One Breath

by Adam Skolnick

  I am F’ed in the head is what happened. I am not relaxing on the way down. I am not performing to the best of my abilities…because I am so burnt out and ready to go home. I need to let it all go and give up…not having fun.

  Jen knew Nick needed a pep talk, or perhaps permission to quit, but when his message came in she was putting her two kids to bed. It was Elizabeth’s birthday weekend. Her eldest had just turned five, and Jen had a house full of family and friends. There wasn’t time to sit down and compose a proper response. She planned to do it on Sunday evening, when she had time to think. By then it was too late.

  The last person Nick wrote on the night of November 16 was Vanessa:

  Vanessa: Hope your ears are okay…

  Nick: Doc says that there is no hole.

  Vanessa: nice and you?

  Nick: I feel like offing myself. Frustration is oozing from my pores.

  Vanessa suggested he go outside and yell into the wind to get it out; she offered a series of yoga postures and mudras that yogis use to release frustration and help reset the nervous system.

  Nick: I am not sure if it will help reset 31 years of anger…

  In retrospect, his comment about “offing” himself seems much more an angst-ridden, off-the-cuff reaction than a serious threat, but considering what he would say to his friend, Junko, on the beach just before his dive, (“I hope I see you again”) it’s obvious that he wasn’t thinking straight and that he was in dire need of intervention. His friends tried to talk sense to him from afar. Johnny urged him to pull back, but nobody on Long Island threw themselves in the path of a train barreling toward disaster, because nobody in the freediving community could ever have imagined what would happen next. If anybody should have seen the signs, it should have been Dr. Jeschke, but her exam was less than thorough.

  Nick knew he wasn’t right, yet he still floated to the line willing to risk it all to grab his elusive second American record. In that infamous Kalamata blog, he wrote, “Numbers infected my head like a virus.” Well, the virus was back, and one number loomed larger than all the rest.

  Seventy-two meters.

  After a week of mostly rough weather, it was a beautiful day at Dean’s Blue Hole the day Nick died. As he breathed up on the surface, some divers wondered why he would choose to dive 72 meters a third time. Athletes often get superstitious with numbers that don’t pan out. Instead of 72, they might have chosen 73, just to shift the energy. Nick wasn’t superstitious.

  He looked relaxed as he lay on his back, eyes closed, and to those treading water around him, it felt like just another dive. Judges and fans chatted off to the side as Sam Trubridge ticked down the time. Daan Verhoeven had the most reliable video footage of the entire episode. With about twenty-five seconds to go, he kicked to 15 meters and waited for Nick, whose descent was smooth. It took just four strokes to get to 10 meters and he looked comfortable as he drifted past the sandfalls.

  Sam and Dr. Jeschke leaned over the sonar monitor together and Sam announced his progress. Seconds after passing 60 meters, Sam noticed that Nick had halted his descent, and hung there, trying to equalize. At that depth his lungs would have been compressed to what’s known as residual volume.

  After a typical inhale and a full exhale, there will still be a thimble of air left in the lungs. That’s residual volume, and underwater, when a diver’s lungs are compressed to that point, it’s dangerous to attempt to access more air to equalize because it requires too much effort from the diaphragm, and when under pressure any unnecessary tension or movement in the core can cause injury. “He told me that he’d used his diaphragm to force air into his lungs in that depth range before,” said Johnny. That was his first thought when Nick started to recommence his descent, and if Johnny was right, it may have caused Nick’s lung injury. Bottom line, if Nick lost his mouthfill, as many suspect, he should have surfaced.

  Instead he fell toward the plate head up. He had less control, and had to scull with his hands to maneuver. At depth, any pronounced or awkward motion in the upper body can also tear tissue. Though it’s impossible to know if that was a contributing factor to his squeeze that day, some, including Grant Graves, believe it may have played a part.

