Decompression Sickness Treatment and Recovery
A true story account of decompression sickness treatment and recovery by Richard Pyle. I’ve posted this article as it represents a serious lesson and learning text for technical divers.
This account was originally posted by Richard Pyle via the washington.edu website, but sadly that webpage hasn’t remained online. In re-publishing this story for posterity and to help promote dive safety, I have taken the editing liberty of breaking down some long paragraphs and adding sub-headings to make reading easier on phones and tablets.
The true story, as written by Richard Pyle, represents his encounter with decompression sickness, including his treatment and recovery. He also displays great self-awareness in identifying the shortcomings of his mindset which enabled this accident to happen. The story is an enormously valuable read if you intend to venture beyond recreational diving depths, exceed no-decompression limits or conduct aggressive repetative diving profiles.
Confessions of a Mortal Diver – Learning the Hard Way
by Richard L. Pyle (email@example.com)
As a high-school student, I had been granted several wonderful opportunities to experience my life’s calling – the study of coral reef fishes – in some pretty exotic places; most notably Christmas Island in the central Pacific, and the Micronesian island of Palau.
At Christmas Island, I had met one of this world’s most genuinely kind and sincere individuals – an aquarium fish collector by the name of David Wilder. David had taken me on many 200+fsw dives off the slopes of Christmas, and it was with David that I experienced my first clinical DCS.
It was on a dive to 110 fsw to collect a new subspecies of butterflyfish (which I later named wilderi in honor of David), and we limited our bottom time to only twelve minutes. After surfacing (with conservative decompression), I felt a mild pain in my left shoulder, which I successfully treated with in-water recompression. That was July 14th, 1985.
Three months later, David, along with Boota Taie and Tebano Sukong, were emergency air- lifted to the Hyperbaric Treatment Facility in Honolulu after all of them experienced severe decompression sickness.
David suffered a CNS hit which has confined him to a wheelchair for the rest of his life, Boota was initially paralyzed but later regained his ability to walk after a few weeks of treatment, and Tebano suffered nothing more than moderate pain in both of his shoulders. A fourth diver, Utrie Taie (Boota’s brother), never left Christmas – he died of DCS-related complications before the rescue plane arrived.
The story of their accident is long, dramatic, and full of heroic efforts and unfortunate circumstances, and would require pages of text to adequately recount. But their story is not the topic of this article. I mention it only as background to my own story, to underscore the irony, and to illustrate that in spite of my first-hand experience with a tragic DCS accident, I was too thick-skulled to learn from the mistakes which David and his companions must pay for the rest of their lives.
Failure to learn from the mistakes of others
I visited David at the Hyperbaric Facility almost every day for the three months of his treatment. Through these visits I learned much about DCS and its treatment, and I spent a great deal of time talking with Dr. Robert Overlock, David’s “bends doctor”.
It was also through these visits that I met John Kraemer, an entrepreneur/fish enthusiast who was a friend of David and who was going to establish an aquarium fish collecting station in Palau. I was eighteen years old and just finishing up my first semester as a college freshman at the University of Hawaii. After my earlier travels abroad, I was quickly becoming bored with the mundane academic life.
John needed someone to help him set up his station in Palau; I had experience in Palau and was looking for something more exciting than college classes. Some long discussions over dinner, a hand-shake partnership, a lot of preparation, and three months later I was on my way to Palau. Testing the Limits
During the first few months of our stay in Palau, we spent our time completing the necessary tasks of establishing any business – making contacts, spending money, learning the ropes, filling out legal forms, and applying for permits.
By the end of June of 1986, we were at the point where we could do nothing more – all of the formalities had been fulfilled,and all the forms had been filed – we needed only to have our Foreign Investment Application approved by the Palauan Foreign Investment Board, and they wouldn’t be meeting again until July 15th. I had unlimited access to a 15-foot Boston Whaler, I had all the SCUBA tanks I wanted, I was surrounded by some of the world’s best dive sites, I was young, and I was feeling pretty damned immortal. All in all, an extremely hazardous and potentially disastrous combination.
I still regard those two weeks as the most fantastic diving experience of my life. For those of you unfamiliar with Palau, it is blessed with perpetually glassy surface conditions, underwater visibility approaching 400 feet at times, some of the most spectacular drop-offs on earth, and an incredibly vast array of marine life. Palau has been designated one of the 8 underwater wonders of the world.
I dived everyday, four or five times a day, pushing my limits a little bit further each time. I was not ignorant – I had completed my diving education through the level of Divemaster. But I was naive – I thought that I could continue getting away with dive profiles which now make me shudder.
Halfway through this fortnight of diving bliss, the eminent Dr. John “Jack” Randall, one of the world’s leading authorities on coral reef fishes, visited Palau. He needed a boat and a diving partner, and I, a budding coral reef fish researcher, was more than thrilled to take him diving wherever he wanted to go.
We dived every day, collecting amazing fish specimens, seeing fantastic things, and generally having a blast. I was having the time of my life! As the date of his departure – July 15th – drew nearer, we had accomplished all of his objectives except one. He wanted to make a dive at the legendary Palauan Blue Holes, a huge and elaborate cavern system located along one of the island’s most spectacular drop- offs. I had been in Blue Holes a number of times before, and each time had encountered some fantastic or unusual fish species.
I was anxious to take him there, and we decided to go July 14th – the day before his departure – exactly one year after I had been mildly bent at Christmas Island.
Exceeding the Limits
We spent the morning loading our gear and driving the hour-long boat ride from the dive shop to Blue Holes. When we arrived, I set the anchor and quickly got ready to get in the water. I rigged my tank and regulator and put on my fins.
When I grabbed my mask, the glass plate fell onto the floor of the boat. I had brought a really nice black silicone mask to Palau with me, but some puppies had found it and had torn it to shreds. The only replacement I could find in Palau was this cheap rubber mask with an oval glass plate which kept falling out. With no small amount of dexterity, I reassembled the mask and re-attached the metal band which held it all together, just as I had done many times before.
