Crowley

The statistical incidence of a recreational dive resulting in decompression sickness is something like 1 in 10,000. Not many people get to make 10,000 dives and the mathematically logical (if not practical) conclusion is that most divers will never get bent, even if - as a dive guide - I feel that some people are working really hard to get themselves into the chamber, and yet we'll take them there free of charge if they really want to have a look around.

I’ve clocked up maybe 3,500 – 4,000 dives in my career (I honestly don’t exactly), with maybe an average of 5 divers following – so it would not be unreasonable to say I have witnessed around 20,000 dives in total (including my own). The statistical probability of a diver getting bent on my watch is therefore 2. Actual cases of people getting bent after diving with me: 0

With a nod to a recent blog by DivemasterDennis, I don't log my dives any more because my log book would take up most of my airline baggage allowance, but I strongly encourage recreational divers to log all their dives and record essential dive data such as temperature, exposure protection, weight, depth, time and air consumed. Some divers like to log problems they encountered and possible solutions, and I love to sign logs where short essays are drafted for every single dive. Me - if I kept a dive log these days, every page would just read "ditto"!

Some instructors I know still log every dive just in case it might be required as legal evidence at a later date, in case of an accident or complaint. Some log every dive just because they’re nice people and Facebook-friend all their students. I don’t even have Facebook and my logbook of 25/12/09 would read:

Dear Dive Log,

Spent most of christmas day with the human cork. Popped to the surface - again - after pressing the wrong button - again - with his girlfriend scrabbling around in the sand. Again. Told them to go away and consider whether they should continue the course, and also would they please complete the knowledge reviews that I asked them for two days ago. If they show up tomorrow with a new attitude and a willingness to learn, then I'll be happy to continue.

This is actually how I blagged my way out of working on Christmas afternoon (I was meeting Vicky for dinner), and also because it's true - they were terrible students until I gave them that lecture!

Statistics are a proven way to ensure statisticians remain employed, because nothing gives you 100% satisfaction like the fact that you are always correct, even if 95% of the population don't know what you're talking about, 50% of the population voted for Kermit at the last election, and 15% smell like cheese.

I have worked in busy environments for most of my career, with a statistical probability therefore of hundreds of cases of DCS, and an actual reality of not very many. I am counting on my fingers - including thumbs – but I have some left over.

But, from time to time, it does happen.

The first guy I "tanked" was a fellow instructor called Mark, who was teaching a Deep Spec. at the wreck of the Hardeep when I was working in Pattaya, Thailand.

Another instructor on the boat called me in advance and told me that Mark had classic headache and nausea symptoms, but told everybody he was fine, had not consumed excessive amounts of alcohol the night before, was well hydrated, and said he was “prone to headaches”, and could not possibly be bent.

I was the most senior member of staff in the centre that day and although I had no prior experience of actually dealing with DCS, I am trained well beyond basic EFR so as soon as Mark returned to the centre, I put him on the O₂ and interviewed him to establish his symptoms. When I asked to look at his torso - there was the classic blotchy skin bends, so it was directly off to the chamber.

We checked his dive computer and he had logged a first dive to 26m and a second to 27, with nothing in the data to give us concern. Some discussion was given to reverse profiles but I personally don’t think the 1m difference was meaningful. He didn’t do anything wrong, he just got bent.

It was my first case, I handled it - I even paid the chamber fee from my own pocket - but the thing that stuck in my head afterwards was Mark's refusal to accept that he could possibly be bent - and he’s not alone in that, which brings me to a case I dealt with last week.

I was working in the office and at about 4pm, one of our guests told me another customer he knew was feeling unwell: headaches, dizziness and permanent pins-and-needles in one arm, like he’d been sleeping on it and it felt numb.

Just like Mark, the diver himself did not report his symptoms personally. He confided in another diver he knew, who is a trusted repeat customer with whom I have dived before, and who then informed me of the situation.

