'It keeps me up at night': Dunedin doctor on Taieri Mouth tragedy

A family outing on the water at Taieri Mouth turned to tragedy but it could have been far worse if it weren't for the heroic actions of four surfers. Doctor William Allen was one of them and tells his story.

My mother died in 2011. I was 19. I'd not seen death or CPR before, and it was quite the introduction. I vowed to surf more. It was my escape.

A family friend reassured me: "There are a few things in life you never get over, you just gotta learn to sit with them."

His words stayed with me. Working as a doctor, I have had to call upon this ageing wisdom a handful of times since.

I kept my promise, I surfed more, a lot more. Waves led me to emergency departments in Cornwall, South Africa's Eastern Cape, and now here, an intensive care unit on the South Island of New Zealand.

April 3 this year was always meant to be a defining moment since I signed up — on impulse — to the 2021 South Island Surf Champs a week prior.

My girlfriend, Michaela Jones, and I were on a warmer water exploration of the North Island and had lucked into swell in Taranaki before heading home to Dunedin for the competition. The event was to be held at St Clair, a spot I check every day from my bedroom window.

By 2pm on the day of the contest, I was nowhere near the beach. I was in the hospital's emergency department, still in my wetsuit. I had flown in with the paramedics by helicopter and a 2-year-old child was fighting for her life. I headed to the staff showers. I cranked the knob to full heat and waited for steam to encompass the cubicle. A minute later I stepped in, peeled off my wetsuit and wept.

A trip to the Mouth

Fingers of sunlight creep over the Otago peninsula a few kilometres down the beach at St Clair. I'm in the third heat at the South Island Surf Champs. I pass my girlfriend, Michaela, my warm tea and wrestle a blue rash vest over my head. The tide is full and the head-high swell smacks into the esplanade.

A wave appears. The thing jacks up and the morning sun engulfs the lip. I turn and paddle, rising to my feet in accordance with that all-too-familiar drive of energy. I commit and make the drop — just — then set my line. I feel out the wave then straighten, pointing the nose of my board to the beach. There's a slight hesitation — a quick nod to the gods — I dig my toenails into the wax and corner, making my way up towards the lip. Timing everything, perfection unobtainable.

I'm pounded straight into the sand and I have that same warm cuppa in my hands when the hooter signalling the end of the heat goes. Michaela mentions something about taking part. My pro surf career is over 15 minutes after it begins. We head back home for breakfast and exchange a few laughs at my first-round flop.

Just before midday our friend Evie Hall, a longboarder and final year medical student from Raglan, and her dog, Elfie, rock up at ours. Along with our 6'7" man-mountain of a housemate, James Welchman, also a doctor, the four of us convoy south in two vans.

Taieri Mouth is a charming little windswept fishing settlement on the banks of its namesake's river about 30km south of Dunedin.

Our two vans pull into the gravel lay-by overlooking the sandbar. We weave in between a couple of utes with their fishing rods stuck out the back like bayonets. I jump out the driver's side of the van, feel a whisper of breeze on my right cheek and fix my eyes on the oncoming waves a few hundred metres offshore. No one is out. Size is difficult to ascertain from the lay-by as the wave breaks so far offshore.

"What's that?" Evie points north, down the beach.

We all reconfigure our stares. I can hardly even make it out.

"Looks like a big chunk of white plastic, like a table or something?" I say.

Eyes better than mine identify that it's an upturned fishing vessel, like a small tinny or similar. On closer inspection, a few dark blobs are bobbing out there as well. A handful of salt-sprayed fishing folk watches on as we suit up and run down to the beach with our boards.

Evie enters the water first heading for the lone dark blob a few hundred metres from the boat, while Michaela and I make for the boat drifting slowly north still in the impact zone taking punishment. The waves are relentless. James follows up 30 seconds behind us. The water is cold. I have an icecream headache after the first few waves wash through.

