Text by Andrea Murdock Alpini. Historical Images: Ansaldo Foundation. Other images courtesy of PHY Diving Equipment.
The day we left the mooring lines on the ground in Montauk, I was reading the Antarctic Diaries to trick myself into being patient. After four years of worry and work, we were finally moving. I have devoted all of my strength to this endeavor—and I hope we’re successful.
On July 25, 1956, the SS Andrea Doria—a microcosm of Italian cultural, social, political, economic, and manufacturing sensibilities—sank off the coast of Nantucket Island. Referred to as “The Renaissance Ship,” she made 100 successful transatlantic crossings between 1953 and 1956. Initially, it seemed that her 101st voyage would be no different. However, she tragically collided with another ocean liner in the summer fog, sinking 74 m/243 ft.
Many refer to the Andrea Doria as diving’s K2 or Everest. Why these mountains and not another rugged and difficult-to-reach peak? Perhaps the comparison pays tribute to the wreck’s fraught conditions—swift currents, poor weather, and freezing New England waters—Yes! Yes, and its formidable roster of brave, lost adventurers (sixteen and counting, to be exact).
And, K2 is often dubbed “The mountain of the Italians,” after all.
It is September 2022, and we’re finally anchored above the Andrea Doria, in the middle of the Atlantic Ocean. It’s been a lifetime dream but I am finally here. Getting here was a feat. Diving here will be, too.
Safety is more than just an implication for dives on the Andrea Doria. We’re 72 km/45 mi from the coast. The current is ever-present and strong—determined to carry you miles from the boat further into the boundless and rough ocean. By comparison, depth and bottom time feel like secondary concerns.
This is my third dive on the Andrea Doria. But my journey to this wreck has been long. Plunging into the water, my mind races with a tumult of thoughts. I’m heading in search of what is left of the Grande Dame.
Beware the Current
What keeps most divers from reaching Andrea Doria? In one word: Current. Swift and unceasing, it’s the first consideration to be made before an expedition on this wreck, in my opinion. Misinterpreting the current can produce a total débâcle. This isn’t a dive for the impatient—it’s often necessary to wait out the current, outlast the temporarily turbulent and overwhelming flow, and wait to enter calmer waters.
On past dives, I’ve seen the water roil on the surface and toss ballast lines as if they were straws. I’ve also seen the current calm completely in an instant.
Mustering the Courage
After my first dive I had reviewed my objectives—considering both current and conditions. I had been slapped back by the Grande Dame herself, and so I tried to find the motivation to face this second dive with the best possible approach. Come on! It’s just the cursed current!
On my second, the visibility had been so poor that I cut my bottom time to avoid unnecessarily long decompression. I knew I wouldn’t have captured any good images: just unclear shots of the wreckage.
I’m determined, therefore, not to waste this chance, my latest opportunity–perhaps my last. I want something more from Andrea Doria, and I’m hoping she wants the same from me, too.
Third Time’s a Charm
When I saw the wreck for the first time, I laid my hand on the left hull, whispering, “And so, you are Andrea Doria.” I knew a lot about the ship, but nothing about the wreck—at least not until the first time I met her.
But, that was then. I’m on my third dive, and now that I’m in the water, I know something has changed.
The water is a different color, a different density. Above all, the current is much less intense. Perhaps it’s even disappearing—a stretch that has taken me two minutes in the past takes me less than a minute to cover. For the first time, the surface of my mask isn’t covered with plankton and nutrients. I can finally see. At 26 m/85 ft, I look up and find a straight, taut, unmoving anchor line.
Proceeding lower, the line still isn’t moving. I can’t believe it; this must be the opportunity I’ve been waiting for. It’s finally time to see the propeller.
I count the cleats—first two, then three.
And here we are! It’s time to cross the keel en route to the left propeller. The current is low under the wall, perhaps only one knot—nothing compared to the four and five-knot flows of my previous two dives. How intense will it be beyond the bulkhead?
On previous dives, when I dared to peek over the wall, I felt the current trying to tear the skin from my face. Now, when I brave a hesitant glance, with both hands firmly gripping the wreck, I don’t feel hostile forces. In fact, just the opposite. Today is a gift.
Crossing the keel is typically laborious, but with visibility somewhat intact, I can move efficiently. Along the hull, the current picks up—just as expected. I continue on, finning in the direction of the propeller.
Within a few minutes, I’m at 70 m/230 ft. Joe Mazraani suddenly appears from the black, calling, “Andrea! It’s here!” Despite nearly a hundred dives on the wreck, I know he’s never experienced anything like this. It makes the journey all the more meaningful.
