test

Orchard Beach. Pia, who was head lifeguard at the

time, was the first to show that real-world drowning

victims—unlike actors pretending to drown in

Hollywood films—don’t flail, scream, or otherwise

sink after a violent, dramatic struggle.

Instead, he says, you exhibit what he’s named the

“instinctive drowning response.” This set of involuntary

behaviors is controlled by your autonomic

nervous system. They’re behaviors as innate as the

reflex to jerk your hand from a hot stove. Among

other actions, your arms involuntarily extend out

from your sides and your hands press downward in

an instinctive attempt to keep your mouth above

the surface. Simultaneously, your torso becomes

vertical in the water, your legs stop kicking, and

you lose all ability to shout or even speak.

As a result, your final moments before submerging

are silent and unspectacular. “It’s not uncommon

for drowning people to be surrounded by

people close by who have no idea a drowning is

even taking place,” says Pia.

Regardless of how unremarkable the process

appears to others, once the instinctive drowning

response kicks in, you’ve become so exhausted that

you have only 20 to 60 seconds more before sinking.

Barring miraculous retrieval from the depths,

submersion then sets off a physiological death spiral

that follows its own inevitable course.

ASSUMING YOU’RE STILL CONSCIOUS WHEN YOU

go under, your first reaction will be “voluntary

apnea”—holding your breath as long as you can.

Eventually, rising carbon dioxide levels in your

blood will bring you to the breath-hold breaking

point, when the urge to breathe becomes too irresistible

to ignore. It doesn’t matter if you’re under

water when this point is reached: Nothing you do

will stop you from inhaling. Researchers call this

the “terminal gasp.”

“When water comes down the airway,” says

Dr. Steinman, “your body will try to defend itself

by slamming your vocal cords shut to keep water

out of your lungs. A few revived victims even say

they can remember the unpleasantness of trying

to breathe against closed vocal cords.”

Eventually, oxygen levels plummet so low that

you lose consciousness and the laryngeal spasm

finally breaks. If you’re still alive at this point—

and most victims are—nothing remains to prevent

inhaled water from flooding your lungs. Regardless

of whether this is fresh water or salt water,

this incursion wreaks havoc with the tiny breathing

sacs, called alveoli, where oxygen enters your

blood and CO2 leaves it.

“Alveoli look like microscopic grapes,” explains

Dr. Steinman. Each one is coated by a special fatand-

protein substance called surfactant, which

works like the soap in soap bubbles to keep the

air sacs open. Fresh water, alas, renders the surfactant

ineffective, and salt water washes it away.

The net result is the same—multiple alveoli end

up collapsing, making them unable to infuse your

blood with oxygen. Water in the lungs also damages

the mesh of capillaries surrounding the alveoli,

causing them to leak. Viscous protein-laden

blood plasma leaves the bloodstream and enters

the lungs, further reducing the amount of viable

lung tissue remaining.

If a victim is rescued in time, the one-two punch

of collapsed alveoli and fluid buildup make resuscitation

challenging at best. “The combination

creates a severe hypoxia condition that has to be

corrected,” says Dr. Steinman. “You have to use

suction to remove the pulmonary edema fluid

and just hope there are still enough noncollapsed

alveoli remaining for the victim to absorb oxygen.”

Few lung-flooded victims, however, survive long

enough to face such a dilemma. Unless the person

is pulled from the water quickly, oxygen deprivation

will lead to brain death. That can take as little

as six minutes in a warm swimming pool, but

in chillier bodies of water, thanks to the ability of

the cold to preserve the viability of the brain and

other organs, that window can extend up to an hour.

WORLDWIDE, A TINY NUMBER OF VICTIMS HAVE

almost drowned in very cold water and later been

brought back to life—even after a half hour or longer

without air—all thanks to hypothermia’s ability

to place the heart and brain into suspended animation.

Such “miraculous” cases make headlines. Less

newsworthy is a more common and tragic flip-side

phenomenon: The nearly drowned man who rises

from the dead and appears saved, only to die up to

three days after successful resuscitation.

