March 29, 2019

We were picked up by the snorkeling company at 5:55 a.m.  The driver shared information with us about where we were going and showed us on a map where to find the fish. He showed us how to use the mask and snorkel. He suggested we leave the beach at 9 to walk back for pick-up in the TGR van.

I entered the water and began swimming and immediately began seeing individual fish, schools of fish and coral.  I spent about 10-15 minutes swimming and observing. I went back to shore to see if I was needed by any of the students.  I swam back out and observed fish again for 5-10 minutes and began heading back to check on the group again.

I felt a burning feeling on my left wrist and right underarm area.  I swatted near my right under arm then, but didn’t feel or see a jellyfish.  I swam straight to shore.  I took off my snorkeling fins and mask/snorkel and left near my bag.  At this point I felt stinging at the 2 locations and felt chest tightness. I went to see the lifeguard.  I explained what happened and what I was feeling.  I was told the chest tightness was the poison moving through my body.  I asked for water, thinking if I drank some it would help me move the poison through.  The lifeguard said she could not administer water, but I could rinse off in the showers just up the hill.  I showered off my body and drank some of the water and went back to the beach.

I found the lead chaperone and told him what happened, and that I was trying to remain calm.  He offered me some Benadryl, which I swallowed with water from his bottle.  He then suggested we get ice from the lifeguard.  We walked back to the lifeguard stand and she was helping a boy who cut his finger and likely needed stitches, so I waited.  She then gave me an icepack.  I was feeling burning pain in the ends of my feet by this time and my face started to burn. 

The chest tightness became worse, and I was agitated.  I couldn’t find comfort sitting, walking around, or laying down, and tried all of these, rotating through multiple times, trying to stay relaxed.

Next my tongue started to burn and felt swollen.  My throat felt swollen too.  My voice was hoarse and I had a difficult time speaking. 

I then began vomiting, and a lifeguard mentioned it was my body trying to move the poison out.  It just looked like a bunch of clear mucous.  I wretched for several minutes, and it became more like dry heaves.  I hadn’t had any food yet that day.

Another chaperone joined us while I was vomiting. 

At some point as I was sitting in the chair, another lifeguard showed up and sprayed my jellyfish burns with vinegar.  I told him my left wrist, right underarm and both feet were stung, because of the burning I felt in each of those locations.  Later I understood I was confused at this time, because I was wearing snorkeling fins and could not have been stung on the ends of both feet.

EMTs showed up and they checked my blood pressure and asked if I have high blood pressure.  I told them that I have low blood pressure normally, like 90 over 60.  They checked my breathing with a stethoscope, I think. 

They said they could take me to the hospital, and I told the second chaperone I felt confused and didn’t feel like I could make good decisions.  The second chaperone said if I felt I should go, that I should go.  I said my tongue and throat felt swollen and my voice wasn’t right, and I felt I should go. The EMTs said that I didn’t have to go in an ambulance, and the second chaperone told them we didn’t have a car.  The put me in a convertible chair/gurney and loaded me in the ambulance.

The EMT with me in the back, directed by the driver, gave me an IV in my hand of a medication that should help with the vomiting.  I’m not sure how it was supposed to work, but I vomited more into the garbage can in the ambulance, pretty much until we got to the hospital.

I began to hurt everywhere, including my vagina, which I thought was weird. 

When we arrived at the hospital, the intake person asked me my SSN and address.  The way I responded felt forced and strange.  My voice was hoarse, and it was difficult to get the answers out from my mind to my voice. He also asked if I had allergies, and I told him I was allergic to sulfa. I told him that I had taken 2 Benadryl after the sting, forgetting to tell him I vomited several times, probably including the Benadryl. He asked me about my level of pain on a scale of 1-10.  I told him 9, maybe 10.  I hurt everywhere, and it felt extreme.

I was taken to room 25. Grace helped me take off my wet swimsuit and put a hospital gown on me.  She put a large pad on the hospital bed and helped me onto it.  She then covered me with a sheet and warm blankets.

I was hooked up to a monitor, with a finger clip and a blood pressure cuff.  The monitor measured a number of vitals. 

My body began shaking, and shook most of the next 3 hours involuntarily.

I couldn’t sleep, or find a comfortable position.

The chest tightness made it really uncomfortable to lay on my back.  I couldn’t figure out how to lower the back of the hospital bed, and I couldn’t find a call button for help, so I slid down the bed and curled up at the bottom on my side which provided some comfort. 

My monitor started beeping at some point and someone came in to check me.  They noticed and mentioned that my oxygen level dropped and maybe it was because I repositioned myself and moved the finger clips position.

They lowered the bed for me and reset the monitor.  I remember laying on the bed shaking with my eyes closed and hearing the monitor start beeping loud again.  Someone came in to check on me and then just turned the monitor off.  I remember thinking that I hoped nothing bad happened, because they wouldn’t know after turning the monitor off.

Dr. Eric and someone else came in to check on me. He looked at my sting areas, including my feet, which I was still confused into thinking were stung.  He mentioned the wound on my right foot, and I tried to tell him that was from my Teva shoes when I hiked at Diamond Head.

