By Mark Cowan and Martin Robson
The gruesome true story of the bends, seen through the eyes of a diver pitched into a natural hell; paralysed and trapped underwater with nowhere to go but sink back into the deep.
Baltic Sea, 1964
HE lay there, incapacitated on the stretcher, in the grip of something he had brought back from the deep. A universal tremor had seized control of all his joints and he was in a bad shape. Every part of him convulsed: his arms, his legs, his hands, elbows, knees. Even his jaw shook uncontrollably. He had never known anything like it before, might never see anything like it again, and couldn’t do much of anything beyond lie there, trembling.
Before him, squeezed into the cylindrical metal pressure pot onboard the Soviet salvage vessel Spasatel'noye Sudno 87, were members of his dive team. They were like brothers to him, he knew them so well. They had lived and trained and sailed out to sea together for years. They had dived into the cold depths of the sea together, been to places where no other human had set foot, beyond the limits of what was thought humanly possible. As a diver medic, he had schooled them on the dangers down there and what they should do if they surfaced with pains in their joints. He looked up at them staring back at him with worry on their faces, but his bright blue eyes did not plead for their help. He had his own plan.
I have no right to ask you to do this, Gennady Mikhailovich Sokolov said to the men.
We know, replied junior doctor, Vitaly Kushnir.
He knew—they all knew—what was being suggested and what had to be done.
It had been ten hours since Sokolov had been down to the black seabed, 374 feet (114 metres) below. Two hours since he went to bed after being hauled to the surface. Working under pressure, he had been tasked with attaching air hoses to the inlet valves of a submarine playing dead in the water. Reaching such depths was no mean feat back then, even for a man wearing the tinned copper helmet every schoolboy associated with deep sea divers back then.
Two men had gone down in the diving bell together that day. Two men had worked together in the alien world of the seabed; two men had come up from the cold depths to the surface side-by-side; two men had climbed out of the spherical craft, splashing into seawater water pooling on the deck beneath the skids; two men had undressed out of their diving gear and, laughing at a joke, had walked into the mess for something to eat. They were going to celebrate. The simulated rescue mission had been a triumph, further proof that, in the event of a catastrophic sinking, the hard-hat divers of the Baltic Fleet could deliver lifesaving air to submariners—at depths greater than the British Royal Navy were willing to attempt at the time—and liberate their comrades from the grip of the deep. Then Sokolov had gone to bed and woken as his body fell apart. Now, inside the chamber his body shaking uncontrollably, he could only wonder what the hell had happened down in the dark to spare his comrade but leave him in the worst shape.
Sokolov felt a twist of anxiety in his gut and tried to convince himself he would be okay, but even he wasn’t sure he’d survive the next few hours. The deep was calling in a debt because Sokolov had not settled up properly following his earlier intrusion. It had unleashed bubbles of gas smaller than the point at the end of this sentence to attack his body from the inside. He was suffering from decompression sickness.
For two hundred years, decompression sickness has plagued divers, miners and engineers in the most disturbing of ways. Astronauts could find themselves stricken and even the pilots of America’s high-altitude U-2 spy aircraft had fallen victim to it (at a rate of 5.6 cases per year between 2002 and 2009). One combat mission pilot had to be coaxed down by ground controllers and came within five feet of slamming into the runway. The incident left him with persistent headaches, joint pain and personality changes. He couldn’t remember how to shave. Divers, though, are the ones who have suffered most from the man-made disease, a product of the Industrial Revolution and a consequence of the vacuum pump and air compressor.
Decompression sickness has gone by many names over the years: caisson sickness, tunnel disease, compressed air illness, dysbarism, the chokes. The Germans called it Druckfall Krankheit. The wives of Greek sponge divers christened it Satan’s Disease. Everybody else knows it as ‘the bends’. To non-divers, the vast majority of people that is, the bends is possibly the only sure thing they know about diving. To them, it is the devil lurking in the deep and is enough to dissuade them from trying this diversion off the field. To deep divers, the bends is the Damoclean sword hanging over them when they push the limits. They can’t see it, but they know it’s there somewhere and they do everything they can to avoid it. Decompression sickness can kill in minutes or choke you to death, or you can wake up from sleep a cripple for life. The list of symptoms reads like an inventory of every doctor’s worst nightmare. Worse still is how the effects pile up, one on top of the other, in a systemic attack which devastates the body from the inside out. “Bent like a pretzel,” as one physician likes to say.