We arrive to a scene of panic. The mother, alive and floating in her life jacket 10 metres from the boat, and the father, clam-shelled on to the hull of the upturned boat. He slides down. We pass them our boards and they grab hold. Dad gives a frightened look back towards the boat, and on the far side, I spot her, a girl of no more than 12. She's just surfaced along with the boat after another dunking from a shoulder-high wave.

She lets out a scream. All I can see are the whites of her eyes and the yellow of her life jacket. She is half under the boat, half out. Her face intermittently waterboarded by the waves. She is stuck. I swim over while James escorts Mum and Dad to shore.

The girl's life jacket is jammed in something on the boat's railing preventing her escape. She's in hell. Her mouth barely above the water at the mercy of the ocean, and the wretched boat keeps dragging her down. Her screams are dampened by water rushing into her mouth.

"Close your mouth. You're going to be okay. I promise. Just relax."

I hold up her head with one hand and begin tugging on her life jacket fastenings. She's tied in tight.

"Wave!" Michaela yells from about 10 metres away.

I grip the girl and railing and we brace for impact. The wave drives us down.

We surface and I try to free her.

"Wave!"

I continue fighting with the life jacket.

"Wave!"

The girl's screams stop and she goes limp. She's unconscious and not breathing. Her face drifts below the surface.

I pull her head up, open her mouth and give her a quick breath. Changing tack, I sink down just under the boat and try unclipping the buckles of her lifejacket — something I hadn't considered while her legs thrashed about.

The life jacket gives way and I pull her down towards me. Her head and arms slide out of the life jacket's grip.

"Wave!"

I lose her.

I find her just below the surface in the foamy aftermath. Michaela is already there with my board. She's been watching on, ready to rescue me if I got stuck or banged my head. A doctor and ex-lifeguard herself, she has my back.

We shimmy the girl on to the board.

Michaela takes over.

"Kick Will, I'll breathe."

I paddle from the back of the board while Michaela blows air into the supine girl's wet lungs.

"Wave!"

I flop my body over hers and hold tight. Michaela clamps her mouth shut.

"Okay, kick."

Michaela continues giving rescue breaths and clearing the white foam escaping from the girl's mouth.

"Wave!"

We ride it a little.

We are through the worst of the impact zone but have a seemingly endless lagoon of swirling murky chop to battle through. My legs grow tired.

Tears began streaking down Michaela's cheeks.

"Look Will, she's moving. She's alive!"

The girl groans, her eyes stay shut.

In cold water

Air and sea temperatures on the day of the rescue were around 12C. Before falling in, the family's body temperatures would have been around 37C. On hitting the water it is likely they all experienced a cold shock response — an initial gasp and a period of rapid uncontrolled breathing. The volume of this gasp is dependent on water temperatures. The colder it is, the deeper your breath.

In these temperatures, a victim will inhale around three litres of air. If this initial gasp is met with water, drowning can occur. The lethal dose of seawater on the lungs for an adult male is about 1.5 litres.

There is another conflicting physiological process that occurs in those first few seconds — the mammalian dive reflex, an oxygen conserving response that allows mammals to stay submerged for extended periods of time. On submersion, apnoea is triggered and the heart rate slows.

After a few minutes immersed in cold water nerves and muscles begin to cool, reducing dexterity, strength and the ability to swim. Deep muscles in the forearm can cool to 27C in 10 minutes.

After 30 minutes core body temperatures really start to plummet. Below 35C consciousness can be impaired, victims can become confused, aggressive, amnesic even.
And below 30C consciousness may be lost. The shivering response will cease at some point — a bad sign.

On the beach, an off-duty policeman had called emergency services starting the all-important chain of survival. Critically unwell patients like the one laid before us in the sand do not make Hollywood recoveries in the field.

We'd moved the girl out of the water laid flat for an important physiological reason, to avoid a drop in blood pressure and subsequent loss of consciousness. Water has a higher density than air so when we are immersed in it a pressure difference is established, essentially squeezing us. Blood is shifted centrally from our peripheries, which is good for maintaining flow to our vital organs in a survival situation. On extraction, this pressure gradient is lost, which risks a fast drop in blood pressure. Keeping victims horizontal at least counteracts some of the gravitational effects that would also play a role if moved in an upright position.

