How many times have we begrudgingly witnessed a pricey travel insurance payment drop our bank account before travel, only to return home without incident and a sense of wasted money? Too many to count, of course. But as lucky or as invincible as we may seem on our adventures, the risks will certainly outspend the savings once they catch up to you. And they will eventually catch up to you.
Let me share my story with the intent of convincing anyone who believes otherwise.
I didn't notice any tingling during the last dive, but it came back shortly after returning to the boat. With a general understanding of DCI, I knew I should treat the disappearance of the tingling while under pressure with suspicion. The nitrogen bubbles formed in my body had been temporarily "reabsorbed", thus relieving the strange sensation while diving. Still, I internally debated about whether or not to say something as I otherwise felt fine. Finally, the agony of indecision was too much to bear and I reported it to Alex, an instructor with dive medicine training whom we had enjoyed socializing with on the boat. She calmly asked me some questions, then checked my body for a frequently associated rash. She noted a faint one on my thighs and thought it would be a good idea for me to breath pure oxygen for the remainder of the boat ride back to the mainland. Her precautionary approach of taking my mild condition seriously was also a huge psychological relief about the validity of my symptoms. I had done the right thing by not ignoring it.
Once the boat had docked, my dread was more about the commotion it would cause among our boatmates when I unexpectedly emerged from my sleeping berth breathing from an oxygen tank. I requested Matt to preemptively spread the message that I was okay in order to minimize the attention, but I still got the pleasure of sitting in a very quiet minivan with all of them for an hour and a half while I sounded like Darth Vader with every breath. Back at the dive shop in Khao Lak, I took a break from the oxygen for saying goodbyes to everyone in the trip.
Since the tingling had continued after a couple of hours on oxygen, the specialists at the nearest recompression chamber recommended that I come in for an evaluation. Wicked Diving kindly provided a fresh oxygen tank and a ride to the Phuket International Hospital another hour and a half south of Khao Lak. Alex stayed by my side to talk me through what to expect, but I was mostly distracted with a new worry about whether or not our World Nomads insurance would cover diving related expenses or not. We had signed up for the standard plan and upon double checking that I would be insured, I discovered ambiguous wording on their website on what it did and did not cover related to diving. Ironically, every other time we had gone diving, we had been members of the Divers Alert Network, but had let our coverage lapse in the last couple of years for lack of use.
I consider myself both extremely fortunate and unusually healthy to have gone about thirty years since my last admission to a hospital. Perhaps the lack of prior experience, paired with a phobia of all things medical, was what made me so overwhelmed despite the absence of any traumatizing emergency. A check of my vital signs revealed a fever, elevated blood pressure, and dehydration, but I swear it was only my nervous adrenalized state that was the cause. The evaluation consisted of a series of physical tests to check for neurological abnormalities. Following the ex-pat technician's directions to track the motion of his fingers with my eyes, etc, was actually complicated by my ineptitude at understanding British accents rather than because of any real underlying problems! I managed to pass the tests despite the language barrier, but was still advised to undergo treatment in the recompression chamber in order to minimize the risk of worsening symptoms or future complications with diving.
After signing an endless series of forms, the wonderful hospital staff began the process of contacting our travel insurance while I prepared to go in to the recompression chamber. I changed into one-size-fits-all-as-long-as-you-are-XXL cotton scrubs and removed all jewelry to avoid the build up of electrical charge. I did not yet know who would be paying for the $1,000 USD per hour treatment I was about to receive for five hours. By now it was 10:00pm, almost twelve hours since the symptoms appeared, and I was exhausted. I entered the underwater submersible-esque chamber along with a burly Aussie technician whose scrubs fit him much better than mine. He got me situated on a narrow bed and hooked up the oxygen mask. We began the descent on our "dry dive" to 60 feet/18 meters as the external operator pumped air into the chamber. I had to equalize my ears constantly as the pressure increased, but it otherwise felt fairly normal (if sitting in a small white room in hospital garb breathing from an oxygen mask can be considered normal in the first place). That is, until I talked and my voice sounded like Donald Duck's, not quite as squeaky as sucking on a helium balloon, but similar.
Once we reached our maximum depth, the operator dimmed the lights and projected a movie onto a white sheet hung across the entrance of the chamber. As I became absorbed in the Adam Sandler/Drew Barrymore rom-com of Blended, the absurd reality of the day slipped away and I actually relaxed for the first time since waking up that morning, which felt like an eternity ago.
On the other side of the chamber, my poor husband did not get a break from dealing with the reality of it all as he kept tabs on the insurance process, checked us in to our post-treatment hospital room, then tracked down some snacks for "dinner" at the nearest 7-Eleven. During my first break from the oxygen treatment, the attendant opened a little side compartment where two yogurts and a Twix bar had been deposited. The lids of the yogurt cups were suctioned in and the wrapper on the Twix was hugging it like spandex.