“This disease is very difficult to nail down. It is, in a way, similar to syphilis which tends to present itself in an absolute myriad of ways,” says Dr. James Francis PhD, retired head of the Royal Navy’s Diving and Submarine Medicine Department. “Decompression sickness is a great mimic of all sorts of conditions and one need to be really astute to make the correct diagnosis.”
The vessels of destruction are microscopic bubbles of nitrogen which birth on ascent and grow slowly, at a rate inversely proportional to the falling water pressure. Imperceptible at first, they lodge in the nooks of the body where they sit, silently waiting for the pressure to fall enough to explode, sudden detonations on a quiet front, which obliterate cells, crush neurons and sandpaper their way through blood vessels. When physiologist Leonard Erskine Hill catalogued fifteen years of research into the affliction, in 1912, he found all kinds of disturbing abnormalities; giant bubbles swelling the skin, spontaneous flexing of muscles, epileptic fits, raging pules, blocked and distended bladders, burning eyes, pain “as if the chest and belly was being torn apart”, and bedsores sloughing from the body, exposing bone. Within Hill’s gruesome archive, three cases stood out as examples of the protean nature of the illness:
The patient was doubled over, all his members were bent against the front of his body. Pains were so great as to make him weep; he finally told me that the pain was as great as if some-one were tearing open his belly and his chest.
His head swelled and lost shape. In particular his eyelids swelled to the size of eggs, which frightened his comrades. His right eye was black, so that cornea and sclera were indistinguishable.
Japanese, aged about thirty. His condition was of great emaciation, free from pain but very apathetic; complete paraplegia with loss of control of bladder and rectum, and loss of sensation to the level of the umbilicus.
And on and on. What happened unsettled doctors. When a pathologist examined one victim, a Royal Navy Petty Officer known only by the initials M.D., black liquid oozed from the incisions made by his scalpel. Veins at the brain’s surface were engorged with the same sludge. Bubbles were found massed in the nerve centre and the liver was so full of froth it looked like it would float in water. The heart was beaded with so much air that, when lifted, it gurgled loudly.
Doctors also noticed the disease had a strange effect on the spinal column. Some sufferers were permanently paralysed. Others, for reasons not clear, recovered mobility after days or months. Many died. Dr. Graham Brick, district medical officer of Broome, Western Australia, recorded an extraordinary grim stretch among pearl fishermen between 1900 and 1908. Of the two hundred divers struck down, sixty died before medical help arrived. “I have had to deal with all degrees of paralysis, from slight paralysis of legs up to total paraplegia and loss of sensation,” Dr. Blick noted. “The legs are attacked before the arms. Death may occur within an hour or not until after a day or two. Clinical experience directs attention to the spinal cord … It looks as if one had stippled the face with a fine knife or needle.”
The only known treatment was to be sealed inside a recompression chamber and placed under pressure that simulated a dive. There, the increased pressure would crush the bubbles and bring some relief. Then the diver would have to wait for hours for the gas to leave his body and hope the bubbles hadn’t caused irreparable damage. Recompression treatment was first used systematically to treat New York sandhogs bent while tunnelling under the Hudson River in 1899. It was another quarter of a century before the idea of recompression treatment made it into the USN Diving Manual. Sealed inside the chamber a man could be placed under pressure that simulated a dive. There, the increased pressure would crush the bubbles and bring some relief. Then he’d have to wait for hours for the gas to leave his body and hope the bubbles hadn’t caused irreparable damage.