Members of the public rushed for blankets and warm clothes. Re-warming a hypothermic patient in the field is virtually impossible but shouldn't stop rescuers from removing wet clothes and covering and insulating a victim from the ground if possible. The aim here is to prevent further heat loss.

The police officer hands me the phone still connected to the emergency services.

"We have an 11- or 12-year-old girl drowning victim. She had a respiratory arrest of around three to five minutes. She is currently breathing for herself; cold and with a reduced level of consciousness."

"How many other casualties do you know of?"

"Mum, dad, brother," I say.

I can see a little boy Evie rescued further down the beach.

"Any others?"

"I don't think so."

I turn to Michaela and then out to sea. Something isn't right.

"Wait."

I hand the phone back to the police officer.

Michaela tends to the girl in the recovery position, wrapping her up in blankets. I run back down the beach towards the shallows.

Dad is still in waist-high water, he has Michaela's board under his arm, his eyes fixed on the boat. He is swaying and incomprehensible.

I took the board from him.

It's now clear. At least one other child is out there. I paddle back out.

Between the waves, I can see James and Evie already making for the boat. They know. The hull comes into clear view about 50 metres out. I see Evie sitting on her longboard, James' board resting next to hers. He is nowhere to be seen.

James surfaces next to the boat. Ten seconds later his feet slap the water's surface and he descends once more. Waves continue to break.

I paddle harder.

I see the yellow of a life jacket breaking the surface, James' arms follow beneath.

"F***."

It is the bravest thing I've ever seen.

Evie scoops up the yellow life jacket and places it on the board. She unbuckles it to reveal a mass of dark hair and a small body — a little girl about 2 years old. Evie begins CPR using the heel of her right hand. On account of the child's size, only one hand is required. Evie stops — James gives two breaths — Evie restarts.

I arrive. The child is ice cold. We make for shore.

Between the thump of waves an engine screams, a jet ski skitters towards us. The driver eases up on the throttle beside us and Evie climbs on. We pass her the little girl and I follow. We speed off just before another wave breaks and James is left to swim in.

A helicopter flies overhead as we slide up the wet sand.

We run up the beach towards the flashing lights, toddler in my arms. The paramedics rush to meet us.

Soon James and the helicopter team join us. I recognise those guys, we worked together on jobs flying patients between various hospitals in the South Island.

Between heavy breaths, I recount the story.

"She must have been down for 20 minutes."

We continue CPR and I insert an inflatable airway device to better control her airway. The paramedic passes James a small drill, a small hypodermic needle made the drill tip. In emergency settings, instead of going intra-venous, you can access the bloodstream intra-osseously via the bone.

He steadies his hand just below her right knee and the small electric motor rears to life. One of the paramedics sticks down the pads of an AED (automated external defibrillator). We stop CPR and analyse the rhythm. Nothing.

"No shock advised," said the crackly machine.

We continue CPR.

High flow oxygen is streaming in each time I grip the bag attached to her breathing tube. Her heart is being squeezed with each chest compression and now a bolus of adrenaline is hopefully exciting the muscle fibres of her heart.

Holding your breath

Drowning is the third leading cause of accidental death worldwide accounting for 360,000 lives every year. Over the last five years, fatal drownings are up 18 per cent in New Zealand. There are spikes in the under-5s and those aged between 15 and 25. It kills more children than many high-profile diseases.

Most of us can hold our breath at rest for about one minute, but when jumping into 10C water in normal clothing this falls to about five seconds. It can even be as low as one second.

In cases of drowning a victim will first stop breathing, respiratory arrest, then progress to a cardiac arrest. The heart will stop beating as oxygen-rich blood is no longer circulating. Unlike in other causes of cardiac arrest, oxygen is the primary issue and needs addressing.

