Nelly

I am including here, the piece I wrote on Nelly as I worked through her death in counseling. The idea of this piece was to include as many sensory details as I could. How I felt. What I was thinking. Things like that. I have excluded a few parts of the story as I want to make sure if her family was to read anything on my blog, it would not upset them. Those excluded parts are marked with .....

I'm including this story now, and then, in the days to come, I plan to talk about what writing this helped me see about this situation and life in general. Much of this may be redundant to what I have already written on the blog about this situation, but again, this was an "assignment" and I wasn't avoiding redundancy. I totally understand if this is not of interest to many of you.

I love to write. I adore it. Why then am I having such trouble figuring how to write this time?

I suppose I should just jump in and start from the beginning. It’s just that I am just not sure where the beginning is.

I guess the beginning would be my first memory of Nelly. My first memory of Nelly was on the first day of diving. It was a Wednesday, November 4, 2009.

We were on the “newbie” boat. The boat for diving novices. My husband was on the boat with us even though he was not a novice. He used to dive when he was a teenager but had gone back to the beginning with me so that we could do the whole process together. That included dive classes and training and now, our first “real” dives.

So Nelly. I remember Nelly on that first day. We were on the boat, and I noticed that she was talking Spanish with our dive instructor, Martin. Since we were in Cozumel, Spanish was not abnormal. But it was abnormal from someone in our group. “We” were a group of individuals attending a Wilderness Medical Society (WMS) conference in Cozumel on dive and travel medicine. I wasn’t associated with medicine in any way. But my husband was. He is a family medicine physician with the U.S. Air Force.

I remember immediately noting how easily she shifted from Spanish to English. ..... I remember noting that she had a hearty laugh and a big smile. She was a bit soft-spoken but friendly and kind. She looked like a woman with a good heart, a sweet spirit, and a gentle nature. Later she would begin talking about her children, and I asked her how many she had. “Two boys,” she told me.

There were approximately 14 divers in addition to the boat captain, a few deck hands, and two dive instructors. Simply based on where we were seated on the boat, we were divided into two dive groups. As I look back, I realized what a roll of the dice that was. The spot we sat in determined the life-altering events that would soon transpire.

Our first dive was 45 minutes away. As the boat took off, Martin walked over to us. A skinny man with a thick mustache, he pulled seven of us together. There were three couples: JB and myself, Josh and Emily (a newly married ER doctor and lawyer), and Spring and Alan (an ER doctor.)

The seventh individual was Nelly. Since she didn’t have a spouse present ..... she was paired with Martin.

Martin kneeled down in the middle of all of and said that we would be under his eye. He told us that since his English, “Was not so good,” Nelly would translate if we got confused. Many times during the next thirty minutes, we’d look to Nelly to help us with the words we were stuck on. She easily translated. We learned that she was from Puerto Rico and that Spanish was her first language. Her English, however, was nearly perfect.

That day we dove twice. The first dive was our first and there were a lot of kinks to work out, but it was breathtaking to say the least. The second dive got started late and as a result, turned into an unexpected night dive.

I remember seeing Nelly looking a little nervous before the night dive. I asked her as I prepared to jump into the water if she was okay. “I’m just a little nervous about it getting dark,” she said. I encouraged her, telling her that Martin would take care of her. She nodded. “I know he will,” she replied.

Nelly was not a good diver. She was nervous. She breathed fast. She got in our way. She had trouble with every aspect of diving. But because she was so kind, it didn’t really bother any of us. At least it didn’t bother me. We were patient with her. Martin was patient with her.

I remember that evening telling JB that I gave Nelly a lot of credit. This did not come naturally to her. She was not in the correct shape to be diving. Honestly if I were her, I would have just said this was more trouble than it was worth. But she was obviously a determined person who didn’t want to let her fear get the best of her. She was a pediatric intensive care physician so she obviously had determination.

Thursday.

It’s funny. I can vividly picture Nelly sitting in a chair next to the dock, waiting for our boat to pull up. There was a chair next to her. But sometimes I am a little hesitant in striking up conversations with new people. So I chose a chair behind her instead of taking the open one next to her.

Now, looking back, I sort of wished I had sat by her. As it was, I didn’t get to talk to her as much as I could have. I did learn that her two sons were adopted from Guatemala. I also talked to her on the boat about her bilingual skills. She told me she dreamed in both languages. People who can speak multiple languages so well, always impress me. And for that reason, Nelly impressed me.

I was walking behind Nelly as we headed to our boat. .....

Thursday was the last day Nelly would be alive. Thursday would be the day she would die.

Here is the point in the story that I want to try to use more sensory details. I want to try to share how I was feeling. This is where it gets a bit more difficult.

Dive one. Nelly was the last one in yet again. I can still see her handing her mask to Spring, asking Spring to dip it in the bucket of water at the foot of the boat so she could defog it properly.

