U.S. NAVAL HOSPITAL

Decompression and escape from a crippled submarine sequestered on the sea bottom was mandatory training and if you didn’t pass this you washed out of the submarine service. “Unless you are a medical officer,” The instructor pointed out. The washout doctrine applied only to the line crew. Shit.

For this training we had to go into a hyperbaric pressure chamber which was 2-3 atmospheres pressure higher than sea level. The chamber was a blue rounded giant caterpillar-shaped tank with tiny round windows at the bottom of a several-story silo. The silo was filled with water. I entered the chamber in my Navy issue swimsuit. The instructions were simple. After pressurization we entered the water chamber and had to slowly ascend to four 25-foot stations in the silo. There was an instructor at each 25-foot level wearing an aqua lung which had a separate facemask and mouthpiece for us as we reachedthat level. It looked so close. I took in several breaths from an offered mouthpiece and mask at my baseline position and ascended. The closeness of the 25-foot station was an illusion. I thought my chest was going to burst. I needed air! I grabbed the air supply hungrily when I got there and after 10-minutes I calmed down and after more breathing the instructor pointed up with his index finger. I had to do this for three more 25-foot levels.

I made it to the top of the silo where I remained for more decompression time in an air chamber. There were two other successful candidates inwardly thanking God for their survival and outwardly voicing weird statements.

“Great wasn’t it?” One new prospective sub officer said.

“Yeah, we can survive anything in the boomers,” The other agreed.

“You two need psychiatric help,” I offered and they looked at me like I was the weird one.

They left and LaStrada surfaced. He looked awful. He was having trouble breathing. He could barely talk.

“Something…wrong…I…can’t…inhale.” His lips were dark.

“Hey, doc, you better look at LaStrada.” The Chief Petty Officer gave LaStrada a mask from an oxygen tank which was labeled “for emergency only”.

I examined LaStrada. His ribs were retracting with each breath and his Adam’s apple would “catch” as his belly bulged outward with diaphragmatic efforts to inhale. I percussed his chest wall with my hands listening for the hollow sound of air. LaStrada’s right chest was dull. “Chief we have to get him to the ER at New London right now. He has a collapsed lung. We don’t have much time.”

The Chief Petty Officer reacted immediately. He hit the red emergency alarm button and in one minute we were speeding to the Naval Hospital in the standby fire truck with the oxygen mask on LaStrada’s face. He couldn’t talk now and was barely responsive. I used the truck radio to talk to the ER doc. “We need to insert a chest tube stat–upon my arrival. This is Dr. Glassman–sub medical officer.”

The ER doc had the tray ready and we both worked fast. He washed LaStrada’s chest wall with betadine in one swipe and I injected the Xylocaine anesthetic below the space I wanted the tube to go. I pushed the hemostat attached to the clear plastic tube right through the stab wound I made above the rib. The other end of the tubing went into a bottle one quarter filled with saline and began bubbling immediately. The ER doc turned on the vacuum and more bubbling was followed by an occasional air bolus as LaStrada’s lung re-expanded. His color turned pink almost immediately. LaStrada opened his eyes and looked around. I was still in my swimsuit.

“What the hell happened? My chest hurts.” He looked at his chest and me suturing the tube to the bandage dressing. An x-ray tech arrived and took the chest x-ray at bedside.

“Lama it’s okay. X-ray will tell the story but I think you ruptured a congenital bleb in your right lung during the ascent in the silo. You were born with some cysts in your lungs which burst when they expanded as the outside pressure of the silo decreased.”

Tears formed and LaStrada grabbed my hand. “This means I wash out of sub school, doesn’t it?”

The x-ray tech came back and slapped the film on the view box. “Congenital blebs. Submarines weren’t meant to be for you my friend.” I squeezed his hand. He wanted to be a submarine line officer as much as I didn’t.