Drowning from the Inside Out

A rare complication makes for a harrowing day.

On Monday, June 21, 2010, I nearly drowned on the back deck of a dive boat 30 miles off Morehead City, N.C.

The day started with a 5:30 a.m. wake-up from an all-too-short night. My teenage son, Noah, and I had arrived in Morehead City the previous evening after a late getaway from Richmond, Va. This was his first offshore trip.

The ride out to the dive site was a little choppy but uneventful. Any day the sea cooperates is probably a pretty good day for diving off the North Carolina coast. The water was a warmish 76°F at the bottom, and the visibility was about 50 feet. We were exploring the wreck of the U-352, a German submarine that was depth-charged by a U.S. Coast Guard cutter during World War II and now lies at a depth of about 110 feet. Exactly one year prior to this dive I had saved a diver who ran out of air on this wreck.

It was just before noon when we began to ascend from our second dive. At 50 feet I coughed for the first time. It was a normal, tickle cough from dry air, except, unusually, there was a gurgle of liquid deep in my throat. By 30 feet I was coughing continuously. With each cough, more liquid rose in my throat. It tasted metallic, not quite like blood but not like saliva either.

When we transferred to the safety line at 18 feet, I began to hyperventilate. I was now actively swallowing the fluids I was coughing up, and the urge to rip the regulator out of my mouth was almost overwhelming. Despite efforts to calm down and slow my breathing, I sucked on my regulator desperately, taking increasingly rapid, shallow breaths. I had no doubt that I was over-breathing the regulator but could not understand why. Bad air? Probably not; I had dived with gas from the same source in the morning. Pulmonary embolism? Doubtful; I had not made any rapid ascents and was well within my no-decompression limit.

It quickly became clear that I'd either have to surface or black out, so I grabbed Noah to buddy him up with somebody else. I put his hand in the other diver's, looked into his eyes and headed up. Leaving was almost as difficult as breathing.

Reaching the stern of the boat 30 seconds later, I signaled distress and was promptly hauled bodily out of the water by the crew. To be perfectly honest, I expected to cough up whatever was in my throat. I thought I'd be fine now that I had reached the boat. I was wrong, and it was the most disappointing and terrifying realization of my life.

As I was hauled onto the swim step of the Diver Down, I gasped for air, croaking "Can't breathe! Can't … breathe!" Behind me, Noah was emerging from the water, safe but shocked as the crew raced to prepare oxygen and move me inboard. My skin was pale, and my lips and fingernails were blue. With each failed breath it became clearer to me that this was where I was going to die, cold and wet on the back of a dive boat — not at all what I had expected.

Just then, luck intervened. My friend Sharky, an EMT with dive-medicine training, was already back onboard. He took my vitals and placed an oxygen mask over my face. Listening to my lungs, he could hear the crackle of liquid as I struggled for air. He relayed the grim news to the captain that they needed to get me to shore as quickly as possible.

Now stripped of my insulating wetsuit, I began to get cold. I remember having increasing difficulty staying awake. I was starting to detach and accept death — at least I was until I looked up and saw Noah at my head. I couldn't possibly die there in front of him. I renewed my struggle for air. Sharky was in my face, staring right into my eyes, imploring me to breathe. Another friend wrapped his body around mine to keep me warm, whispering, "You're safe now. We've got you, brother. Stay with me." The divers and the crew all found ways to help; a few joined Sharky in debating possible diagnoses. Had I inhaled water? No. Had I come up too fast? No — at least not according to my computer. Did I have the chokes? It didn't seem likely. Meanwhile, I was barely holding my own on a back deck now awash with dive equipment and worried divers.

With all the divers safely back onboard and no help available from the Coast Guard, the decision was made to race in. One of the great things about the Diver Down is its speed. It can do 21 knots at a push, making it perfect for reaching rarely dived wrecks far offshore. That day, it was to be my ambulance. My buddies took turns trying to keep me warm, all while making entirely inappropriate jokes about splitting up my dive gear, taking my money and so on. It was hard to breathe, but it was also hard not to laugh.

As we got under way, Noah took his turn sticking with me to keep me present. Throughout the one-and-a-half-hour trip, he kneeled behind me, supporting my back. Swell from the bow sprayed over us as the vessel hammered through the waves. Each time Noah would hunch over me protectively. The guys took turns taking vitals and making sure I was awake and breathing.

Ten minutes after making landfall, we were in the emergency department at Carteret General Hospital. From there I was transferred to the critical-care unit as they worked to keep up my oxygen levels.

Twenty-four hours and a lot of oxygen later, I walked out under my own steam to the applause of the unit's nursing staff — apparently such dramatic recoveries after such serious symptoms didn't happen there often. Thanks to the quick actions of the crew, my son, my friends and the experts at DAN®, I had survived. It was a really good day.

Walker undergoes testing in a hyperbaric chamber at Duke University
Medical Center.
The obvious question is, "What happened?" To put it simply, I drowned from the inside out. The DAN medical team pegged my condition as immersion pulmonary edema (IPE), also known as swimming-induced pulmonary edema. IPE is an accumulation of fluid in the lungs while in the water. Unlike drowning, IPE does not involve the aspiration of water through the mouth. Instead, a spike in blood pressure in the pulmonary vessels causes blood and serum to leak into the alveolar spaces in the lungs. The reason for the spike, particularly in otherwise healthy individuals, is not entirely clear. However, research at the Duke Center for Hyperbaric Medicine and Environmental Physiology under Dr. Richard Moon is helping to improve our understanding of the phenomenon and its causes.

After extensive testing, the assessment was that I am one of the unlucky 1 percent or so of divers prone to this condition. To return to diving, I have been advised to lose some weight and lower my blood pressure, get recertified with my drysuit and start diving dry for anything colder than tropical dives. The doctor also recommended that I avoid excessive hydration prior to diving and consider taking anti-hypertensive medicine before I dive. (Editor's note: Always defer to your personal physician for medical advice.)

After careful consideration, I ultimately made the decision to retire from offshore wreck diving, decompression diving and any dives deeper than 100 feet. The logic is simple: It appears likely that despite my best efforts, I might experience IPE again while diving. If it occurs at depth, I will use up all my air in a heartbeat. I am fortunate to have a wonderful family whom I love and who need me. I also have an incredible dive family who would do everything within their power to save me. I cannot responsibly ask either family to bear this risk, so instead I will enjoy the wonders, colors and warmth near the surface and look for other ways to engage my passion for the depths.

Every incident has its causes. The bottom line is that a gap in my fitness level combined with unfortunate genetics seems to have caused this one. Like many of us, I've picked up some pounds over the years, and this has raised my blood pressure slightly. It hasn't been a big deal on land, but it became a huge deal underwater.

I was already a huge fan of DAN, but this cemented it for me. DAN's awareness campaigns ensured that there was a lot of oxygen onboard and that the crew was trained to administer it. Research done by DAN informed the dive-medicine training of everyone onboard the boat, and DAN's medical staff helped ensure I got the right diagnosis and the right treatment. DAN funds supported the research I participated in, and DAN insurance paid all my out-of-pocket expenses. It is hard to imagine any other way DAN could have helped.

Here's my takeaway: I have a resting pulse in the 40s and can ride, run or swim for hours at a stretch — in many ways I'm a pretty fit guy. But diving takes me into an environment that is inherently hazardous. Any weakness in my constitution, when combined with circumstances and genetics, can generate many different ways to die. While advances in equipment and training have made diving safer than ever, I need to keep my DAN membership and dive accident insurance up to date and bring my A-game every time.

You do, too.

© Alert Diver — Summer 2011