I interviewed the symptomatic diver as best I could in my broken German and discovered that he had been feeling unwell for several days, had had difficulty sleeping for two nights, and also that he had not drunk enough water the day before and felt dehydrated.

Headaches, nausea, vomiting - we see it all the time in Egypt. It gets very hot here and the air temperature is already over 35C. There are lots of bars in the resort and the sea is often rough. Overapplication of one or more of these things makes for classic symptoms of the bends – and also of a bad hangover. The thing that gave it away for me in this case was the one-sided arm tingling... if it's one-sided it means there's a high possibility that the "bend" is in the nervous system or the brain.

In my opinion, the diver already suspected that he was bent and knew that asking the staff would only confirm it. We told the guy he needed to visit the chamber but he refused to go because he didn't want to miss his flight home - so we insisted he breathe pure O₂ while we decided what to do with him. We put him into one of the classrooms and told him to wait while we monitored the situation and I personally said to the guy that if he didn’t get a medical check and he really was bent, then he would be in for a whole world of pain on the flight home, but he was having none of it.

What do you do? We can’t exactly handcuff him and drag him down to the chamber, because people object to this sort of treatment and then there’s litigation and paperwork. Also we don’t want him to fly home because – ya know – he might die – and then there’s more litigation and paperwork.

So – we put him on the O₂ to see if his symptoms lessened – especially the arm thing. If this had happened, then we would have insisted he go to the chamber, in handcuffs if necessary, because a reduction in symptoms after administration of oxygen is another good indicator of the bends. I visited him several times over the next 10 minutes and he said he felt a little better. We got suddenly busy and it was another 10 minutes before I checked again… and he was gone. He didn’t believe us, he didn’t believe he was bent, he went for a swim in De Nile…. And he flew home.

Guess what?

Yup, he's in the chamber. Told ya so....

Now - going back to the bit about log books. I said earlier that I have never had a diver get bent on my watch. This is true, however last year, one guy I guided at Thistlegorm did, indeed, get tanked after diving with me.

SO! you cry! He got DCS after diving with you, Crowley!

And I say: "NO! The Thistlegorm trip was on Thursday, and yes, he went to the tank on Thursday, but he got bent on Monday!"

And how do I know this? Because this diver, a certified instructor, wrote in his log book that he suspected he had DCS after diving on Monday. He then continued to dive for the next two days, then did the deep and nearly-deco-dive at Thistlegorm. On Air. Of course we didn't find this out until later, and for sure I was pooping my pants for a little while thinking I'd done something wrong and now this guy is in the tank because of me!

But no - his first dive with me was three days after he got bent. Why would anybody write a dive log saying "I think I'm bent", and then go diving and make a note in their log book that they still feel bent - for three consecutive days - and it's only when they start to poop their pants that they tell someone. If there was a talent show called "America's got Denial", then this guy would be a contender. Really!

Dear Dive Log,

Monday I got Bent; Tuesday, Wednesday, Thursday…"ditto". Friday: 30m dry dive in big metal tank. Missed flight home. Can't fly for two weeks. Love to the children. Say sorry to your mother, kids. I love you, darling, when I get back will you be my Miss Piggy and call me your li'l green Kermy-Wermy?

I really hope she doesn't sleep with Bert and Ernie while I'm gone...

K.T. Frog (Muppet).

After we heard that the guy from last week had been tanked back home, we talked to some of his dive buddies and we learned that he was very drunk in the small hours of the morning before the dive trip when he first became symptomatic. He made a similar trip the next day and a house reef dive on the third. He finally admitted to his symptoms after arranging to meet other customers for a few beers before he flew home.

Classic denial – asking other people if they feel the same way because the first person that says “yes” absolves them of responsibility. I do understand, and getting bent is like a diving equivalent of some sort of “social” disease where you don’t want to admit that you have it, even to the doctor. But - if it gets to a point when you know you have a problem, but ignore it – and also log it – then you’re drowning in a river much more powerful than the Nile.

I have never actually seen the Nile, by the way, but Denial… yap, that’s a river in Egypt.

Cheers,

C.