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By Cristina Condemi, Translation by Fabrizio Schepisi
Header photo by Dario Condemi
Are these bad times to be talking about dreams, beauty and The Sea? And what about the realm of scuba diving, a term that opens up a wide range of meanings for its practitioners? It’s impossible to get the pandemic out of our thoughts, and the rising death toll, our inescapable fear, and common sense remind us to stay at home.
Nonetheless, by degrees, we have been able to set aside a few hours in our increasingly absurd daily routines to take shelter in the universe of our passions—whether they belong to the underwater world or to the land above the sea. Dreaming has proven to be a sound way to tackle this situation, a safe haven in such insecure times. Let’s try and dream then: it’s one of the few things we have left, and it won’t make us run the risk of appearing to be superficial or seeming to be careless about Covid-19 if we do so.
Let’s try and dream as best we can and whenever we can, even in this very moment: I, as I’m writing down my impressions, the dreams and feelings of an Italian scuba-diver quarantined in her flat in a city in Southern Italy, and you as you read my words. Always keeping in mind that all storms must pass eventually, and then we will go back to sailing upon and diving into our sea. Presently in Italy, as in most other countries around the world, our days are marked by the news of how the virus is speeding up or slowing down its spread. Our hours are punctuated by attempts at finding something to do within the walls of our own houses and trying to take our minds off the tragedy..
Especially here in Italy. Especially in the north of the country, the opposite side of the boot from where I am, although distance has never been less of a divide than today. Our lives now revolve around a daily disease report, always hoping to hear the virus has passed its peak and waiting for the moment when we are allowed to start the slow reversion to normality, getting out of what has been defined as a kind of “war”. However, this is no war, and there will be no truce. Our will to “cease hostilities” just doesn’t seem to be enough to put an end to it. In fact, there seems to be but one thing we can do: we have to stay home!
Facing the Onslaught of Covid-19
The beginning of March marked the onset of radical changes in our lifestyles, at least in the South of Italy. The most plagued regions, such as Lombardy in the North, were in dire straits for a longer time. In the beginning, many of us thought of Covid-19 as little more than flu; those who gave it serious credit were deemed to be scaremongers. However, the virus soon revealed itself for what it really is, ending up in a pandemic, forcing everyone—none excluded—to an unexpected quarantine. Since then, previously high-valued items like power and beauty have lost much of their appeal. We realized that there were no borders or barriers to hold it back. The virus could hit anyone, and no amount of money or customs control could prevent it from spreading.
And how do we see the virus? Here in Italy, we learned to fear it. Our national health service made many cuts in funding over the past few years, and what really scares us is that in all likelihood some of us might lose the right to be treated if too many become infected. Intensive care units have been filled to capacity in some regions, and our front-line doctors and nurses are doing endless shifts. In many cases, there isn’t enough medical staff, and the safety measures in hospitals are totally inadequate. We just weren’t ready for a pandemic, and we somehow hope the Covid-19 lesson will be a spur to improvements in hospital equipment.
There are many theories of how it all started: conspiracy theorists think the virus was created in military labs first and then somehow got out of control. Green-collar workers are up in arms about our attitudes toward the environment and see it as a revolt of Nature revolting and taking revenge on humankind as retribution for all the stress and suffering it has been subjected to. Similarly, some think that epidemics, being the by-products of unrestrained globalization and urbanization, could be construed as the result of unhealthy eating habits. They pin down the causes of Covid-19 to the consumption of meat from intensive breeding establishments—pork meat in this case. In their view, we should take up healthier eating regimes and give up the thought of going “back to normal”, as that normality is precisely what has brought us here. Finally, there are those who read up on past epidemics and talk about the unavoidable cyclicity of history.
Regardless of all the differing opinions about its causes, we are willing to admit that a tragedy of such magnitude is something new to us, something unexpected and overwhelming. Like anyone else, I find myself coping with it, especially as I am part of a generation that has been through a lot of hardships here in Italy but has never had to grapple with a real war, real famine, let alone a worldwide spread of pandemic. It may be the evil of our times. I tell myself, ”And it will pass as all evils do.” At least, let’s hope it is teaching us something.
Italy used to be nicknamed the “Belpaese”, the “Beautiful country”, but much of its allure seems to have been lost now. Of course, our architecture and artistic heritage, our history and landscapes are still intact, as are the favorable weather conditions we have been blessed with. But, as many tell themselves, what’s the use of it now if you can’t enjoy it? What’s the use of having museums full of precious items and impressive collections of enormous cultural prestige if you can’t visit them anymore?
