I took my stethoscope away from Paul’s chest. A rough noise was coming from his right lung, but there was silence on the left side. I listened again. I could hear nothing on the left, and noise on the right.

The Kavieng Hospital in Papua New Guinea was 10 minutes away. The weather was rough, and the dinghy bounced heavily creating a spray. That is when the full story came spilling out.

He came up and was flailing about. His lips were blue…

My twins had already told me part of the story. “He came up and was flailing about. His lips were blue,” said Karen. “His head was kind of under the water and then he kind of waved his head about,” as she mimicked what she had seen. Henry chimed in. “He was faking it. He’s done this before.”

Meanwhile, Paul was pretty pumped. “I was under water for three minutes and two seconds,” Paul said. “I just got really calm at the bottom and acted like I was asleep and just watched my watch.”

Asleep. What the hell?

Paul has met numerous freedivers. He has no formal training. Yet, there he is, swimming down to 22 meters. All of my kids can tell you how deep they can swim. This time, Paul had been swimming to 10 meters. I was washing dishes at the time.

The story of what happened at the surface bothered me. I didn’t know the worst part.

When Paul went for a nap in the afternoon, I wanted to keep an eye on him. It wasn’t very long after he emerged from his room with a fever, and I listened to his chest with a stethoscope that we wound up going to the hospital.

There is no triage at the Kavieng hospital. You take a number and you wait outside. We held number 3. It rained as we waited, and I watched the other people in the seats with a jaundiced eye. A man got out of his seat. He was number 2. Perhaps he’s just itchy, I thought. I am not a trained medical person. But, surely having possible barotrauma warrants some quick action?

As we sat in the waiting room I contemplated speaking up. Paul scoffed. “We don’t need to be here.”

“I can’t hear breathing in one of your lungs,” I said. The quiet between us was palpable.

Paul had no recollection of arriving at the surface

In the dinghy, I asked Paul about his behaviour at the surface of the water. Much to my frustration, Paul wanted to talk instead about his experience underwater. Finally, he announced that he had no recollection of arriving at the surface. He felt calm and then he was at the surface.

Before he swam to 31 feet, he had hyperventilated to get as much oxygen to his lungs as possible. I have since learned that this practice is dangerous. By hyperventilating, he had upset his natural balance of oxygen and carbon dioxide. He had suppressed his natural urge to breathe. Paul had been afraid to tell us he had blacked out. I think he scared himself. During the day, he had been googling his symptoms and wanted to reach out to Henry, a freediver friend we had met previously.

The doctor was surprised that I had waited so long to bring him in. “He didn’t tell us he had lost consciousness,” I said.

My thoughts were entirely jumbled. Who hasn’t held their breath in a bathtub? What was he thinking?

It was sobering to consider that my twins were watching their brother begin to drown, thinking it was a joke. Later, they told me they saw him cough up about five mouthfuls of water.

The admitting doctor said Paul’s oxygen levels were low. She said he had wet lungs from aspirating water. He would be admitted for about 24 hours, put on oxygen and given antibiotics. She explained that the water from his lungs would have to be emptied through urine or they would have to drain his lung with a pleural tap.

The admitting doctor was met by Sister Regina Nason who mentioned Medivac to Port Moresby as a possibility. Sister Regina explained that they did not have the facilities in Kavieng to test his blood for nitrogen. At that point, the gravity of his situation must have struck Paul pretty hard. For several minutes, Paul lost his vision and said he had fuzzy hearing. He was asked to stand up and walk. His balance looked good.

The next steps were to contact Dr. Bobby Wellsh, diving doctor in Port Moresby

Sister Regina contacted Dr. Bobby Welsh who is the diving doctor in Port Moresby. Over the phone, Dr. Wellsh requested an x-ray and blood test. I called Rick and he came to the hospital.

 It was horrendous to learn that a game of hold-you-breath could be deadly. Paul told me that he had reached the bottom at 31 feet, and then looked at his watch. He remembers seeing the timer reach 1 minute 30 seconds and the next thing he knew he was at the surface of the water. Karen said she saw him bump his head on the dinghy. But, by the time he arrived back onto our boat Paul seemed fine. It was as though nothing had happened.

Dr. Wellsh would determine whether Paul would need to be put in the Dive Recompression Chamber in Port Moresby. He assured me that I could call him anytime 24/7.

Soon after, a man named Jimmy arrived at the hospital to give Paul a chest x-ray. While Rick went with Paul, I stepped out to get some food and bedding for an overnight stay in the emergency ward of the hospital. The staff were very friendly. But, it was a sobering place with crying children. Some grim relatives were hovering over an elderly person.

After his x-ray, Paul remained on oxygen, and had antibiotics delivered intravenously.

Together, we ate thick crackers and Paul had some cookies. We had an early night. Paul slept on a hospital bed, and I slept on a yoga mat on the floor. The nurses came to check on Paul a couple of times in the night. I also kept watch. Every time I got out of bed, I would stare intently at Paul’s chest. They had used the term “flail chest”. I was so relieved to see his body moving.

Most people who experience shallow water blackout die.

Meanwhile, Rick was back on the boat and said that he had a fitful sleep. He felt sick thinking what a close call we had had.

In the early morning, Sister Regina showed me her phone. She had received a text message from Dr. Wellsh. Paul’s x-ray showed that he had “micro-aspiration in the right lung fields” but that he showed no signs of barotrauma.

Paul received 18 hours of oxygen therapy.

When he reached an oxygen saturation of 100 percent, we were told he would be released from hospital. Paul was prescribed oral antibiotics. In short order, we were back out in the sunshine.

When I returned from the hospital, my computer opened to where I had left off the day before. I had been searching for terms like “lung squeeze”, “pulmonary edema”, “freediving blue lips lung damage,” and “pulmonary barotrauma”.

Paul is doing well now. We will still enjoy swimming and snorkeling. But, we won’t be playing breath hold games. I am grateful for the support and direction from Dr. Bobby in Port Moresby, and to the staff at the Kavieng hospital: Sister Regina, Nancy, Jimmy and our attending GP who didn’t seem to ever go home.

Thank you.

More information about Shallow Water Blackout

Swimming Canada Natation Shallow Water Blackout: PDF

“Shallow Water Blackout (SWB) is a term describing loss of consciousness arising from oxygen deprivation brought about by voluntary or involuntary hyperventilation. In swimming voluntary hyperventilation occurs when a swimmer intentionally over-breathes or hyperventilates. Involuntary hyperventilation can occur as a result of stress and physical exertion during a workout that pushes the swimmer beyond his/her maximum aerobic capacity (VO2 max).  This results in blowing off carbon dioxide (CO2) and essentially lowering serum or blood CO2.  What happens next is a cascade of physiological events that can end up in a devastating result for a swimmer…”