In the fifties, the US Navy produced an educational film showing the effects of the bends on a hard hat diver. Shot in black and white, it shows the crew-cut man chasing his bubbles to the surface, before cutting to the bloodstream of a frog which had been rapidly decompressed. Gleaming with a silver sheen, the bubbles race across the screen, first in ones, then twos, until they coalesce. From the outside, they look like peas in the withered pod of a vein. The film cuts back to the diver sitting on the deck of a ship being stripped of his equipment by his bears, the attendants who look after him. He is visibly in discomfort. Then he collapses. The narrator says, a little soberly: “Decompression sickness is a most serious condition that requires immediate care to prevent permanent damage and perhaps death.” The last few frames show five bears hurrying across the deck, the diver in their arms, passing him through the narrow circular doorway into the recompression chamber.
This, Sokolov knew, was the part assumed by a diver suffering decompression sickness: to be bundled onto a stretcher by his comrades; to be carried to the chamber, the Baltic Sea rolling beneath their feet; to be placed gently inside; to lie there, powerless inside the sunless prison with no horizon on which to rest any hope for the future, and wait for the medics to save him. To be utterly dependent. Only Sokolov had no intention of assuming that final part of the role.
He knew what all the textbooks said about recompression therapy, after all he was the Fleet’s chief diving doctor. According to the rules he operated under in the Baltic Sea War Fleet, he would have to be pressurised to the equivalent of 300 feet and hope his condition improved. Such a treatment would have to be reported up the chain of command. Diving would be halted because the chief of medicine was injured and locked away under pressure. The whole exercise and all that went with it, could be shot. He wasn’t paralysed by fear though when he spoke with Kushnir.
I have a plan, he said.
For some time, Sokolov had been turning over in his mind a new treatment regime for the bends. Instead of using air, he would breath pure oxygen under pressure. As a result, the treatment was shorter in time and required less pressure. It was a radical departure from standard treatments and Sokolov was willing to experiment on himself. His unflappable cool and encyclopaedic knowledge of diving medicine had earned him a reputation on board for taking calculated risks, and his disciple listened carefully as the plan unfolded. Sokolov would go inside the chamber and tell Kushnir what to do. He had no authority to give his deputy orders in such circumstances and Kushnir was not compelled to follow them. If anything went wrong Kushnir would be the one to carry the responsibility.
But who was anyone to argue? Those onboard knew Sokolov as a man with a shock of fair hair and boyish smile that said all you needed to know about his love for diving. They knew him as a man who didn’t tremble. Only thirty, Sokolov’s exploits in the team were legendary. He had trained to be a doctor, but had decided to join the diving team so he knew firsthand what any patients of his had been asked to do. He had been paired with future cosmonaut and hero of the Soviet Union, Valery Rozhdestvensky, and they carried out secret underwater experiments hundreds of feet below the surface, Sokolov had himself reached a depth of 525 feet, quite the extraordinary achievement back then, and tested equipment for submarine rescue. Sharing his plan, the good doctor was outwardly convincing, and Kushnir agreed to follow his prescription.
Inside the recompression chamber, Sokolov prepared for the experiment to begin. There’s no guarantee I’ll survive this, he thought. But there was no guarantee the traditional treatment would cure him. Either way, this could be the end, and every one of the divers on the ship must have feared it. Sokolov breathed in deep. He heard the heavy metal door clang shut, and readied himself for the hiss of air to pressurise the chamber.
Kabardino-Balkaria, Russia, January 2012
A GENTLE wind rolled in from the distant snow-capped mountains, between the trees and across the mirrored surface of Blue Lake towards the dive centre. The muffled whirr! of a compressor engine groaned away in the background and divers with unfastened dry suits hanging at their waists carried aluminium diving cylinders which complained with a clank! when stacked on the ground. Air hissed from the valves in staccato bursts as divers checked the cylinder contents. Two guys in matching red dry suits and woolly hats loitered on the concrete platform extending from the centre’s main doors on the lake’s northern shore talking about the dive ahead. Visiting the lake was their annual pilgrimage to herald a new year of exploration. A cameraman from Russian television news channel МИР 24 towed a reporter who stuck a microphone under nose of anyone who looked important. The pale winter sun had ushered the darkness from the sky a few hours earlier and possibility was so thick in the air it could almost be brushed away with the hand.
