Immersive Pulmonary Oedema (IPO) in divers is often referred to as if it is a relatively new phenomenon – but it isn’t. Plymouth diver JANET CHAPMAN shared her story with Diver magazine readers 34 years ago and here it is again, as she recalls the horrifying wreck dive that nearly killed her, and which she left on a helicopter-borne stretcher…
On the evening of Thursday, 15 June, 1989 I organised a dive for members of our Plymouth Sound BSAC from mv Maureen out of Dartmouth. It was very nearly the last thing I ever did.
There were 14 of us on board, nearly all experienced wreck divers. The only exception was Dave, newly qualified as a Sports Diver but very competent and confident in the water after years of sailing.
To save arguments, I decided to dive with Dave myself. It was a perfect evening, flat calm, with the sea like velvet. We were to dive the wreck of the Greatham, a large steamship about four miles out of port. As we steamed out, there was the usual banter. You could tell we were all friends by the number of insults flying about.
The six of us in the first wave began to kit up while the others drifted off to help play with the ‘toys’ in the wheelhouse. We were soon on site and the shot was placed; 42m to the wreck. There was so little current that the two buoys on the shotline bobbed gently together, the lines sagging between them. I could hardly wait to enter the water.
It was dark going down the line, of course. I switched my torch on and swam as fast as I could, knowing that Dave was close behind. On reaching the loop, which we had made earlier, I clipped a distance reel on and dropped the last couple of metres to the deck. Visibility was about 10m.
After checking that Dave was OK, I started leading the way slowly along the wreck. Every surface was covered with life: huge, sticky plumose anemones, clumps of dead men’s fingers, multicoloured featherstars and small white anemones.
We inspected a short ladder completely bedecked in white, then peered down an open hatch, but there weren’t any goodies down there. The next section had a piece of somewhat fragile deck-rail miraculously intact and now the home of millions of animals. What a nice dive! I was enjoying myself.
Suddenly Dave was giving me a ‘something wrong’ sign. Narced already, and only a few minutes into the dive? Reluctantly I agreed to turn round. We had hardly travelled more than 15m or so. Almost immediately he became trapped by his leg.
Black mark
Big, clear signals were required for ‘OK’ and ‘I will do it’. Dave’s knife was attached by a telephone cable (black mark to me for not having noticed this earlier). It had fallen out of the sheath and the cable had wrapped around the deck-rail.
Fortunately, it took only a few seconds to free him, but as I glanced up to give Dave an ‘OK’ signal, the look on his face made my heart lurch. The man was close to panic. Suddenly it wasn’t fun any more! We were in a deep, dark, alien environment, and would be lucky to get out alive. I reacted as calmly and confidently as I could: ‘you’… ‘me’… ‘up’… ’hold the line’.
As I kicked off the bottom, I started to pant a bit. Nothing unusual in that, it doesn’t take much exertion to make me breathless. But there wasn’t any current and it wasn’t far to swim. I began to doubt that I could make it back to the shotline.
Flash! Away to my left a strobe went off and two streams of untroubled bubbles headed lazily for the surface. Paul and Mike were down there, only a few metres away, but in that other world where everything was still all right.
I pumped extra air into my suit to achieve positive buoyancy. If I rode up and reeled in quickly, I should reach the shotline close to where we clipped on, and I would surely feel better once I had the sturdy rope to hang on to.
Sure enough, we reached the shot just above the loop. I clung on, vainly trying to get my breath back, while Dave unclipped. I didn’t want to tell him that I was in trouble; he had enough problems of his own.
Steep-sided pit
We began to ascend. I tried hard to keep the rate down to something reasonable, when all I wanted was to get the hell out of there as quickly as possible. All would be OK at 6m.
We reached 6m and all was not OK. I checked my computer and was horrified to see that it was telling me to decompress. Help! I could hardly breathe.
Try not to panic. I signalled Dave to do a stop. I felt that I was in a steep-sided pit, and realised that I was going to die. My only regret was that I hadn’t made a will, as I’d been meaning to do for months.
I could not hold on any longer and decided to miss the stops. Better to be bent on the surface than be drowned at 6m. At that exact moment, the computer cleared. Thank goodness! I signalled Dave ‘up’ and headed for the surface in something less than the recommended 60 seconds.
It was good to be back in the air. I inflated my suit and gave a single wave of an emergency signal. I don’t know to this day why I didn’t continue waving. Was I incapable of more, did I desire not to make a fuss, did I think that I would be all right soon, or was it trust that once was enough?
Soon Dave was beside me. I felt him take a firm hold, inflate my life-jacket and wave vigorously. “Come on, come on!” The boat turned slowly towards us. I passed out.
Emergency signal
Meantime, back on the bridge of Maureen, Andy was chatting idly to skipper Mike Rowley. Nobody was expected up yet. Suddenly: “That’s an emergency signal!”
“Where?”
But Andy was already legging it to the stern, heaving his 17-stone bulk over the deck-rail and dropping the 2m to where he hoped the inflatable would still be!
As he pulled the unfamiliar engine into life, Roger dropped in beside him and they were soon speeding to where Dave was supporting my unconscious body and yelling desperately at me to keep breathing. Poor Dave! He had been apprehensive all along and now he was wondering what he had done wrong, when in fact he had behaved admirably.
Somehow the three of them managed to remove my kit, lift me into the boat and race back to Maureen, leaving Dave to swim. On board, Bob had got everyone organised. Apparently it was quite a struggle to haul me up the ladder, but quickly accomplished using a rope and all hands.