As I plunged over the side of the boat and descended through the fabulous caverns, I was in awe at the incredible visibility of at least 400 feet. The main body of the cavern opens to a drop- off with an enormous gape of about 200 feet across. The top of this entrance is at a depth of about 90 fsw. The floor of the cavern is a steep sandy slope which begins at 70 fsw at the back of the cave, drops to 150 fsw at the mouth, and continues down into the abyss. Four large circular holes, about 30 feet in diameter, connect the ceiling of the cave at 50 fsw to the reef-top at 10 fsw. A truly spectacular system.
I had spent a good deal of time exploring the cave system on previous dives, and I decided to follow the sand slope down outside the cavern on this dive, rather than further explore its insides. I wore only a single aluminum 80 cu. ft. cylinder, and in those days of overconfident stupidity, I had no qualms about dropping down to 250 fsw for a quick look around with such meager equipment.
Diving the “Bendomatic”
Jack had loaned me one of his old mechanical decompression meters (a.k.a. “Bendomatic”), so I used it as a guide for decompression. Arriving at 250 feet, I experienced one of the most intense moments of awe – the closest thing I’ve had to a religious experience – in my entire life.
I looked back up the slope through the incredibly clear water, and even from that depth, I could see the boat hanging lazily over the edge of the drop, I could see ripples in the surface, I could even see the anchor line connecting the boat to the reef – from 250 feet away! (No kidding!) A small Gray Reef shark swam along the reef a hundred feet above – 150 feet below the surface – and a White-tip Reef shark lay resting on the sand a few yards away.
But the most spectacular sight of all (by far) was the cathedral- like columns of light penetrating the darkness of the cavern, emanating from the four round “chimneys” which give the Blue Holes its name. Given this setting, along with the comfortable numbness of narcosis and the warmth of the surrounding 82-degree water, I was feeling content with just staying there – forever.
The spell was broken when I suddenly noticed a vast school of small fishes off to my right. I could recognize that they were a group of fishes called “Anthias” (or “Fairy Basslets”), but the color pattern of black and white bars was unlike any known species. I frantically tried to collect a few specimens with the hand nets I had, but they were evasive.
Narcosis at 250 feet
With the narcosis, it seemed like I was down there for hours. I knew it was deep – really deep – and I had this constant nagging feeling that I really should get the hell out of there soon. But the needle on my decompression meter wasn’t yet in the red, and my pressure gauge read 1100 psi, so I ignored my pangs of concern and continued my efforts. I chased and herded and swung my hand nets in a desperate effort to collect this unknown species.
Finally, after what seemed like hours of bottom time (but was actually about 15 minutes), I managed to catch one of the fish, and without hesitation I headed back towards the surface.
Broken SPG, out-of-gas and a fast ascent
Ascending past 200 feet, I noticed a slight breathing resistance in my regulator. Two breaths later, it was clear that I was running out of air. My gauge still registered 1100 psi, but the breaths were getting progressively more difficult – time to pick up the pace. At 150 feet, it was like sucking air through a hypodermic needle. I stared at my gauge, still reading 1100 psi, and could not understand what was happening. All of a sudden, the needle dropped instantaneously to zero – the needle had been stuck! By this time, I was rocketing towards the surface at break-neck speed. I barely made it.
I climbed in the boat, where Jack was fiddling with his underwater camera, and I forgot about my perilous ascent as I groped through my collection bucket to find the unusual fish I had collected. On the surface, the black and white bars appeared in their true colors of red and yellow. I held it up to Jack, expecting him to confirm that I had indeed collected a new species, and he said “Oh yes. That’s Pseudanthias lori. I named that fish after my daughter because I collected the first specimens on her birthday.”
It turns out, he had collected the beast more than 20 years before. Oh, well.
Decompression sickness – the creeping pain begins
At about that time I began to notice a curious pain in the middle of my thigh, slowly increasing in intensity. “That can’t be bends“, I thought. “if it were bends, my joints would be hurting, not the middle of my thigh…that’s what all the textbooks say, anyway…“.
Textbooks aren’t always right. Within minutes I began to notice a moderate pain in my left shoulder, followed by pain in my right shoulder. Then my elbows, followed by my knees, thighs, wrists… Yep, I was bent alright.
Attempts at in-water recompression
Not getting overly excited about the situation, I calmly rigged a second tank, briefly described my situation to Jack, then rolled over the sideof the boat before Jack could tell me any different. Descending below 15 feet, all of the pain completely vanished. Just to insure the bubbles were squeezed back down, I made a brief “spike” to 125 feet. I then slowly ascended to 60 feet for 2 minutes, then 50 feet for 5 minutes, 40 feet for 5 minutes, 30 feet for 20 minutes, then finished the bottle off at 20 feet.
Climbing back into the boat, I didn’t feel any symptoms of DCS. Jack was still finishing his second dive, so I rigged a third tank, just in case. About fifteen minutes later, I felt a very mild twinge in my left shoulder. I decided to spend a few more minutes decompressing while waiting for Jack to return.
I “spiked” to 60 feet, slowly ascended to 40 feet for a few minutes, stopped at 30 feet for five minutes, then spent the next forty minutes hanging just below the boat at 10-20 feet. My tank was still about half full, so I climbed back into the boat saving the rest of the air…just in case I wanted to make another dive. Jack returned and was naturally concerned with my well-being. I assured him that I had fixed myself and was just fine, that he needn’t worry about me, and that I was a big boy and could take care of myself.
We ate lunch and talked about fishes and fish scientists, and I listened as Jack retold some of his better diving stories (and believe me; after nearly fifty years of diving, with perhaps 30,000 dives under his belt, he tells some good diving stories!). Two hours went by and I all but forgot about my little mishap during the morning dives. Jack wanted to use half of his third tank to photograph some fishes in a particular boat channel on the way back from the dive site. Since there was nothing in the channel of interest to me, I decided to let Jack dive it solo while I waited in the boat.
The symptoms seemed to be relieved
Three and a half hours post-bends, and I felt fine. No pain, no weakness, no excessive fatigue; nothing. At that time, my story was only an anecdote – a little tale to tell my friends back home. It was an in-water recompression success story. It was a nice little example of how one should not trust their instruments more than their intuition.
It would have served as a harmless reminder of the potential hazards of deep diving. If I had gone home at that point, that day would not have been much different from many others. But I didn’t go home. Consequently, that day; that sunny July 14th, exactly one year after my first and only previous clinical DCS hit; would profoundly alter the rest of my life.
