So nearly a disasterBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6935.1047 (Published 16 April 1994) Cite this as: BMJ 1994;308:1047
- T R Wiggin
My African houseboy, Linus, and I were due some annual leave, and what better place to go than the number one tourist spot in Cameroon - Kribi- “on-sea.” My sister in law had thoughtfully sent us both new swimming trunks so that we would be well dressed for the beach, and we had been practising for the rigours of the ocean by swimming regularly in the numerous rivers that flow through the hills and grasslands of the north west province, where we work.
Kribi was all we had heard it to be. Hot sun, cool breezes, golden sands, swaying palm trees, tarred roads to get there - a complete difference from the quagmire tracks we were used to. It did not take us long to find our digs and get down to the beach for Linus's first Atlantic swim.
The beach was packed with local people, enjoying cooling off after a busy day at the Kribi harbour and market, making for a tremendous community atmosphere with all the laughing and shouting, splashing and other tomfoolery that goes with the seaside. The sea was perfect: waves just strong enough to ride in up the beach, but never too high, and with no undercurrent to pull you down. Linus stuck to our rule of always keeping the water lower than his chest.
So went the first two days of our holiday. Swimming, relaxing, and investigating the many rock pools; all great fun. Day three should have been the same. It was certainly proving to be, except that the waves were stronger. I began to feel tired much earlier than before and after a decade of being on insulin I knew that it was time for a carbohydrate top up and went scrambling up the beach to find the beach bag and biscuits.
It was while I was groping in the bag that I first noticed that Linus was in trouble; his head and arms more often under the water than on top. I dropped the bag and belted back into the sea towards him.
My hypoglycaemia had not been corrected, however, and I could feel the usual warning signs; clarity of thought was becoming more and more difficult. So many questions flashed through my mind: “Why on earth didn't you have something to eat? What are you going to do when you reach him? How are you going to rescue him in your state?” Clear answers became annoyingly obscure as my glucose level dropped. Bizarre thoughts would loom through this fog of confusion - of different types of biscuits, like custard creams and chocolate chip cookies, and how much more tasty they were compared with the local brand. I have tried ordering a request for an urgent computed tomogram by telephone, taken colleagues by car to run the Boston half marathon, and done a manual placental removal on the labour ward while being hypoglycaemic, but I had never attempted a sea rescue. I vaguely remembered life saving instructions at secondary school being driven into us by a formidable, 700 kg instructor called Irene: “Orlways approach ‘em from be'ind, ‘else they'll pull ye' unda, an' knock ‘em unconscious if they ‘aint aready!”
By now I was within feet of Linus who was wide eyed and gagging. “I can't possibly hit my boy,” I remembered thinking, and just as Irene foretold he did pull me under and then pushed me still further as he climbed on top of me. We weren't all that far out of our depth, only a metre or so, but the swell was like one of those fairground rides that throw you back and forth in your car while gyrating you round and round. The added thrill for our ride was being submerged most of this time.
Having managed to push Linus off me, I surfaced for a breather that was not nearly long enough. Linus disappeared with the next swell and I was forced to go under again and this time to lift him up by the trunks and attempt to push him forward while standing on the seafloor.
So we continued in this strange fashion towards the shore; each of us alternately coming up for air, then submerging. Frustratingly, the swell seemed to thwart our efforts and I was rapidly losing what little strength I had. I could feel that Linus's body was getting more and more limp, his head now always under whenever I came up. I tried calling to the shore for help in a mixture of pidgin English and O level French but from its effect I am sure that what came out was the rubbish talk of hypoglycaemia and desperation.
“We're losing it,” I thought as I went down again, totally exhausted and maddeningly confused. “We've had it - we're drowning good and proper. I just can't, can't do anymore. This really is it.”
Then suddenly the ground seemed to come up and greet my feet with a thud and I found me head was above water. I felt Linus's body move in front of me as he started to stumble to the shore. What an immense sense of relief came over me. Not that I had any energy to do anything else, I was content to let the waves carry me ashore to join Linus, now collapsed in a heap a little further up, both of us like Robinson Crusoes, lying in the sand, bathed in surf, vomit, and, embarrassingly, uncontrollable diarrhoea. All that I distinctly remember is how nice the afternoon sun felt.
We must have lain there for some time. The locals had congregated around the pathetic sight and were discussing if they should take us to the local government run hospital. Having been working in a mission hospital and seen the government alternative, I knew that we would be in trouble medically and financially if they succeeded. I managed to get someone to get a taxi, to drag us off the beach, and dump us in it, and then drive back to our digs and bring us the universal panacea, hot sweet tea.
A happy ending indeed, I feel. Could we have avoided this near disaster? Could anyone have predicted that swell at that particular hour on that day? I did try to correct my hypoglycaemia as soon as I felt the warning symptoms, though perhaps I should have taken more food beforehand. I think we were just unlucky - fatally so, had things been different. The Almighty truly is omnipotent.
What did impress me apart from the emetic and laxative effects of saline and adrenaline were the rigours and generalised myarthralgia that we both experienced afterwards. So much so that being in an endemic area I nearly convinced myself that we had chloroquine resistant malaria and was ready to start quinine if only we could have stopped vomiting.
Would we go to the seaside again? Undoubtedly so. Linus got over the incident far better than I did - hence my need to relive the experience on paper. He was content to show off his new skill. He touch typed the copy of this personal view.