Surviving the Bends
By surviving the bends I am not referring to listening to Radiohead’s most famous album that I particularly love, but rather I am referring to decompression sickness. You learn about it when you go through your scuba diving certification. They casually graze over it and inform you that less than 1% of the diving population ever suffers from it so you easily assume “that it will never happen to me.” But if/when it does you realize how dangerous the sport can be especially if you don’t dive with a reputable company. This entry is not aimed to steer you away from scuba diving as I believe everyone should try it if you have the chance, but instead I am hoping to raise awareness and educate this community about how dangerous and sometimes fatal DCS can be.
Just begin to imagine the feeling… Traveling solo in a third world country, performing a sport that you have done countless times before, but then something goes wrong and you’re in so much pain you can’t think straight. The hospital has holes in the ceiling and doesn’t even carry supplemental oxygen. A local family screaming in terror as their dead relative lays just meters away from your bedside. The pressure, the joints, the nerves... Everything aches, the tightness in my chest, the pangs of intense stabbing, the numbness, the tingling, the earth shattering cry of the nitrogen bubbles stuck under my skin and in my body. The dive shop won’t admit that it’s DCS to save face and the stabbing pains continue to pulse throughout my body for three whole days, I’m panicked and helpless and the only thing that can save me is a decompression chamber islands away in Manila...
I have around fifty dives under my belt in various countries, but the Philippines is where I did more than twenty dives in two months. As an advanced certified diver I felt incredibly comfortable underwater, my air consumption was impeccable and it started to serve as my way to relax. The sea was a place of complete silence, offering a meditative and calming effect. I loved exploring this other world always curious as to what was around the next bend while eyes of many different species stared back at me. You realize how much humans don’t know about our own oceans even though it comprises over eighty percent of the Earth’s surface. Everything is alive, colorful and interesting.
On June 1, 2018 I went wreck diving with Reggae Divers in Coron, Palawan. I woke up in the morning after a solid nine hours of sleep had some oatmeal and headed to the dive shop. The first dive was in Barracuda Lake which was a very rad thermocline lake. You dive without a wetsuit because the lake goes from 20 degrees Celsius to a smoking 38 degrees Celsius. It’s like diving in a jacuzzi. The mixing of the two drastic temperatures creates a blurry trip for your eyes. The next dive was at Morazan Maru, a Japanese cargo ship from World War II. We explored the cargo ship before making a stop for lunch, where the crew offered me a beer which if you are a diver you know is an ABSOLUTE BIG NO NO. I knew it wasn’t a good idea so I refused the offer until after my last dive.
After lunch we did our third dive at Kyogo Maru another cargo ship from World War II. The current was pretty strong to kick out, but nothing I’ve never done before. We were down exploring the massive ship swimming through tunnels with a bottom time of 53 minutes. As we were ascending I felt rushed as if something was off, but because I didn’t have a dive computer my faith was put into my said “certified dive guide.” When we got back up to the boat my guide said “one minute for deco,” I responded with a question about what that meant, but his broken English served no good at the time so I let it go. I was later told that we did not make a decompression stop at twelve meters because there was not enough time. I never got to see the dive computer to prove this, but I am sure they knew they were in the wrong.
Immediately after removing all my gear my left shoulder began to itch terribly. I was getting a lot of bites and random rashes throughout my two months in the Philippines so I asked the girl on the boat what she saw because I couldn’t see it very well. She noted it was red, but nothing out of the ordinary. I decided to go back into the shade and sit down cause I really wasn’t feeling myself, lightheaded, a bit nauseas and then the soreness started to kick in. I looked down at my arm and the inside was an indigo blue. I thought, hmmm maybe I’m tripping out. I drank some more water and messaged my friend or as I like to refer to her “my guardian angel.” She was an Australian nurse by the name of Deeda, I had been traveling with her for the past couple weeks and without her I don’t know what might have happened to me.