When Jack finished his dive in the channel, he said that he wanted to use the rest of his tank on a bounce dive to 140 feet to collect a particular rare fish species he had seen on another reef. I pulled anchor and headed off to Augulpelu reef, commonly referred to by visiting divers as “Short Drop-off”.
Short Drop-off is a large off-shore reef near Koror, the main town of Palau. Although its name may imply a drop-off which bottoms-out at moderate depth, it is actually a sheer vertical cliff beginning just below the surface and plummeting hundreds of feet straight down. Its name actually comes from the fact that it is close to the dive shop and requires only a short boat ride to get there.
Jack had seen a rare species of dartfish at 140 feet on an earlier dive there, and he wanted now to use his remaining air to quickly drop down and collect some with a small amount of rotenone (a fish poison). When we arrived at Short Drop-off, I said I would use the remaining air in my tank to drop down to 140 feet to make sure we were in the right place.
“No way!” Jack said. “After getting bent this morning, there’s no way I’m going to let you go back down there.“
After I reminded him that he was not my mother and that he was a guest on my boat, and convincing him that I was fully capable of taking care of myself (yeah, right), I grabbed my gear and jumped over the side. I went straight down to 140 feet, saw the fish he was looking for, then came straight back tothe surface; total time underwater: 5 minutes.
Another dive, against advice
I waited as he prepared his small portion of fish poison and prepared to make his dive. The plan was that he would drop down, find the fish, spread the chemical, then return to the surface. After waiting a few minutes for the fish to succumb, I would drop down, collect the first few fish (if placed immediately in clean water, fishes collected in this method often revive. I wanted some live ones for my aquarium, so I wanted to go down first and collect the first few.).
While I decompressed, Jack would go down and collect the rest of the fish. All in all a very efficient plan (except for the fact that, given my state of nitrogen saturation, I would be committing virtual suicide.)
Jack went down, found the fish, distributed the rotenone, and came back to the boat. He told me that he left his powerhead at the spot where he put the rotenone, and that in order to find it, I should go down to the big sea-fan at 140 feet and turn right. (He left the powerhead because sometimes, in the presence of dying fishes, sharks tend to get a bit excited.)
He tried one last time to convince me not to go back down, but I wasn’t about to listen to him. I knew everything there was to know about everything, and there was nothing this world famous researcher with nearly 50 years of diving experience could possibly know that I didn’t already know better. I was nineteen – I was immortal. Or so I thought…
I followed Jack’s directions to the rotenone station with utmost precision…except for one minor detail. Instead of turning right at the big sea-fan, I turned left. Four minutes into my dive, I realized my blunder and headed back (upcurrent) from whence I came. Passing the big sea- fan, I continued along the ledge at 140 feet for a short distance and came upon Jack’s powerhead.
I looked around, but saw no fish – absolutely none! I looked at my gauge which read 1000 psi, and continued searching for fish (I just hated to come back empty handed).
A few minutes later, I suddenly remembered about my earlier faulty pressure gauge reading and grabbed for the gauge again. It registered 750 psi – at least my gauge was still working. I finally saw a few disoriented fish. I quickly collected them, and started for the surface.
The faulty SPG strikes again
At 120 feet the breathing started getting tight. I was breathing hard after my exertion, and the regulator wasn’t delivering what I needed. I looked at my pressure gauge, and it still read 750 psi. I was struck with horror when it suddenly jerked down to zero. I was on the surface less than a minute later. Jack was fully rigged and about ready to roll over the side of the boat.
“Where the hell were you!” he shouted. “You were only supposed to be down a couple of minutes! Are you alright? Do you have enough air to decompress?“.
“Yeah, I’m fine”, I said, not wanting to admit to him my blunder of trusting the faulty gauge – again.
He briskly replied “Then get back down and decompress!!”
With that, he fell over the side of the boat and went down to collect the rest of the fish specimens.
I clambered aboard the boat and hauled my gear in. The weather was mild, and the sea was glassy and mirror-flat. I began breaking down my gear and stowing equipment. I briefly looked at my catch of fish – nothing exciting, and all dead. I stood up and looked down the reef at the boat owned by the “Fin’n’Fins” dive shop. I recognized the dive guide as my friend Melvin, and I waved to him.
He saw me and waved back shouting “How was your dive?“.
I yelled back “Great…just great.”
I watched him help the tourist divers into the boat, pull anchor, and motor off towards the dive shop. When his wake reached my boat, it rocked a little and I lost my balance slightly. I reached for the steering console of the 15-foot Boston Whaler, but my hand wouldn’t go where I wanted it too.
The numbness and shock reappears
At first I didn’t think much of it, but a few seconds later I realized that both of my hands and arms had lost all coordination! My body went cold and I broke out into a sweat. I fought off panic as m ybrain scrambled to fully comprehend the situation.
“Oh Jesus!…Oh, Jesus!” was all I could say.
I looked out at Melvin’s boat, but he was already too far away to hear my yelling over the roar of his engines. I continually moved my arms about, trying desperately to prove that they were really O.K. But they were getting worse. I can’t explain the incredibly horrifying feeling of losing control of one’s appendages – it’s something which can only be understood though experience, and I wouldn’t wish the experience on anyone. My arms were starting to go numb.
I began pacing back and forth trying to think of what to do, when I noticed my legs were also losing coordination and getting numb.
Suddenly I became very dizzy, and I knew that if I didn’t do something soon, I would probably die. In the two minutes since I had surfaced from the dive, my body had deteriorated with every breath. I quickly got down on my back on the floor of the boat and wrapped my legs over the steering console. I maneuvered my body so that I was in a near-vertical head-down position, using the console for support.
As I lay there, upside down, my head cleared up and I was no longer dizzy. Slowly, my arms began to regain some coordination, although my hands and fingers seemed to have minds of their own. I decided that I had to find some way to get back in the water and recompress.
After a minute in the head-stand position, I got back to my feet and grabbed my regulator. There were five tanks on board, and I knew that at least three of them were dry. I frantically cracked the valves on each one, but only one of them had any air at all. I put my regulator on that one, turned on the air, and saw that it had 100 psi remaining. I didn’t waste any time on a backpack, fins, or weight belt – I just wanted to get underwater fast. I grabbed my mask and heard a loud “KLINK” as the glass plate fell to the deck of the boat. What timing!
