FEATURE: Blood loss almost kills diver after shark strikes

ALEX HICKEY
Napier man Stam Pishief always knew taking on the job as sole GP for the Chatham Islands would be a challenge.
Dealing with the complex medical needs of an isolated island community is never an easy task, but running a de facto blood transfusion clinic on the back of a truck, in an airport and then on a plane, all in the same day, exceeded even his expectations.
The reason behind the introduction of the emergency transfusion clinics was that one of the islanders had once almost been torn in two by a white pointer shark and had lost more than half of his body's blood stocks.
It's almost nine years since the incident but not surprisingly the Napier Health Centre GP's recollections of events that day remain as vivid as ever.
He moved to the islands in 1996 because he wanted a change of scenery.
Dr Pishief said he had been the owner of a GP practice in Greenmeadows and thought a spell on the Chathams would do him good. He had spent a few weeks as a locum there some months before and had been seduced by the wildness and desolation of the island group.
When word came back that a GP was needed he put his name forward.
He was aware of the demands of a small rural practice of no more than 750 people would be different from a suburban surgery - and he was right.
The first four months of the job had been relatively humdrum and when he went back to work after a two-week holiday in the South Island he was expecting a normal day at the office. It turned out to be anything but.
"I was seeing my first patient of the day when I heard a commotion on the hospital's VHF (radio communications) system," he said.
A nurse on Pitt Island, about 12 km from the main Chatham Island, had been calling for help as a shark had attacked a local man. That meant action stations for Dr Pishief.
Although there is a small hospital on the island, he was the most senior medical expert.
The hospital, now administered by the Hawke's Bay District Health Board, was then run by a Catholic order of nuns (The Sisters of the Society of St Mary).
Some of the nuns had also trained as nurses but there were no surgeons or specialists of any kind.
He quickly threw resuscitation gear and bottles of IV (intravenous) fluid into the back of the island's fixed wing Cessna aircraft and made the short trip to Pitt Island with the pilot.
Unfortunately it was a typical winter's day in the Chathams - wet, windy and cloudy. And to compound matters the plane's navigation system was broken.
"The plane had blown off course because the weather was so bad," Dr Pishief said.
Low-lying cloud had made visibility poor so the pilot leaned over to him and said: "keep an eye out for the surf."
The pilot could use the surf to work his was down the coastline and get them safely to their destination, he said. By the time they landed at the small runway, the man was lying motionless on the back of a truck.
"He looked like he was dead."
The man, Vaughan Hill, was an islander "in his early 20s".
He and a friend had been diving for paua in a small boat in about 6 metres of water.
"He had been coming up with a bag of paua when all of a sudden he felt a whack on his side. He turned round to find he was in the jaws of an enormous white shark," Dr Pishief said.
One of his arms and the side of his chest was in the shark's jaws, although his other arm was free.
Not only that but the white pointer was eyeballing his intended prey.
"The shark looked at him straight in the eye."
The victim then started to hit the shark in the eye with the paua hook but it then had a go at his other arm before letting go.
Dr Pishief said the last thing Mr Hill could remember was waking up in hospital in Wellington.
His friend somehow managed to haul him into the boat and seek help back on shore.
Luckily there was a nurse on Pitt Island who radioed for the doctor's help but when he arrived things were not looking good.
"He had lost so much blood, more than 50 percent, and the nurse said he was no longer breathing."
However, his heart was still beating and Dr Pishief believed the wetsuit had helped save his life as it gave him some level of compression.
The doctor managed to find a weak pulse on one of his arms. He could not find one on the other because there was "no flesh, just bone on one lower arm and not even any blood left."
The arm with a pulse had been badly damaged but he found a thin blue vein and managed to get a line of IV fluid in. He put a tourniquet on its lower half to stop blood pouring out from the other end.
"We then started pumping IV fluid as fast as we could," he said.
The fluid had an almost instant effect as he started breathing and his pulse quickened.
Almost four litres later he was ready to be flown back to the main island for blood transfusions.
One of the nuns from the hospital had organised a mini blood donor centre at the airport.
Around 10 donors were hooked up to IV drips with their blood draining into collection bags.
When they arrived at the airport Mr Hill started to receive the transfusions.
Dr Pishief called an emergency team in Wellington during the flight but it was clear it could not arrive in time.
The doctor and his patient, notwithstanding a couple of donors for the two-hour flight, would have to make the trip to the capital.
The group flew out on a metroliner but the seats inside the aircraft were taken out to accommodate them.
The more blood that was pumped into Mr Hill the more he moaned and groaned which was a good sign, Dr Pishief said.
"Once they took over in Wellington it was a huge relief. When we got him to the airport I knew he had a 50/50 chance."
Mr Hill lost one arm and severely damaged the other as well as suffering injuries to his chest.
He received 24 units of blood, which is roughly equivalent to 12 litres - four more that the average body needs.
There were also no long-term complications as a result of such a massive transfusion.
By the size of the bite marks on his body and wetsuit the shark was estimated to be at least 5 metres long.
It was no surprise Hill gave up diving, Dr Pishief said.
Dr Pishief spent another year and a half on the islands and his life-saving turn is still remembered by locals.
One of them is Kina Scollay, another local diver, and patient of the doctor's, who also fell victim to a shark attack just six months before Mr Hill.
Mr Scollay said the GP had worked wonders in saving a fellow diver and helped him back on the road to recovery.
"He's a bloody good doctor," he said.