Big Guy - Out of Gas

A pony bottle (left) attached to a larger cylinderImage via WikipediaWhen I get on a dive boat, I invariably do 3 things that end up getting me in trouble (actually, its just the third thing that leads to trouble):

  1. Pick out a spot where I'm not in anyone's way.
  2. Put my gear together quickly and stow whatever I don't need.
  3. Find a good perch from which to check out the other divers.


And so it was on the Monday of a 2009 trip. Nearly every diver on board was an old friend or, at least, well known to me. However there was one guy, let's call him "Steve" (I'm going to use pseudonyms for other divers unless I have permission to discuss them directly), who looked out of place and more than a little uncomfortable. This big, happy, boisterous fellow was putting his regulator together with the tank backwards (think back, we've all done it or something like it). Fumbling with the screw on the yoke of his first stage, he spun it right off and dropped it overboard triggering a scramble for a new one before we headed out. Lots of folks helpfully dug around for a replacement. I ended up lending him the one from my DIN-to-yoke adapter. I decided to keep an eye on him when we splashed. What I should have done was pulled him aside and checked on his background. It's the first of two major regrets I have from that day.

A couple of hours and one fantastic below deck snooze (for me) later, Steve entered the water. I followed immediately, caught up to him on the hang line below the boat and followed him down. Reaching the wreck 100' below, I found that the current was flowing from the anchor at the stern toward the bow. The return trip was going to be up-current but the current was light so it was no big deal. To my right, Steve floated with the current down the hull. He was clearly having some buoyancy issues and was blowing a lot of bubbles. As we reached the far end, I asked how much air he had. After a couple of false starts, Steve understood and showed me his gauge. It read 300 psi! He'd used over 90% of his air in 8 minutes. And he didn't seem to see this as a problem.

Deciding that I needed to get him to the anchor line before putting him on my air, I grabbed his wrist and hauled him the length of the wreck. When we got to the line, he was nearly out of gas so I switched him to my 40 cubic foot pony bottle which also had the EAN30 mix we were diving. We quickly ascended to 50' so we could cut down on his air volume per breath. At 50', I showed him his gauge , made it clear that he was going to be ok and tried to convey that I was running the dive now. We ascended slowly, Steve calming as we rose.

As we approached the boat, Steve started looking up with concern at the "headbanger" mushroom anchor weighing the hang line down. The surface chop was ramming it up an down as is typical for an offshore dive. To protect his head, I rotated him away from the line so that I was under the weight and prepared to transfer us to our safety stop. At 20', Steve suddenly spun away from me to grab the hang line. As he did so, he moved past the limit of my pony's reg hose, the mouthpiece clamped fiercely between his teeth. Before I could pull him back, he ripped the mouthpiece from the reg and took a huge 'breath' of water. His eyes rolled with panic as he tried to sort out what had happened. I took my reg out and purged it as I popped it into his mouth. With my other hand I moved to my Air 2 (by the way, I now have an 8' octopus reg on my main first stage and on my pony - just in case). He shook with spasms of coughing and retching; and started a run for the surface which I aborted with a clamp on his shoulder.

After a couple of minutes calming him down, we were getting really low on air. I guided us to the surface and inflated his BC as he grabbed hold of the ladder. Unfortunately, after 15 minutes of panic, he was exhausted and could not climb out under his own power. The guys on the swim step were pulling but he was at least 400 lbs fully geared up. I settled in on the bottom ladder rung with my shoulders under him and, in a moment worthy of Borat, helped heave him out of the water.

When I arrived on deck, he was out of his gear and lying prone; eyes shut. "Shit!" I thought. "He's dead." But Steve opened his eyes and smiled, "Did you just save my life?" "Three times." I answered. "Let's get out of this gear and talk about it up top."

Out in the warming sun, we rehydrated, grabbed a sandwich and talked through the incident. Steve was visibly shaken and both of us were wiped. It turned out that Steve had just 6 dives - his certification dives. This was way beyond his experience set. Watching him getting ready, it had been obvious. We figured out that he was over weighted, which led in part to his buoyancy problems; and we talked about air management. I offered to guide him through his second dive and to get him properly weighted. On that dive, when he reached 1000 psi, I sent him up the line with some other divers - he had a great time.