In retrospect, I can say with confidence that the ensuing few moments represent one of the five most intense moments of my life. With fingers that did not seem to pay much attention to the instructions from my brain, I desperately tried to reassemble the pieces of my mask. I don’t know how I managed to stay calm through those moments, but I know for certain that if I had panicked, I would not have been able to get the mask back together.
Another attempt at in-water recompression
Somehow, I was able to repair it. Holding the tank under my arm and placing the regulator in my mouth, I rolled off the boat and pulled myself along the gunwale to the anchor line. In my efforts to pull myself down the anchor line with a buoyant nearly empty aluminum-80, I suddenly realized how useful a weight belt would have been.
It didn’t matter much, though, because within a minute, the tank was dry. After that failed recompression attempt, I managed to heave myself back into the boat, where I realized that the symptoms were getting worse again. I got back into my headstand by the console, and waited for Jack’s return.
A few minutes later (I’m not really sure how long because my mind was considering options at a blistering pace for what seemed like an eternity), I heard Jack’s bubbles breaking the surface near the boat. I quickly got to my feet and saw that he was decompressing on the anchor line.
I very gingerly grabbed my mask, put on my fins, and jumped over the side. I dived down to Jack, who was about 10 feet under, and motioned that I needed to buddy-breathe. I did what I could to explain my predicament using hand signals, and although he didn’t grasp the full extent to which I had DCS, he got the gist of it.
He showed me his pressure gauge which read 500 psi, and it suddenly dawned on me that by buddy- breathing with him, I was now cutting into his decompression gas supply. I wasn’t sure what to do at that point, because if I didn’t decompress some, I would be screwed; but if I kept buddy-breathing with him, then he might not have enough decompression time and he might get bent too.
Jack must have realized the mental dilemma I was struggling with because he motioned that he was O.K. and that I should stay with him and share his precious air.
Unfortunately, I had forgotten to bring my weight belt, and I was very definitely positively buoyant. In my struggles to stay down, I was using up our air too quickly, and we needed to conserve as much as we could. I took a deep breath, swam down to the bottom ten feet below, and picked up a fairly large rock to use as weight.
I wasn’t wearing my wet-suit (it would have compounded the buoyancy problem, and the water was warm anyway), so I carefully stuffed the rock down my pants. Despite the fact that I could feel small marine creatures crawling about parts of my body where most people definitely do not want creatures crawling about, I was glad that I was neutrally buoyant.
Decompression sickness symptoms allieviate underwater
Underwater, I had regained control of my arms and hands, and my legs felt fine as well. We held each breath as long as we possibly could, and we managed to stay 8 minutes at 10 feet. When we just couldn’t suck any more air out of the tank, we surfaced and hauled ourselves back into the boat. I moved my arms and fingers about, and walked around on the boat.
Everything seemed to be working fine again, but it was clear that I wasn’t out of the woods just yet. Jack and I agreed that we both should get back in the water as soon as possible, and the only way to do that was to go back to the dive shop and get more tanks.
Fortunately we were diving at Short Drop-off, so the dive shop was only a ten-minute boat ride away. But it was 4:55 in the afternoon, and the shop closed at 5pm – we had to hurry. We pulled the anchor right up, started the motor, and headed for Koror.
There are two boat channels through the barrier reef between Short Drop-off and the dive shop. The main channel is clearly marked, but it is farther away and it would take us half an hour to get to the dive shop if we used it. The other channel leads straight to the dive shop and would require only 10 minutes, but it was unmarked and could be safely used only on a clear day.
Since I didn’t see any rain clouds, and since time was of the essence, I opted for the short cut. Jack said he felt a mild pain in his neck, so I told him to get down on his side and elevate his feet while I drove the boat.
Just as I was entering the channel, a rain squall like none I had ever seen suddenly announced its presence. Rain drops the size of marbles pounded my face, and visibility dropped to 20 feet. I couldn’t see the reef – in fact I couldn’t see anything at all due to the rain hitting my eyes. I grabbed my mask, which fell apart; then I grabbed Jack’s mask.
Unfortunately, Jack’s mask had prescription lenses installed, so I couldn’t see very well. But at least I could see better than I could with the rain in my eyes, so I slowly motored on. Looking for the reef was useless, so I had to go on my memory of the direction of the channel. I almost ran head-on into another, larger, fishing boat coming out the channel. My legs were starting to feel numb. That was another of the five most intense moments of my life.
I somehow managed to weave the boat through the channel without hitting the reef, and the squall passed on. At full throttle, I glided the boat between patch reefs and around the maze of small islets towards the dive shop. Fifteen minutes after we had pulled anchor (delayed by the rain squall), we arrived at Fish ‘n’ Fins Dive Shop. Francis Torribiong, the owner, had just locked up and was about to leave.
“Wait!” I yelled. “We need tanks!”.
Francis called back “What?!? You want to do more dives?”.
“I’m bent!”, I replied.
He called back “What?! Bent!? Who’s bent?!“
“I am,” I yelled, “and maybe Jack too.“
Without hesitating, he ran to the dive locker, unlocked the door, and instructed two of hisemployees to bring us some tanks. As I pulled-up alongside the dock, I took one step toward the bow-line…and fell flat on my ass.
The strange symptoms of decompression sickness
My legs were more than numb, they were virtually incapable of standing or walking. It was clear that this episode wasn’t going to be over anytime soon. Francis said he only had two full tanks. He told one of his employees to drive our boat and take us out to the harbor to recompress. Meanwhile, he would fill more tanks and alert the hospital to start preparing the recompression chamber.
Twenty two minutes after leaving Short Drop-off, Jack and I once again plunged into the water. By this time, my legs were numb, weak, and totally uncoordinated.
The numbness wasn’t so much a tingly sensation, but rather a reversal of temperature sensation (i.e. the cold water felt warm on my legs). My arms and fingers were moderately uncoordinated, but not nearly as bad as they were back on the boat at Short Drop-off.
As I descended this time, however, something was different – the symptoms did not go away.