  “Be ready for this one,” Sam warned the safety team as he began to ascend. Nick’s dive time was a concern. He’d burned nearly thirty seconds trying to equalize at 68 meters, and hypoxia and underwater blackout were likely. But he didn’t black out. He swam his ass off. Joe Knight duck dove and kicked down to meet Nick at 30 meters. Ten seconds later, Ren Chapman sliced the surface and met them at 20 meters. Daan followed Ren and waited at 15 meters. By then Nick was gassed. On Daan’s footage Nick is seen fighting to get to the surface, Joe and Ren facing him at an angle.

  “I remember looking at his face and thinking it didn’t look right,” said Joe. At 10 meters he thought Nick was blacking out and went to grab him. “He was just working too hard. He wasn’t streamlined. He looked like a level 1 freediving student coming up from 20 meters.” Ren shook Joe off. He wanted to give his friend every opportunity to get his record.

  Nick’s final 10 meters were slow. He exhaled and a storm of bubbles rippled toward the surface. Again Joe went to grab him, thinking he was losing motor control. This time Nick shook him off, and Joe backed away once more. Nick surfaced a few feet from the line, and offered the okay sign, saying the words before removing his nose clip. That’s an improper protocol, but it didn’t matter yet, because the sequencing only begins once the diver clears his face of any equipment. Nick still had time to book a white card. He lunged and grabbed the line, while shouts of “nose clip!” went up from the athletes and spectators, everyone pulling for him. But he was hypoxic and teetered backward. Ren was there and held him upright with a gentle hand. He removed his friend’s nose clip as Nick gripped the line, unable to speak. “You were almost there, buddy,” Ren said.

  Nick looked to be breathing on his own, but instead of recovering, his color got worse. He’d been at the surface for over thirty seconds, yet hadn’t had a nourishing breath of air in almost five minutes, and he wore a thousand-mile stare, a telltale sign of distress.

  “Sorry Nick,” said Carla Hanson as she removed the competition’s official dive computer from his wrist. For about ten seconds he seemed to improve and relax, but then he took another dip, hyperventilating, struggling for air. Still nobody came to his aid. After twenty more seconds he could no longer hold himself upright on the line and he fell backward into the arms of the safety team. One minute after surfacing, he was still conscious. Ren and his crew moved him toward the platform, while Nick groaned, his condition deteriorating. He was pulled onto the platform 1:20 after surfacing and within seconds he was out.

  “I’d never seen a competition blackout like that,” said Ren. “Usually you’ll black out within the first fifteen seconds, within the first three breaths. Something definitely was not quite right.”

  “I feel something in his lung,” said Marco Consentino, who attended to Nick along with Joe Knight, while Dr. Jeschke moved in with a bag valve mask, an ideal piece of equipment if used properly.

  “Bag valve masks require two people,” said Kerry Hollowell, who has shown the video to dozens of colleagues and watched and analyzed it over a hundred times. “One person with two hands on the mask to create a seal and the other to squeeze the bag.” Jeschke attempted to use it alone, and it was not hooked up to oxygen. “If it was hooked up, it could have given him 80 percent [oxygen]. Instead she was pumping air, which has 21 percent oxygen.”

  Jeschke had already been late on the jump and now she was misusing her equipment. The mask and bag attachment came apart after two pumps. She reattached it and started again, still without a proper seal and without hooking it up to her oxygen tank. She was not off to a good start.

  “He can’t breathe because he’s full of blood,” said Marco. “His lungs are full of blood.”

  Nearly three minutes after surfacing Joe and Jeschke moved him into the res
cue position, on his side, in anticipation that blood might come pouring out. Jeschke continued to pump away with a poor seal and the mask continued to fall apart. The third time it happened she had to fish the mask out of the sea, while Nick’s head lolled and bloody saliva seeped from his mouth.

  Jeschke reattached the mask to the bag and placed it back over his mouth, but by then Nick was almost on his belly, his neck kinked. There was no way to monitor chest rise, and nobody was checking a pulse.

