Posted by msblucow on November 06, 2001 at 14:59:58:
This past Saturday, I got to go on the kind of diving adventure that no diver wants to take intentionally – a 10 1/2-hour ride in the Catalina Chamber. In the hopes of educating folks about what this process is all about, and also to get some feedback on what has turned out to be very ambiguous situation, I’ve decided to share this experience with the rest of our little diving community. This is a long story, and some of it may be redundant for the more experienced, so I’ll try to break it up into manageable bits.
THE DIVE:
I was taking a Reef Seekers trip on the Mr. C out to the oilrigs (I should have known I was in trouble when I showed up at the boat and the Divemaster assigned me to spot 13 ;-) ). Unfortunately for us, when we got within radio contact of the rigs, we found out that they weren’t letting anyone closer than 300 feet. Improvising, Captain Ray took us to the Ace One, an upside-down wreck not far from the Moody that sits in about 120 feet of water. This would be my deepest dive (I think the deepest I’d been before was about 110-115 fsw), but I was game since I’d brought my camera and this would be my first chance to photograph metridiums.
The boat did the dive in two groups of 10. I was in the first group. I buddied up with an older gentleman (who was also taking pictures), jumped in the water, and descended down the anchor line. The vis wasn’t great, maybe 20 feet, but the water was very calm – no surge or current. When we bottomed out we saw the wreck directly in front of us. I was really amazed, the metridiums were gigantic, as big as my arm. I was having a fine time circling the wreck taking pictures of metridiums and a garden of sea pens waving in the sand. I didn’t even mind the cold – a bracing 52 degrees. After a few minutes, I realized I was having way too much fun. I was completely and totally narced.
I had planned a maximum bottom time of 10 minutes. When the time was close to being up, I swam to where I thought the anchor line was. When I didn’t see it, I turned around and realized that my buddy was on the other side of the wreck, motioning to me – I had gone in the wrong direction. So I swam over and joined him. Together, we began ascending. But that extra time had cost me – I ended up with a bottom time of 14 minutes with a maximum depth of 124 feet (if you count from the time I first descended). My computer put me into deco, with a ceiling of 10 feet. (I use a Suunto Vyper, which on that dive I used as a computer and not just a bottom timer) I decided to incorporate some deep stops into the ascent, so I made my first stop at about 55 feet for 1 1/2 minutes, then ascended to 30 feet, made a second stop for about one minute, took about 2 minutes to ascend to 20 feet, then stayed in the 20-15 foot range for about 4 minutes, and finally ascended to the boat. My dive buddy did the same stops I did. My computer had cleared me of any deco obligation and put me firmly in the green. I returned to the boat with 500 psi of air.
POST DIVE:
Looking back, I think had my first symptom almost as soon as I got on the boat. After I stripped off my gear, I lifted it up to the fill station and immediately noticed that my left hand felt numb – all pins and needles. At the time I dismissed it. I thought I was just cold, after all my feet were numb too, and it wasn’t uncommon for me get very cold extremities after a dive.
Ken and Captain Ray decided to go to Catalina for the rest of our dives. Since it was going to be at least an 1 1/2 hours until our next dive, I decided to strip off my wetsuit and go below to warm up. After about 20 minutes under the blankets, I started to feel better. But when I turned over, I noticed my left hand still felt all pins and needles. So I proceeded to have the following conversation with myself.
ME: "Oh-oh."
MYSELF: "Naw, couldn’t be."
I: "I must have slept on my hand."
ME: "You didn’t sleep."
MYSELF: "Shut up."
I: "You shut up."
ME: "My glove was too tight."
MYSELF: "You wore the same gloves you always wear."
I: "Now I feel it in my arm."
ME: "Oh s**t!"
MYSELF: "Oh, F**k me!"
I: "KEN!!!!!!!!!!!"