Through the double doors, where neoprene hoods and gloves hung from pegs, and along the tile-floored corridor, past a whiteboard and its unintelligible squiggles, beyond the storage boxes and duffel bags filled with gear, towards the drone of the compressor at the end of the corridor, British explorer Martin Robson crouched over a wooden bench examining his sophisticated rebreather, lost in the percussion of diving.
The compressor groaned on. The building was carved, like an underground bunker, into the banks of the lake’s north shore. The main corridor, tiled in white like a sterile cave, was the artery for the centre’s operations. Along one wall stood benches used by divers to prepare and don their gear. Various rooms branched from the corridor; a sparse kitchen cum briefing room, a cramped storeroom for equipment, workshop and filling station. At the end of the corridor was a spiral staircase which led to a white-washed apse with a mortar board roof leading to a tree-lined courtyard and patio overlooking the lake. Wrapped with floor-to-ceiling windows and decorated with a panoramic mountain frieze, the building had been completed in 2005. It was originally designed as a scientific centre for research into the lake. Now it stood as an empty edifice to a long-forgotten or unaffordable dream.
The place was a second home to Robson’s new friend Eduard Khuazhev. For the past six years he’d been working as a diving instructor, guide and general manager at the centre.
Vy gotovy k pogruzheniyam? his bass voice echoing along the corridor. Are you ready to go diving?
Da. Yes. Robson replied in his simple British please-and-thank-you manner. He had been recruited two months earlier to lead a multi-national diving expedition to find the submerged cave system hidden somewhere in the lake outside, close to the physiological limits of human survival underwater and deeper than the crush depth of a World War II U-boat. He might come back from the depths with tales of someplace not seen since the dawn of time or he might come back with nothing more than a long immersion on his dive computer.
The diving promised to be extreme, but the inventory of Robson’s life suggested a man who lived at the limits: Military childhood. Disciplinarian father. Special forces warrior. Falklands War veteran. Counter insurgency specialist. Commando diver. Light middleweight Boxer. Rock climber. Cave explorer. No pushover. Robson was a private man with brown eyes and military-grade, grey cropped hair. He stood six-foot tall and packed one-hundred-and-sixty pounds of wiry muscle and unfazeable features, a demanding gaze and a mouth that takes time to warm into a smile. His hard-bitten exterior, weathered at the edges by years of exposure to the cold, dark and deep, did not invite admiration on its own. He shied away from smalltalk—“He didn’t need to fill the silence, but when he did speak it was rarely without consequence,” says one friend—yet a persona polished hard by experience drew people into his orbit.
Having arrived in the mountains of the distant federal Russian republic of Kabardino-Balkaria, in the North Caucasus borderlands, somewhere between Georgia and Chechnya, the previous day, Robson was already the star attraction. In the days that followed television journalists and newspaper reporters would award him grand epithets, describing him as a “champion deep diver,” a “famous expert in salvaging,” and the “world’s best diving trainer and instructor”. Robson humoured the journalists, he was too polite to question their characterisations, but the adulation made him smile.
The compressor hummed on as Khuazhev handed Robson two three-litre tanks for his rebreather. Closed circuit rebreathers are a complex piece of military-grade hardware. Unlike conventional scuba equipment, the unit recycles a diver’s exhaled breath, contained in a closed loop, scrubbing the carbon dioxide from it, and adding a squirt of fresh oxygen so it can be breathed again. Efficient and economical, the bubble-free machines would allow them to venture deeper and longer than logistically acceptable on tradition scuba, known as open circuit, where air is breathed from a pressurised cylinder and then released into the water with each exhalation. In the plastic crate at his feet was the rest of his gear, the dive torches, reels, computers. He had back-ups for everything, the writing slates, bolt snaps, finger spools, strobes, mask, which would be stuffed into a pocket or clipped onto his harness before he went underwater.