  “At that point he should have been on his back,” said Kerry. “One person should have created a seal with the mask and another person bagging it. [Jeschke] should have stepped back and made sure everything was running smoothly. Is the bag valve mask attached to oxygen? No it isn’t, let me do it. Does he have a pulse? Cut his wetsuit off, get that wetsuit off! And she should have been asking, Do we have chest rise? Do we have a good seal? Is there blood in his mouth? With Nick on his side his left lung was compressed, it couldn’t expand normally. She was behind the eight ball already.”

  He’d been out of the water for 3:30 and hadn’t had a nourishing breath in seven minutes. His time was short. The resuscitation did not improve and neither did Nick’s condition. The bag valve mask kept falling apart, and wasn’t hooked up to oxygen until seven long minutes had passed, though several people attempted to point that out to Jeschke, including Daan, the videographer. If Nick still had a pulse at that time, it’s difficult to tell because according to the video, Nick’s pulse was not monitored consistently.

  Joe and Jeschke as well as two nearby volunteers attempted to get a peripheral pulse—a pulse at the wrist—from time to time. But ER doctors argue that it is difficult and often impossible to monitor a peripheral pulse during such an emergency because the pulse is almost always too weak to register at the wrist. Joe did check the carotid artery in Nick’s neck a handful of times, often with gaps of twenty seconds in between.

  Through it all, Nick remained unresponsive. At the 9:00 mark they finally cut off Nick’s wetsuit, though he remained on his side. At the 11:30 mark Jeschke checked his pulse herself, again opting for a peripheral read on his wrist. She seemed to feel something, and went back to pumping the bag, which continued to fall apart. This all happened in front of a rapt, concerned group of freedivers in disbelief. Johnny was appalled at the resuscitation effort. “It was like watching a bad movie unfold,” he said.

  “I can’t see his chest move or his stomach move,” said Daan, hoping to trigger a response from Jeschke. It wasn’t until Nick had been out of the water for thirteen minutes that he was placed on his back, the preferred position to access his airway. By then he had no pulse, and nobody involved in the rescue effort could pinpoint when his heart had stopped.

  “Barbara was out of her comfort zone,” said Joe. “She told me that.” Dr. Jeschke is an anesthesiologist, which means she’s an expert in airway management. If anybody should have been able to get chest rise in a patient like Nick, who was in the midst of respiratory arrest, she should have been able to do it. “She had the right medical background,” Joe added. “She was just a little bit uncomfortable we weren’t in a hospital, her normal place of work.”

  She also didn’t bring the advanced airway equipment she was comfortable using in a crisis with her to Vertical Blue from Germany. Nick was never intubated at the scene—a process that allows a doctor to funnel air through the trachea directly into a patient’s lungs. Jeschke, an anesthesiologist, should have been proficient in intubation, but because her kit was cobbled, she likely did not have the proper equipment with her on the platform. She did have an oropharyngeal airway, which elevates the tongue and makes it easier to ventilate a patient, but she didn’t use it until it was too late.

  Joe doesn’t believe any of that impacted the rescue effort. “The protocol went perfectly,” Joe said. “Clinically, it was perfect as far as how I’ve been trained. Yeah the mask fell off and bits and pieces went wrong because the kit was shit, but overall it went exactly how we trained it. It felt good because it showed that our training worked.”

  Joe Knight runs popular waterman courses—a blend of water safety and freediving—in his native Australia and internationally. He hasn’t been a paramedic in the field since 2010, but he was hands on, and is convinced he felt a pulse and saw chest rise throughout the first thirteen minutes. He also contends that he and Jeschke established an airway. Unfortunately, the video tells another story.

  “The rescue was completely botched on so many levels,” said Kerry. “It’s painful to watch.”

  “This physician did not do a very good job of maintaining his airway,” said John Shedd. “She was having problems with the bag valve mask, she was confused, there were times when oxygen was not connected. You can’t get adequate vital signs with his wetsuit on. It was one fuck-up after another.”

