Each year when I step off my favorite liveaboard after a week of incredible diving, I look forward to returning to the warm, tranquil waters of the Caribbean the following year. This year seemed no different from any other. We arrived around noon on a beautiful July day after uneventful flights. The sky was clear, and the turquoise water looked inviting. The next day we awoke to a spectacular sunrise and almost mirror-flat seas. When we finally splashed I enjoyed a leisurely 45-minute dive and returned to the boat, but when I got back on board and took off my gear, I immediately felt faint.
I have almost no recollection of the next two hours. From my dive buddies I know I was exhibiting bilateral tremors in my fingers and toes but was able to respond to commands to move my hands and feet. Some nurses on board began administration of 100 percent oxygen. Over the next 45 minutes my condition stabilized, but when I later got up to get a drink of water, my left leg suddenly gave way. There was simply no connection between my brain’s command and my leg’s ability to respond. At that point we decided it was time to call DAN.
A DAN medical information specialist suggested that the ship’s captain call a local resort that had a hyperbaric chamber to see if the medical staff would perform an evaluation and, if necessary, treat me in their chamber. In a long conversation with the resort, however, the staff explained to the captain that they did not want to treat me because I was not their guest and that decompression illness (DCI) could not be confirmed by a left leg deficit. At this point, it was late in the afternoon and the sun was beginning to set.
I got up again to get another drink and noticed I was now experiencing symptoms in my right leg as well. The captain and I decided to take a dinghy to an island clinic, hoping the clinic’s attending physician would call the resort on my behalf. The clinic’s attending physician called DAN to get some basic information about DCI so she could perform a more thorough neurological examination. While she was consulting with both DAN and the local resort, my left leg developed an uncontrollable deep muscle tremor, which recurred every 50 seconds. As time passed, the period between tremors decreased until the resort eventually agreed to see me.
Despite my inability to stand or walk, the resort personnel insisted that no neurological deficit could be observed. They recommended against chamber treatment and advised me to return to the boat for rest. We were discussing some options when I decided to get up to urinate before finalizing the game plan. Despite an overly full bladder and an exhaustive effort to urinate, I was unable to do so.
At this point I knew I was going downhill fast and that time was becoming even more critical. It was clear to me that my problem was serious despite not being considered so by the local medical professionals. I told the captain I was ready to place my life in the hands of people I trusted: DAN.
We called DAN when we got back to the boat. A DAN representative immediately arranged an airlift for the next day at 9 a.m. to transport me to a hospital in Miami. I asked the captain to take me to the island’s clinic to be catheterized; the pain in my bladder was intense. The island’s doctor was very responsive, and I was relieved of almost 1.5 liters of urine.
The next morning the air ambulance arrived on schedule and departed immediately. Once airborne I was told that I would be taken to the Hyperbaric and Wound Care Center at Mercy Hospital in Miami and placed under the care of Dr. Ivan Montoya, a leading expert in the field of DCI treatment. The pilot executed a special pressurization protocol to keep me safe during the flight. Approximately 90 minutes after wheels up, I was in the chamber beginning a U.S. Navy Table 6 treatment.
I spent almost nine hours in the chamber that day. After the second treatment Dr. Montoya asked me to stand up from my wheelchair. I was able to do so without assistance. He then asked me to walk. I was able to do this also but was very unbalanced. Dr. Montoya treated me in the chamber many more times during my 12-day stay at the hospital. I am forever grateful to all who helped me through this DCI incident and its aftermath. Without their collective efforts I might not be here today.
I hope my experience helps to raise awareness. I close with these lessons I learned:
- Be a DAN member, and get DAN dive accident insurance. Consult DAN for any questions you have before, during or after diving.
- Always make sure your boat operator or dive center has oxygen. If you have symptoms after diving, receive oxygen first aid.
- Trust the experts. If you have any reservations about the advice and information presented to you, insist on a second opinion. In my case, my dive buddies, the ship’s captain and crew, DAN and the hyperbaric and physical-therapy staff knew what they were doing and were able to prevent a catastrophe. The local resort, on the other hand, wasted more than eight hours of precious time with concerns other than saving my life.
- Consider whether you will have prompt access from your dive destination to adequate treatment or near-term transportation to an adequate treating facility — especially if the destination is remote or in a developing country.
- Be aware that at many dive destinations, operational limits on flying at night can delay medical transportation.
© Alert Diver — Q1 Winter 2015