Dead man walking

IT IS HUMAN NATURE TO MAKE ASSUMPTIONS. Take diving. How many divers who get decompression sickness are assumed to be bad divers, pushing the limits or novices literally out of their depth?
But sometimes accidents do occur. Steve Kitson knows that. He inadvertently opened the door to an incident and suffered a catastrophe from which he is still fighting to recover.
Steve was no novice, trainee or bad diver, however. BSAC-trained in 1993, he was highly experienced at deep diving and instructing.
On Jubilee weekend 2002, he joined a club-led boat dive to a planned dive site of around 40m. He found a suitable buddy with whom he had trained and dived several times, but as the boat left, the other divers decided to do a 55m wreck instead.
"This was a bit annoying for me," says Steve, "and a bit upsetting for my buddy, who hadn't done a lot of deep decompression stuff.
Steve tells me that his ppO2 was very near the mark. "It wasn't until we got
to the site that we found that the wreck was actually 53m, so I was borderline. My buddy and I decided to dive. I was the leader, and we agreed on a short dive with a 12-minute ideal bottom time and maximum of 18 minutes as a bail-out."

A WRECK DIVE OF THIS SORT - deep and off Weymouth - is generally dark, and the depth means that bad nitrogen narcosis is a possibility. Sure enough, at the bottom Steve's buddy became narked, and Steve aborted the dive.
"We got to 25m and my buddy was then fine and I was fine. But after a couple of minutes, somehow I lost my buoyancy. I grabbed my neck seal and pulled it to vent excess air. In that time I had risen from 25m to 9m, and eventually stopped at around 8.5m.
"I could see my buddy below me, but knew that to go down after missing deco stops was a no-no. So I decided to surface and take the chance.
"I felt no ill-effects, and summoned help from the boat. Once aboard, I told the skipper what had happened, and asked to go onto oxygen.
"After about 15 minutes I couldn't stand, and started vomiting from what I thought was an inner ear bend. Within 40 minutes I had lost the sensation in both legs." The feeling
was excruciatingly painful, he says, like being cut in half.

STEVE VOMITED EVERY FEW MINUTES in the helicopter, and in the ambulance to the chamber. He stayed conscious, but cannot recall entering the chamber.
Out of his drysuit, he was connected to an ECG monitor and recalls a 1940s aviator-style facemask - the regulator to give him oxygen.
"All I remember is the dive medic on the outside saying that I had to suck hard to get the benefit. This was very difficult, as my mouth was dry and I was vomiting at the same time or, by that stage, retching. It was like breathing on a deep regulator at the surface."
His lungs were collapsing, his heart struggling and he was in severe pain.
"After five hours, I overheard the doctors saying that they were struggling to keep me stable," Steve explains. "It was because of the extent of my injuries. They felt they had to take me deeper."
He was put on helium and put under more pressure. After eight hours of severe pain, constant vomiting and retching, and disorientation, he lost consciousness. "I remember waking up in a hospital bed, paralysed from the chest down," he says.
It was a very scary moment. And while Steve's endurance was remarkable, it pales compared to his fight to overcome the repercussions of his decompression illness.

EVERY JOURNEY STARTS WITH A STEP
"Severity of dCI is related to gas-loading," says Spencer Phillips, Registered Manager of the Diver Clinic, Poole. "Obviously deeper and longer dives increase this particular risk factor, but there are others, such as fitness, ascent rate, stops completed and so on.
"Severe spinal DCI, such as in this case, is most often associated with deep dives, high gas loads, rapid ascents and omitted decompression."
First for Steve came a series of tests to assess the damage. "My doctor said that as far as he was concerned, I was never going to regain anything because of the severity and size of the nitrogen bubbles that came down my spine.
"They crushed the T5-6 vertebrae and, as they dispersed, took out the nerves down to my legs. They hadn't seen anything like it."
Through a hail of emotion, Steve asked the doctor: "Where do we go from here?"
The answer was stark - the likelihood was that Steve would be paralysed. His doctor confessed that he had not come across anyone as badly affected who was still alive.
Thankfully, Steve wasn't alone. His wife suspended her business in St Albans and, using her husband's specialist dive insurance policy, moved into the hospital as he commenced a 40-day course of 90-minute chamber treatments to stimulate the nerves. No one had ever received more recompression.
"They were pretty difficult sessions because of the repercussions of where I was," Steve recalls. The spinal injury also caused leg spasms so fierce that staff had to put bungee straps around a pillow wrapped around Steve's legs, to stop them hitting the side of the chamber.
Spasms are the result of impulses being thrown down the damaged nerves and causing uncontrolled muscle contractions. They weren't one-offs - they occurred every 15-20 seconds.
"They drive you absolutely wild," says Steve. "They're extremely painful and both legs would fire up, not at the same time, but irregularly. They would kick ferociously, so much so that I could sit on a leg and it would throw me off."
The fact that impulses were reaching his legs gave Steve hope, but he was worried about deteriorating muscles.
They decided to try a Slendertone machine. "We stuck the 12 pads anywhere and everywhere - my backside, my legs etc - to try to gain some sort of movement. We did this twice a day."
The machine ran for only half an hour but Steve's wife would go on rubbing and massaging his legs. After four weeks of this, Steve noticed a tiny movement in one of his little toes.
"It was about 5.30am, and I couldn't wait to phone my wife," says Steve. The nurses who witnessed the moment cried with joy.
He worked on the movement day and night, and over time he got two toes moving, then three, and then a big toe.
Spurred on, he rubbed his legs every hour, lifting them around and pulling himself about on the bed just to get any movement, but all he could feel was a dull, cramp-like ache.
"I worked at it constantly," Steve explains.
"I sat in a chair and tried to think about moving my foot. After many weeks, I got movement from my knee down and I could sit in a chair and push my feet out of the stirrup. It was a fantastic feeling - a road to hope.
"The opportunity gave me the strength to think that if I could get this far, then I wasn't paralysed." But it's a long road through hell, and Steve had no idea how far he could get.

