Photography by Ginny Rawlings and John Campbell
When it happened, I was stunned…the hit was completely unexpected because the dives had been so uneventful and simple recreational level dives like we have done literally thousands of times before. The sudden numbness in my right arm had caught my attention…the near paralysis of my legs captured and held it. I knew what had happened, but didn’t know why. All I knew was that in a single moment my entire world had changed, and not for the better….

Earlier, upon surfacing from our second dive, I saw some blood on the stern near the dive ladder. Glancing upward, I saw another diver on the deck while the crew was obviously treating a bloody wound on her leg. I later found that her leg had been smashed between the ladder and the hull due to the rough seas, lacerating it severely. Seeing her in obvious need of medical attention, I struggled to get my camera system up to the Divemaster, literally tore my fins off, and heaved myself up the ladder. Little did I suspect that my exertions were to give the unfortunate crew a second medical disaster in addition to the one with which they were already dealing.
My right arm had been pulled severely several times while on the down line, again while handing my camera up, and finally when hurriedly yanking myself up the ladder. Removing my gear, I placed my camera system into the camera tank, and attempted to stay out of the way of the crew as they performed first aid on the injured diver. Physically, I felt great for around 15 minutes…until, suddenly, I felt what I would describe as a “nerve pinch” directly behind my right shoulder blade. I attributed this to the over-extension of my right arm and shoulder, so I had no real concern. However, less than a minute after that first twinge, my entire right arm turned completely numb. I could move my arm freely, but the numbness was total. It was as though I were watching someone else’s arm move rather than my own. I knew that something was drastically wrong, despite the fact that the dive had been uneventful, and both of my computers had cleared me long before I ascended.

Feeling my arm with my other hand, I sat down to consider what might be happening. Within moments, I realized that my legs had suddenly become extremely weak - I could only move them slightly, and then only through great strength of will. Realizing that I was undergoing a Type II DCS hit, I immediately beckoned my best friend, Sparky, and the Divemaster to my side. I told them that I had a Type II “hit” occurring, and needed O2 immediately. Within a couple of minutes, I was breathing from the on board O2 bottle, and we were heading into the harbor, radioing in for the chamber to be ready. Sparky stayed at my side, concern flooding over his face, doing whatever he could to help while keeping me from falling over as the boat churned through the waves.

Once ashore, it took two strong men – one on each side – to assist me to the waiting van. At this point, I was stumbling like a drunk and my legs felt as weak as a kitten…being strong as a bull one second, and unable to walk without help the next is a HUGE mental shock! Fortunately, the chamber was only minutes away, and they were awaiting our arrival. Even after this short time, I could feel the benefits of the oxygen that had been administered as first aid, and some of the strength had returned to my legs while the numbness in my arm had partially dissipated. Following evaluation by the chamber physician, I was in their small two-man chamber within an hour or so after the onset of symptoms. The quick response of everyone involved has undoubtedly had much do with the success of my recovery. Even though O2 had alleviated some of my symptoms prior to my chamber ride, that relief would have been only temporary - especially with a Type II hit. Somehow, I had managed to get a shower of nitrogen bubbles into my spine, and they were wreaking havoc with my nervous system.
The Diver’s Alert Network (DAN) was contacted immediately, and from that point onward my DAN insurance and their team of experts kicked in. I was given an extended US Navy Table 6 treatment - 6 1/2 hours at both 60 feet and 30 feet, breathing O2 for 20 minutes at a time with 5 minute air breaks. Unusually for me, I found myself in the grip of claustrophobia while in the chamber, possibly caused by the extreme difficulty I had in drawing breaths from the oxygen mask – simply breathing in and out involved a great deal of work while on the mask, and I could feel my claustrophobia increasing as I waited impatiently for each air break. To experience claustrophobia like this for the first time (I’ve never felt it before, even when in zero visibility or inside tight spaces) was quite alarming…at one point, if I could have gnawed my way through the wall of the chamber with my teeth, I would have gladly done so!

At 60 feet within the chamber, my symptoms were completely alleviated. There was no numbness or weakness of any kind and my body worked well. The tender had me drinking water constantly, and I was able to urinate easily at 60 feet without discomfort. However, upon being brought up to 30 feet, I could feel a subtle tingling begin to grow in my legs. Shortly after reaching 30 feet, I felt a strong urge to urinate, but to my dismay found that I couldn’t do it…something had changed. Entering the chamber, my symptoms were a ”pinch” in my right shoulder blade, numb right arm, and weak legs - leaving the chamber my symptoms were partial numbness and tingling in both legs (from about my navel downward), some difficulty in walking, and a complete inability to urinate! While I was in the chamber, both the Divemaster and the chamber physician examined my two computers and saw no indication of any factor that would point to a specific cause. Later, DAN would state that I had been diving “aggressively” and had a lot of nitrogen within my system. But there was no obvious explanation as to why that nitrogen had entered my nervous system, and done the damage that it did.

Following my chamber run, the chamber physician advised me to return to my room and take it easy – he would reevaluate me the following afternoon. I explained that I was having difficulty in urinating, and asked for a catheter since it had become quite painful. Perhaps it was the language barrier between us, but I don’t think that my desperation got through to him. He again simply advised me to return to my room, relax, drink lots of water, and things would probably “open up” later that night.

They didn’t.

