Fear the Squeeze
Posted By Peter Scott on 7 April 2003
In the fall of 2002, after a year off from competing, I decided I wanted to train in no-fins constant ballast. Initial training went really well. And then it happened again, despite all of my precautions, and this time I experienced the worst lung squeeze ever.
I had set a new unassisted Canadian record of --35m with on September 14, 2002, after recovering from a two-week long chest cold. The following weekend, I tried for --42m, a depth well shy of my personal best with a monofin, and, I assumed, nowhere near a depth that could squeeze my lungs. When I surfaced from the dive, I told my buddy, Eric Fattah, that it was the hardest dive I had ever done. True, because I was gasping desperately for air. The coughing and wheezing was so bad, it took a good ten minutes for my arms and legs to recover their oxygen debt. I clutched the float, trying to ride the wave of spasms each cough ripped through my diaphragm. Stephanie Ortlepp dragged me back to shore because I couldn't breathe well enough to swim on my own. I had the distinct feeling that my lungs were coated from the inside with blood, preventing the alveoli from absorbing oxygen. Not surprising, given the quantities of blood I was hacking up into the ocean. It took nearly two hours before I could take a full breath without coughing up bloody sputum; plenty of time to reflect on what had gone wrong. I took the whole week before the pain in my chest went away, and another week after that until I could breathe freely.
Respecting the Weight of the Ocean
What had happened? Was it because my chest congestion had not completely cleared, or was it the extra stress of using my arms for propulsion on the chest wall?
I decided to rest for at least six weeks before diving again at all. I also decided that in addition to reevaluating the precautions I had taken in 2001, I would try to find out what diving medicine had discovered about barotrauma of descent since the 1960s, in order to avoid future injury altogether.
In my mind, I had a working definition of lung squeeze. It was a combination of pulmonary edema (the swelling of blood capillaries and accumulation of fluid in the lungs), intra-thoracic hemorrhaging (caused by negative pressure at the alveolar level that ruptures the alveoli and surrounding capillaries), and the resulting blood in the lungs and hemoptysis (the coughing up of blood in the sputum, as the body tries to eliminate the blood that is impeding alveolar gas exchange). The symptoms of lung squeeze, as I had experienced them and according to definitions of the conditions I just listed, include: cyanosis, an intense coughing reflex, coughing up blood, wheezing, rales, shortness of breath, dizziness, feeling of suffocation, weakness, extreme fatigue later in the day, tightness in the lungs, and pain in the chest area. The greatest danger of severe lung squeeze is that it can cause secondary drowning, meaning that instead of drowning under water, you drown in your own blood, as your blood-coated alveoli can no longer exchange carbon dioxide for oxygen. Not a nice way to go.
Some important questions remained. Did lung squeeze episodes cause permanent injury? Was I in some way predisposed to it? Was there one factor in particular that could predict an injury?
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