Issue 3 At the Chamber from the Archives of the London Diver Magazine

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20 April 2024

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	ISSUE 3 ARCHIVE - AT THE CHAMBER THE BENDS PAULA LICHTAROWICZ I am four foot eleven and 'bent'. I'm straightening out now, but it's unlikely I'll see five foot for some time. But it's not just that my legs are too wobbly for high heels, I've got extensive nerve damage and sensation loss, and all because of a five-week delay in being diagnosed with Decompression Sickness after a 'fun' dive. I count myself very lucky. You might be wondering how someone can fail to notice nitrogen bubbles romping around their system for five weeks. You may have seen the movie; diver surfaces from the deep, staggers a step or two and before there's time to pluck the leeches from his mask, he expires, whispering 'The Bends… the Bends!' But in the real world of recreational diving it doesn't happen quite like that. The truth is, between an ignorance of Decompression symptoms, and a denial about having 'taken a hit' many 'fun' divers are putting their long term health, if not their lives in danger.
	Take me, I'm probably more closely related to a tequila cocktail than I am to Jacques Cousteau. The whole diving thing was merely a useful accessory to my cliché-coated career-break; if the Thai beach got boring or the novel-inprogress stalled, then a day spent finding nemo was the perfect tonic. I'd picked up the season's must-have item – a dive instructor boyfriend – and life was good; until the Sunday before Christmas, and a dive trip in the water off Koh Chang. The day passed without incident. It was only my eighth dive, and the boyfriend was being suitably solicitous. Like the 85 % of recreational divers who get 'bent', we were sticking to the safety tables that govern how long you should spend under water. There was plenty of snot, spit and sea-water and that was it. That evening I felt tired and passed on the beers with diving. I'd had a headache for a couple of days and it was still niggling.
The next morning I woke feeling odd – odder than usual. It was as though someone had hoovered up anything that wasn't screwed down in my head, and replaced the wiring while they were at it. It seemed insufficient cause to unleash my inner drama queen in a public display of hypochondria, besides there was nothing wrong with the dive, I knew that. 'I feel strange' I said as often as I dared to the boyfriend, and whomever else I could find to whinge at. 'I'm confused – I don't feel like me.' 'You are you. It's because you're a vegetarian,' answered the boyfriend-cum-nutritionist firmly. 'You need vitamins' he said. And bought me some. But I still felt odd. For three days little things – like my own fingers – would baffle me, whilst bouts of nausea and dizziness worked me in shifts. Then four days after diving, I walked into a bar and fell down. I was carried back to the boyfriend's bungalow. Soon it was impossible to lift my legs or left arm. At 3 am friends carted me to the island's Medical Clinic. 'Hmm' said the doctor, yawning, 'very strange. We will give you a painkiller and you will be transferred in the morning to the mainland.' 'It's really not necessary' I said. Did she not know it was Christmas Eve the next day, and there were barbeques on the beach to consider? The next morning I was shipped to Trat Hospital. I recounted my symptoms, I'm pretty sure the diving was in there somewhere, but I started the whole tale with my headache. Bad move; the next thing I know, my head was being CT scanned. It was Christmas Eve and things were not going to plan. 'We looked for your brain, and found nothing.' The doctor said, which was a Christmas present, of sorts. Christmas Day, I was transferred up to Bangkok Hospital, the boyfriend forsook a second day of beach barbies to come too. I had a nerve test for MS.'Everything is normal' said the neurologist pinging my bouncy reflexes with dismay. 'Anything strange happen?''I did have a headache...' I started. 'We went diving' said the boyfriend, 'but it was a week ago, and only to 15 metres'. 'Too shallow' said the doctor. 'Oh yes, too shallow' said the boyfriend, and they swapped business cards, in case the doctor had a free weekend. I returned to Koh Chang diagnosed with a 'mystery virus'. The next ten days passed by, legless but serenely enough; me falling over around the island and young strong-armed men portering me from bar to bar. It didn't seem like a bad life, and the painkillers were great. Except that friends arrived from England, and spoiled everything. 'This is not normal' they said. 'You should come home' they said. 'No thanks, I'm fine,' I said, and shuffled to prove it. There was the year masterplan to think about – the epic-in-progress, and the perma-tan, new friends and flip-flops. About the only thing I was missing from home were my patent pink stilettos. Then, on cue, pain erupted in my legs; fireworks squealing from my thighs to toes. 'You're back,' said the doctor in the Medical Clinic. 'Can I have some morphine?' I said. 'Certainly' she said. Which suited me fine. But not my friends. They rolled up their sleeves, made the insurance calls and shipped me back up to Bangkok. Narrowly avoiding the Neurologist's desire to continue investigations with a lumbar puncture, I was flown back to England, in frostbitten January, with a list of unpronounceable nerve disorders and a big sulk on.