I had stopped breathing by this time. I was completely blue and looking pretty hopeless. Fortunately, when laid out on the deck I started to breathe again and Bob was able to give me oxygen. Mike radioed the Coastguard. Five minutes had elapsed.
Struggle to breathe
When I came round, it was as if there had been no interval. Immediately I knew where I was. The struggle to breathe was exactly the same. All I could do was to concentrate on one breath at a time, unable to breathe, knowing that I must, fighting to get the air in, choking, gasping, half-wanting to die to hasten the end of the agony.
The faces of my friends swam in and out of focus. Somebody was holding each of my hands. That helped a lot. I clung on tight.
I was clinging to life itself. I became convinced that I should not give in, but must make the effort to turn on my side. My attempts to put myself in the coma position caused extra problems for my rescuers. “The helicopter will be here in 10 minutes.”
Ten minutes! I didn’t believe I could hang on that long.
“Can’t breathe.” I found it necessary to keep telling them this, although it must have been obvious. But soon it was true. The oxygen pressure had fallen too low for me to be able to operate the demand valve, although the cylinder was still a quarter full.
I fought the mask off. Bob cursed as the others rushed to change the cylinder.
Eventually the helicopter arrived. I have been back to the Maureen since, and wondered at the narrow approach between masts, aerials and wires. The crew did a superb job to pick me off there. They strapped me into a stretcher just like the one in the rescue manual.
Once I had seen a casualty winched into a helicopter, and it looked stomach-churningly awful. I was somewhat apprehensive but I need not have been. It was OK. I did not feel as though I was moving at all, just the helicopter getting closer.
Then it got dark, and I was inside. I had always wanted a ride in a helicopter. Here I was getting my wish, and in no fit state to enjoy it. Dave was winched in beside me, and we were off to Bovisand. I felt very alone.
Soon I was out in the light and the helicopter was getting further away. We must have arrived. Faces crowded the harbour wall, staring. The down-draught from the rotor blades caught my face, and for a few blissful seconds I had enough air to breathe.
Drysuit hacked off
“Hello!” Dr Maurice Cross was beside me. I managed to gasp a reply, then we were running towards the Diving Diseases Research Centre (DDRC). I should feel OK soon, once I was in the pot.
There were about a dozen people in the centre. So many! All turned out just for me. A quick examination, a nod, and two pairs of shears were produced. My drysuit was hacked off me. More tests, then I heard ‘MI’ (myocardial infarct) muttered. “Christ! They think I’ve had a heart attack.”
Large needles were stuck into the veins of both my arms. I was too distressed to care. Then Maurice explained that I had some fluid on my lungs and that he had given me a diuretic to transfer the fluid to my bladder. He would accompany me to the local hospital.
By the time the ambulance arrived, the injections had begun to work. On the journey all I could manage by way of intelligent conversation was “Need a loo!” I had to wait until we got to the hospital for a bedpan.
Another crowd was waiting for me at Casualty: porters, nurses, radiographer, doctors, diving medics, all ready to help. They sat me up to take the X-Ray and I caught a glance at the time – 10 o’clock. So late! The incident had happened at around 7:30. I had managed to keep going for over two hours. Maybe I wasn’t going to die after all.
Shortly after that I was able to start breathing through my nose. My mouth, now I could close it, felt lined with corrugated cardboard.
The X-ray confirmed a diagnosis of pulmonary oedema. Approximately 2.5 litres of fluid had leaked from my circulation onto my lungs. It was now certain that I would not need to be recompressed.
Intensive care
I spent the night in intensive care. I was on oxygen all the time, as I had been continuously from the start. I also had a drip, a urinary catheter, a heart monitor and a nurse to check my blood pressure every hour. I was propped up on dozens of pillows and dozed fitfully. The old man opposite kept falling out a bed. By the following morning I was more or less back to normal, just exhausted.
That Friday I had extensive medical tests: ECG, echocardiogram, X-rays, heart scan, blood tests. All were normal. I also had dozens of visitors, phone calls, cards, presents and enquiries from the press.
I returned home on Saturday. Further investigations have revealed no significant abnormality to satisfactorily explain why I developed this rare condition.
I know that I was extremely lucky. There were so many links in the chain of events that saved my life. If it had not been for my own experience, my buddy’s support, the prompt, effective action of my friends, the availability of the oxygen kit and the knowledge of how to use it, the speedy and efficient response of the rescue services and the expert medical attention I received at DDRC and Derriford Hospital, I would not be here today to write this article.
I tried to thank Andy for the part he played in the rescue. He shrugged. “You’d have done the same for me, wouldn’t you?” I hope so Andy, I hope so.
Dr Peter Wilmshurst, who had first described the condition in the early ‘80s, wrote at the time: Diving-induced pulmonary oedema is an uncommon but potentially fatal condition that can occur without warning. It seems that excessive vasoconstriction of blood vessels in some individuals causes back-pressure on the left heart and hence pulmonary veins.
The high pulmonary venous pressure forces fluid out of pulmonary capillaries into the alveoli. The effects are similar to drowning. First aid treatment is by administering oxygen.
(This article first appeared in Diver magazine, October 1990. Original photo: Paul Dart)
Also on Divernet: Surviving IPO: A diver’s perspective, Hydration is vital, sure – but here’s why overdoing it is risky, Breathless swimmer’s case boosts IPO awareness, Red flags for snorkellers: how to stop the quiet deaths