Once safe and on a stable surface, rescuers should commence uninterrupted chest compressions at a rate of 100-120/minute if the person is unresponsive and not breathing normally. Thirty compressions then two breaths, then repeat until help arrives.
Compression should be about one third the depth of the victim's chest over the sternum, with two hands for adults, one or two hands in the under-8s, and two fingers in infants. In-water rescue, breaths are an advanced rescue technique and the priority should always be getting the patient to shore and safety.

Research suggests that the sooner basic life support is initiated the better the outcome.

Pete, the heli-paramedic, crouches next to me.

"Shall we think about moving forward to the heli?"

I shimmy into the helicopter alongside the stretcher holding the breathing tube steady and take a seat. We put on the headsets and continue CPR.

I glance out the window and spot my board floating out there, a brand-new board, still un-surfed.

Things are not looking good; we haven't seen any electrical heart activity on the monitor. The line is stubbornly flat. She's been under for a long time.

I can't help but wonder, though, maybe she was stuck in an air pocket in the bow of the boat, breathing even. We don't know how long she'd truly been down for.

Whenever I fly in the heli I always reflect on the peaceful Earth beneath me. There is calm and order that comes with distance, cars move slowly and waves break gently.

From up there, I can't quantify the maelstrom of panic that had overcome me minutes earlier. I collect my thoughts and keep squeezing the bag. We are approaching the 25-minute mark with resuscitation attempts.

As doctors, we like to look for the exception, not the rule. The rarities are what keeps it interesting. The record for submersion survival dates back to 1988 when a 2-and-a-half-year-old named Michelle Funk from Salt Lake City survived a 66-minute submersion in 5C water. Her core temperature on arrival at hospital was 19C.

We touch down on the roof of the hospital. An army of doctors is waiting for this 28C toddler. I hand over to the on-call anaesthetist and feel the life drain out of me. I stand there wet and sandy staring on as they start with their resuscitation attempts. I swallow the lump in my throat.

Ninety percent art, ten percent science

A couple of days later we visited the 11-year-old in intensive care. She was eating her lunch when the four of us arrived. I think it was the best moment of my life. I squeezed Michaela's hand tight.

Unfortunately, the little 2-year-old couldn't be saved. A case that brought tears to many eyes in the hospital. The resuscitation efforts went on for hours.

The other family members made a full recovery.

When I was a medical student, a retired general practitioner told me, "Forget what they teach you in medical school, son, medicine is 90 per cent art and 10 per cent science."

I resisted the temptation to call this crusty old bloke delusional and reopened my textbook.

His point stuck with me, however, and the longer I am in this game the less senile this GP appears to be. We practice medicine after all.

As doctors, we have our own graveyards that we stroll through from time to time, and this little 2-year-old is buried front and centre. In all deaths you can't help but wonder "what if… if only I'd been wiser, better trained, had more support, better resources even".

Here it felt different. The wound stayed open for longer.

It keeps me up at night. "If only I'd been braver. I should have checked the underside of the boat. Maybe I was just scared. James would've got her out sooner. I didn't know there was another victim, I never asked."

I lie awake imagining how close I must have been to that little girl when I first arrived. I'm thankful for James' bravery, Evie's intuition and Michaela's clarity, all in the face of death. We are bound in blood. I love them all.

We met the family a couple of weeks later. Seeing brother and sister running around, laughing and playing was a special moment. They are a beautiful family. Every so often I'd look towards the vigil of teddies and pictures they'd created on the sofa. The sense of loss hung in the air. The burden of guilt did lift though. I felt better.

Science can only take us so far in both life and medicine, there is something more and that was what that old GP was on to, the art. Not just in the way we treat our patients but in the way we treat ourselves. And it is here that we truly find our medicine; to accept, forgive, learn and move on.

Will Allen is helping organise a Surf Survival Week in Dunedin in November and is creating a web series on ocean safety. Details will be in New Zealand Surf Journal - nzsurfjournal.com.