Looking around, Robson saw fellow expedition member Roman Dounaev assembling his own gear. A former student, he had talked himself onto the expedition when he heard Robson was coming to Russia. Slightly taller than Robson and weighing more than two-hundred-pounds, Dounaev was huge—and hugely gentle—with an easy-going nature and an instantly disarming smile. He was from the tough industrial port of Rostov-on-Don, on the Sea of Azov, in south-west Russia, and was thirty-seven years old although his puppy dog blue eyes, dimpled chin and short brush of brown hair, meant Dounaev could easily have been mistaken for ten years his junior. They shared a cup of tea while analysing the contents of the cylinders with a gas handheld analyser. Then they installed them in their ‘breathers (some experienced users dropped the ‘re’ when speaking about them, for no obvious reason).
Nearby, was Sergei Gorpinyuk, a deep diver who Robson had met for the first time only two days before. Forty-three with short, receding brown hair and a physique that was more builder than athlete, he had agreed to accompany Robson and Dounaev underwater. Gorpinyuk and Dounaev were old friends who could talk for hours about diving; affectionate stories of where they had been, what they had done, how deep they had gone. But then, who else understood their strange dreams and even stranger language of decompression schedules, run times, set points and oxygen toxicity?
Robson smiled to himself. Every dive centre he’d ever known had been occupied by a bizarre mix of pragmatists and dreamers who had been presented with opportunity, packed with breathing gas and sent on their way. There were always those who wanted to see mysterious creatures, sat next to those who saw diving as a spiritual journey, next to those who wanted to prove something and he savoured the comradely tone. He’d been here before, many times over the years, ever since diving had chosen him, or more accurately Commando training officers had chosen it for him, and he’d been happy because it came with the privilege of wearing the coveted green beret. As a nineteen-year-old, he’d crawled through the murk of some dank, dark pool unable to see the hand in front of his face, with just his breathing for company, and he’d loved it.
Once the three men had finished prepping their rebreathers, and after a final drink and a hot soup for lunch, they were zipped inside their protective waterproof diving dry suits. Each man smoothed out the latex or neoprene seals around their necks to prevent water leaking inside. Bulked out by chunky thermal undergarments worn next to their bodies, the men began to cook as relative humidity inside the suits rocketed to one-hundred per cent. Their movements slowed, noticeably; you don’t want to get too hot before a dive into cold water.
Settling into his equipment harness which was attached to his buoyancy wing and rebreather, Robson shouldered the unit and pulled the breathing loop over his head. He cinched the straps on the load bearing webbing harness to the same point he had done countless times before, connected the loop pressure inflation hose to his suit as he always did, he held his light in the same hand, the separate battery pack placed in the same millimetre-perfect spot on his webbing as it always was, his spare light clipped to the same harness ring, back-up mask in the same pocket, gauges lined up in the exact same order—compass, computer, back-up computer—on his right wrist.
Then he heaved himself to his feet and Dounaev and Gorpinyuk followed. The rebreather hung heavily from his shoulders and Robson wanted to get into the water, to see what was so special about the body of water that it had brought a group of divers and scientists to her shores. They all wore neoprene hoods, like a balaclava, over their heads with black face masks and thick waterproof gloves and emergency cylinders hanging from their harness. These layers of gear made them look alien, a black creature with just a flash of skin showing behind his mask. On the surface, the men could barely move under the weight of a hundred pounds of equipment, underwater they would be weightless.
“I think my next job should be an international tiddlywinks referee,” Robson joked in such circumstances. “The gear will fit into my pocket and it’ll be warm and dry. It’s still going to be dangerous, though, one of those counters could have my eye out.”
Approaching the water, each man ran through their own last-minute mental checklist, triple-checking equipment, performing the little personal rituals, spitting into their masks, checking computers or whatever else it took to focus their minds. They donned their fins and stepped into the lake, and as the first droplets of water wrapped around them everything changed.