This bizarre scenario used to be called “secondary

drowning,” though researchers have recently

rejected the term as misleading. The actual cause

of death is pulmonary edema—fluid buildup in the

lungs—initiated by lung injury incurred in the water.

Even the purest water is damaging to lung tissues.

When you factor in the bacteria, vomit, dirt, and pollutants

that drowning victims so often inhale along

with water, the damage can prove insurmountable.

Early in his career, Dr. Lundgren received a call

from a local hospital about a despondent young

man who had tried to drown himself. The docs

managed to revive him but decided to keep him

overnight for observation. At first he seemed to

be moving toward full recovery. But over the next

several hours, his lungs began filling up with sticky

fluid and he slipped into a coma.

“They’d done everything in the book,” Dr. Lundgren

recalls about heroic attempts to clear his lungs

and bring him out of the coma. Nothing worked.

“They asked if they could bring him to our hyperbaric

chamber as a last attempt to save his life.”

Dr. Lundgren quickly agreed. Hyperbaric oxygen

treatment, which is used to treat decompression

sickness in divers, increases the atmospheric

pressure surrounding a patient’s body, effectively

forcing extra oxygen out of a patient’s lungs and into

the bloodstream. Dr. Lundgren hoped this could

buy the young man enough time to allow his damaged

lungs to heal.

The technique worked, at least initially. “He woke

up inside our chamber,” Dr. Lundgren recalls, “and

was even able to communicate with us a little. But

then he developed a pulmonary edema and he slid

back into the coma. We inched up the oxygen pressure,

and he briefly woke once again. We tried raising

it a little more, but this time he didn’t respond.”

Today, Dr. Lundgren says, a heart-lung bypass

machine might have saved him, but that technol ogy

was not yet available. The young man drowned after

all—not by the seawater into which he’d thrown

himself, but by an unstoppable accumulation of

fluid produced by his own body.

WHEN A POLICE BOAT FINALLY REACHED PLAYA

Tortuga, the pilot plucked one of the would-be rescuers

out of the ocean. Then he tried to coax Brian

Simmons aboard as well. Simmons declined, determined

to keep searching. For a while, the rescue

craft puttered in circles in search of the missing

student. Finding no signs, the pilot headed back.

Exhausted and distraught, Simmons clung to

his boogie board, remembering how many times

he’d swum—alone and without any flotation—in

these same waters, oblivious to danger. It occurred

to him he’d never meet the stranger he’d tried so

hard to save, a young man who, like himself, had

come here for adventure and a chance to make a

difference in the lives of others.

When Simmons realized the search was hopeless,

he was nearly a quarter of a mile offshore. The

water was now so rough and churned with currents

that it took him 40 minutes to swim back in.

It was another several hours before authorities

notified Ros Thackurdeen about her son’s disappearance.

She and her husband, along with her

daughter and other son, caught the first flight to

Costa Rica and arrived the following day. “We immediately

joined the search,” Ros says, her voice breaking

in grief two years later. Neither this search nor

a second attempt that night found any trace of Ravi.

Then, on Tuesday afternoon, 52 hours after

Thackurdeen disappeared, a fisherman reported

spotting a body on a beach several hours away. His

parents made the identification. “This was an ordeal

nobody should ever have to go through,” Ros says.

FOR PEOPLE WHO LOVE THE WATER, FEW ASPECTS

of life rival the pleasures of a summer swim. But it’s

also true that few can turn lethal so quickly, pitching

us into mortal jeopardy that we can’t always escape

on our own. The solutions seem so obvious: Always

swim in guarded waters; wear a life jacket on boats

in cold water; learn to recognize and avoid the conditions

that have already drowned so many of our

brothers. Perhaps most of all, says lifeguard Wise,

we need more respect for the water’s power—and a

little less for our own. “As men,” he says, “we need

to know our limitations.” J