  Unlike Kerry and John Shedd, Larry Stock, fifty-two, is not a freediver, but he has been an emergency room physician for twenty-five years. He’s on the board of the American College of Emergency Physicians and teaches emergency medicine at UCLA medical school. He has also delivered emergency care in remote locations, ranging from the war zones and displaced people camps in Eastern Myanmar to the aftermath of earthquakes in mountainous Pakistan to the Ebola wards of Liberia. He watched the video twice, and though he qualified his opinion through the lens of hindsight bias—a measurable factor which implies that knowing the outcome can color a doctor’s opinion of how a medical mortality was handled—he felt that from the moment Nick was on the surface, precious little went right.

  “Immediately after surfacing, any experienced emergency physician should see that this guy’s in serious life-threatening trouble, and that he is going to stop breathing and go into full cardiopulmonary arrest very soon. He’s awake but he’s not alert,” said Stock, who like Kerry and Shedd, said he would have shown up with his own medical kit. “The best time to resuscitate someone is before they arrest, because once they arrest, their body starts shutting down and goes into something called metabolic acidosis. Acid starts building up in their blood, and the heart gets irritable, and it’s a downward spiral. It gets harder and harder the longer they’re in arrest to resuscitate them.”

  Stock believed Jeschke should have read the signs and stripped Nick’s wetsuit right away. He also agreed with Kerry and Shedd that Jeschke never established an airway or got an adequate seal with the mask, that Nick should have been placed on his back, and that neither Joe nor Jeschke checked the pulse correctly or frequently enough. “I didn’t see a lot of pulse checks going on. To me it looked as though he could have lost his pulse long before they began CPR; it’s possible at least.”

  Joe Knight and Grant Graves, the lead judge that day, have been supportive of Dr. Jeschke’s efforts, as have officials within AIDA. When confronted with criticism, they’ve responded that most of it was coming from Monday morning quarterbacks who weren’t at the scene.

  Most, but not all. Marco Consentino couldn’t sleep for four nights after Nick died. “If proper emergency management had been given to him, Nick would still be alive,” he said. “I will always think his life could have been saved. [Jeschke] was completely in panic. She was unprepared for this kind of emergency.”

  Ren has since learned proper advanced cardiac life support protocols and is also upset at how Nick’s case was handled. “[Jeschke] was an anesthesiologist, which is what you want,” Ren said. “They are trained in airways, the first thing in the ABCs. Airway, breathing, circulation. You establish an airway, then you establish breathing, then you establish circulation. She didn’t do that.”

  Fifteen minutes and thirty seconds after Nick surfaced in distress, Jeschke finally got her team organized. She and Joe operated the bag valve mask, and Ren began chest compressions. As Will swam toward the platform to help, Jeschke prepared and administered three shots of epinephrine, or adrenaline, which might have jump-started his heart if given immediately after it stopped. They had no effect, which suggests that his heart had sto
pped beating minutes earlier.

  When Ren, Jeschke, and Joe finally moved Nick from the platform to the beach, over twenty minutes after he’d surfaced, there was a pause in CPR. Not long, but enough to snuff out any hope he had left. Ren and the others kept up with chest compressions anyway. They refused to give up as Will drove over sixty miles an hour along Long Island’s ribbon road toward Vid Simms Memorial Health Clinic. According to Dr. Yvette Carter, the attending physician, once Nick arrived at the clinic, Jeschke intubated and ventilated him and there was chest rise without any need to drain his lungs. By then, of course, it was much too late.

  “When he came in there was no pulse. We worked on him a long time,” Carter said. “Nobody wanted to give up. People were sobbing, people were praying.”

  There is no doubt that mistakes were made during resuscitation, but in the aftermath of the event, AIDA’s position was that no matter Jeschke’s faults, there was no saving Nick. His lungs, they said, were beyond repair. Kerry was never comfortable with that theory, and she didn’t believe pulmonary edema told the whole story.

  If his lungs were so filled with fluid, why was Jeschke able to get chest rise once he was at the clinic? If pulmonary edema killed him, why wasn’t there more blood in the water? Nick hadn’t regurgitated that much blood. There had to be a better answer. She and Dr. Gilliland found it as they continued to examine Nick’s heart and lungs.