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Ed Deery's Survival Story
To SeaKayaker Magazine, from Ed Deery

I was attending [advanced kayak] training early last spring at the tip of Washington’s Olympic peninsula.
 
Shortly before we launched, I felt a burning sensation in my lungs like I get when I’m going to come down with bronchitis. That feeling went away, and we got on the water and spent about an hour practicing in the surf before setting a course for our lunch spot.
 
I felt fine generally, but was getting cold despite the many layers of insulation under my drysuit that should have kept me almost too warm in the existing conditions. Then my arms suddenly got so weak that I could barely hold the paddle off the deck. Next, my equilibrium failed me.
 
I told one of the instructors that I was struggling. They thought I was hypothermic and seasick. This made sense to me; I’ve experienced the former but not the latter, so wasn’t sure what it feels like.
 
When we hauled out for lunch, I didn’t get better, and was very short of breath. More about this event.
 
I could tell that everyone was worried about me. They put me in a rafted tow to get me to the nearest access point, then drove me to the clinic in the closest town. More about the Evacuation.
 
The doctor there gave me the official bad news that I was having a heart attack, then called a helicopter to take me to the hospital in the big city.
 
There are several morals to this story.

The Event
So, what does a typical heart attack feel like?  I can’t tell you, because mine was apparently quite atypical.  I don’t know if this is because heart attacks are an individual thing, or if my presentation relates to my good athletic condition.
 
I woke up on the morning of the trip with a sense of anxiety.  This is not an emotion I usually experience, but I attributed it to the importance of the class to me and to the prospect of pushing my envelope.  I decided to skip my usual morning cup of tea.
 
The first hint I had that I was getting sick was a slight feeling of congestion in my trachea – exactly the sensation I get when I’m starting to come down with a bad cough and a fever.  “Just what I need”, I thought, “I hope I can paddle tomorrow.”  The sensation went away.
 
By the time we were preparing to launch, it had been hours since breakfast.  I didn’t want to bonk, so I ate one of the bite-size candy bars I keep in my PFD pocket because of my tendency to bonk. (Bonk is the cyclist’s term for exercise-induced blood sugar depletion.)
 
We launched and did a practice drill going in and out through the surf (if you can refer to gently-spilling two-foot waves as surf), then gathered together to start the first leg of the course we had plotted.  I was feeling a little bonked, so I had another bite of candy. My body temperature felt comfortable.  In retrospect, this should have been a red flag.  Given the conditions and the clothing I had on, I would normally be so warm that I would need to Eskimo roll to cool off.  “It’s a good thing I wore all my layers," I thought.
 
Before launching, we had stored our charts in our cockpits so that they wouldn’t get washed off our decks in the surf.  We undid our spray skirts, put the charts under our deck bungees, and reattached our spray skirts.  Shortly after that, one of the guides noticed that I didn’t have one side of my spray skirt all the way over the coaming.  “That was sloppy of me”, I thought, “I’ll have to double check that in the future.”
 
We paddled 25 minutes on the first leg of the course.  I had no difficulty keeping up with the group.  I was alert, watching the others and counting them periodically as I habitually do when I am leading a trip.
 
We turned and began the second leg of the course.  I was definitely feeling bonked, so I ate another piece of candy, clumsily letting the wrapper escape my fingers instead of tucking it back into my pocket as I usually do.  I was feeling cold.  “I should put on my gloves when we stop for lunch," I thought.
 
My paddle stroke was getting weaker and I wasn’t keeping up with the group. Something was definitely wrong.  I was more exhausted after an hour on the water than I usually am after a full day of energetic paddling. I paddled over to the nearest guide (one I hadn’t paddled with before) and told him I was really struggling.
 
“What do you mean?”, he asked. “I can’t keep up the pace”, I said.  He started giving me advice on my paddle stroke.  After watching me for awhile, he asked me if I had any water.  I told him I did.  He helped me get it out of my day hatch (we had been told not to keep any gear on our decks) and I drank some.  Then he paddled off and another guide appeared. 
 
By this time, all the strength was gone from my arms and shoulders. I would take a few weak strokes, then my arms would fall to my lap.  (For comparison, I normally get tired uniformly from my arms down through my torso and into my upper legs.)  My field of vision was narrowing and my equilibrium was deteriorating.  Instead of my usual instinctive edging into the waves, my hips jerked from one side to the other.

  The conditions had intensified somewhat.  We were now exposed to two to three foot swells refracting around the rocks in the water. 
 
The group was playing in the surge against and through the rocks – something I would have loved to do – but I stayed on the protected side of the rocks to conserve my strength.
 
The guide thought I might be getting seasick.  I thought this was a possibility since, while I have extensive experience in whitewater, wind waves, and even some in the surf, I have essentially none in ocean swell. All these environments have different rhythms, so I couldn’t rule out seasickness just because I haven’t experienced it before.  However, I had no sensation of queasiness.
We got to our lunch spot in about another 15 minutes. Usually I leap out with my boat still afloat, throw my boat up on one shoulder, and carry it up the beach.  This time, I grounded it and dragged it up on the sand without even trying to lift it.  I pulled out a warmer hat and put it on.  I took my lunch and thermos and sat heavily down a driftwood log.  I drank a few capfuls of tea and ate a couple of cookies, but I had no appetite.
 
