This is a full transcript of Do We Drown or Rocket to the Surface? as first broadcast on 29 June 2018 and presented by Beth Rose.
BETH - Hi, it's Beth Rose here with the latest BBC Ouch podcast. This week I spoke to Rich Osborn. He spent a perfect summer working as a scuba diving instructor in Cyprus when he was 21, but his summer came to an abrupt nightmarish end when during a deep dive with three friends their oxygen ran out. The group had a decision to make: drown there and then or rocket to the surface and face the consequences of the bends. For Rich that meant a crushed spine.
So, yeah, if you want to tell me first off what life was like when you were a teenager, where you grew up, what you were interested in?
RICH - So, for me growing up I've always been around and about Edinburgh for all of my years. I was very interested in outdoor pursuits; I was mad into my skateboarding, snowboarding, just generally getting out on my mountain bike and just embracing nature and the outdoors really. I had a great childhood and stuff. We're very lucky where we live here in Edinburgh; there are lots of green spaces and hills around about. Obviously the spinal cord injury hasn't really stopped that, that fire for outdoor activities and stuff.
I was looking to be an engineer. I carried on with that but then found a different passion, like a different path for me, so scuba diving I went into that during my holiday break from school, so summer holidays and stuff. I used to go out to Cyprus, I had friends there, I just used to work in the kit room at a scuba diving centre throughout the summer holidays and that kind of instilled the love of scuba diving, and then my career trajectory changed to that.
BETH - How old were you when you got into the scuba diving the first time?
RICH - My first ever dive I was 14 years old, and then I got into and done my instructor examination by the time I was 18.
BETH - Was it from when you were 18 you would spend longer periods out in Cyprus?
RICH - Uh-huh.
BETH - And then did you get a job out there?
RICH - Yeah, that's right. At the time it was seasonal so I'd do from about April through to November, I'd do the full season once I'd finished my school and things. Just things kind of took off living quite a nice lifestyle in Cyprus; sunny every day when you get up and it's living the dream. It was excellent.
BETH - And what kind of stuff were you doing?
RICH - Taking out certified divers, so that's people that have already done their basic qualification so they have an understanding of scuba diving and all the principles that go along with that, all the safety. So, I'd take them out on dives, tours around the local reefs and shipwrecks and things that we've got around Cyprus. I'd also do courses, so that's everything from the classroom work all the way through to the pool sessions, so confined water so you can practise it in a safe environment, and then open water sessions for practising the skills that you've learnt in a safe environment out in an open water environment.
BETH - So, you were obviously having a great summer, and then one day something a bit unusual happened. Tell me what happened.
RICH - That's right. It was our day off so me and a couple of the other people that I worked with, so all dive professionals, we decided to go a little bit deeper than normally. Obviously we're all trained in deep diving and stuff like that. And just decided yeah, let's try this. Obviously being young you want to kind of push the limits a little bit.
BETH - How deep are we talking?
RICH - So, about 40 metres or so. If you imagine 30 metres is the usual depth you'd go in recreational scuba diving, and 40 metres is slightly deeper, obviously you need to be deep dive trained for that. There were four of us on the dive. We'd all planned thoroughly before the dive obviously. But what happened was a disparity between what was planned in terms of breathing rates and what actually happened on the dive. So, a couple of people ran out of air before they'd planned to run out of air, if you know what I mean.
BETH - So, it was a surprise was it?
RICH - Yeah, it was an absolute surprise. Obviously as you go further down every breath you take in off the tank you're breathing more of the air because it's condensed because of the pressures, so you're breathing more in. They unfortunately ran out of air.
BETH - At that point what were you thinking? Is that not routine but is that kind of expected?
RICH - It's not routine but you're prepared for it. From there we were breathing breath for breath off of the two remaining tanks that had air in them, and we were coming up slowly as you have to do with scuba diving, so we were coming up slowly.
BETH - No element of panic or anything at this point?
RICH - No, no element of panic. And then we got to about 25, 30 metres safely, and then from then we were all out of air. So, from that point you make a decision: do you drown basically or do you rocket to the surface and risk decompression sickness.
BETH - The fact that all the air was out tell me what was in your mind at that point? And were you able to communicate with the other guys down there with you?
RICH - Yeah, as we're all dive professionals we've got extensive training in how to communicate under water and things like that. There are also little slates and pencils that we all carry with our dive gear so that if we can't communicate with hand signals we can write down what's going on and get the message across to everyone that's diving.