This time in-water recompression didn’t help
I followed the steep slope down to 80 feet, where it bottomed out into mud. The poor visibility compounded my uneasiness about the fact that my symptoms were unchanged, even at this depth. I had an overwhelming urge to remain as deep as I could until the symptoms vanished, but Jack (and my common sense) convinced me not to stay at 80 feet more than two minutes. I certainly didn’t need any more nitrogen in my body!
Five minutes later I was at 40 feet; ten minutes after that I was up at 30 feet. After 20 minutes at thirty feet, I began the long wait at 20 feet.
At about 7:15 in the evening (an hour after entering the water this last dive), I was down to 500 psi in my tank. Jack had long-since gotten in the boat and was waiting with the Dive Shop employee. I wanted to stay out there, underwater, as long as I could – at least until the chamber was ready for me.
I surfaced and asked Jack if he had any air left; he had none. They decided to leave me there,go back to the dive shop for another tank, and then bring it back to me. They gave me a flashlight (it was night), and I descended back to the reef, 20 feet below. I was alone.
Fatigue was beginning to set in. My mind began to wander. I wondered what I would do if the boat never came back. Would I be able to swim back to the dive shop? At night? Half paralyzed? What if a shark got me? What if the chamber isn’t working? Will I get worse? Will I be confined to a wheelchair for the rest of my life? Am I going to die? I kept pointing the flashlight straight up.
Fifteen minutes later, the boat glided to stop directly above me, and an anchor fell to the reef a few feet away. I shined the light up at the white hull of the boat, and saw that they were lowering a SCUBA cylinder with regulator over the side. They hung it beneath the boat at a depth of twenty feet.
I decided to leave some air in the tank on my back, just in case I needed it later, and I began breathing off the new cylinder. I spent the next hour and fifteen minutes alone in the darkness, thinking about life in general, thinking about the ludicrous mistakes that day, and wondering what price I was going to have to pay for them.
There were many thoughts of “If I had only...” and “Why didn’t I just…?“, and there were many, many regrets.
I also thought about David Wilder…and Utrie Taie. At one point during my long wait, another boat came to a stop alongside the one I hung below. I could see flashlights moving about and pointing down at me, and it was clear that the occupants of the two boats above were exchanging information.
It was nearly nine o’clock at night, and I had spent more than six hours of that day underwater. My body was saturated with nitrogen, and probably filled with tiny bubbles. I was exhausted.
I freed my mind of the sobering realities of the situation just long enough to appreciate the amazing light show going on around me. The water was rich with bioluminescent planktonic organisms which would glowbright green when disturbed. Passing fish left glittering green trails of light behind them as they swam. I was momentarily bemused by the thousands of tiny sparkles of light I created in the wake of my arm as I swung it through the water. But my amazement didn’t last long.
When I had finally breathed the last few breaths of air out of the SCUBA cylinders, I came to the surface. Jack was still on the boat, and he asked me how I was feeling. It was difficult to assess my state in the weightlessness underwater, but back on the boat I could confirm that my condition had not improved. But it hadn’t gotten any worse, either.
Rushed to the recompression chamber
I was informed that the recompression chamber was ready and waiting for me, and we unanimously agreed that I would be better-off in the controlled, dry, and warm environment of the chamber than I would be underwater. Besides, I was at the limits of exposure; my fingertips looked like white raisins, and my jaw and lips were fatigued from holding a regulator for such a long time.
Arriving at the dive shop, I did my best to hobble to my feet, but had to be virtually carried off the boat. On shore, and with a great deal of concentration, I was able to stand on my own and even walk the three or four yards to Francis’ car. I plunked down on the back seat, and lifted my legs inside. Someone shut the door, and Francis drove off towards the hospital.
During the short drive, I remembered what one of the American Peace-Corps students had told me: “If you ever find yourself sick while in Palau, the last place you want to go is the hospital. It’s appalling!“
Francis was driving, and I said “So I bet you think I’m pretty stupid, huh?”
He only said “No, Richard, I don’t think you’re stupid. Just relax.“
I sat for a moment and said “I’m really sorry to keep you up so late at night.“
“Don’t worry about it.” he said, and we were quiet for the rest of the trip.
Decompression Sickness Treatment
At the hospital, Francis helped me out of the car, and semi-carried me through the entrance and down a long hallway. We came to the room with the recompression chamber. It was a yellow cylinder, about six feet long and two feet in diameter, with a number of pipes, valves, and miscellaneous other contraptions fastened to its sides. About a dozen SCUBA cylinders were lined up along one end, the first connected by a high-pressure hose to the chamber. I was placed on a stool and given a quick physical to evaluate my condition. After answering a few questions, they asked me to undress, wrapped me in a sheet, and asked me to try to walk over to the chamber.
With a lot of concentration, I was able to walk, one uncoordinated and shaky step at a time, all the way over to the chamber. I climbed in and they closed the big round metal door. As they were pressurizing the chamber I looked out the small round window above my head and could see Francis reading the owner’s manual.
Although this seemed a bit disconcerting, I was really too tired to care. I remembered how Boota Taie, one of the divers from Christmas Island, was bent to about the same degree that I was, and he almost totally recovered after extensive treatment. I never allowed myself to believe that my prognosis was any different.
The first chamber treatments
The chamber was only capable of simulating a depth of 165 fsw, and it required the air from several SCUBA tanks to pressurize it that much. I don’t remember the exact profile they treated me with, but it involved breathing pure oxygen through a mask for four twenty-minute bouts (with 5-minute air breaks) at a simulated depth of 60 fsw, and the full treatment lasted over six hours.
I remember hearing voices outside: Jack was telling the doctors what had happened, and insisted that he should pay the bill. John Kraemer visited me and gave me a great deal ofmoral support. Other, unfamiliar voices discussed possible plans of action. I talked over the microphone system and recounted all of the dives I had done that day. After that, all I could do was lie and wait.
About an hour into the treatment, my legs began to feel very tingly. At first I thought that in the cramped quarters in that steel coffin, the blood circulation to my legs had been constricted and my legs had fallen asleep. But I soon realized that the sensation was obviously bends-related. I didn’t worry much about it, I decided that it must be due to fatigue. I was extremely tired.