Of course, I’m not suggesting that they should be reopened to the public, I’m only hinting at the temporary loss of significance of this heritage. Quite romantically, in my mind I can picture Caravaggio’s canvases piling up dust in those closed museums, losing some of the light that made them sparkle with life: works of art “saddened” by the lack of viewers’ eyes feeding on their beauty.
Quite romantically, in my mind I can picture Caravaggio’s canvases piling up dust in those closed museums, losing some of the light that made them sparkle with life: works of art “saddened” by the lack of viewers’ eyes feeding on their beauty
I also think of one of the very few positive aspects of this absurd situation: our planet is breathing again, recovering from the devastating impact of human activity. News of this kind is consoling, especially to those who love nature in all its forms, in water and on land. There is hope that this will be a starting point for serious meditation on how we can change our destructive lifestyles.
Whether we come out of this tragedy torn apart and morally crippled or totally unhurt, the clouds above our heads will be blown away by a new wind someday. On that day, hopefully we will brush the dust off those works of art and look at them with fresh new eyes. We will rediscover how beautiful and fulfilling it is to nourish ourselves with the sight of art and natural landscapes and to let ourselves be kissed by the sunrays.
In our case, we will also go back to marvelling at the beauties of the underwater world, which it is hoped will be all the more powerful an experience after this forced break. For now however, all we can do is wait. Let us not wait as patriotic soldiers forced to a quarantine by governmental decrees, but rather as citizens fuelled by solidarity, well aware that isolation means safety in this case, for ourselves and others.
Sharing Who We Are
Spending long days at home, many will run the risk of surrendering to psychotic fears or to the sadness that comes with feeling as if we are powerless prisoners. To escape this sense of isolation, some have started up a number of solidarity initiatives: some leave food packages in empty baskets outside supermarkets to help out those who can’t afford to go homeshopping; others sew homemade protection masks – a very rare item these days – and hand them out to people who need them.
Many of us are also finding strength in our passions, telling ourselves that we’ve got time on our hands now to do all the things we couldn’t dedicate enough time and care to during our “normal routines.” Even so, they’re all passions we must now pursue at home. Because we can only go out for what is strictly necessary. We can’t go for walks, not even by ourselves. And that includes, understandably, walks out to the sea.
It was particularly hard in the beginning: many of us had a sense of dizziness, and felt deprived of everything we cared about. At that time, we were probably as yet unaware of how serious the pandemic was and would become, and all we could think about was the injustice of not being able to go on with our lives, see our loved ones and kiss or hug them. Such simple gestures that became as dangerous as weapons.
We felt stuck in a brand new asocial universe, because life is all about sharing, just like diving is. What else is scuba diving but the sharing of magic? Indeed, certain didactic orientations to it inform us that having a “diving buddy” at one’s side reduces risks, and that is a thought I personally subscribe to (although it might not hold true for certain kinds of more “extreme” excursions). However, I am not talking about this aspect of the issue.
What I actually mean is that we need to share the feelings and sense of adventure that make up our diving experience with others. Even those who are used to diving solo have a support team backing them up and always find themselves telling their diver friends about their experiences or maybe holding conferences, or writing books, articles, and posts to share their feelings and discoveries.
Even for them, sharing is an integral part of an experience they apparently live in solitude. As for me, I am one who likes scuba diving with others. Whenever I chance to spot something in the distance and point to it, the joy of that vision is cut by half if I realize I’m the only one who has noticed it. When you see something worth spotting underwater, its beauty is always heightened by being able to share it with another pair of eyes. That’s what makes your enthusiasm bubble up, when your happiness is widened and doubled by the presence of a buddy. In the end, sharing sums up the whole diving experience for me.
When you see something worth spotting underwater, its beauty is always heightened by being able to share it with another pair of eyes. In the end, sharing sums up the whole diving experience for me.
Divers’ Special Powers
I still remember the only time I went scuba diving alone, reaching a depth of 42 meters/138 feet. I had planned an excursion with three other divers on the ‘Mpaddata Shallows of Scilla, a 20-minute drive from Reggio Calabria, my hometown. I won’t take offence if you’ve never heard of it. When I lived in Wales, and someone asked me where I was from, most people had no idea where Reggio was, I resorted to the only description that always worked: “Italy is a boot, right? I come from its toe”. I can also tell you that Reggio, the Strait of Messina and especially Scilla are like my underwater heaven.