The joint pain instantly ignited and progressively began to worsen through to my left fingertips and across my chest to the point where I couldn’t lift my left arm. My friend insisted something was wrong and to tell the crew immediately. As we returned to the dive shop they took me to the back sat me in a chair and administered ten liters of oxygen via nasal prongs for two sessions of thirty minutes with a ten minute break in between. After receiving the oxygen I reported the symptoms remained, my arm was stiff and really swollen and the pain was increasing incrementally as the minutes wore on. The dive instructors and masters advised me "to go home, have a cold shower and do not have any sex because I was obviously dehydrated and suffering from heat exhaustion".
I was in so much pain I could not really think or respond properly (I swear if this pain is anything like child birth, there is a zero percent chance I am having kids). Deeda disagreed with the staff’s recommendation to go home and pushed them to continue the oxygen for another forty minutes. The symptoms persisted and continued to worsen. The staff advised "the pain was probably from a jelly fish sting,” urging me “to go home, take a shower and rest." Regardless of the staffs’ recommendation, I visited the Coron District Hospital and completed another four hours of continuous oxygen (no testing was completed at the dive shop or the hospital in regards to DCS). This “hospital” was by far the worst I’ve ever seen with holes in the ceiling, absolutely no privacy, and locals dying nearby. The bathroom was completely flooded and I swear I saw some form of rat run by at one point in the night. By this point I couldn’t walk without help and was in this sort of numb daze.
After four hours on supplemental oxygen I reported my symptoms worsened, increasing in pain and swelling with the tightness in my chest never faltering. Deeda contacted DAN, the emergency diver’s network, but they could give little advice and stated to follow doctor's instructions, little did they know the doctor’s didn’t even fully comprehend what was happening. I was discharged by the hospital although I had symptoms of tingling fingers, persistent and shooting nerve/joint pain, loss of range of motion, swelling and numbness in my left arm.
In the morning, I was referred to the decompression chamber by the hospital as the pain remained and swelling had worsened. I returned to Reggae Dive Center for details regarding the decompression chamber, but they stated "they had already called the chamber operator on the island earlier that morning with a description of my symptoms and was informed that the chamber was not necessary." (I believe this may have been a false statement due to not wanting to pursue initiation of the decompression chamber and having to contact chamber operators in the area). There was no dive medic or chamber operator on the island that I could get a hold of and my dive shop was against putting me in the chamber, so they put me on more supplemental oxygen throughout the day.
Later that evening a “chamber operator” volunteered a visit with the reassurance that oxygen was all that I required for Type I DCS. He said that my pain was most likely caused by working/twisting my muscles from lifting diving equipment and that DCS does not cause swelling. He assured that with further oxygen treatment overnight these symptoms should disappear. The diving staff did not pursue further medical help or offer information. This man obviously did not know what he was talking about in the end.
I was given further oxygen treatment with overnight administration, but the symptoms remained and proceeded to worsen. That morning, I was given a contact number for a doctor at Advanced Hyperbaric Life Support in Manila where I received education that I must be transported immediately for urgent decompression chamber treatment after 72 hours of painful DCS. Dr. Jose Bernardo has stated if I had left the symptoms untreated they would not have resolved on their own and because I waited so long to be treated residual joint and nerve pain are to be expected.
I was told not to fly although I had a flight booked to Manila on that same morning. I missed the flight and booked a ferry for the next morning all the whilst staying on supplemental oxygen. The nightmare continued as I was unable to board the ferry the next day because there was no supplemental oxygen and I was unable to carry my own backpack. This is the problem with getting sick in third world countries, you will honestly never know if you are receiving the truth even if you ask a handful of “qualified” people. There are zero processes or regulations in place causing for massive amounts of confusion and frustration. I felt completely helpless wailing/screaming bloody murder in Francis’s truck... all I wanted was to go home. All I wanted was my arm back, for this pain to go away and to hug my family. I didn’t think I was going to survive. I booked the next flight out under doctor’s orders with his assurance that because the flight is only forty minutes, we wouldn’t reach a high enough altitude to cause any problems.