From there you get a little bit kind of panicked, but the way that decompression sickness affects individuals it's to do with your physiology and your make up. From there obviously we rocketed to the surface obviously on a couple of breaths and stuff, and then we all got to the surface, and once on the surface I knew near enough instantly what had happened: my back started to tighten up a little bit. It felt like when you need to crack a joint when it's stiff, so it felt very, very stiff. So, I was trying to kind of move myself about to see if it would crack and relieve the stress that was on it. From there the nausea and vomiting started and coordination went. Obviously with the sky being blue and the sea being blue I was kind of a bit disoriented and rolling around and trying to get some breath, and then swimming back towards the shore because we weren't far from the shore. My legs, obviously I was swimming on my back, started to slow down and eventually stopped. And from there finally got to the shore helped out by some surface support people that we had there, and popped into the back of a truck and then whisked off to the recompression chamber, the hyperbaric chamber.
BETH - And did you know in your heart and mind what had happened, how potentially bad a situation you were in?
RICH - Yeah. I knew that I had decompression sickness, because obviously having done the extensive training I knew exactly what had happened. It was tough to get my head around initially but I knew what had happened; I knew it was a pretty bad variant of decompression sickness.
So, what happens with decompression sickness is it often affects you in your elbows and your shoulders and knees, sometimes it gives you kind of a skin itch, and that's usually the way it affects you. But it can result in paralysis and death in extreme circumstances. And this guy, that doesn't do things by halves, ends up with a full-on spinal decompression, commonly known as the bends.
BETH - I've heard of the bends before, I'm sure loads of people have; I've heard the bends inflicting this sort of injury. Normally yes, sickness and that's what you expect. So, tell me how would you describe how the nitrogen or the gas bubbles react, what's different to us being on the surface when you shoot through water?
RICH - When we're on the dive we'd be breathing the same air that's around us right now. That's what's in your tank. That predominantly comprises of two things: so the nitrogen and the oxygen. Your body uses up the oxygen while you're scuba diving but you have to come up slowly from scuba diving because the nitrogen still remains in your system. It's not like you're at the surface where it can just disappear as you're walking around; because you're under all that pressure with all the water on top of you you have to come up very, very slowly to let it dissipate.
Now, what happened in my situation we had a rapid ascent from 35 metres or so up to the surface the nitrogen bubbles have got caught in my spinal column and as I've come up to the surface they've expanded whilst lodged in my spinal column and crushed my spinal cord. The analogy that I often use, or often did use when I was teaching it was kind of a fizzy pop drink: you shake that up and if you open it very, very slowly the bubbles expand but they don't fizz up and over the top; whereas if you open the bottle very, very fast the bubbles they fizz up and spill over. So, it's the same principle with scuba diving really: the nitrogen bubbles that are in your system you come up slowly to give them time to dissipate from your system. But in our situation obviously as I rocketed to the surface they got lodged in the spinal column and expanded and crushed my spinal cord.
BETH - Can you just describe what you could see or what you felt or what you thought at that point where you checked your oxygen tanks and all of you were out?
RICH - Yeah. You look round at your colleagues and stuff like that, and there was a little mix of kind of fear and unknown I guess. Because obviously we prepare for with extra air and things like that, but in this instance there were disparities in the breathing rates and stuff.
BETH - Was there lots of sign language involved?
RICH - Yeah. Obviously when you're scuba diving and stuff you've got basic commands, so popping your hand up, palm out, for stop and then the okay symbol - everyone knows those. But there are a lot more advanced ones, so frantically kind of trying to sign to one another. And as I said, we have slates and stuff so scribbling down notes, thoughts and plans and things like that before we rocketed to the surface.
BETH - What were the plans?
RICH - The idea was to try and slow down the ascent as much as humanly possible, because obviously the faster you come up the worst off. So, tried to think about how we were breathing, so talking about exhaling lots because obviously when you're coming up the gas expands, so that principle applies to the air that's in your lungs as well. So, effectively just try and breathe out the entire way up from 35 metres rather than taking any breaths in - obviously we couldn't take any breaths in because of the air being completely out. Our training just kind of kicked in to slow the ascent as much as humanly possible given the situation.
BETH - And when you say slow the ascent how quickly did you get from 30 metres up to the surface?
RICH - It seemed like a matter of seconds but I'm sure it wasn't that. It all went very, very fast. We tried to slow it as much as possible. Some people, as I say, that had the fear kick in a little bit more in this situation they were trying to kind of go a little bit faster than we would like, so it's just trying to maintain that rate of ascent that it's not too fast, not too slow. Obviously we've only got one breath to do it on but we don't want to go up at light speed. So, it's finding that middle ground.
BETH - And is it a case of holding your breath?