I immediately lay eyes on two shovels and start counting the others—I’m starting to film. Upon discovering a thin, precise, powerful blade, I feel ecstatic.
I turn to see the propeller, and for a moment I feel like Vaslav Nijinsky. It’s so big that I can’t see it all at the same time. Somewhere, under the soft blanket of anemones, “Genoa” still adorns the hull.
The bulb tapers like a bullet. It’s beautiful and refined—like the architecture of Michelangelo and the engineering of Leonardo. Even individual details embody the ship’s allure.
Beautiful Ship, Marvelous Wreck
In July 2016, nearly six decades after she sank, ocean exploration company OceanGate ventured on three nearly four-hour underwater expeditions to the wreckage, capturing more than a dozen sonar images of the liner. The company’s findings were consistent with reports of intrepid divers’ observations: The Grande Dame of the Sea was rapidly deteriorating.
Recent underwater sonar imaging of the wreck reveals that this majestic ship is deteriorating more rapidly than originally thought—a large section of the bow has crumbled, and most of the superstructure has collapsed.
Andrea Doria was a floating masterpiece—so much more than just a luxury ocean liner. Underwater, she was perhaps an Eighth Wonder of the World. But today, devastating currents and ocean storms have nearly totally reclaimed her form.
Yet, a masterpiece remains in the details. Like the works of a Renaissance master, no one needs to see every brushstroke to understand the beauty of the whole picture: even a part of the whole is enough.
If you travel to Florence, Rome, Milan, Venice, Naples, Palermo, Urbino, Parma, or Genoa, you’ll catch a glimpse of the greatness of Italy that was. You’ll discover the same on the Andrea Doria. She, too, exemplifies the Italian spirit—what it means to be Italian.
The Boot has something to offer to anyone open to learning about its cultural sensibilities, despite some natives’ cynicism. But, many say that seeing the Andrea Doria today makes no sense because it’s disappearing—I defend that by suggesting that more divers should see it before it disappears.
Seeing the Andrea Doria is like seeing the Colosseum in Rome; even if its architecture constitutes only a fraction of the former Teatro Flavio, the remains make their own kind of sense, and seeing them feeds one’s soul. American architect Louis Khan describes “Beautiful buildings, marvelous ruins.”
The Andrea Doria is a beautiful ship and a marvelous wreck.
My dream had always been ahead of me, on the run and out of reach. To spend a moment in unison with my dream—to reach out and touch it—was nothing short of a miracle.
Journal of Ship Production and Design: The Decay of the Andrea Doria by Philip Sims, John Moyer, and Steven Gatto. J Ship Prod Des 26 (03) August 2010: 187–198
Other stories by the prolific Andrea Alpini Murdock:
InDEPTH: Hal Watts: Plan Your Dive
Andrea Murdock Alpini is a TDI and PSAI technical trimix and advanced wreck-overhead instructor based in Italy. He is fascinated by deep wrecks, historical research, decompression studies, caves, filming, and writing. He holds a Master’s degree in Architecture and an MBA in Economics for The Arts. Andrea is also the founder of PHY Diving Equipment. His life revolves around teaching open circuit scuba diving, conducting expeditions, developing gear, and writing essays about his philosophy of wreck and cave diving. He published his first book, Deep Blue: storie di relitti e luoghi insoliti (2018) and IMMERSIONI SELVAGGE, published in the Fall of 2022.
Hyperbaric Chambers Are Turning Away Divers. Will There Be One Nearby When You Need It?
Unfortunately, it’s hard to make a business case for treating divers versus wound and burn care victims. As a result, many hyperbaric chambers no longer treat divers, leaving fewer facilities available for divers in need and increasing their post-dive time to treatment. InDEPTH editor Ashley Stewart reports on this growing crisis in the US and what can be done!
By Ashley Stewart
Steven Wells was diving on the scuttled wreck of the USS Oriskany off the coast of Florida in 2016 when a problem with his buoyancy compensator caused a rapid ascent to the surface.
Wells’ dive buddies followed the emergency action plan for the Oriskany listed on the Florida Fish and Wildlife Conservation Commission’s website at the time and brought Wells straight to Naval Air Station Pensacola, the nearest facility with a hyperbaric chamber. The facility turned him away because there was no one there to run it.