The doctor ordered pain meds, and a hot shower. I think the meds were administered through the IV in my hand within an hour, not right away.

At some point during my shaking, I realized I was drenched in sweat and the gown and sheets felt damp. 

About 2 hours after I’d seen the doctor, Grace came in and said she was taking me for a shower.  She put me in a really wide wheel chair and it was really awkward to put my feet down because it made me spread my legs.  All I had on was a hospital gown.  I ended up putting both feet on one side in the end.

Grace wheeled me to an area of the hospital where there was someone sitting with arms cuffed behind, somehow.  Grace had to do something to get clearance into the shower room.  She then wheeled me into a room.  There was no shower.  She put a towel on a chair and helped me remove my gown, and had me sit. She then turned on a faucet that was leaking into a large bucket. There was a narrow hose on the spigot.  She waited till it was warm and hosed me down.  She grabbed a bottle and squirted some shampoo into my hair and moved it around. I was now wet and cold and asked if I could hold the hose to keep myself warm with the water.  Then she added soap to a washcloth and started to bathe me.  I told her no one had bathed me since I was a child. She asked if I wanted to do it myself, and I said yes.  She handed it to me and I scrubbed myself down.  I washed my hair a bit more thoroughly too.  She stood in the room with me and I remembered thinking about how embarrassed I would feel about the situation if my mind wasn’t so muddled. I used the hose to rinse the soap off and to try to get the shampoo out of my hair.  Grace handed me a towel and I dried off.  I put a towel around my hair.  She gave me two gowns this time, one forward and the other layered on backwards.  I got a pair of yellow socks with grippy things on them at some point.  I can’t recall if that was after the shower or not.  Grace wheeled me back and changed the bedding. She got me settled again and brought me more warm blankets. 

My roommate chaperone asked me if I felt better after the shower.  I told her there was no shower, it was a hose.  My roommate chaperone helped me lower the back of the bed at some point, I can’t remember when. My roommate chaperone also went looking for someone to see if I could have more pain meds.  I remember at some point someone telling My roommate chaperone that I was safe. 

Dr. Eric came back to check on me at some point and I tried to explain that I was ordinarily a very calm person and the pain I was feeling was intense.  He looked at my sting areas again and when he saw the one near my right under arm, his expression changed and he said it hadn’t looked like that earlier. 

He ordered additional pain meds with Benadryl to reduce the chance of me vomiting.

I’d estimate that within half an hour a new nurse came in and gave me, first the Benadryl, I think and then additional pain meds through the IV in my hand.

Within minutes I looked at My roommate chaperone and told her this is the first time since I was stung that I have been without pain.  I think this was about 11:30.

I closed my eyes and drifted off for a bit, I think.  When I woke, I talked with My roommate chaperone about getting an Uber for her to head back to the hotel.  Her phone was nearly dead.  I used an App on my phone and called an Uber for her and when the driver called, I gave her the phone and then she left.  She asked me to let the other chaperones know she was on her way back and her phone was dead. I did this.

I rested some more.

About an hour later I asked to be discharged and if they could write me a prescription for pain meds if I needed them, since we were to fly home that afternoon.  I didn’t have a wallet and asked the lead chaperone to send me a photo of my IDs, Insurance Card, and Credit Card. 

When I visited the pharmacy and told the pharmacist what happened he said I had a very severe allergic reaction to the sting.  It seems odd to me that the ER staff didn’t discern this. 

I felt glad to be alive.

Over the next month, I dealt with serious brain fog and the skin at the center of the sting began to dissolve.

As it turns out, it is common for box jellyfish to move inland after a full moon. Beachgoers can expect influxes of jellyfish on Oahu’s south facing beaches about eight to ten days following the full moon.  I wish our guide had told us.  I wish the people who trained us how to stay off the coral reef had told us.

I also discovered that when I showered at the beach, trying to drink water, that I probably triggered the release of more venom.  I wish the lifeguard had told me this.

Here is information I wish I’d had before choosing to snorkel that day:

Taken from an article on the Gear Junkie website:

Dr. Angel Yanagihara of the University of Hawaii is the world’s foremost expert on box jellyfish. She notes that they do not inject venom like other animals, such as rattlesnakes. Instead, it releases a “digestive cocktail” that causes holes in all our cells. Scientists are still unsure as to why some box jellyfish cause more dangerous clinical syndromes. Some researchers have suggested that certain species, including Chironex fleckeri, inject their venom more deeply than others.

What makes box jellyfish particularly dangerous is that they do not float passively –- they move. They open and shut their bells (heads) to propel themselves through the water.

Unfortunately for beachgoers, experts warn that their numbers are increasing, and so are incidents with multiple people stung at the same time. Without better education, they believe that swimmers, surfers, and other water lovers are increasingly at risk.

Taken from an article from the University of Sydney:

The Australian box jellyfish (Chironex fleckeri) has about 60 tentacles that can grow up to three metres long. Each tentacle has millions of microscopic hooks filled with venom.

Each box jellyfish carries enough venom to kill more than 60 humans.

A single sting to a human will cause necrosis of the skin, excruciating pain and, if the dose of venom is large enough, cardiac arrest and death within minutes.