RICH - No, it's exhaling on the way up. So, if you were to hold your breath, if you imagine the same principle that I talked about earlier, so it affects your lungs, so if you were to hold your breath the air that was remaining in your lungs would expand as you came up from the pressure as you came up. Obviously the pressure would release and the gas would expand that's within your lungs, and if you were to hold your breath that would just stretch your lungs and do damage to your lungs.
BETH - Wow, I didn't realise that. That's a hard thing to do to sustain over that many metres.
RICH - It's a constant exhale but at a rate that you're not running out of air. If you're coming up quickly you don't want to take a massive breath in, so you want to maintain kind of a slow exhale, much as the situation can allow.
BETH - So, before you ascended did each of you take one last breath?
RICH - Yes, so you take the one last breath. Obviously as the tank decreases in the air that's in it you can feel the breathing getting tighter through the mouthpiece, what we call the regulator, you can feel the breathing getting tighter through that, so you know the tank's just about dry. So, it's one last breath and then a slow exhale whilst ascending to the surface faster than normal.
BETH - Is it quite a battle with your mind and your theory I guess in that you know that you have to go slowly but you want to get out of there as soon as possible?
RICH - But everything in your body is screaming to get to the surface so you can breathe, yes, it's quite an internal battle.
BETH - So, you were taken to the local decompression tank. How long do you spend in there? How big is it? What's it like?
RICH - Recompression chamber is about double the length of an average male, so 12ft, maybe something like that. And it's quite wide so you could get maybe three or four people lying side by side. What the recompression chamber does is it's a sealed unit, they fiddle about with the pressure, so what they effectively do is take you back down to the depth that you were at, so they apply pressure to your body similar to the depth that you were at when you started the ascent and bring you up slowly whilst administering oxygen to you at various points at pure 100% O2 this time, rather than the air mix that's around us now as oxygen is a great healer for the body. So, that's kind of how the recompression chamber works.
BETH - And how long were you in there?
RICH - I was in there for about six hours a day, and I did that for a week after just to make sure that all the nitrogen bubbles that were trapped in my body were all dissolved and things like that and I was back to being as normal as possible.
The issue with the recompression chamber is all about the time getting into the recompression chamber from when you surface. Now, unfortunately in Cyprus there's only a couple of recompression chambers for the island and my nearest one was about a three, four hour drive away, so that's quite a substantial amount of time from ascending and surfacing to getting into the recompression chamber. And by that time the damage that was done to my spinal cord couldn't be reversed. It was a matter of kind of just making sure that all the nitrogen bubbles had gone from my spine.
BETH - At what point were you told that your spine was permanently damaged and the extent of it?
RICH - So, that was when I was in my rehabilitation in Glasgow Spinal Unit. So, that was quite early on after they'd done pin tests; they prick you with a pin to find out where you're feeling and level of injury and things like that, combined with MRIs, combined with consultants and their opinions, and obviously the doctors at a place called Divers Alert Network, who have my diving insurance and safety stuff. So, they all kind of got together, looked at the evidence and then a decision was made and it was relayed to me that there wouldn't be any prospect of walking again.
BETH - And what was that like?
RICH - Well, I've always been a bit of a weird glass half fuller regardless of the situation. It wasn't so bad. I've always looked at life as a series of hurdles or challenges to be overcome. This is the new normal and then you just embrace it and go from there, start again.
BETH - What happened to the other three divers that you were with?
RICH - Two of them were absolutely fine. There was one individual that had a little bit of nitrogen build up in his elbow; a little bit of oxygen sorted that out. This guy who doesn't do things by halves gets a full on spinal bend. But yeah, it's fine. As I say, you take what life throws at you and then you put a positive spin on it. Well, that's what I do.
BETH - And were you frustrated that the others got through it unscathed? I mean, at 21 I don't think I would have been so positive as you. Was it tricky at times?
RICH - There were little moments when it was frustrating but nothing major for me. The only times that I got frustrated was in the early days just after getting out of my rehabilitation stint at the spinal unit, and just things like trying to get things out of top cupboards was a little bit frustrating and then you'd get a bit annoyed with that, and then one thing would seem to lead onto another thing and it would just be an awful day. The way I kind of look at things is, I'm very good at kind of compartmentalising stuff, so I just go to sleep, maybe have a little cry, cry it out, and then wake up the next day and it's a new day and then you just go from there.
BETH - Are you still in contact with the other three?
RICH - Yeah, yeah, still speak to them on regular occasions.
BETH - And did it kind of bond you that you'd been through this?
RICH - Yeah, I think a situation like that does bond you, yeah.
BETH - That sounds very impressive because were you 21 at this point?
RICH - 21 yeah, yeah.
BETH - 21. Did you just think okay, I'm just going to carry on with my engineering and my outdoor activities or did you come up with a new life plan?