Wells was taken 30 minutes away to Baptist Hospital, which also has a chamber capable of treating his injuries, but the hospital had years earlier decided only to use it for wound care. Doctors there decided Wells would be taken by ambulance more than an hour away to Mobile, Alabama, the nearest facility that accepts divers.
By the time Wells arrived at the only chamber that would help him, it was too late.
“I got a call from the hospital saying, ‘Your husband is on life support. You need to get here now,’” Rachel Wells said of her late-husband of more than 23 years.
Julio Garcia — the program director of Springhill Medical Center’s wound care and hyperbaric facility where Steven Wells was to be treated — told InDEPTH that while no one can be certain how sooner treatment would have affected the outcome of Wells’ case, it would have given him the best chance for a full recovery.
Each year in the US, there are about 400 serious cases of decompression illness (DCI) — a category including both arterial gas embolism and decompression sickness — in divers, according to one 2020 paper. The Divers Alert Network (DAN) hotline dealt with 587 cases annually over the past five years.
The availability of hyperbaric chambers to treat decompression illness is something many divers take for granted. We try to avoid dive-related injuries through training, but expect treatment to be available when we need it.
The reality — as Steven and Rachel Wells tragically learned — is that only a minority of divers are close to care for diving-related injuries, according to medical professionals in the field. The estimates vary, but it’s generally believed there are about 1,500 hyperbaric medicine facilities in the US and only 67 are currently treating diving accidents, according to DAN.
The estimates vary, but it’s generally believed there are about 1,500 hyperbaric medicine facilities in the US and only 67 are currently treating diving accidents, according to DAN.
“The problem is only getting worse, not better,” Garcia, the Springhill Medical Center program director, said. Garcia has been sounding the alarm about this problem for more than a decade. His hospital takes patients from as far away as Florida cave country and treated 20 DCI cases in 2022. Those patients had an average transportation time of 11.5 hours, according to an InDEPTH analysis of Garcia’s records.
Florida stands out because it’s a popular diving destination, DAN Research Director Frauke Tillmans said, but the situation is not much better across the US. Many of the 1,500 hyperbaric medicine facilities, like Pensacola’s Baptist Hospital, have transitioned to treating wound care only for economic reasons. Emergency hyperbaric services are expensive to train and staff, and come with increased liability.
Time to treatment can be important in DCI cases
Time is of the essence when treating DCI. Divers Alert Network Director of Medical Services Camilo Saraiva told InDEPTH time to treatment is a “pivotal determinant” when it comes to outcomes for DCI patients. “Swift intervention significantly influences the effectiveness of therapeutic recompression,” Saraiva said.
Decompression sickness, for example, results from rapid changes in pressure and can form gas bubbles in body tissues. Initiating recompression therapy minimizes bubble size and number, Saraiva said, enhancing their elimination and reducing the risk of further vascular obstruction and tissue damage.
“The timely provision of hyperbaric oxygen therapy not only aids in bubble resolution but also mitigates the potential for neurological deficits and other severe complications, highlighting the critical role of early treatment in optimizing outcomes for DCI patients,” Saraiva said.
The 2018 paper “In water-recompression” stated delays to recompression in military and experimental diving are typically less than two hours and more than 90% of cases are completely resolved during the first treatment.
Frank K. Butler and Richard E. Moon, hyperbaric medicine experts, wrote in a 2020 letter to the Undersea and Hyperbaric Medicine journal editors suggesting a minority of patients who need life-saving hyperbaric oxygen treatment (HBO2) are close to a major hospital with a 24-hour emergency hyperbaric facility.
“Despite the urgent need for treatment, most hyperbaric chambers will decline to accept emergent patients at present,” Butler and Moon wrote. “Patients may eventually receive HBO2 but after a significant delay and a transfer of several hundred miles. Many never receive indicated HBO2, often resulting in poorer patient outcomes.”
Patients who are delayed treatment, they wrote, face the possibility in some cases of “death, permanent neurological damage, permanent loss of vision, or loss of an extremity, most of which would have been readily preventable had emergent HBO2 been administered.”
Why fewer chambers treat dive injuries
As recently as two decades ago, according to Butler and Moon, the majority of hyperbaric treatment facilities were available 24/7 to treat emergency patients. The percentage of those facilities now treating emergency patients is unclear, but it’s universally agreed the number has fallen significantly.
The reasons for the loss of emergency HBO2 facilities, Butler and Moon suggest, include “a better economic return when chambers focus on wound care patients as opposed to emergencies; the greater legal liability involved with treating high-acuity emergency patients; and the increased training and staffing requirements that would be required to manage critically ill patients — especially diving injuries and iatrogenic gas embolism patients.”