When the treatment finally ended at 3:15 in the morning, more than twenty hours after I had awakened the previous morning, I could barely keep my eyes open. I was so tired that I could think of nothing else besides sleep. I’ve never been more physically and emotionally exhausted in my life. I was too tired, even, to care that I was by that time unable to move my legs, and could only barely move my arms. I only wanted sleep.
When I awoke at 10:30am, I was in a room full of other patients with a wide assortment of maladies from broken legs to burns to cancer. Otherwise, I was alone. I could just barely wiggle my feet slightly, and both arms were numb and uncoordinated. There was a clear demarcation in feeling across my chest just below my collar bone.
Numbness below the collar bone
My entire body below this demarcation felt the way my lower lip feels after my dentist fills a cavity – numb. I had lost all bladder control, and had been hooked up to a urinary catheter. It was difficult to breathe lying down because my diaphragm was non-functional. When my chest muscles expanded my lungs, there was nothing to prevent my other organs from filling the space, and I had a hard time fully ventilating my lungs. John Kraemer came in and sat by the bed. I told him how it all happened, and I wasn’t quite sure whether or not he was really pissed-off at my irresponsibility.
He told me that once word had spread of my accident, someone broke into my apartment and stole an airline ticket and $400.00 in cash, along with my brand-new speargun. (The nerve of some people!) John was dressed up because he was on his way to the government building to meet with the Foreign Investment Board regarding our permit to do business.
I was supposed to attend that meeting, but I had to cancel – health reasons. Jack stopped by on the way to the airport and offered more moral support. He had to leave, but he would contact me after he returned to Hawaii. Francis also came by and asked me for a detailed description of how I felt. He told me they were preparing the chamber for another treatment, and I should be ready to go back in that afternoon.
I told him I hadn’t made any other plans, and that I probably wasn’t going anywhere, seeing as I couldn’t walk and all.
The second chamber treatment lasted eight hours, and was generally uneventful. There was neither any improvement in my condition, nor did I get any worse. Francis told me they had made arrangements with a Coast Guard C-130 to take me up to Guam, where there was a more fully equipped and staffed recompression chamber. John came by again and told me the Foreign Investment Board had flatly refused our permit to do business. He said it had nothing to do with my accident, but rather was some sort of political thing. He was going to try again, but I was clearly out of the picture.
Evacuated to Guam by the Coast Guard
The next morning I was put aboard the Coast Guard plane and flown in a pressurized cabin over to Guam. The attendants were incredibly kind and helpful, and I never really had a chance to thank them. The flight was long and grueling – there were no windows near me. For my in-flight meal, I was fed intravenously.
In Guam, I rode inside a military ambulance to the U.S. Navy Hyperbaric Facility. Iwas greeted by an assortment of very friendly military personnel, most of whom were officers. I was given a thorough examination, and tested carefully for various reflexes and sensory responses.
The “Wheel of Death”
It was there where I was first introduced to the “wheel of death”, as I call it – a shiny stainless steel wheel of very very sharp needles, attached to a short metal handle. The idea behind this simple torture device is that a doctor could roll the needle wheel over a person’s body to locate exactly where the demarcation between normal and impaired sensory perception was.
The doctors determined that the line of sensory impairment was a few inches above my nipple-line. Below that line, the wheel of death felt like the wheel of a toy motorcycle. It was then when I really began to realize the extent of my injury. Sharp pain was entirely absent from most of my body, and an ice cube on my foot felt like a hot coal. But when the doctor tickled my toes with the tip of a feather, I could feel it just fine – as though there were nothing was wrong with me at all. I was even able to feel a tiny ant crawling across my big toe.
After a great deal of poking, prodding, questioning, and swapping tasteless paraplegic jokes, I was again put inside a big steel chamber. This chamber was very different from the one in Palau: it was about 4 feet in diameter and twelve feet long, and had two beds and all sorts of instruments inside. I was accompanied this time by two attendants who took care of my every need (emptying catheter bags and whatnot) and continuously monitored my condition.
More hyperbaric chamber treatments
This time I was initially pressurized to a simulated depth of 165 fsw, and brought to the surface again over an eight hour period. Afterwards, I was placed on a cot in the middle of the commanding officer’s office floor. The doctor in charge was Dr. Cy Severns. Although he knew a great deal about treating DCS cases, he was not the resident expert.
The real “bends Doc” of that facility was out of town, and the general consensus among the half dozen military officers who kept me entertained was that I should be flown to Hawaii. I watched as they made a long series of telephone calls to various places – including the Pentagon – to make arrangements to fly me out to Hawaii. After a while, they brought me a telephone and asked me if there was anyone I’d like to call.
I decided that it might be a good time to break the news to my parents, and a few minutes later, I heard my mother’s voice over the receiver. She already knew about the accident because the doctors in Palau had called. She had answered the phone when it rang, and she heard the voice say “Yes, hello, this is the Palau Hospital calling concerning Mr. Richard Pyle…is Dr. Robert Pyle there please?”
My mom replied “This is Mrs. Pyle, I’m Richard’s mother…”
After a long pause, the doctor said “Uh, I think I’d better speak with his father...”
With that, my mom solemnly gave the phone to my dad, went in the living room, and told my sister “That was the Palau Hospital…I think Richard’s dead.”
For half an hour, she and my sister sat in silence, listening to my dad say “Uh huh…Uh huh…Yes, I understand...”
Although my dad told her that I was alive, she was nonetheless exceptionally pleased to hear my voice over the phone when I talked to her from Guam.
Transfer to Hawaii for further treatment
After a second chamber treatment in Guam, my condition was reassessed and we were all delighted to find that the numbness demarcation line on my chest had dropped to several inches below the nipple line. I was asked to sign a form saying that the military could, should they so desire, send me a bill for the flight (although they never did), and I was taken by ambulance to the military airfield and put aboard a humongous jet bound for Honolulu.
If the two hour plane ride from Palau to Guam seemed bad, this ten hour excursion from Guam to Hawaii was going to be a living hell. It was. Again, no windows, no movie, and intravenous dinner. But seriously, those men and women of the 8th MASwere truly a fantastic bunch of people, and I am eternally grateful for their help and encouragement throughout the long and boring flight.
After we finally arrived in Honolulu, I was loaded onto yet another ambulance and rushed to Kewalo Basin, where the Hyperbaric Treatment Facility is located. As they opened the ambulance door, I could see that the place was exactly as I remembered it from the times I had visited David Wilder.