As we began our descent, I remember being awestruck by the beauty I witnessed. It was as if we were descending into the deep end of a huge pool. It was gorgeous. But I was nervous. Where was Martin? I couldn’t find him. I saw everyone else in our dive group except Martin and Nelly. For a moment I thought maybe they had gone back to the boat. Gosh I wish they had. But there was Nelly and Martin descending. Slowly. He trying to help her stay calm so she didn’t go through so much air. She had a bigger tank this time.

We dove. I remember having to “push” Nelly out of the way a few times as she often lumbered into our line of sight. Again, I wasn’t frustrated. I respected her determination.

My last view of Nelly was under the water. She was buddy breathing with Martin because she was low on air. Later Martin would tell us that she wasn’t out of air. She was just getting panicked about the amount of air she had (700 psi which was plenty) and so he wanted her to save her air so she didn’t get too nervous.

That’s when I started floating to the surface. My tank was running low and I couldn’t stay neutrally buoyant. I fought my ascent but ultimately gave up and surfaced. My buddy, my husband, surfaced with me.

John looked off in the distance as we came up to the surface. A storm was rolling in. “Look at the sky,” he said as the waves picked up. A few more minutes passed and then Nelly surfaced.

I can vividly see her break through the surface of the water. She instantly spit out her regulator and said, “I ran out of air.” I swam over to her. She looked scared. My mind instantly returned to all the lessons we learned about helping a troubled diver in our classes. I inflated her BC vest so that she could float on the surface.

She looked scared. She looked panicked. I remember that her cheeks seemed to get more flushed with every second that passed by. I swam to her and took her hand and began stroking her arm and talking to her. I said things like, “We are here with you. We aren’t going anywhere. You are not alone. Just relax. Take it easy. It’s going to be fine. The boat is on its way. Martin will be up on the surface soon.”

The waves were getting higher. She kept getting splashed in the face. She said her vest was too tight so she took a bit of the air out. JB asked her if she wanted to put her face in the water with her snorkel so as to avoid getting hit by the waves. She said she could not do that. As she said it she shook her head violently from side to side. JB nodded and instead adjusted her body position so that the waves would hit from behind instead of head-on.

I was still calm, but I remember, with every passing minute, feeling a bit more anxious. I kept looking over my shoulder at JB. I would give him a face that said, “Is everything okay? Is she going to be all right? Is there anything else we should do.” And he would return my glance with a face that said, “It’s okay. She’s going to be fine. Keep doing what you are doing.”

I was looking to him for approval. I was looking to him for comfort. I was looking to him for guidance. I was also wondering why he wasn’t doing more. He was the doctor so if he wasn’t concerned I shouldn’t be either. My mind danced back to the times our boys have been sick. Sometimes I would worry, but John would instantly tell me that I was overreacting.

I remembered when our son Elijah was born. I can’t remember if I thought of that then or if I am just thinking of it now. I remember that Elijah came out doing very badly. I had asked JB, before his birth, to make sure that as soon as he was born, he told me that the son we waited ten years for was okay. But in the operating room, he came over to me, and behind his mask, I could only see his eyes. His eyes screamed in one split second, “I should say something comforting but I have nothing to say because things are very, very bad.”

I saw John’s face in my dreams for months to come. I began pulling at my arm restraints. They had to drug me to calm me down. I fought falling asleep the whole time.

JB wasn’t giving me that face on the water. Later he told me that he was a bit seasick. He also didn’t want to crowd someone having a panic attack.

The thing was, we were so busy dodging waves, trying to get us and Nelly above the water, that there wasn’t much time to do other things.

I wonder right now, as I write this, if Nelly would have died if that storm wouldn’t have come in. If she wouldn’t have swallowed as much water. Maybe she would have stayed more calm.

Martin came to the surface. I don’t remember how we communicated with him that something was wrong with Nelly, but we did. Somehow. He immediately swam over to her. They began conversing in Spanish. I remember wishing I could understand what they were saying. I wish now, afterwards, I would have asked Martin what they said. Later Martin told me he took off her weight belt. Later I wished I would have done that.

As Nelly and Martin conversed, she almost appeared to be desperate, terrified, panicked, and in great fear. Martin’s tone in reverse was encouraging, but he also seemed to be a little scared as well.

We saw the boat in the distance. It had completed it’s pick-up of the other dive group and was heading our way.

I kept talking to Nelly. She would nod. She would tell me okay. She would look at me out of the side of her eyes and try to provide an understanding smile.

The boat arrived. They threw us a rope. I can picture JB. He was by the ladder. The left side of the ladder. Martin was on the right side of the ladder. The other dive instructor from the other group, dove into the water. He was in front of the ladder.

It was at this point that I got scared. While Nelly was able to grab the rope, I remember that her face looked blue. Literally blue. It had been getting more and more flushed, but now it looked blue.

I remember Martin telling us as the boat came that Nelly would be getting on the boat first. I remember thinking, “Duh!” Of course she would.

As the boat pulled up, Nelly asked me to hold her hand again. We had gotten separated a bit amidst the attempt to all hold onto the rope. Emily was behind me. I remember that Emily and the other members of our dive group looked confused. They hadn’t surfaced early enough to figure out everything that was going on.

