A “shallow water blackout” is a silent killer

In Jacksonville, Florida, a 50-year-old woman was found at the bottom of her backyard swimming pool. She was an experienced scuba diver who “often stayed at the bottom of the 9-foot deep end without oxygen to increase [her] lung capacity for future dives.”

Despite receiving CPR from her son, she could not be revived.

The Associated Press story about this tragic incident did not explain why a swimmer with her background drowned.

It appears to be a classic case of “shallow water blackout.” This phenomenon occurs when people hyperventilate before diving.

An increasing level of carbon dioxide (CO2) is what triggers the urge to breathe. Hyperventilating causes hypocapnia, a reduced amount of CO2 in the blood. If a swimmer uses up enough oxygen to pass out before the CO2 trigger point for breathing is reached, drowning will occur without notice. Victims are usually found at the bottom of the pool.

Here’s what it looks like in a diagram from Wikipedia:

A physician who lost her son to this little-known phenomenon started a websiteto heighten awareness of the problem. The site contains more information and stories about other drownings caused by shallow water blackouts.

Here is a video of a woman swimming laps of a pool underwater. Advance to the 0:50 point and watch what happens as she begins to slow down. [Addendum 8/13/15 12:50 pm: Warning. The video is graphic. It shows the unconscious swimmer being pulled from the water.]
 

A shallow water blackout may have been responsible for the death of Natalia Molchanova, the world’s foremost freediver, who went missing a few days ago.

Hyperventilating prior to diving is not recommended. Tell your friends.

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Another Caribbean med school graduate needs advice

I did not attend St. Georges, Ross, or Saba. I chose my school because it has a premed program which leads to an MD program. My USMLE Scores on Step 1 and Step 2 CK are above 230.

I did not apply for the 2015 match because I did not have my step 2 CK results until November. It would have been too late. I could have rushed my step 2 but I wanted to get a good score and be a solid applicant. Also I would not have been able to complete my surgical electives in time to get letters of recommendation. At some point, I will be doing research at [a very well-known medical school]. I felt that for these reasons this would make me a better applicant the next year.

Since graduating I have been trying to find a medical related job (scribe) but have had no success. I have reached out to many institutions regarding research opportunities but have come up dry. I may be able to secure a volunteer research position by next month. Do you have any suggestions for me? I knew I would hate being out of the medical field for this long but this was my best bet. Does this gap hurt my chances?

I am concerned that despite your excellent USMLE scores, taking a year off from clinical medicine may cause your application to be rejected immediately. I do not know if a 9 week research elective, even at a premier med school, would be enough to offset your lack of clinical experience over the entire year. Acting as a scribe would not be considered clinical experience.

Another issue is what is the record of your school regarding matching graduates into surgical programs? Since you didn’t tell me your school’s name, I cannot give you any insight into that situation. Even if I did know the school’s name, it may not have published its match results.

To answer your specific questions:

How many gen surg programs should I apply to? I was thinking ~100. That seems reasonable. You should be able to gauge your chances better after you see if you receive any offers for interviews from the 100 programs.

During a gen surg interview, should I be open about my backup specialty? I would advise you to say that you would take a preliminary spot in general surgery if you didn’t match in a categorical position. Admitting that you would do internal medicine is often seen as a lack of commitment to surgery.

Most hospitals I am looking to apply are IMG friendly. Which means the surgery and medicine programs are both IMG friendly. Would it be a bad idea to apply to different specialties at the same hospital? I think it would be a bad idea. I suggest you wait and see if you get interviews from the general surgery programs. If you don’t, then there would be no problem applying to internal medicine at the same place. I doubt very much that the two services would talk about any specific applicants. Most surgery programs get hundreds of applications and those applicants who are not offered interviews are not remembered.

Some readers may have other opinions. I hope they will comment.

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