Which leads me to my second major regret. What we didn't talk about was his general lack of fitness and how that had endangered both of us. Steve had no business being out their because he was too inexperienced, yes. But he also was grossly overweight and completely unaware of how his lack of fitness drove the causal chain that could have ended his life.

Just over a year later, Steve died of a heart attack while diving in the Virgin Islands. When I heard he was gone, I felt more than a twinge of guilt. His hometown paper ran stories about all of the wonderful things he had done and was doing with his life. What stuck with me was how popular he was for officiating at weddings. With his cherubic grin and easy charm, he was kind of unforgettable. He may have been a terrible diver but he was one heck of a guy.

I should have laid it out for him when we first talked after the rescue. I should have said:

  1. Look, you're lucky to be alive.
  2. You are too inexperienced to be diving out here without expressly seeking guidance from an experienced buddy.
  3. You ran out of air because your lack of fitness compounded a slight buoyancy problem into a major air supply issue.
  4. You could have killed both of us trying to get you out of the water.
  5. You have to think about this like hiking underwater. If you couldn't comfortably go on a six mile mountain hike, you shouldn't be out here.
  6. You are too nice a guy to lose ... please drop 100 lbs or quit diving.
  7. Please, take the second dive off and think about it.


I wonder if that conversation would not have served him better?

A couple of weeks later I shared this story with our dive club. That experience led to this blog's first entry.

Dive safe,

Phil

Next time - Out Of Gas, Too!
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A Thousand Ways To Die


(continued from previous post)

So, the obvious question is, "What happened?"

To put it simply, I drowned from the inside out.

The DAN medical team pegged my condition as Immersion Pulmonary Edema (IPE), also known as Swimming Induced Pulmonary Edema (SIPE), is an accumulation of fluid in the lungs while diving. Unlike drowning, IPE does not involve the aspiration of water through the mouth. Instead, a spike in pulmonary artery blood pressure causes blood and serum to leak into the alviolar spaces. DAN has a really good summary of the symptoms. The reason for the spike, particularly in otherwise healthy individuals, is unclear. However, testing at the Duke University Hyperbaric facility under Dr. Richard Moon, is starting to tease out the details and causes.

On January 10th, 2011, I traveled to Duke for testing with Dr. Moon's team. As a diver, this was like going to the mothership. The facility and its team left me awestruck. Meeting the great folks who work and study there was a real treat. The experiments I participated in tested the theory that there are some individuals who have higher pulmonary artery pressure spikes in response to immersion in cold water. They didn't tell me how cold but it was PLENTY cold!

I had to lie face down in a metal rescue litter while they lowered me into the water! The last thing Dr. Moon said before I went
under was, "Try not to gasp too much. It messes up our numbers!" The chamber tech, Eric, gave me a smile that said, "Gasp away my friend!" After lying still in the litter for a few (endless) minutes, I hopped out and the pool was reconfigured for underwater cycling. Then it was back under wearing a full face mask for 12 minutes of moderate pedaling while the medical team took blood samples, pressures and other measurements through various catheters and ports.

(this is not me but it is the same aparatus)

I have never been so cold in my life! After an hour or so of rewarming and a dose of Viagra (apparently it wasn't designed to give old guys "performance" - that was just a happy side effect), we did the whole thing again. Strangely, the water was a lot less shocking the second time.

(I know! It sounds like fun, right? Seriously though, if you think you've experienced this you should email Dr. Moon the Duke center and get into the testing program so they can help identify and treat these issues. So far, they've only had two divers agree who had experienced IPE.)

The assessment is that I am one of the lucky 1% or so of divers prone to this condition. To return to diving I must:

  1. lose some weight and get my bp down
  2. get recertified with my dry suit and start diving a dry for anything less than tropical dives
  3. avoid over hydration prior to a dive
  4. consider taking anti-hypertensive medicine prior to diving (Although, if you try this be sure you're working with a doctor familiar with dive medicine. In animal studies, Viagra appears to increase susceptibility to Oxygen toxicity - unless you want to posthumously help nail down the data for humans, I'd be more than a little careful with the magic blue pills!)

Every incident has a cause. The bottom line is that a gap in my fitness level, combined with unfortunate genetics, caused this one. Like many of us, I've picked up some pounds over the years and this has raised my blood pressure slightly. Not a big deal on land. But a huge deal underwater. I have to shed the weight and get my BP back to 120 / 70 or better or pick another hobby.