So I go up and find Ken Kurtis, pulled him aside and tell him about my arm. With a calm that only comes from lots of practice (sorry, Ken, could resist), he put me O2, had Ray call the Coast Guard, called the Chamber himself, and described to them my symptoms. While we waited for the Baywatch boat, Ken and Jerry (the divemaster) take my pulse, ask me detailed questions about my dive profile (this is where the Vyper came in really handy – you can look at your dive profile minute-by-minute without having to download to a computer), how and what I was feeling, medical history, and contact information. They helped me gather up any personal items I wanted to take with me and promised to take care of the rest of my dive gear (I think the exact quote from Ken was, "I don’t think I can get anything for all that DIR crap, but the camera should fetch a good price.")
Meanwhile, my fellow divers on the boat begin to realize what’s going on and start eyeing me with sympathy more deserving of an Anthrax victim.
"I’m fine!", I assure them, not at all convinced this is true.
A Baywatch boat from Cabrillo arrives in 25 minutes. They keep me on O2, take more medical history, ask more questions about my dive profile, hook me up to an ekg, take my blood pressure and my pulse (both a little high), and ask me to describe how I feel.
One thing occurs to me at this point. I had just switched out the straps on my wrist-mounted compass and computer and replaced them with bungee straps. I wear my compass on my left hand, and my computer on my right. My right hand, however, was fine, so who knows. The EMT takes note of this information anyway.
Another Baywatch boat, this one from Catalina, meets us and I switch boats. It’s a fast and bumpy ride on to the Chamber. Still on 02, I arrive at the Chamber facility in 25 minutes.
PRE-TREATMENT:
As soon as I arrive, there are folks from the Chamber there to meet me. Even though I can walk just fine, they politely insist I get on a stretcher, so I do. They roll me into the big hanger where the Chamber lives. For anyone who hasn’t seen the Chamber, it basically looks like the world’s biggest HP Steel tank, except it’s painted blue and has little portal windows. The Chamber has two ‘rooms’ – a main compartment where they treat patients and a smaller area that acts as an airlock – a space they can pressurize independently so that medical personal can visit or leave during a treatment session. As Chambers go, it’s actually quite large. At one point during my treatment, we had 5 people in there and everyone had plenty of room to move around.
They had already flown a doctor from LA County to do a brief medical exam. He does a neurological assessment and a strength test, both of which I pass. He asks me more questions about my medical history, dive profile, how I’m feeling, etc… Also, like the Baywatch EMT, he takes note of the compass I had strapped to my left arm. He consults by phone with Dr. Sipsey, our local decompression illness expert, and they discuss a plan for treatment.
Meanwhile Baywatch gets another call – a diver ran out of air and made a rapid ascent – they suspect an air embolism. The patient arrives within minutes. She’s conscious, but groggy. Since my condition is stable, they decide to treat her first. They take her into the Chamber and bring her down to 165 feet (the recommended treatment for a suspected air embolism). Her symptoms show immediate improvement. I have to wait 30 minutes while they bring the Chamber up to 60 feet, then they’ll put me in the air lock and I’ll start my treatment too. I use the time to call my non-diving husband, who is worried sick. Ken’s already called him (my last words to Ken as I get on the Baywatch boat, "Don’t freak him out".) After I’m able to explain to him in great detail what is happening and that, really, I’m not going to die, he seems to calm down. I can’t imagine what is going through his head. I promise to call him again as soon as I get out of the Chamber, which, I’ve been told, could be anywhere from 4 1/2 to 12 hours.
THE TREATMENT:
Finally, at around 1 PM, I go into the Chamber. It's been nearly 4 hours since I first noticed symptoms. The first thing they do before you get in the Chamber is to make you strip off your street clothes and your shoes. They give you a cotton hospital gown to wear for modesty (yeah, right) and provide blankets once you’re in the Chamber for warmth. They do this because of the potential fire hazard. Nothing that’s flammable or could cause a spark in the dry, oxygen rich air is allowed – no paper, no books, no magazines, not even toilet paper to use for the little porta-john.
