I said "no wayÓ, I'm sitting this out."
Too bad I don't always follow my instincts.
J borrowed my fins and went looking for her lost fin... C and I sat on the beach and watched the waves... his regulator was jammed so he was trying to unjam it... Watching T&V kicking out to the wash rock, I felt that longing... I wanted to be out there with them, I wanted to be preparing to sink into that glorious Other World, to be amongst the kelp and the fish... to hang suspended on that slope peering into the dark of that first canyon dropoff... to be with the seals...
J recovered her fin and after talking we all decided we'd give it a shot.
I got through the surf ... got slammed hard twice head on, but managed to stay pointed outward and kicked through the surf...
We took a long leisurely kick out and descended into about 35 feet of water... I led us out to about 84 feet...where we explored for about 5 or 10 minutes... then we swam up to about 60... a curious harbor seal was swimming around us... watching us carefully... I watched as he began swimming up a kelp vine... slowly, gracefully spiralling upwards...
Sometimes, I'd like to be a seal.
About 15 minutes into the dive, I noticed that I didn't see C... he'd swum ahead of us a little bit and when I looked a second time he was gone... I signalled to J and we looked around a little bit... after about a minute, I decided to ascend and look for him... standard buddy procedure. J motioned that she's stay at the foot of the kelp and wait. So I slowly ascended up.... going no faster than my smallest bubbles... a classic proper ascent.
When I reached the surface, I started looking around... C was no where to be found. We were in about a 3.5 to 4 foot swell, which made it a little hard to see... I felt a bit anxious, because I knew C didn't have a lot of experience with this site... I was thinking of heading back down to search, but there, off in the distance, I finally saw him... looked like he was heading in... I yelled to him and he yelled back that he was heading in....Taking a deep sigh of relief, I waved and headed back down to my buddy J... who was waiting at 45 feet.
J motioned to me that she was having equipment trouble.... an airleak somewhere in her system... we checked it out and determined that her dump valve on the back of her BC had a small leak... She wanted to continue the dive, even with the leak. She also showed me that her computer had stopped working.
We continued on our dive, working our way in along the edge of the kelp.... it was truly beautiful with the sun shining down to the depths. Not a spectacular vis day, but I was very happy to be there and very happy to be diving with J.
When we got to about 30 feet, I started thinking about the exit... and wanted to see where we were in relation to shore. So I motioned to J that I was going to take a look. I ascended slowly and carefully up. Checked the distance and headed back down.
When I got back down, J was nowhere to be found... I looked around... moved inward a bit, looked some more... and then decided I better head to surface, where I was sure she would go when she realized she couldn't find me. So I ascended again... had to spread myself out a bit, with the surge in the shallower water, it was harder to stay slow, and my tanks were getting lower and were more buoyant... but it was still a proper ascent. When I got to the surface, I stayed up... looking around for J. I waited for what seemed an eternity... thinking about her malfunctioning BC and computer... wondering where the hell she was.... finally I decided to dive down again and look more. I was really worried by this point.. we'd been separated for awhile now. I was thinking to myself that we should have aborted when we lost C, or when we realized we had equipment problems...
By this point I was down to about 1000 pounds... and had a hell of time staying down when I got there... so I decided to return for the surface... only this time, being slow was really hard... the last seven feet or so were a little fast. I've been that fast before... this was not that unusual, and when I didn't feel any overexpansion -- nothing in the lungs or breathing to indicate a problem -- I just didn't think about it. "that was a little fast, Mary... guess you need a little more weight in this kind of surge."
After awhile, J surfaced and I shouted to her... we joined up again.. she said she was going to swim under the kelp and meet me on the other side... and we'd go in through the surf together. I told her I would stay up on the kelp... and climb over it.
We met on the other side... going in through the surf, I had problems... got hit and pushed and dragged a little... my biggest problem was the knot of Fear in my stomach going through the surf line... but I made it through... a lot of exertion though. I was quite winded and felt really weak.
I noticed a sharp sharp pain in my ankle almost immediately... I figured the surf hit me from behind and bent my ankle... and that I torqued it somehow. I was totally exhausted too... it was awhile before I could get to my feet. But I assumed that was from the stress and the surf work. When we got up to the car, I noticed my left knee was hurting a lot too.. and my ankle really hurt. But I didnt' think anything of it... I figured my bad knee was acting up... its happened before from improper kicking technique. My calves also hurt like hell... they'd been crampin on the dive a bit... but I'd done a fierce round with weights 36 hours before and figured that was the cause.