Here's my big takeaway. I have a resting pulse in the 40s and can ride, run and swim for hours at a stretch. In many ways I'm a pretty fit guy. But, diving takes me into an environment in which I am decidedly unfit. It's cold, dense and hypoxic. Any weakness in my constitution, when combined with circumstances and genetics, can generate any of a thousand ways to die. While advances in equipment and training have made diving safer than ever, I need to bring my A game every time.

You do too.

Here are more pics.

A very long 3 minutes or so.


Eric hooking me up for some dry land testing.

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Arguing With The Coast Guard

(continued from prior post)

As I was hauled onto the swim step of the Diver Down, I gasped for air croaking "Can't breathe!! Can't .... breathe!" Behind me, Noah was emerging from the water safe but shocked as the crew raced to prepare oxygen and move me onto the deck. My skin was pale, my lips and finger nails blued by cyanosis. With each failed breath it started to dawn on me that this was where I was going to die; cold and wet on the back of dive boat. Not at all what I had expected.

But, just then, luck intervened.

On the first dive, several divers, including Matt, Roy and Sharky, had elected to do a single, long rebreather dive to more fully explore the wreck. Usually, they'd be just starting up the line from their second dive when I emerged from the water but this day they were dry and on deck. This meant that Sharky, an EMT with dive medicine training, was on scene when I arrived. He took my vitals and placed the oxygen mask over my face. Listening to my lungs he could hear the crackle of liquid as a struggled for air. He relayed the grim news that we needed an air evac ASAP to Bobby in the wheelhouse.

Now stripped of my insulating wetsuit, I began to get cold. I remember having increasing difficulty staying awake. I was starting to detach and accept death. That is, until I looked up and saw Noah at my head. I couldn't possibly die there, in front of him. I renewed my struggle for air. Sharky was in my face, staring right into my eyes, imploring me to breathe. Roy wrapped his body around mine to keep me warm whispering "You're safe now. We've got you brother. Stay with me." into my ear. Dave Gulley, now on deck, joined Sharky in debating possible issues - had I inhaled water? (no). Had I come up to fast? (computer said no). Did I have the chokes ( no)

In the wheelhouse a different war was being waged. The captain was declaring our emergency. He asked for a medical evac from the Coast Guard. The USS Enterprise carrier group, just 14 miles away, picked up the call and offered to send a chopper. Incredibly, the Coast Guard waved them off and declined to send a helicopter of their own. I'll let Matt and the others fill in the details but it apparently got pretty heated between our guys and the Guard. The argument would continue until well after we landed in Morehead City. Meanwhile, I was barely holding my own on a back deck now awash with dive equipment and worried divers.

With all the divers safely back on board, the decision was made to race in. One of the great things about the DiverDown is its speed. With two new diesels it can do 21 knots at a push. This makes it perfect for reaching wrecks far offshore and rarely dived. This day, it was to be my ambulance. To get us ready to roll the crew moved me, my medical team and my oxygen bottles up the deck. Roy, resumed his position warming me keeping up a patter of entirely inappropriate jokes about splitting up my dive gear, taking my money and so on. It was hard to breathe but it was also hard not to laugh. As we got underway, Roy was replaced by my son, Noah. Throughout the one and a half hour trip, he kneeled behind me, supporting my back. Swell from the bow sprayed over us as Bobby hammered through the waves. Each time Noah would hunch over me protectively. Dave Gulley and Sharky took turns taking vitals and keeping me awake and breathing. Every couple of minutes they's ask if I could take a sip or two of water. I'd remove the mask take a few sips and then go back on the oxygen as the world started to gray from breathing normal air. All in all they pumped 5 bottles of water and 6 bottles of O2 into me. By the time we reached shore I was in much better shape but had to make a fast visit to the toilet to get rid of at least 4 of those water bottles!

Ten minutes after landing, we were in Carteret General Hospital emergency and, later that evening, in the Critical Care Unit as they worked to keep my oxygen levels up. 24 hours and a lot of oxygen later, I walked out under my own steam to the applause of the nurses in the Critical Care Unit (apparently that doesn't happen in that ward often). Thanks to the quick action of the crew, my son and my friends, I had survived. It was a really good day!

My heroes from left to right, Sharky, Roy & Dave.

Next Time: A Thousand Ways To Die

- Phil
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Diver Nearly Drowns on Dive Boat Deck

On Monday June 21, 2010, I nearly drowned on the back deck of a dive boat 30 miles off Morehead City, NC. There's a big lesson to be learned here so pass this one around!