There was Dr. Overlock, the same doctor who treated David, looking me over as they brought me off the ambulance.
“Hi” I said, “remember me?”.
“Yes” he said, “I sure do.”
He repeated many of the same tests that were given to me in Guam, and he finally asked me to try to sit up. I could barely lift my head, so he helped prop my torso upright. Within seconds, I began feeling very light headed and I started to faint. They carefully laid me back down and I regained consciousness. They took my blood pressure – it was 40 over 17 (no kidding). Apparently, because of the paralysis, all of my veins and arteries had completely dilated; so I was basically just a big sack of Jell- o.
Thus began the long series of treatments at the Honolulu recompression facility. The first few treatments were 12 hours in duration, but most of the rest were standard eight hour “Hyperbaric Oxygen” (“HBO”) treatments.
These consisted of an initial “spike” to a simulated 220 fsw, a slow ascent to 60 fsw breathing a special enriched-air nitrox mixture, four 20-minute periods of breathing pure oxygen (with 5-minute “air breaks” in between) at 60 fsw, a long haul on pure oxygen at 30 fsw, then a very slow ascent to the surface.
I was given one such treatment per day, then taken to a nearby hospital to spend the night. I had many visitors at the hospital. Besides my parents, Jack Randall came by several times to check on my progress. Many other friends visited as well. Between visits, I became involved with an assortment of television soap-operas – there really wasn’t much else for me to do. I was subjected to a series of tests to determine the full extent of damage to my body.
For one of them, numerous electrodes were attached to my scalp, and electrical probes were fastened to my toes and fingers. I was administered a rapid succession of fairly painful electrical shocks which were detected by the electrodes on my head. That test revealed that there was permanent damage on my spinal cord – scar tissue – which would have unknown permanent affects.
The Long Road to Recovery
Slowly, day by day, I began to recover. I wasn’t able to stand on my own for a full week after the accident. I could barely walk on my own another week later. My legs were still very weak, and I still had no feeling of sharp pain or hot/cold below my waist. The treatments themselves were not exactly an exercise in comfort either.
As you can well- imagine, breathing pure oxygen at three atmospheres absolute for extended periods is quite toxic, and can cause any number of a wide variety of side-effects. Fortunately, I never had any problems with CNS (acute) oxygen toxicity – I never convulsed. But after a week or so, I began feeling the effects of cumulative oxygen exposure and pulmonary or “whole-body” oxygen toxicity. My fingertips lost all feeling, and I would get terribly nauseous.
Every day I entered that chamber, I would succumb to extreme abdominal discomfort, and I would inevitably vomit (you can imagine how the fine aroma of puke can quickly permeate the air inside a steel can). Also, each day I came out of the chamber, I was nearly deaf for several hours. I never understood why breathing high partial pressures of oxygen could lead to deafness -I suppose it’s possible that Dr. Overlock tried to explain it to me, but I probably couldn’t hear him.
Day by day, I continued on. Despite the physical troubles I was having from theoxygen, I was eager to go into that chamber each day; because each time I came out, I could detect a small improvement in my condition. Also, breathing hyperbaric oxygen has some other good side-effects too.
During several of my treatments, I was joined by another patient, a woman who had taught SCUBA for many years, who was suffering from severe osteoporosis. Before she began the HBO treatments, she had been confined to a wheelchair because of her problem. But after a few months of one treatment per week breathing hyperbaric oxygen, her condition improved dramatically – she could walk with only a moderate limp. Also, a nasty gash on my leg I had received in Palau refused to heal for weeks. But within days of starting the HBO treatments, the wound healed right up.
There were two notable incidents during this long series of treatments in the chamber.
Hyperbaric chamber oxygen toxicity scare
The routine of each treatment began with a fairly rapid pressurization of the chamber to a simulated depth of 220 fsw. Just like filling a SCUBA tank quickly, the chamber would get warm on pressurization, so as soon as we reached maximum depth, the outside tenders would ventilate the air inside to cool it down.
These ventilations were incredibly loud inside the chamber. After a minute of ventilation, the inside tender would give me the mask which delivered the EAN mixture, and I would put it on and breathe from it throughout the rest of the treatment. After many such treatments, the process became routine.
On one occasion, just after initial pressurization, I habitually reached up and grabbed the mask and put it on. The tender, who was a medical technician rather than a seasoned diver, was understandably influenced by the nitrogen narcosis, and had no qualms about me putting the mask on – he even assisted by handing it to me. For a full minute, throughout the ventilation process, I breathed from that mask without problem. It tasted fine, I felt fine, everything was okay.
When the roaring sound of the ventilation stopped, a voice from the outside tender came over the speaker: “Uh, did you verify the hook-up on that mask?”
The insider tender, a bit bewildered and somewhat under the influence of nitrogen narcosis, said “What…what do you mean?”
The voice on the speaker came back “Did you check to make sure the mask was hooked up to the right gas supply?”
The tender looked around, and all of a sudden realized that he hadn’t checked, and that I was breathing pure oxygen at a simulated depth of 220 fsw! That’s an oxygen partial pressure of about 7.7! Needless to say, the problem was immediately corrected, there was a lot of yelling going on outside the chamber, and I never even noticed the difference. After that, we always waited until the ventilation process was complete before I breathed from the mask, and we always verified which mixture it was connected to.
Breathing mask pressure suffocation
Another time, again just after initial pressurization, the tender waited for the completion of ventilation, verified that the mask was connected to the correct breathing mixture, then handed the mask to me. I took hold of the mask and brought it towards my face. When it was about half an inch away, I was horified as the mask suddenly grabbed my face like some terrible monster and instantly sucked all the air out of my lungs! The mask clung to my face with incredible strength.
Its hose was accidentally connected to outside ambient pressure, and the simulated 220 fsw pressure inside the chamber was trying to force my lungs out my throat!! I frantically pulled and tugged at the mask trying to tear it off my face, but it wouldn’t budge. It gripped my face with a vengence.
The tender quickly understood what was going on and helped me try to struggle it free. I finally grasped the edge of the mask where it formed a seal with my face, and ripped the thing off (aided by the strength of adrenalin). There was no physical harm done – after a few moments I was able to catch my breath. Again, a lot of yelling was going on outside, and the problem was quickly corrected. After that, I was very careful whenever I put that mask on!