Well, on the day of that diving excursion we were just off Scilla. As sometimes happens, while we were sailing on a dinghy toward the starting point of our excursion, I suddenly had a hunch it wasn’t a good day for diving. For no apparent reason. Once we had reached the chosen point, I started fitting myself up and realized I didn’t have my computer with me, and that’s when I thought I’d better call myself out that time. I knew that wasn’t going to upset my friends: I know them, and they wouldn’t have forced me to do the dive or pressured me. Because what they taught me and—I’m sure—both my buddies and I thought on that occasion was that a good scuba diver is also one who knows when to say “No”. So, the others dived, I stayed on the dinghy with that day’s support staff, and everything worked out smoothly.
At the end of the diving expedition, the dinghy driver tried to weigh the anchor, but it was stuck. After a few minutes and several attempts, we thought someone should dive down to pull it loose if we wanted to get on our way again. As I hadn’t dived, had no residual nitrogen, and had lost my earlier reluctance to dive, I volunteered to go down. I put on my diving gear and went into the water. After a last look at my friends on the boat, I released my BCD, exhaled and started my descent along the rope.
When I got to the sea bottom, I saw the anchor was actually stuck in a rock spur. So I tried to pull the rope downwards to slacken the resistance and get the anchor unstuck. As I busied with the anchor, something that often befalls us divers happened. Though some might be less used to it, accustomed as we are to alternative ways of communicating when we are immersed in liquid and words are useless and undecipherable, it often feels like we are able to widen our perceptions. It’s as if we are endowed with a gift—being able to feel the presence and energy of things surrounding us while underwater.
I promise I’m not going mad. Hasn’t it ever happened to you? You get the feeling something is behind you, prompting you to turn around. You do so and find yourself face to face with a wonderful creature? At times, I have had the chance to discuss this idea with people who don’t view me as a lunatic and who in fact have agreed with me.I like to think of it as a “special power” that we divers have, a magic of our own.
Going back to the moment at the anchor, I got precisely that feeling of something behind me, so I turned around despite how busy I was, and what did I see? An eagle ray was moving in my direction, probably made curious by my presence and my awkward movements. It came very close, and I tried to keep still and hold my breath, so as not to scare it away.
It was as if it was aiming directly for me, though it moved very slowly. It “flew” past me, only a few inches above my head, and I followed it with my eyes. It was a magical moment, made all the more special by those unique feelings that we divers have—or by sheer coincidence, I’ll let you decide. However, in that very moment I thought to myself that I would have liked to have someone there with me. Seeing my joy reflected in the big, smiling eyes of my buddy behind his frameless mask, would have made this moment even more magical.
We Are Social Animals
And that’s what life’s all about: we humans may need our moments of solitude, but we are still “social animals” and need other people to share our experiences with. We’ve never felt it more than in these strange days. The time we’ve spent on the phone with other people, texting and video chatting with friends we might have not been in touch with for a long time, bears testimony to this need of ours. We live in a world of social networks —and this is no chance choice of words—following live broadcasts on an array of different themes and topics.
In our case, these may involve free divers and scuba divers talking about records and discoveries. We use video-conferencing apps to talk about excursions in submarine caves, underwater photography, or more broadly about the sea and the feelings it gives us. Even people who weren’t used to communicating on the internet have had to give in to it, because that’s our main means for sharing now. As we can’t yet meet people physically, we must be content with seeing them behind a computer screen.
As is inevitable, much of the talking revolves around the virus and how we got to this point. We also discuss what the next phase will be like, how we will try to bring our lives “back to normal”, in spite of the fear we will still have of infecting and being infected, but still hopeful that the present crisis will bring about positive changes in our lifestyles.
Our ability to think about what comes after is good. As is solitary reflection on what we have really missed–our loved ones, our work, and the activities we performed with others. And, since this is a diving magazine, I’m quite sure readers will understand when I mention how much I miss the sea.
Whether the talk is about tropical waters, the temperate waters of my beloved Mediterranean, oceans, or lakes. We divers are all missing the underwater world. But we also know the sea is waiting for us, and we will find it again sooner or later, as blue and strong and beautiful as it ever was. With a difference: when we get back to it, we will be more aware of the need to protect it with all our strength.
We divers are all missing the underwater world. But we also know the sea is waiting for us, and we will find it again sooner or later, as blue and strong and beautiful as it ever was. With a difference: when we get back to it, we will be more aware of the need to protect it with all our strength.
Cristina Condemi is a RAID diving instructor and a staff member of the Scilla Diving Center. She was born in Reggio Calabria and the sea of the Strait of Messina has always been her natural environment. A DAMS graduate (disciplines of Art, Music and Entertainment) at the University of Bologna, she has lived in Spain and in Wales. A dive guide in Scilla since 2014, she brings divers of all levels to discover the extraordinary seabed of Scilla and its creatures, with special care for protecting its fragile ecosystem: a care she always tries to pass down to her students. An enthusiastic ecologist, vegan, and animal-rights supporter, she started technical diving in 2018, sharing the story of her experience as a diver on the web.
