Trouble on Flight 1368

A wonderful vacation puts newlyweds in a tailspin

"IF THERE ARE ANY DOCTORS ON THIS flight, could they please identify themselves by ringing the flight attendant call light?"

"I'm an ER doctor," I told the flight attendant.

"Well," she said, "she's back here,"

In the last pair of seats sat a pleasant-looking young man and woman. She was sobbing loudly.

"Hey," I said. "I'm a doctor. What's going on?"

The young man looked up at me in bewilderment. "She's crying. I don't know why."

"You're traveling from Miami?"

"We're on our honeymoon," the man said, a little shyly. His wife nodded.

"Did you have a fight?" I asked.

"No" she said, "it was the most wonderful trip I ever had. I just feel like I want to die ..."

The husband had an expression that read, "Would you fix this, please?"

"Has your wife ever seen a psychiatrist? Does she have any history of depression?"

"No" her husband said. "She's really, really healthy."

I looked at the woman. "Tell me what's going on now."

"I'm just so sad."

"Because you are going home?"

She shook her head. "I want to go home" she said, sobbing. "I miss my d-d-d-dogs"

"Have you ever been on anything for depression before, any drugs?"

"Never" she wailed, pounding the seat front of her.

"When did you start feeling sad?"

Sad wasn't the right word. She was close to hysterical.

"When did this start?" I asked her husband.

"Just after we took off."

What produces psychiatric symptoms at cruising altitude in a plane? Hypoxia? A subtle stroke? I began to free-associate on "sadness." Maybe something nonorganic--not a physical illness. Maybe she was having an existential crisis, realizing, for the first time in her life, and at the altitude of 30,000 feet, how meaningless life can be.

I focused on Miami. "So you're coming from Miami?" I asked again.

"Bimini" he said. "The Bahamas. We flew in from there to Miami?"

"How did you feel then?"

"When, on the plane? Not very good," she said. "I don't know ... I just think this whole marriage thing was a big mistake?'

"What did you do in Bimini?" I asked.

"We were scuba diving," the husband said.

"The whole week?"

"Yeah, we took a course at a resort."

"I'm a diver too" I told him. "How were certified? PADI and NAUI?"

He looked at me, a little bewildered. "I don't know."

Resort course. Diving is not a sport to take lightly. Many resort courses provide only a minimal amount of real training.

When I dive, I usually travel with doctors, who are, of course, safety-conscious. Once, though, I had gone alone vacation to a dive resort in the Caribbean. It was the worst vacation of my life. That week the resort was filled with friends the owner. Anyone was allowed to dive whether certified or not. No one used U.S. Navy Dive Tables, created to minimize the risk of the bends, or dive computers, or even much common sense. People would dive down 220 feet--an insane depth--to take pictures of a plastic chicken tied to a stake to prove they "dove with the chicken."

Now I looked at the weeping wife. "What's five times seven?" I asked.

"I don't know"

Her husband leaned over, even more alarmed.

"I forget" she said. "I can't think, Then she tried for a moment. "Twenty-eight?"

I turned to the husband. "Did you keep a diving log?"

"Oh, yes" he replied, pulling a notebook out of his carry-on bag. At least the resort had him do that much.

Diving logs record the depth and length of a dive. They help you figure out how close you are to the safety limits. The two major medical catastrophes that can occur with diving are air embolism and diver's decompression sickness, or the bends. Air embolism occurs when a bubble of air is trapped in the bloodstream; although it can develop at any depth, it most frequently happens toward the surface. The bends (so called because the victims are sometimes bent over by pain) can result from a diver staying in deep water too long.

Nitrogen is key. When a diver goes underwater, the ambient pressure increases dramatically. Ambient pressure doubles at 33 feet under the surface and, at 100 feet below, it's four times atmospheric pressure. This pressure drives oxygen and, more important, nitrogen, from the air the diver breathes into the tissue. The extra nitrogen sits, inert, until the diver returns to the surface. If a diver rises slowly enough, the nitrogen gradually exits the tissue without problems. But if the diver rises too quickly, the sudden difference in ambient pressure forces nitrogen to pass out of the tissue into the gaseous state again, forming bubbles. The bubbles can form anywhere: muscles, where they can cause severe pain as they deform and disrupt muscle fibers; joints, where they can inflict even more pain; blood, where they can initiate blood dots; the heart, where they can precipitate a heart attack and other nasty things; and the brain, where they can cause anything from subtle memory loss to severe, irreversible stroke damage.

I looked at the weeping woman, then looked down at the logbook.