Intensive physical therapy
Through intensive physical therapy, my legs increased in strength. I regained control of my bladder, eliminating the need for a catheter. I began walking up and down stairs for additional exercise. I had many long discussions with Dr. Overlock regarding the theory and practice of recompression treatment, and long discussions about the physiology of bends as well.
He explained to me that my injury was analogous to a shotgun wound to my spinal cord, and he made certain that I understood that many of my nerve cells had died forever. He explained that my recovery was not a result of new nerve growth, but rather a result of my brain learning new nerve pathways to send signals to the rest of my body.
A bleak prognosis for future diving
He explained how I was now much more susceptible to DCS, that a subsequent hit would very likely occur in my central nervous system, and that I had used up just about all of the “extra” nerve pathways in my spinal cord. He made it clear, in no uncertain terms, that if I continued to dive I would be much more likely to get bent, and that full recovery from such a hit would be much less likely. Basically, he did his best to convince me to give up diving for good.
After 28 treatments, I could walk on my own (very slowly, and with a substantial limp), although I still had no sharp pain or hot/cold feeling in my legs. The increments of improvement in my condition with each passing day had diminished to the point where I really couldn’t detect them. So finally, more than a month after the accident, the decision was made to stop the chamber treatments. I was afraid that my condition would remain that way forever. True, I could walk, and I was certainly in better condition than I had been a month earlier, but I couldn’t run, I couldn’t jump, and my body was still suffering from some serious impairment. But Dr. Overlock assured me that the chamber treatments were yielding diminishing returns, and that only time would heal my wounds. He said the healing would continue for a couple of years, but he could not tell me how much my condition would improve.
Decompression Sickness Recovery
As the months passed, my ability to walk continued to very slowly improve. With practice, I was able to conceal my limp and appear to walk normally, but it took a great deal of effort. Climbing stairs was not much of a problem, but coming down them was difficult. Even stepping off a curb required a great deal of concentration. I was able to contract the muscles in my leg fairly smoothly, but I was unable to relax them at a controlled rate. Also, my legs would occasionally convulse spastically and uncontrollably. The feeling in my legs did not improve as quickly – I still could not feel any sharp pain, or distinguish hot from cold in my legs.
In order for my father’s insurance to pay for the bills, I had to be enrolled as a full- time student. So, in spite of my handicap, I returned to the University of Hawaii the next semester and did my best to hobble around campus from class to class. I did not dive again at all for nearly a full year.
I understood Dr. Overlock’s concerns about my diving again, but I knew in my heart that I could never give up diving. In fact, I knew that I could never give up deep diving. Otherwise, life slowly returned to normal. I had lost a lot of weight during the accident, and I slowly began to put it back on. I continued with an assortment of leg exercises, and my condition very slowly improved.
Diving after decompression sickness treatment
I limited my first post-bends dive, nearly a year after the accident, to a maximum depth of 25 feet. As the months passed, I slowly increased that to 60 feet, then 130 feet; always following an extremely conservative decompression profile. On my first post-bends dive to 180 feet, I was very nervous. After a ten-minute bottom time, I decompressed for well over an hour.
One of the effects of my impaired legs was that after long exposures towater, they would feel weak and numb. It was terrifying every time I surfaced from a deep dive with long decompression because my legs would feel almost exactly the same as they had felt in Palau, right after the accident. On the decompression line, I would continually monitor the coordination of my fingers by touching each fingertip to my thumb in rapid succession. Every time we returned to the harbor after a dive, I would trot around the parking lot to determine if my legs were fully functional.
Two years after decompression sickness treatment
Two years after the accident, I was able to walk almost totally normally, and I could even jog reasonably well. The feeling in my legs had improved, but was far from normal. By December of 1987, a year and a half after the accident, I had logged nearly 200 post- bends dives, more than half below 200 feet. In all of these, I never experienced any CNS DCS symptoms. Also in December of 1987, on Christmas day at, of all places, Christmas Island, I made my first post-bends dive to 300+ fsw on air. Decompression was scary, because an effect of extreme nitrogen narcosis for me was numbness in my legs. The numbness didn’t wear off for almost an hour after the dive, and I didn’t leave the water for almost two hours. But I was fine.
It’s now been 6 years since the accident. I’ve made well over fifteen hundred post- bends dives, more than two thirds of which were in excess of 180 fsw. I’ve also made dozens of air dives beyond 300 fsw, and I’ve begun using mix to penetrate depths of more than 400 fsw. In all of this deep diving, I have not experienced any further DCS symptoms. And so it continues.
Retrospective on Decompression Sickness
In retrospect, I now feel I understand the fundamental factor which led to my severe bends hit that sunny July 14th in Palau. It wasn’t because I went too deep or stayed too long. It wasn’t because of the decompression meter I was using. It wasn’t even because my pressure gauge malfunctioned. Although these were all contributing factors, they were not the fundamental reason I got bent.
The real reason was that I had a very bad attitude about deep diving. I got caught in a trap which snares many young, bold, and “immortal” divers – the trap of overconfidence.
Since I was continuously pushing the limits – and getting away with it – I felt overconfident about pushing the limits even further. I was sure that I would never get bent. I regarded all of the emphasis on safe diving practices and self dicipline as “sport-diver crap”, and I felt as though I was exempt from following conventional guidelines. I was wrong…almost dead wrong!
So why, then, do I continue to dive deep? It would be naive of me to think that I have “learned my lesson”. The risk of decompression sickness follows anyone who breathes gases at greater than one atmosphere pressure – that risk cannot be avoided, and it increases with increased depth of diving. Will I ever get bent again?
To be honest, I don’t know. Many friends and colleagues feel as though I’m living on borrowed time. Maybe I am. But at least I have changed my attitude about deep diving. I no longer view it as a test of my abilities, or as a means to demonstrate my courage. Statistics of diving accidents suggest that I am more likely to get bent again, now that I’ve been hit once already. I’m not convinced this is true, but whenever I find myself hanging on a decompression line after a deep dive, I always assume that it is.
This story was taken from this webpage which is no longer being maintained