Undergoing PFO Surgery as a Team: Deana & Bert’s Excellent Adventure
People like to give GUE a hard time for their uncompromising focus on team diving. But a pair of divers from GUE Seattle has taken it to a new level: getting their PFOs fixed together. The team that bends together, mends together? Instructor and tech diver James D. Fraser willingly tells the tale.
by James D. Fraser
Header photo courtesy of Dr. Doug Ebersole
This is the follow-up to the story that ran in InDepth December, 2019: No Fault DCI? The Story of My Wife’s PFO
It has been a year since my wife Deana had a decompression illness (DCI) hit in Bonaire requiring her to do a Table 5 recompression profile in a hyperbaric chamber. At the time of my previous article’s publication, Deana had a Transthoracic Echocardiogram (TTE) bubble study and found out she did have a small to moderate patent foramen ovale (PFO). Two physicians offered similar options for Deana to consider when it came to her diving activities:
- Stop diving, as this eliminates any risk of DCI in the future.
- Modify her dive profiles to be more conservative: diving only once per day, diving nitrox 32 using air tables, and/or extending her decompression profiles and safety stops.
- Have the PFO repaired, knowing it is not a guarantee, and continue diving as conservatively as possible.
Deana had initially decided to wait on doing a PFO closure until after our daughter’s wedding in March 2020, but she realized very quickly that being “conservative” was not in her nature. Deana had already returned to diving within 12 days of her hyperbaric chamber ride. In the 46 days since her treatment, Deana had already done another 15 dives to depths of 90 feet; being conservative really was proving to not be an option for her. Diving was just too much a part of her life.
In mid-November, Deana reached out to cardiologist and tech diving instructor Dr. Doug Ebersole for a second opinion on the bubble study and his advice about her options. Dr. Ebersole gave Deana the same response as the other physicians; but, knowing Deana and her passion for diving, he suggested that she have her PFO fixed, since her plan was to continue diving.
Deana also spent time talking to other divers who had been diagnosed with PFOs—some who had them repaired and some who had decided against it—in order to get a more complete picture from both a patient and a doctor point of view. One of the final conversations that pushed Deana to have her PFO repaired was with a coworker who was a nurse practitioner in cardiology with knowledge of PFOs and diving. Her coworker was pretty blunt, stating, “Why are you playing Russian Roulette? You have worked in cardiac and know the risks.”
Some of these risks include Arterial Gas Embolism (AGE), Venous Gas Embolism (VGE), and cerebral embolism. That was the final “Aha” moment to tip the scale and get Deana to schedule her PFO repair, since “Russian Roulette” was exactly what Deana was doing based on her diving activities following her DCI hit.
Team Approach to Treatment
Bert Berzicha, one of our GUE Seattle community members, also completed his TTE as a result of having had some symptoms of DCI in the past. The test confirmed the presence of a large PFO. Deana and Bert compared notes initially and discussed diving as a team on future dives using more conservative decompression profiles than other teams, allowing the other teams to get out of the water sooner. Deana, however, related what she had learned from talking with her coworker and changed her mind about diving conservatively and instead decided to get the PFO repaired.
Deana did not want to take the risk of neurological deficits that could be irreversible. Deana suggested to Bert that he come with her to have his PFO repaired at the same time. Bert continued to research the subject, looked at his work schedule, and decided doing a “team” procedure made sense. Just as a dive team shares a plan, resources, and emergency procedures, a medical procedure shares similar benefits when working as a team.
It was time to plan a date for both of them to have the procedure. Deana and Bert both live in the Seattle area. Dr. Ebersole lives in Lakeland, Florida, so logistics included time off work, pre- and post-surgical care, flights, hotels, and transportation. Deana arranged to have her sister Jessica fly into Tampa from Dallas, prior to them arriving, so she could pick them up from the airport to make it to the hospital in time for the procedure. I was going to be in Australia on a business trip at the time, so I was not able to be there pre-surgery. I ended up reworking my return trip and flew from Canberra, AU to San Francisco, then on to Tampa, to land just an hour after their surgeries were finished and meet them back at the hotel.