Nelly was still conscious when they got her to the ladder. I felt relief that she would soon be on the boat. I wanted so badly to get her onto the boat and feel peace. I remember feeling an incredible urgency to get her and all of us out of the water. Things would be so much better in the boat. And back on land.

Nelly made it onto the first stair of the ladder. I remember feeling that the timing of this storm was so bad. The boat was going up and down with incredible force. She tried to get to the second stair.

And then she passed out.

For some reason, in my memory, I picture her in a black swimsuit here, even though I know she was wearing her wet suit with blue trim.

I remember thinking that if Nelly were to pass out and fall in the water, she would die. That was the first moment I thought that something bad might happen. She already had her BC off. She had no way to float if she were to fall in the water. She was a heavy woman. The boat was bobbing uncontrollably.

She could not fall in the water.

My husband was with her. Martin was with her. The other dive instructor was with her. The other dive team on the boat pulled her in. The people in the water pushed her in.

And somehow they got her onto the boat. I remember thinking: They just saved her life. If she would have fallen in, she would have died.

But she was going to die anyway.

I was hanging onto the rope. Emily was next to me. I didn’t want to get into the boat until I had to. I wanted them to fix Nelly first.

But John was calling me over. He was insisting that I got into the boat before he did. Later he would tell me that he could not have focused on what might be needed in the boat until I was in the boat.

As I worked my way up the ladder, I could see Nelly lying face down. It was at that second that I heard the Navy GMO say, “So are we starting CPR?” She rolled Nelly over with Martin's help nd she began chest compressions.

I did what I knew I should have done. I sunk into the back of the boat, under the cover that would protect me from the coming rains. There were five doctors on board. They would take care of things.

JB followed me out of the water. Within five minutes, everyone was out of the water and they were in full swing of CPR. My husband was running the code. The other docs were rotating chest compressions. Martin was doing mouth-to-mouth. Alan would later intubate.

I flashed back to an episode of ER. They were doing CPR on someone. John turned to me and said, “I hope you know it isn’t like this in real life. In real life it is different. In real life, usually, when a person gets CPR, they don’t make it out alive.” He quotes some stats. Twenty percent of those who require CPR come around.

For some reason I had a feeling Nelly wouldn’t be one of them.

The only time that I was valuable during the next thirty minutes as we sped toward some unknown dock where an ambulance was supposedly waiting, was when they decided to load Nelly off of the boat. They needed all of us to line up so we could move her from the boat to the stretcher on the backboard that they had tied her to with weight belts. The boat was still rocking like crazy and it was pouring down rain. As I stood there in the rain, waiting to help Nelly cross from water to land, It was freezing. Absolutely bone-chilling.I remember wanting so badly to get warm but knowing this was a time where my own needs were as irrelevant as they possibly could be.

I asked JB later if he was cold, standing in the rain, while all of those not involved waited underneath the boat’s covering. He said he didn’t even know it had really been raining. He hadn’t been cold at all.

The ambulance took over from this point. Two of the doctors and Martin went with her to the hospital. Everyone else, including John, returned to the boat.

The other dive instructor asked us if we wanted to continue the day’s dives. Was he joking? We all shook our heads vehemently and he took a deep breath and said, “Thank you.” I was told later that the head of the outfitter had required him to ask that. That they cater to high-end clients and they wanted to make sure everyone was pleased with their service. They didn’t want to cut us short.

I thought of how absurd this was. Someone was very hurt. She may die. Or, as John told me on the ride back to our hotel, she may permanently neurologically effected by this event. Who the heck cared about diving?

The head of the WMS met us at the dock. I recognized him from a breakfast we had shared one morning earlier. He ushered us to a suite where we had a “decompression session.” JB talked he and the head of our scuba outfitter through everything that had just happened. During this, there was a call. It was from the hospital. I’m not sure who specifically. But we were told that she had a pulse and had pinked up.

Two hours later JB would wander into our room where I attempted to read on our hammock. When he said, “Hey,” to me and turned the hammock so that I was facing him, I knew what he was going to say. “So,” he said, and glanced out at the water. “So, she died.”

How did I feel at this moment? Sick. Like I was in a movie. Like this could not possibly really be happening. I realized that this would be with me for the rest of my life. I would never get this day out of my head. I didn’t cry. I was more mad.

I also wanted to know why she died. I wanted someone to tell me it was for a reason that none of us could control, no matter what we did.

But the autopsy report would later just say she drowned. Her heart looked fine. No evidence of an embolism.

She didn’t drown. I was with her. She was talking thirty seconds before she passed out.

Maybe I should write more. About meeting with her sister the next evening and recounting the events. About being asked if I could remember her having a wedding band on when I held her hand because she didn’t have one on at the hospital and they couldn’t find it in her room. About giving a police statement with John in our room and recounting the events so stoically – so matter-of-factly.

About missing my two little boys so much more than I had just a few hours earlier.

But for now, I will stop here. She died. I was the last person who talked to her. She asked me to hold her hand again. I told her, “We are here. The boat is coming. Hang on Nelly. We’ll have you on board in a second.”

And then she died.