I go into the little airlock area with my ‘tender’ – nice woman name Patti, who will be with me for the duration of the treatment. (Ironically I had met Patti once 9 months before – we buddied up for the Catalina Cleanup dive in February). Patti secures the outer door. It’s cooler inside than it was in the hanger. Once the door is closed, they begin a countdown to compression. "…Five, four, three, two, one…" There is this incredibly loud sound, like a jet taking off, and my ears start to pop. We both equalize furiously while someone outside the Chamber checks in on us through a window. We both hold up the "ok" sign to let them know we’re equalizing properly. At the same time, the airlock gets amazingly hot amazingly fast. Finally the noise stops and we’re at 60 feet. The tender on the other side opens the door to the big room with a pop like a champagne cork, and Patti and I go in.
The first thing that hits me, is how COLD the room is. When they brought the big room down to 165 feet to treat the other patient, it heated up to 110 degrees, but when they brought it back up to 60 feet, it had cooled the Chamber down to where it felt like someone’s basement on a cold Fall day. I’m escorted to a cot against one wall. The other patient is already lying down on a second cot, bundled up in blankets. At the moment, she’s not on oxygen, but her tender, Sid, is standing over her poised with an 02 mask. I lay down and Patti prepares an 02 mask for me. I hear a countdown over the intercom. When it reaches zero, Patti and Sid put the masks over our faces and I begin my first treatment period.
They end up running a Table 6 treatment on me. This means that they take me down to 60 feet and start me on 02 for 20 minutes at a time with 5-minute air breaks in between. Each 20-minute period is considered a "treatment". Each treatment is highly regimented – the tenders outside the Chamber use digital timers to precisely map out these treatment periods and the tenders inside the Chamber have to call out to confirm when the patient is on O2 and when they are on air. They constantly monitor my progress, not only asking about my hand, but asking about my lungs as well. As it turns out, if you breath pure oxygen long enough, you can cause something "pulmonary oxygen toxicity". Basically you irritate your lungs to the point where they begin to lose some function. To mitigate this, they break up the 02 periods with 5-minute air breaks. Still, there’s a limit to how long this can be done and this limit varies from person to person, so each patient must be monitored closely.
After 3 treatments, I show some improvement, but I’m still not 100%. After 6 treatments, I show further improvement, but I’m still not normal. Finally, they go for broke and I do the maximum 8 treatments at 60 feet. At this point, the doctor has come in to check on both the other patient and myself. The five of us now ‘ride up’ to 30 feet at a rate of a foot a minute. Since the other patient has fully resolved, the doctor decides to take her out of the Chamber. They continue on to the air lock and complete the treatment with another 30-minute ride to the ‘surface’.
So now Sid, Patti and myself are in for the full ride. Since we did the maximum number of treatments at 60 feet, we are now obligated to do TWELVE treatments at 30 feet, which means we’ve got a little over 6 hours to go. AAARRRGGGGHHHH! No longer worried about my hand, which is more or less resolved to 90%, I can now fully concentrate on obsessing about 2 things – I’m starving (I haven’t eaten anything for 12 hours now) and I have to pee (and there’s no toilet paper). After convincing them that, no, I’m not nauseous and I won’t throw up in my mask and that yes, faster than you can say "explosive decompression", I’m going to break down the airlock door if I don’t get something to eat soon, they bring me the best plate of enchiladas I’ve ever had in my life. And as for the bathroom break, well, you can just use your imagination for that one.
The last 2 hours were the hardest. The three of us tried to amuse ourselves as best we could, playing ‘charades’ and ‘hangman’, listening to music piped in from the outside, but we were really going stir-crazy. By this time the oxygen had really started to get to my lungs too. Every breath felt like I was inhaling a load of dry pins down my throat. The last 1 1/2 hours Patti and Sid had to go on oxygen too, so all conversation stopped. By the time we did the 30-minute ride up to the ‘surface’, I was counting the minutes. By the time the door opened at 11:30 PM, I was filthy, tired, cold, emotionally drained, and just grateful to smell fresh air.