Even though Deana and Bert could fly home 24 hours after the procedure, they decided to stay the weekend just in case there were any complications and to take it easy. Deana, however, had a different take on “easy.” The morning after surgery, Deana was invited by Dr. Ebersole to watch a procedure that he and his team perform called the “WATCHMAN” procedure (less than 24 hours after post-op). Then we picked up Bert and Jessica, and jumped into the truck to do a 300-mile, five-hour road trip to High Springs, FL, to take a tour of the Halcyon facility and say “Hi” to Orie Braun, Lauren Fanning, and Mark Messersmith; stop in at Global Underwater Explorers (GUE) HQ to buy some swag; and drive down to Ginnie Springs to see where Cave 1 may take place in Deana’s and my near future. Not bad a day after surgery.
It was at Ginnie Springs where Bert came to Deana and stated he thought he had active bleeding. We all paused and turned pale, knowing we were not in a great location for this to be happening, but after being assessed by Deana it turned out to be post-op bruising from the surgery. This did, however, make us stop and think, “We just drove 300 miles away from the hospital we had decided to be close to in case of complications.” I am sure Gareth Lock would find a really good human factors story in there somewhere.
Deana’s PFO adventure Timeline
- OCT 8: 47 m/153 ft technical dive resulting in a DCI episode requiring recompression.
- OCT 20: First dive post-chamber ride to 16 m/52 ft
- OCT 29: TTE Bubble Study; “Deana has a small to moderate PFO”
- NOV 17: Dr. Ebersole receives Deana’s TTE study for a second opinion
- NOV 21: Deanna dives now to 28 m/90 ft
- DEC 4: Last dive before PFO repair. In the 46 days since her hyperbaric treatment Deana made 15 dives: “Conservative Not”
- DEC 12: Deana and Bert have PFO procedure
- DEC 13: Lakeland to High Springs road trip
- JAN 27: First dive post closure—15 m/49 ft and spaced dives 2-3 days apart
- FEB 15: Started doing multiple dives daily no greater 15 m/50 ft
- MAR 8: PFO follow-up; OFFICIALLY cleared by Dr Ebersole to dive
- MAY 7: Dives now pushing 30 m/100 ft
- MAY 31: First Tec dive to 33 m/110 ft
Since May, Deana has done 120 dives in 2020 with a max depth of 52 m/170ft, which she did on September 12. Deana has gone back to no-restriction diving and has completed 16 technical dives since this summer. Some of these have been assisting with photogrammetry dives.
- 46 m/150 ft to 52 m/170 ft: 3 dives
- 40 m/130 ft to 46 m/150 ft: 5 dives
- 30 m/100 ft to 40 m/130 ft: 8 dives
Getting Personal With PFOs
COVID-19 has prevented us from doing a dive trip this year, which is the one main test we still have yet to do: repeat the scenario that always led to her getting DCI, which was three consecutive days of recreation and tech dives, to see if she experiences any recurrence of DCI symptoms. 2021 will hopefully open up this opportunity, or by that time Deana will already be training for GUE’s Tech 2 course. In either case, Deana and Bert are both very happy to have had their PFOs repaired; both have seen improvements in their health in other areas such as endurance, no longer being easily winded, and, in Bert’s case, less headaches, which he had prior to the PFO closure.
To get a PFO repaired is a personal choice, and no one should ever take surgery lightly as it has its own risks. Divers with PFOs need to do their own research and consult an interventional cardiologist, such as Dr. Ebersole, who understands diving. Only then can they make an informed choice based on their own unique situation whether or not a PFO closure is right for them. This article is meant to show the process and outcome of two very experienced and ambitious divers who made the choice to have their PFO repaired and the results of that decision.
Diving and Hyperbaric Medicine: The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale by George Anderson, Douglas Ebersole, Derek Covington and Petar J Denoble. 2019 Jun 30.
Alert Diver: PFO Study Update by Petar J Denoble
Alert Diver: Cases studies of divers who had their PFOs closed with transcatheter-applied occluders: Divers with Holes in their Hearts by Petar J Denoble 2010
James D. Fraser is a GUE Fundamentals and Rec 1/2 Instructor, PADI MSDT, and NAUI Scuba Instructor, and has been diving in the Pacific Northwest for over 30 years. James currently lives in Seattle, WA, with his wife and dive teammate Deana Fraser. As a member of the GUE Seattle Board of Directors, James is able to share his experiences and work with Deana at growing the local diving community sharing their passion with all who are interested. James recently embraced technical diving, becoming certified as a Technical 1 diver with GUE. James and Deana have had opportunities to travel all over the world to experience their passion in amazing places such as Egypt and the Maldives. James currently works as a Cyber Security Director with a Fortune 500 Defense Contractor and has been a residential construction business owner and Emergency Medical Technician (EMT).
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