Elective Extravaganza! Hyperbaric and Diving Medicine, Cape Town

It’s alive! (This feature, that is.) Today I chat to Inutti McApple (nickname) about her fifth year elective in Hyperbaric and Diving Medicine, which I know next to nothing about. Inutti is now a final year student at Stellenbosch University and set to start internship in January! I’ll give the rest over to her.

elective diving

What is Hyperbaric and Diving Medicine?

Initially when asked by people what hyperbaric/diving medicine was all about I had no idea. Having no exposure to it in my undergraduate year, I didn’t even think it existed. Both of these specialties have little exposure in the undergraduate program. Hyperbaric medicine maybe less so, as it is sometimes mentioned in some undergraduate classes as a treatment option for carbon monoxide poisoning, decompression sickness and compartment syndrome.

Essentially both are sub-specialties of Occupational Medicine. Interestingly enough, one doesn’t have to be an Occupational Medicine Specialist to be able to practise as a hyperbaric/diving medicine officer so it is sort of a special discipline. I will expand later on what they actually do.

Inutti with an oxygen mask in one of the hyperbaric chambers. Image: Provided
Inutti with an oxygen mask in one of the hyperbaric chambers. Image: Provided

Why did I decide to pursue this elective?

Brace yourselves. This is the longer version. I had never planned a career in medicine. Throughout a great part of high school I wanted to do electronic engineering with computer science. I had a unique dislike for biology and a great love for physical science and electronics. It made sense that I would end up doing engineering and thus had planned my whole life around it: I would eventually move out of the country – Japan probably, I would work my way up the electronics industry and probably end up somewhere as a robotics specialist.  I was a young girl with big plans and it was how I kept myself motivated.

In my last year of high school my ideas about life changed and I was drawn to service and people, and back then I couldn’t connect my career choice to my new interest. (Now I do have a few ideas.) To cut a very long story short I went through extensive career counseling till I bumped into medicine.

Suddenly, unlike some of my peers who were sure surgeons, dermatologists, neurologists and the like, I had no plans in life about what I was going to do with medicine and my future. I had known a few doctors in my life before and I was not particularly excited about what they did. My research talked about specialties, but I hadn’t planned to “be” anything.

I went through a few ideas earlier on in medical school: Psychiatry, Paediatrics, Internal Medicine and Family Medicine – only because I had read psychiatry novels in high school, I loved kids and I came from a rural area. In my fourth year of medicine and a part of my fifth year I started to resent my career. I planned quitting a few times. I was exhausted from the workload and not knowing where my future was headed. I couldn’t quit for obvious reasons: I had a year and a few months to go before graduation, and training a doctor is freaking expensive in my country. My second elective was planned in the midst of that great struggle. I was hungry for inspiration.

Marveling at the view after a team-building hike with the divers. "One of the worst ideas of my life. My legs were sore for days."
Marveling at the view after a team-building hike with the divers. “One of the worst ideas of my life. My legs were sore for days.”

The journey to my elective

By the time I got to fifth year I had gone through most of the specialties in undergrad and I was that awkward person who just didn’t connect with most of what was offered. Psychiatry had too much depression, Internal Medicine was too diagnostic and Paediatrics, even after compulsive hand-washing, gave me bouts of diarrhoea. And I couldn’t stand seeing kids suffer.

I had done my first elective in Internal Medicine and I had told myself that my next elective would be more focused on my interests as a person. One of my medical elective heroes was a girl who worked her way to aerospace medicine with NASA. Some of the things I had thought of, like robotics/computerised surgery, would have needed years of planning, thus I remained practical.

I decided I would do marine-based research or something, find a medical connection then pass it off as a medical elective. I had no idea what this would be, but I knew it had to be marine-based for my own sanity. I had been obsessing about the ocean enough that when I stumbled upon diving medicine I just knew it was what I wanted to do. It was during one of our academic projects that I came across an occupational medicine specialist based on campus, who would assist me. I saw a poster in his office and I told him I wanted to do that. He was pretty awesome. Through numerous emails and phone calls, he took care of the logistics and I took care of the other stuff like accommodation and travel, which was pretty easy.