POST TREATMENT:
I ended up spending the night on a cot in the med locker. My lungs were so irritated, it was impossible for me to sleep. I felt fire everywhere – my chest, diaphragm, esophagus, even my sinuses. I ended up wandering around the facility for a couple of hours until I was too tired to keep my eyes open, then finally I was able to catch a couple of hours of sleep. The next morning, Baywatch would take all of us – me, the doctor, the other patient and her husband - to Avalon so we could catch the 8:00 AM boat back to Long Beach. By this time, my lungs would start to feel better. My hand felt okay, but still not a 100%.
CONCLUSIONS AND QUESTIONS:
So it’s been a few days now and I can report that except for some residual tingling in my left hand (mostly my pinky), I seem to be okay. I’ve been advised not to do any diving for 4 to 6 weeks and to get a follow up with my regular doctor in a week.
But the really astonishing news is ,after all that, I may not have gotten the bends at all.
According to Dr. Sipsey, it is possible that the bungee strap on my left arm may have caused some temporary, mechanical nerve damage to my forearm that radiated down to my hand. (There are several reasons for him to suspect this. One, I felt symptoms as soon as I surfaced. Two, I did not improve at all on oxygen before I got to the Chamber. And three, I showed some improvement with treatment, but did not resolve completely) Or it’s possible that the bungee strap could have restricted enough blood flow to that area of my arm to have trapped a bubble. OR it’s also possible it’s a combination of the two.
The other ironic thing is that my dive profile was almost no different from the other 9 people who went down with me. In fact, yesterday, Ken Kurtis and I compared our dive profiles we were virtually identical!
So did I get bent or didn’t I? If I did, why me and not the other 9 people on the same dive? If I didn’t, why wasn’t my right hand affected the same as my left? Was I dehydrated? Did I get enough sleep? Did I stay down to long? Did I come up too fast? Who the hell knows? The answer might best be described by a famous quote from William Goldman when asked what makes for a successful movie:
"Really, nobody knows anything."
So what have I learned from this? What will I do differently? Well a few things (in no particular order).
1) I am never, ever going to do another dive with an END of more than 100’
2) I am going to get nitrox certified.
3) Next time I do a deeper dive at a new site, I’m leaving the camera on the boat.
4) I am going to learn as much about decompression and dive threories as I can.
5) If I ever feel a symptom after diving that feels strange or unusual for me, I’m not going to debate it for 20 minutes before I act.
6) I’m going to loosen the bungee straps on that stupid compass.
7) Every 15’ safety stop is going to be 5 minutes instead of three.
8) I am going to get better at navigation.
9) I am going to make it my mission to find some non-flammable games that can be used in the Chamber.
10) I am going to give the Chamber every dime I can spare next Chamber Day and urge everyone I know to do the same. If I didn’t mention it before, the Chamber crew are UNPAID volunteers and deserve every bit of support we can give them!
11) Renew my DAN insurance as soon as it’s up and urge every diver to get DAN insurance if they don’t have it now. I can’t tell you what a load off my mind it was when I could just give the Chamber folks my DAN number and not worry about it.
AND FINALLY, SOME THANKS
Thank you Ken Kurtis for handling the whole incident professionally and calmly. And thank you for not freaking out my poor husband. Thank you Capt. Ray for also being calm and professional. Thanks to all the EMTs at Baywatch for the help and reassurance. Thanks to everyone who heard about my incident and expressed their concern.
Most of all thanks to the entire Chamber crew, and especially those two women, Sid and Patti, who road out the whole 10 1/2 hours with me. Without their good humor and tireless, selfless devotion, I don’t think I would have gotten through the experience in one piece. We're so very lucky to have these people to help us.