After two hours, we began our slow ascent back to sea level, with breaks between each level to hydrate and "dehydrate." At this point, I was so grateful for my outdoorsy background that allows me to be comfortable taking a pee in random places. Even so, this definitely won the prize for most awkward. The movie screen doubled as a privacy screen while I squatted behind it over a bedpan with the attendant just a couple of feet away on the other side. Then he had to report over radio to the external operator the quantity in and quantity out (estimated by looking in the bed pan), along with the status of my symptoms.
I finished the session and got in to my hospital room at 3 a.m., but by the time Matt and I had debriefed everything and were ready to sleep it was 4 a.m. The hospital room was far nicer than any of the budget hotel rooms we had been staying in, but I got the shock of hospital staff entering without warning, beginning with waking me up for a very random blood pressure check at 6 a.m. Just as had I drifted back to sleep, someone else delivered breakfast at 6:30. This continued in half hour intervals with a different person coming in to do one small thing, like clean the bathroom we hadn't used, empty the trash can that was already empty, and bring me a fresh towel and new hospital gown. I wondered how anyone could ever recover in a hospital with all of the disruptions from restful sleep!
We eventually got news that I was scheduled for a follow-up session in the hyperbaric chamber later that morning. The first five-hour treatment alone was enough to remove the nitrogen load from my body, so the continuation of tingling afterwards was attributed to micro-damage of cells made by the formation of the tiny bubbles. The second two-hour session was more than precautionary though. Breathing pure oxygen assists the healing process, and doing so under pressure enhances its effectiveness.
Quite absurdly, but purportedly for liability reasons, I was required to be wheelchaired to an ambulance to be driven to the recompression chamber, even though I could see it across the courtyard from the window of my room. I was joined by a German woman who was on her fifth day of recovery from a much worse case of DCI than mine, although her story began quite similarly. She was also on a diving liveaboard in the Andaman Sea and reported mild symptoms to the staff on the boat. Unfortunately, they ignored the situation and told her not to worry about it. She continued diving, her conditioned worsened, and she was unconscious by the time she arrived at the hospital and went in to the chamber! This contrast made me so grateful that we had chosen the professional company we did and had the assistance of highly-trained staff.
After finishing the treatment, annoyingly just before the conclusion of the suspenseful Now You See Me film, I was officially released from the hospital. We were relieved to have a guarantee of payment from World Nomads for the hyperbaric chamber fees, but a separate guarantee of payment was still in process for the hospital stay and other expenses. To be discharged, we would have to put it on the credit card until the insurance came through. We braced ourselves for a bill that would max out our modest credit limit, but the cashier handed over an itemized invoice that totaled a whopping $300 for the same standard of care as the States (and certainly friendlier staff)!
So for a second time we found ourselves in Phuket, the one place in Thailand we were determined to avoid. We found a quiet guesthouse in the old town and simply slept hard for about fourteen hours. I awoke the next day with my leg feeling back to normal, so we hopped on a northbound bus to Ranong, where we had intended to go to directly off the boat before this inconvenient turn of events.
The bus ride gave me plenty of time to reflect on the incident. It took a while to come to terms with the fact that I will never know for sure exactly what led to the DCI. There were no mistakes, events, or disregard of diving rules to point to. After all, my dive computer told me I was within mathematical limits of safety for all dives. So why did I present symptoms when everyone else in my dive group was fine? Of course, the main culprit of pushing me into the risk zone was the simply the quantity of diving done over a short amount of time.
Many aspects of DCI are still mysterious to the medical dive community, but it is accepted that individuals vary in their diving limits. A convergence of additional risk factors can change where those limits are day to day and dive to dive. The chamber technicians were quick to attribute it to dehydration, but I am confident that I was sufficiently hydrated while diving. Apparently women report an overall higher incidence rate than men, but I also wonder if cultural influences keep some men from revealing mild cases whereas women are more likely to acknowledge them. Some research indicates that menstruation is a risk factor, and if so, the timing couldn't have been worse in that regard. Exertion while at depth has been shown to increase risk and the kicking in to the strong currents during the last few dives was the most strenuous diving I had ever done. Fatigue is both a risk factor and a symptom of DCI, and I was definitely "out of it" the morning my symptoms appeared. So while I can assess a long list of risk factors, I will never be able to say exactly what triggered it.
Despite the possibility of DCI developing without definitive reasons, diving is still statistically much safer than any of our other outdoor passions like cycling and skiing. It is certainly safer than sitting in a minivan barreling up the road to Ranong! For example, one out of every 211,864 dives ends in a fatality, whereas one out of every 5,555 registered drivers in the US dies in a car accident.
Will we keep diving? Probably. But not for a while. And sadly, we're not too likely to dive in to the liveaboard thing again. One thing is for sure though, we'll definitely double check our insurance coverage before we dive.