"Emerging from a submarine with the biggest smile. One of the coolest things I have ever been inside of." Image: Provided
“Emerging from a submarine with the biggest smile. One of the coolest things I have ever been inside of.” Image: Provided

What did I do

I spent the first two weeks at the university doing research and at the hyperbaric unit on campus where we treated patients in oxygen chambers. There was a whole morning routine I had to learn; concepts that had long been forgotten about gases, pressures and physics. We had private as well as state patients come in for treatments; I sat in on consultations and assisted where I could. Most of the patients were cancer patients who had complications from radiotherapy.

The next two weeks were spent at the naval base where I was working with the diving medical officer. She worked between the military hospital and the special diving clinic doing diving medicals and certification for both navy divers and submariners. Some submariners were due to sail thus she was busy with their medicals and certifications. What that means is that over a period of time, naval submariners and divers need to go through a series of medical examinations and tests to deem them fit for work. Divers like aviators and space troopers are exposed to special environments and thus need a specialised doctor that is familiar with their environmental exposures, physics and their occupational needs. She was also responsible for continuous care – primary health needs such as the flu, skin rash and those sorts and on-base emergency care.

In the first week I was in the clinic, accompanying the divers to their training diving sites, and was incorporated into their training and lay-activities scheduled such as hiking and drills. In the second week I was at the military hospital siting in on consultations, following around military doctors and learning the trade of military medicine. One of the frigates (ship) was due to sail for three months so I was privileged to see how the military doctors prepared for sail: packing of medical supplies, equipment checks and so forth.

When pursuing an elective

When approaching an elective, one has to decide what they want to achieve by it: fill a knowledge gap, catch up on work or skills development, walk in the shoes of their future selves or have an unconventional medical experience in a field of interest.

I had done catch up work in my first elective and I didn’t have much of an idea about my future so I was left with the unconventional option. Even though I was not learning any new skill that would help me in the undergraduate program, the elective was a worthwhile pursuit to give me perspective and to give medicine a chance. I would recommend it for anyone and everyone really, but maybe as a second elective. You want to use your first elective for skills development. I don’t have as yet a concrete idea of what I want to do with my career, however I have a new-found comfort in that I will never be “stuck” in medicine. There are so many opportunities in the field and so many new specialties to be discovered.

Now, two months from graduation, I can envision a life-long career in medicine; and I will obviously spice things up a bit with “technoawesomess”. This entry got a bit heavy but I hope it helps someone out there who is planning their elective and a future in medicine or just fed up and stuck.

Look at all the exit points: one of them has a tiny hole, big enough to get at least your head out there to see beyond the walls you and others have put up. If not, then you better grow some nails and dig the hell out of there.

inutti quote


  1. TrishaDM says:

    So, so cool!
    I have never actually been able to see what they do at a hyperbaric oxygen unit. And yet, I have referred a patient (actually two now, I think if I count one I saw in med school) for hyperbaric oxygen for radiatiotherapy complications after the first line medical management fails. And that one I really remember did very well with it. I’m going to have to ask to go check it out one of these days.
    Thanks for sharing your experience.

    1. inuttimcapple says:

      Glad to know you have at least referred some patients to a unit. One of the challenges in the field is that of too little referrals, due to the lack of knowledge concerningsome of the indications for barotherapy (there are so many). It is usually post-grads who refer. And these treatments really do make a difference. It would be worthwhile to check a unit out. -Inutti

  2. juanbankas says:

    Hyperbaric and diving medicine, aerospace medicine? Where have I been? And just like that a whole new world has been opened up to me.

    Great post, very informative.

    1. inuttimcapple says:

      I’m glad the post did that for you. Open up a new world that is. I would love to meet an aerospace physician…I think that is my biggest dream, well, aside from winning a triathlon that is…. Thanx for the comment.

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