Instantly upon my arrival to Dr. Bernardo’s facility I was diagnosed with Type II Decompression Sickness. I was thrown into a decompression chamber for six hours at a time for two days straight. It was like living in a spaceship with a Darth Vador oxygen mask being put on and off every ten for fifteen minutes. I was alone in this space ship, my body cracking and popping, my chest pains slowly decreasing and the movement in my left shoulder getting better with each moment that passed in the chamber. Thankfully Dr. Bernardo invited me to stay with his staff at the treatment facility instead of having to leave and come back in the morning. I slept on a couch outside of the chamber for two nights. It was lonely and terrifying.
After my second six hour treatment, Dr. Bernardo informed me that I could fly after 72 hours of being out of the chamber, but boy was that inaccurate. Everything came back on my flight to London. It was the longest most terrifying flight of my life. The pain I felt up my neck and into my head was unlike anything I have ever experienced. The pressure was unlike anything I’ve ever felt before. My arm was going numb and swelling yet again. I was thrown back into a chamber for two days in London after my symptoms persisted for over a week. The doctor explained that I was lucky to be alive, the nitrogen bubbles could have easily traveled up my spinal cord and killed me. He recommended I stay in England for at least four weeks to allow my body to heal properly with no change in elevation.
Since returning home to the states I have been going to physical therapy, acupuncture and getting chiropractic care on a weekly basis. I still struggle with nerve and join pain stemming from the base of my skull down my left side neck into my arm and through to the tips of my fingers. The doctors say it could be months or years before I return back to normal or even worse, these symptoms could stay forever. With DCS there is no black and white answer especially when dealing with nerves.
I suffered major consequences in regards to my health and a large financial burden from lack of education and expertise. My sincere concern is the lack of education, help and support that I received during DCS when diving with a PADI registered company. There wasn’t a DCS emergency action plan in place and members of staff including the dive instructors and dive masters had very little, if any, education on DCS. The local hospital of this diving island had no knowledge or contacts for DCS treatment. Afterwards, I also came to the knowledge that my dive was led by a dive master trainee (DMT), not a certified dive master, DM. The aim of this article is to push Emergency Action Plans and education in these more remote diving areas and to prevent future harm to divers and potentially save lives. Since returning home I realize how fatal DCS can be. I am lucky I did not have a brain embolism or suffer from complete paralysis. I am lucky to be alive.
I assumed it would be safe to dive with Reggae given it was PADI certified and came highly recommended by other divers. It seemed as though they were covering something up, making very little if any eye contact when asking questions. If it weren’t for Deeda and my couchsurfing host Francis, I don’t know how this would have ended up. Little did I know how painful nitrogen bubbles released in your joints and muscles could be or how dangerous scuba diving can be.
Realistically, I am very lucky. I was traveling with someone who cared. I did not have a brain embollism and although I still struggle on a daily basis with neck/nerve pain, I am still capable of performing daily activities. This incident brought me home and for that I am very thankful. I will never be able to repay Deeda, Francis, and Diego for their help during this scary time in the Philippines, but I am unbeliveably grateful for them. Please share my story and be very careful divers, always dive with your own computer and always know the necessary steps to take if you or a fellow diver ascends with frightening symptoms.
“ Finally . . .
If you suspect a diver has a dive-related injury and needs evaluation, you should safely:
Monitor airway, breathing, circulation and provide 100 percent oxygen if you are a trained oxygen provider
Call the local EMS for transport or assist in the transport of the injured diver to medical care
Call the DAN Emergency number +39 06 4211 8685 for consultation and advice.
Perhaps you’re uncertain about symptoms after diving and there is no emergency, or you may wish to ask questions about the signs and symptoms of DCI. If so you can also contact the DAN Europe Hotline at +39 06 4211 8685.”