CLOSER TO HOME
After three and a half months, Steve Kitson was transferred to Stoke Mandeville Hospital's Spinal Injury Unit. The staff had not come across a decompression injury before, so continued the same treatment. By now he could move his knee almost 35°, but he still couldn't feel anything, was in pain and under a lot of medication.
The regime at Stoke Mandeville was different. Steve was almost expected to fend for himself.
"That was scary," he explains. "I' went from having streams of nurses and my wife giving me 24/7 care to being left to do things like having a shower or going to the toilet by myself.
"So I took the bull by the horns, and struggled onto the shower seat, put the shower on and within seconds ended up on the floor. The water had come down my back and the injury couldn't cope with the temperature difference. It initiated huge spasms that kicked me onto the floor."
A few days later, Steve was taken to the gym. Fairly soon he was going every day, and to the pool twice a week. He worked at everything he could think of to improve his movement, using the techniques physiotherapists had shown him.
It's hard to imagine what Steve experienced. His life was on hold, he was frustrated at the slow progress and tired from lack of sleep and the drowsy effects of the medication. He was also constantly battling his body.
Towards the end of his time in the hospital, Steve took part in a course for nurses, learning Bobath treatment. This is a tailored system that aims to assess and treat patients to improve and restore function after a neurological impairment.
"Bobath was a chance to have a professional young lady stand over me and pull me around, so it had to be good," says Steve, smiling. "I did the week's course and it was really interesting, because it uses specific movement and weight distribution to work on an individual's needs.
"The girls had me standing and walking with support within a couple of days. To be able to stand up and walk, albeit crudely, was the most wonderful sensation ever."

FACING THE WORLD
When Steve was discharged, he was wheelchair-bound, but able to walk about 3m using two walking sticks. He used a Zimmer frame to walk further, but had little or no feeling in his legs and ankles, and his feet had no strength. He had stability in his lower core simply by working his muscles, and he was able to sit in a chair without needing to be strapped in.
Leaving hospital was a scary proposition, however, especially because the NHS physiotherapy would come to an end. Steve called Emma, one of the women who had taken the Bobath course. She was based at Stanmore Orthopaedic Hospital in Middlesex, where the Association for Spinal Injury Research, Rehabilitation and Reintegration (ASPIRE) is located. Steve joined the unit and continued to work on his movement.
Soon after this, Emma went private, working at the Hendon Therapy Clinic. Steve again contacted his dive-specialist insurer and, because its policy covered private treatment after NHS treatment runs out, he was able to carry on with his rehabilitation. "I was having private sessions of rehab and Bobath treatment at HTC for just over two years," he says.

RELEARNING
"Consultants told me that if I kept my legs moving it would help my metabolism, which might then help the relearning of my body," says Steve. "My brain and my muscles would relearn, as would my senses and nervous system."
It took much time, effort and determination, but that is exactly what Steve's body has done. It has learnt how to work around the damage.
Steve is learning to walk again, and to deal with the painful leg spasms.
"I sat back and didn't get aggressive with my body. Working hard didn't help." He stopped the medication and the overworking. "The body will work only as hard as it wants to. Mother Nature has strange ways of telling you that you have pushed too hard. For me, it was through spasms.
"Now I give myself little challenges, like seeing if I can walk up a slope or a set of steps. At the moment, my goal is to walk with one walking stick for a short distance.
"I have regained good muscle tone and I almost have my independence back, but I know I will never be like I was before the accident. I am thankful that my loved ones and friends continue the support and keep me positive.
"And I would like to say to other people who suffer a spinal injury - there is hope."