The day started off with a 5:30 wakeup from an all too short night. My son and I had arrived late the previous evening after a late get away from Richmond due to my participation in an Xterra off road traithlon Sunday. When we got to the motel at 9:30 we were greeted with hugs from old friends Matt Hahn, Tim Quitter, Sharky Anderson, Dave Gulley and Roy Knecht. Matt's a dive instructor and merchant marine captain, Tim flew jets for the Navy and now runs war games for them, Sharky is an EMT, combat veteran and barotrauma specialist, Dave's an EMT from St. Louis, and Roy is a SWAT team member, combat veteran and former secret service protection agent for Presidents Bush and Clinton. We all have hundreds if not thousands of dives. They're great guys to dive with, have a beer with, and even better guys to get in trouble with.

My son, Noah, was on his first offshore trip. For years the guys had been adding trinkets to my goody bag for me to take home to him from various sites we dove together. They quickly absorbed him into the crew, showering him with attention, barbs and questions. We turned in around 11 looking forward to a great week of diving.

U-BoatImage by phatcontroller via Flickr
We hit the water for our second dive around 11:00 in the morning. The first dive, like this one, was to the wreck of the U-352 a WWII era German U-Boat. She lies in 108' of water about 30 miles fro
m Beaufort Inlet. Exactly one year earlier I had saved a diver who ran out of air on this wreck (see my original post). That diver has since died in an incident - but that's another story ...

The dive was unremarkable except for some distracting mask leakage for Noah. We were diving with EAN 30 but using air tables for an extra margin of safety. The water was a warmish 76 degrees at the bottom and vis was about 50 feet. We headed back up the line ready for some lunch and a visit to the head. Not to put too fine a point on it, but I had to pee like a racehorse.

Olympus Dive Center, Morehead City, North CarolinaImage by CasaDeQueso via Flickr
At 50' I coughed for the first time. It was a normal, tickle cough from dry air except, unusually, there was a gurgle of liquid deep in my throat. By 30' I was coughing continuously. With each cough, more liquid rose in my throat. It tasted metallic, not quite like blood but not like saliva either. When we transferred to the safety line at 18' I began to hyperventilate. I was now actively swallowing the fluids I was coughing up. The urge to rip the regulator out of my mouth was almost overwhelming. In spite of efforts to calm and slow my breathing, I sucked on my reg for air.  I was taking increasingly rapid, increasingly shallow breaths. I was over breathing my reg but could not understand why. Bad air? (probably not, I'd dove the same source in the morning), Pulmonary Embolism? (nope, no rapid ascents, well within deco limits), CNS or bends? (nope, wrong symptoms, no pain, no reason).

It quickly became clear that I'd either have to surface or black out so I executed a plan I'd been scrabbling together: 1. Keep Noah on the line for at least 2 minutes, 2. Hand him off to Tim Quitter before surfacing so he'd be safe, 3. Surface at the normal pace at the back of the boat to the right of the ladder, 4. Inflate BC and give the crew a huge arm wave to signal distress and yell for help if possible. I started by putting Noah's hand in Tim's. I looked into Tim's eyes and tried to somehow communicate how much I needed his calm reliability.  I signalled for him to buddy with Noah and head up, then I looked back at Noah and signaled the same thing. Leaving him was almost as difficult as breathing.

Reaching the back of the boat 30 seconds later, I went ape-shit to get everyone's attention, told the guy on the ladder (I think it was Steve, sorry bud') to get the fuck off and was hauled bodily out of the water by the excellent crew of Bobby Cox's Diver Down. To be perfectly honest, I expected to cough up whatever was in my throat. I thought I'd be fine now that I had reached the boat. I was wrong and it was the most disappointing and terrifying realization of my life...

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Fit To Dive is back!!

Hi again,

Scuba Diving - TobermoryImage by Explore The Bruce via FlickrAfter promising to, uhm, 'dive' into diving fitness, I totally got side tracked - sorry. But I'm back now with a new approach and plan. I've been fortunate (or unlucky) enough to have participated in a fair number of rescues over the years. So I'm going to start with each of them and talk about the role th
at fitness (or a lack thereof) played in each. I'll start with one where I was the victim in my next post.

Dive fit!


- Cheers ... Phil
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