One of the guides brought a large, vapor barrier pullover and put it on me.  After a few minutes, I was so claustrophobic that I had to get out of it.  I felt short of breath, and it took a conscious effort to breathe.
 
One of the group members, who happened to be an EMT, sat down observantly in front of me and started asking medical questions:
 
“Can I take your pulse?  Hmmm, it feels a little thready. Do you have any pain in your chest?  On a scale of 1 to 10, how intense is it?”
 
"Maybe a 2.”
 
“Do you have a pain radiating from your chest into your arms?”
 
"It feels like I have a tight muscle in my upper arms, but it’s along the bone where there isn’t any muscle.”
 
“Do you feel like you have a weight on your chest?”
 
"Yes, that’s a good description.”
 
While the pattern is evident in retrospect, it was certainly not obvious at the time .  Until we hauled out for lunch and I experienced intensifying symptoms instead of a quick recovery, the symptoms were such that they could easily be confused, by both subject and observer, with afflictions common to the setting.  Furthermore, anyone not well familiar with my paddling strengths and limitations would not have had any benchmark for comparing how well I was doing with how well I should have been doing.
 
I got the subliminal impression from every one of the countless people who asked me medical questions that “2” was not the right answer to their question of how intense the pain was on a 1 – 10 scale.  “8” would have been acceptable, and I would have gotten a gold star for “11”.  I think someone even called me a stoic.  As I speculated at the start of this article, I don’t know if heart attacks are just individual in their presentation, or if the typical symptoms relate to this physical condition of the typical victim.  Could it be that other athletes would experience it more like I did?
 
In summary, the symptoms were:
  • Initial, temporary chest pain
  • Sense of overall weakness
  • Obvious weakness in arms and shoulders
  • Symptoms of oxygen deprivation: narrowing of vision; poor coordination; poor equilibrium
  •  Tightness under sternum, giving a sensation of weight on the chest
  • Mild, dull pain (more accurately described as discomfort) radiating from chest into upper arms
  • Discomfort in blood vessels of upper arms
The key indicators least readily mistakable for symptoms of hypoglycemia, hypothermia, or motion sickness were:
  • Tightness in chest
  • Discomfort in blood vessels of upper arms
  • Failure to recover after getting off the water

The Evacuation
 
I saw the two lead guides walking shoulder-to-shoulder away from me, talking quietly. I knew they were talking about me. A minute or two later, they came back. “We have to take this seriously,” they announced.
 
“I understand," I said.
 
They gave me an aspirin and told me to chew it. At that moment, I knew the diagnosis was a heart attack.
 
They sent their assistant guide back to the put-in to bring a car to the access point nearest to our location. In one smooth motion, he slid his boat into the water with his body on the back deck, then dropped his legs into the cockpit and vanished.
 
They got my boat pointed away from the beach at the water’s edge, then had me get in and attach my spray skirt. The beach where we had stopped for lunch was sheltered from the surf, so this was not a factor in launching. One guide shoved me off, while another waited in the water a short distance away. I was given a short tow to where a towing team was already staged. Two kayaks were set up for an in-line tow, while a third was rafted up with me, gripping my cockpit coaming for stability. One of the towers was the individual who I had learned earlier was an EMT.
 
While being towed, my raft partner started asking me questions that seemed out of character for a medical layperson. When I asked him if he was a medical professional, he replied that he was an anesthesiologist.
 
The beach where the car was to meet us was exposed to the one-and-a-half or two feet of surf. Outside the surf zone, one of the towing boats was disconnected. One of the guides then connected his towline to my stern to set up a retard tow. He called the shots as we went in through the surf, telling the lead boat when to back paddle so as not to get surfed ahead by an incoming wave. He also would back paddle when a wave came through. One of the larger waves partially turned my raft partner and me sideways to the surf, with my partner up-wave from myself. I reflexively edged my boat into the wave, which then passed under us.
 
The car arrived a few minutes after we did. They carried my boat up to it. When I tried to carry some of my gear, one of the group members said, “I’m a nurse. You shouldn’t be exerting yourself.” I then noticed that the people at the vehicle with me were all either guides or medical professionals, the rest of the group remaining down on the beach. I concluded that this was the result of a conscious group management effort, to keep the medical people close while preventing the other well-wishers from crowding around.
 
One of the guides drove me to the clinic in Neah Bay, a few miles away. The doctor there, as soon as he saw the EKG, started calling to arrange for an air ambulance to take me to Seattle. When someone asked him about this, he said that the nearest hospital was two hours away by road and wouldn’t have the capability of dealing with my situation.

The Morals to This Story
  • Healthy people can have heart attacks. (Everyone who knows me has informally nominated me for the honor of least likely to have a heart attack.)
  • The conventional wisdom about how to recognize a heart attack isn’t very useful.
  • I could have bought a new car for what the helicopter ride cost. Fortunately, my insurance covered it. You should check to see if your insurance does. If it doesn’t, and your adventures take you to remote locations, give serious consideration to buying a life flight policy.
  • Everyone has the right – and the responsibility – to make thoughtful, informed decisions about his or her medical care. You owe it to yourself and your love ones to obtain a Physician’s Orders for Life-Sustaining Treatment (POLST ). An advanced directive is not sufficient.