We all decided to go to Chevy's and have some lunch.... decided that one dive was enough! I didn't drink any alcohol at lunch... just lots of water. I then drove with T &V to see their new house in the Santa Cruz mountains.
Up in the mountains, I noticed that the ankle and knee felt worse... driving was hell. I headed for home and when I got near my club, I decided I would soak for a few minutes. I was conscious of the fact that diving and hot tubs can be a bad idea, but I figured that it had been eight hours or so since I surfaced and that I was probably ok.... so I hopped in for about 10 minutes.
When I got home I laid down in my bed... called a friend of mine and we were chatting.... it was then that I noticed that my left leg was tingling... "hmmm... hey Rich, my leg's tingling... think I'm bent? " I joked. I was kinda wondering what was up, but I was so tired... so very tired. Keeping my eyes open was really difficult. So I fell asleep... for about 11 hours. Literally passed out.
When I woke up the next day, my ankle was a little stiff, but not bad.... and my knee felt better. However, when I sat down at my computer, I noticed that my left leg was tingling the whole length... and felt a little numbish. My left arm and hand was too.
That's when I realized there was a problem.
So I called DAN --- the Diver's Alert Network based at Duke University. They maintain a hotline where you can call for information and referral to a chamber if appropriate. I described my dive profile, ascents and symptoms to a Dr. Barbara Wallingham. She told me that it was an emergency and that I needed to get to an ER with a chamber very fast.
I called my dive buddy J and said "hey, I might be bent". We talked for a few minutes -- I was cracking jokes -- the Buffington response to stress. Then my right hand started this numb flush that began at the finger tips and started moving up the hand... so I got off the phone and hopped in the car and drove to Walnut Creek -- location of the nearest chamber to SF.
It was a slow easter Sunday afternoon at the ER... the intake physician put me on 6 liters/min(?) of O2 right away and did a neurological exam. I had numbness and tingling in the left leg and arm... big numb patch in the thigh and numbness and tingling in the right hand.
The symptoms were puzzling to me because they moved around. I'd have a straight line of tingles on the outer forearm... which would then move laterally inwards about 3 inches... then back out again... from 3 inches long to 6 inches and back again... it was quite bizarre.
They did a pulmonary xray to check for overexpansion -- found a tumor on my lung which added to the day's excitement, but found no evidence of pulmonary embolism for which I was thankful. (the tumor has since turned out to be nothing to worrry about)
And then they sent me up to the chamber.
Diving Costs Dollars
The chamber at Walnut creek is typical of many hospitals with hyperbaric facilities. They have a mono-place chamber -- its like a big glass tube with a submarine style door. They compressed me to 3 Atmospheres -- about 60 feet, for 3 hours, while I was breathing 100% O2. I felt relief from the tingling almost immediately once we were at depth... And they let you watch videos while you're in the chamber.. the doorway at the head end is fitted with speakers.The first treatment, I watched The Abyss, naturally. The second day I watched "The Hunt for Red October." By the third day, I needed comedies... Kevin Kline and Meg Ryan kept me company. Over the next week, I had treatments daily -- five total. Most of them were at 2 ATMs for 90 minutes. Each time my symptoms lessened. But its quite exhausting. And depression is quite common too.
I am through with the chamber treatments now. I've had my followup exam and my doctor says I had Type II DCI... which is neurological.. .I took a "hit" as its called, in the spinal column.
Evaluation
In looking back at the dive, I've assessed what went wrong -- what could have been done better. This is what I've come up with:- Should have explicitly discussed buddy procedures with C and J before diving. Specifically, what to do when we lost each other. This was a dive where solo would have kept me safer.
- Probably only one ascent. Maybe two.
- Should have been weighted a bit more for diving from the beach in surge -- would have prevented the speed on the last ascent.
- Should have taken the torqued ankle more seriously and sought treatment immediately.
- Shouldn't have gone into the mountains -- even 1000 feet can have impact.
- should not have gotten into the hottub.
- once the tingling started and I wondered about DCI, I should have called DAN. The fatigue was a symptom as well. As was the extreme weakness when I got out of the water.
- no safety stops.
- four ascents -- different pressure levels do different things to your tissue loading and offgassing. I don't know why the ascents caused me a problem on this dive, where they haven't before.
- the speed of the last ascent.
- exertion in the surf speeding up respiration and offgassing
- The mountains -- 1/4 ATM change.
- The hottub -- increases vascularization, which affects offgassing.
- Not enough sleep the night before, and the extreme workout 36 hours before may have also contributed.
April 11, 1997
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