A letter from an administrator at Baptist Hospital — which sent Steve Wells to Springhill Medical Center — viewed by InDEPTH shows the hospital discontinued hyperbaric emergency services in December 2010, citing lack of staffing for specialty trained hyperbaric physicians who can provide 24-hour patient care. Baptist has yet to respond to InDEPTH’s request for comment.
There’s also the issue of pay. Garcia, the Springhill program director, said the current rate of pay for doctors who administer hyperbaric treatments regardless of length is around $150. A typical hyperbaric treatment for other conditions is about two hours. Diving treatments are usually six or seven, he said. “What doctor wants to get paid $150 to be up all night for seven hours, at that point making less than the technician?” Garcia said. “The fix is that healthcare payers need to pay more for the supervision of the treatment for diving injuries. Make it something that’s worth a doctor’s time besides the goodness of their hearts.”
Silence from lawmakers
Medical and diving organizations in 2020 sent a letter to the House and Senate, federal government agencies, governors of Florida and California, and the American Hospital Association expressing concerns about the lack of availability of chambers to treat diving injuries.
“There are approximately three million recreational scuba divers in the US,” the letter stated. “In the unlikely event that they suffer a diving-related injury, they trust that the US medical system will provide state-of-the-art care for their injuries, but the steadily- decreasing number of hyperbaric treatment facilities in the US willing to treat them emergently for decompression sickness or arterial gas embolism often places them at much greater risk than they realize.”
Garcia has on his own contacted lawmakers, reporters, medical systems — even private space companies like SpaceX because his facility is also the only one nearby treating altitude decompression sickness from space and air travel.
Little has changed, Garcia said.
Garcia showed InDEPTH a 2014 letter from a Defense Health Agency director who said, while there are three Undersea and Hyperbaric Medicine Society-accredited clinic hyperbaric medicine facilities and two additional facilities that can treat civilian emergencies, they are not staffed 24/7 and not designed for patients with other medical illnesses. Garcia at the time requested the creation of a federal grant to support the expansion of 24/7 hyperbaric services, but the director said that was outside of the agencies’ purview.
Two years after this exchange, Steven Wells was taken to and turned away from one of these facilities — the NAS Pensacola, listed on the Florida Fish and Wildlife Conservation Commission’s (FWC) emergency action plan at the time.
The Florida Fish and Wildlife Conservation Commission website now shows a map of the nearly 4,000 artificial reefs across Florida’s 1,350 miles of coastline. Two chambers, one in Mobile, Alabama, and one is Orlando, cover 500 of those miles densely packed with dive locations, according to Garcia.
The FWC website now shows a map of the nearly 4,000 artificial reefs across Florida’s 1,350 miles of coastline. Two chambers, one in Mobile, Alabama, and one is Orlando, cover 500 of those miles densely packed with dive locations, according to Garcia. A report from the University of West Florida estimated the sinking of the Oriskany, scuttled in 2006, generated nearly $4 million for Pensacola and Escambia County in the next year alone.
An FWC spokesperson said the agency provides diver safety reminders and recommended actions on its website “as a courtesy” and is not intended for emergency response. FWC and Visit Florida did not respond to inquiries about how much Florida’s government spends on advertising the artificial reefs and other diving activities, or whether any effort to expand the availability of hyperbaric facilities to treat the divers who show up as a result.
“My question is what is my husband’s life worth compared to your chambers,” Rachel Wells, Steven Wells’ widow said. “Why did he have to die?”
DIVER: A Crisis in Emergency Chamber Availability by Dan Orr (April 2022)
Divenewswire: A Crisis Lurking Below the Surface Emergency Hyperbaric Treatment Availability by Dan Orr (August 2021)
Undersea and Hyperbaric Medicine (2020): Emergency hyperbaric oxygen therapy: A service in need of resuscitation – an open letter by Frank K. Butler, MD, and Richard E. Moon, MD
InDEPTH: A New Look at In-Water Recompression (IWR) (2019) by Reilly Fogarty
Diving and Hyperbaric medicine (2018): In-water Recompression, Doolette DJ and Mitchell SJ
InDepth Managing Editor Ashley Stewart is a Seattle-based journalist and tech diver. Ashley started diving with Global Underwater Explorers and writing for InDepth in 2021. She is a GUE Tech 2 and CCR1 diver and on her way to becoming an instructor. In her day job, Ashley is an investigative journalist reporting on technology companies. She can be reached at: firstname.lastname@example.org.