'It has to be to do with diving' non-diving friends started saying. 'It can't be' the long-distant-boyfriend said. 'We've all discussed it out here. Your head would have blown off in the plane from the pressure if it was.' 'Probably a virus' smiled my GP, 'but then that is what we doctors say when we don't have a clue, isn't it?' I was referred to a neurologist, sometime in the dim future and in the meantime I ran out of nerve medication and the pain began to frazzle me. So finally I did it; I unleashed the inner drama queen on internet search engines. I found my symptoms, and the number for the London Diving Chamber. 'Come in now' they said. Five weeks and a day after my dive, I am wobbling my way through neurological tests in front of Dr Eden. He eyes my hunched posture with more sympathy than I feel I deserve. 'There's a one-in-a-million chance this isn't diving related.' he says gently. 'But... the headache, the shallowness, the safety tables...' I'm still protesting, I don't know why. Dr Eden nods, then explains that Decompression Sickness is no respecter of dive safety tables. The tables were created for young, fit navy divers, and not other mortals. There are many myths about 'the Bends'. The reality is that under pressure, excess nitrogen, breathed in from the scuba tank air, dissolves and accumulates in the body's tissues. If it doesn't have enough time to be released back into the blood stream, often by the diver ascending too quickly, the nitrogen returns to gas form, and the bubbles cause trouble. In my case they were busying themselves in my nervous system. 'How did you feel on the dive day?' Dr Eden asks. Now I remember the little things – not eating between dives (no veggie food on the boat) feeling very cold under water, and then there was that headache. Cold, sickness, and tiredness are all possible factors, along with dehydration, because they don't help your body to work efficiently to 'off-gas' the nitrogen. He suggests another possible factor – a PFO (Patent Foramen Ovale) – in other words a hole between the right and left ventricles inside the heart. It's a common condition – affecting one in three people. Recent research has linked it to cases of unexplained Decompression Sickness. Then, again, he says it might not be a PFO either. There are 'PFO' people who go diving for years without getting 'bent'. The only truly predictable aspect of Decompression Sickness is its unpredictability. Dr Eden has a simple mantra for any diver: 'If you develop any strange symptoms in the week following a dive – do not ignore them. Presume they are pressurerelated until proven otherwise, and get treatment immediately.' The London Diving Chamber is NHS funded for emergency treatment – the sooner they get to those bubbles, the sooner you're sorted out. I am whisked into a recompression chamber, something akin to a dry-docked baby submarine. I have visions of a Bond dispensing a splattering decompression death to an unspecified Bad Person. 'That's technically impossible here' soothes Simon Wilson, the chamber supervisor, as he shuts us in. Outside his colleague Dave turns a lever and starts to squash the air, and us. We 'descend' to 18 metres where I suck oxygen for five hours, and try to ignore the fact that I look like a mutant Ninja-anteater in my metal mask. The theory is that under pressure my squatting nitrogen bubbles will redissolve and the oxygen I'm breathing will help chase out any shirkers. As the gases battle unseen, Simon recounts gory tales from his commercial dive days. Halfway into the session, pizza is passed through the airlock. It is all rather civilised. I come out feeling ten years younger, high as a kite and, briefly able to walk.
The rest of the week I have shorter treatments daily. It's miraculous – by Friday I can skip. But I am to pay the price for my five week delay. The bubbles have laid timebombs in my nerves; over the weekend my legs start up fizzing. By Monday I'm shuffling again. Now Dr Eden begins talking about permanent damage and treatment 'plateaux'. It hits me that I might never wear my heels again. I am dispatched to see Dr King, gentlemandoctor and hyperbaric specialist. In his Harley Street suite surrounded by giant bubble-filled crystal balls, I learn more about the randomness of nitrogen in the body. 'The Bends' can be progressive and move from small symptoms to big problems. Now I learn, if untreated, it can be recurrent too. 'You mustn't feel foolish,' he says, kindly, though, of course, we know I am. Then he adds, 'I think we can get you in much better shape than this.' Pink heels waltz back into vision. I want to kiss him. 'A week more in the Chamber' he prescribes. Back 'under', Dave pulls out of the hat an 'explosion in the chamber' story to cheer me up. Later we inflate balloons under pressure and watch them pop as we climb to the surface, anything to pass the time. After two weeks of treatment, I can hopscotch again. I show off my mobility to friends. Men, amused, play Radiohead's 'The Bends' at me (how I laugh), and express fascination with the mechanics of bubble-theory. Women, anxious, fret over the high-heel crisis, and are curious about the anti-ageing properties of oxygen. Then another regression sentences me to another two more treatments. It's only with Simon's gentle promise of a really good dive-bell 'and they all suffocated slowly to death' incident, that I clamber in. Finally that's it; I've 'plateaued'. All told I've managed 8 dives in water, and 12 on dry land, it's a fairly abysmal record. So ten weeks on, what am I left with? Wobbly legs, a disconcerting wet thigh sensation (only with my clothes on), and 'long term nerve damage' says Dr King soberly. All of which could have been avoided if I hadn't been so ignorant, and a diagnosis had been made much sooner. I learned the hard way that it's not enough to expect other people to know the facts, or spot the signs. There's too much denial and too little knowledge out there in fun diver land. So now I'm re-plotting my year away, somewhere land-locked perhaps. I'm discarding the heavy rucksack, test-driving the lighter wheelie bag option, and dreaming of dancing in pink stilettos, one day.
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