RICH - Yeah. I wanted to get into sport. I'm a huge advocate of sport being a great rehabilitation tool, so I kind of threw myself into sport at the start. Obviously being a bit of a water baby I started my swimming up again and I got back into the scuba diving as well after about a year, and now I teach disability scuba diving, a bit of basketball, a bit of hand cycling and just anything I can throw myself into.
BETH - And how hard was the rehab, what kinds of things do you have to go through? And also do you know what your exact injury was? We haven't mentioned that yet.
RICH - My exact injury is a T4 incomplete. For everyone who's not familiar with the spine, you can break it down into four main areas, so if you imagine up at the top of your neck it goes from C1 to 8, so that's the cervical vertebrae. So, one at the very top down to eight, and that's the big point at the bottom of your neck, so that's the eighth vertebrae. If you feel at the back of your neck the big point that comes out that's the eighth vertebrae that comes down so that's cervical. And then the main part of your back, the thoracic spine, that runs from T1 to 12. Again, that's the vertebrae. And then it goes L1 to 5, so that's the lumbar part of your spine. And then right at the very bottom, so your coccyx, the fused part, is the sacral part of your spine, so that's S1 to 4. My injury is at T4, so the main part of my back, thoracic spine and then the fourth vertebrae down.
The incomplete part of that, you can either complete or incomplete, complete means no motor or sensory function and incomplete means motor or sensory or both.
BETH - And how does that work for you?
RICH - I can't walk at all; I'm in a wheelchair all the time. But the incomplete part for me is I have a small amount of movement in my right ankle, so I can flex my right ankle, but that's all I've got in terms of motor function. In terms of sensory function the way I would describe it is if you go out and play in the snow and you get really, really cold arms and then somebody touches you on your arm you know exactly where they're touching you but it doesn't feel quite normal. That's pretty much what I've got all over my lower limbs.
BETH - Okay, so from T4 downwards. But above it's…?
RICH - Maintain kind of normal feeling and function, so I have full arm function. I'm a paraplegic which means I still have arm function, but leg function is gone and some internal organs have a bit of paralysis but generally maintain their good working order.
BETH - Okay, you really have worked around everything that's been thrown at you, and you're saying that you got into your activities once more. And you are off to climb Snowdon.
RICH - Yeah, very soon.
BETH - Tell me a bit about that and how that works, how you're doing it?
RICH - Well, as I was saying before, I've always been into kind of the outdoorsy stuff. I'm really looking forward to the Snowdon Push Challenge where I'm doing it with a team of able-bodied individuals from a firm called Leigh Day, so that'll be good. I'm doing it in an adapted chair, so it's a standard wheelchair pretty much but with mountain bike tyres on the back, so big grippy tyres. I'm very much looking forward to the challenge. It'll be tough but we've all been training hard, me and my team for it, so hopefully we'll maybe get up to the top and I can get that feeling back of a sense of achievement, being at one with the elements and things like that.
BETH - I think there are 14 teams going up. It's Saturday 6th July and you're all fundraising for the charity Back Up which helps people with spinal cord injuries. How hard is it really going to be for you, Rich? You're sat in an adapted wheelchair. It's your team, isn't it, or do you have to put some effort in as well?
RICH - Yeah, there's going to be a lot to do with the team, but I've been working hard because you want to contribute, you want to push as hard as you can. But there are some parts on the mountain that I physically won't be able to do myself, so that's where the team comes in helping lift me up and over certain big boulders and things. It will be tough but I'm very much looking forward to the challenge, both from a personal standpoint and from raising money for a wonderful charity that I personally know does so much amazing work.
BETH - So, you're going up Snowdon which is the highest mountain in Wales, which is 3,560ft.
RICH - That's right.
BETH - Do you have to come back down again?
RICH - Yeah, so all the way up and all the way down. I'm not entirely sure how long that will take; I would imagine seven, eight hours, something like that.
BETH - Well, I wish you all the very best for that. It sounds exciting.
RICH - Yeah, thanks so much.
[End of interview]
BETH - It's quite a tale and hopefully Rich will successfully ascend and descend Snowdon when that adventure comes around. As always we love to hear from you. You can find us on Facebook, just search BBC Ouch; we're @bbcouch on Twitter; and of course you can email us email@example.com.
Now, the Ouch team is currently in the middle of reading an incredible bunch of stories that you've written for this year's BBC Ouch Storytelling Live event at the Edinburgh Fringe Festival which will be hosted by Lost Voice Guy. The deadline for entering your stories has long since passed, but you can still apply for free tickets. Just go to bbc.co.uk/showsandtours.