In one of the longest nights of my life, I hobbled back and forth to the bathroom all night long…each time praying that I could unload the by now extraordinarily painful amount of urine my body had created. The damage done to my nervous system ensured that the “floodgates” would simply not open, and I literally cried tears of frustration. My best friend watched each of my painful trips – wanting to do something to help; yet knowing there was absolutely nothing he could do. His night was pretty damn bad as well.
DAN was contacted again the following morning with an update. Alarmed, they immediately dispatched an air ambulance Lear Jet with a paramedic and an RN on board. They also urged me to get to the local clinic for catheterization, and the Divemaster, Patrick Jenkins, immediately drove me to have this done. It would be impossible to explain the utter relief it was to have a catheter thrust in and unload the painful pressure I had carried all night…it was incredible, and the answer to a prayer. Patrick handled the logistics, getting us to the airstrip in time to watch as the Lear Jet touched down. Soon, along with Sparky and all of our gear, I was in the air to Miami under the care of an RN and a paramedic. Upon arrival, we were met and cleared by a customs agent (pre-arranged by DAN), and then quickly transported by ambulance to Mercy Hospital.

After being routed through the emergency room at Mercy Hospital, I was introduced to Dr. Ivan Montoya and his staff. Dr. Montoya is one of the leading experts in hyperbaric medicine in North America, and specializes in Type II DCS. It didn’t take long for me to understand why he and his team are so well respected in the hyperbaric community. Over the next several days, I was struck by his and his team’s professionalism and caring as I did three additional Table 6 treatments in a huge chamber capable of holding multiple patients, as well as four Table 2 treatments (2 hours each at 30 feet while breathing pure O2) in a small one-man chamber made of clear Plexiglas. Other doctors at Mercy Hospital took care of other aspects of my treatment. They, too, displayed high levels of professionalism. Each hyperbaric treatment showed noticeable improvement, and a sense of optimism pervaded both team and patient. I will be eternally grateful for the care I received, and that DAN chose to evacuate me into their hands.
A complete MRI series was done on my spine, neck, and skull - all showed nothing irregular. Believe it or not, the MRI was one of the most difficult things for me to do - try lying completely and utterly motionless on a rock-hard table for a solid hour, if you wonder why! Another aspect of the treatment was physical therapy – a thera pist assisting me daily in walking through the corridors of the hospital. I kidded him that I had learned to walk again years ago while recovering in a US Army hospital, and compared to THAT this was far easier! Still, the persistent tingling and sensitivity in my legs was troubling…and that catheter was still there….
I had called my wife, Ginny, upon arrival in Miami, telling her that I was doing fine and not to worry. Later, she spoke with Dr. Montoya and Sparky, subsequently flying all night from Seattle to be at my bedside the following morning. She took a hotel room nearby that Sparky had arranged for her. DAN paid for the hotel once I became an outpatient, which happened after four days of treatment. By that time, the numbness had mostly disappeared, I was walking fairly well...AND I could finally urinate on my own!!!! Following my chamber treatment on day six, I was able to walk a full mile. After my day seven treatment, I walked slightly over two miles and could have done more. Between walks, my wife and I swam in the hotel pool and I could feel the strength returning rapidly to my legs each day.
On day eight, I did a Table 2 treatment at 6:30 AM followed by another Table 2 treatment at 1:00 PM. At that point, Dr. Montoya told me that I had had a “remarkable” recovery, pronounced me basically ”fit,” and told me that any remaining symptoms would probably disappear with time. I was told to wait at least six months before returning to diving, and to honestly evaluate myself before doing so. I was not cleared to fly until 72 hours following my last chamber treatment, so Ginny and I were not able to fly home for three more days. If I had to put a number to it, I would say that at that time I was about at 95% compared to how I was before the hit, the most noticeable of the residual symptoms being extreme sensitivity to temperature in the skin on my legs.
Dr. Montoya was uncertain as to why I took a DCS hit...perhaps it was the jarring that my right arm and shoulder took...perhaps the extra exertion that occurred when I exited the water…perhaps I was slightly dehydrated...perhaps I didn’t sleep as well as I should have the night before...perhaps it was a “left-over” from my long bout with illness the previous month...or perhaps it is simply because I’m now in my 50’s and my system may not be able to take what it used to. Upon my return home, my doctor immediately ordered an echo-cardiogram to determine if I had a Patent Foramen Ovali (PFO), which is one of the suspected “culprits” in Type II cases such as mine. The results show that I do, in fact, have a PFO, albeit a small one. The discovery of this PFO would seem to indicate that it was most likely the extra exertion coupled with the extreme amount of nitrogen I had accumulated that caused the advent of my DCS hit. While it is my intention to return to diving once my six-month hiatus is over, when I do my style of diving will be better adapted to my changed realities.
I write these words almost as a pressure release, but also in the hope that this article will force at least some of you, the readers of ADM, to evaluate your diving and your planning. I know that some of you have no diving medical coverage whatsoever, while there are others that feel that you will always be in a position to do everything correctly, and therefore DCS will never happen to you. Situations can change in the blink of an eye, sometimes from things that you cannot control or things of which you are unaware. It behooves you to be prepared to deal with the results. Those of you that DON’T have dive insurance from DAN or another reputable carrier NEED to get it! I’m living proof that sometimes, even if you supposedly do everything right, you CAN take a hit! In my case, that hit involved my spinal cord, an air evacuation, a hospital stay, and multiple chamber treatments. I absolutely shudder to think about how much everything would have cost my family had I not been adequately insured. As it was, the costs were something that I didn’t even have to think about, other than out of my personal curiosity.

Take care of yourselves….