This week’s conversation is with Dr. Richard “Harry” Harris, an Australian anesthetist and cave diver who played a crucial role in the Tham Luang cave rescue. 

For those of you unfamiliar, it’s an incredible story…

In June 2018, Harry was about to depart on a cave diving holiday to the Nullarbor Plain.

He and dive partner Craig were requested by the Thai government, on the advice of British cave diving experts attempting to rescue twelve Thai children and their soccer coach who were trapped in the Tham Luang Nang Non cave system… to provide assistance with the rescue efforts.

They were jointly awarded 2019 Australian of the Year as a result of that rescue.

I wanted to speak with Harry to understand how he did it… what gave him the courage to put his life on the line on a whim for strangers?

I think you’ll be fascinated to not only hear about Dr. Harry’s first hand experience but also the mental skills he utilized – imagery, calm, confidence, focus… it’s all there.

“It was either leave them to die, a very slow, awful death from starvation, exposure, or infection, let alone, the psychological terror that, that would impart upon them, or you’d take them out and probably they’ll die, but they’ll be anesthetized and asleep when that happens, so essentially euthanizing them.”

In This Episode:

What’s the link between his two passions – anesthesiology and cave diving? 

That’s really easy actually, because for me, those two disciplines are extraordinarily similar in many respects. And I think the adage of wartime, 99% boredom and 1% terror, can apply to both of those things very, very easily, in anesthesia and in cave diving. If you’re well-prepared, you’re well-trained, your equipment is good and checked and tested and the conditions are right, then it should be a very relaxing and pleasant endeavor. And to be an anesthesiologist, you couldn’t do that every day, if you’re on the edge of your seat the whole time when you’re at work. You’ve got to be able to relax and enjoy yourself, obviously. So I find those two disciplines to be very similar, because if it’s all going well and it’s actually fun and it’s safe and it’s relaxing, one is what I do for a living and one is what I do for my sport. But when it goes bad, it can go bad very, very quickly, and the outcomes can be catastrophic. Obviously, in anesthesia if the outcomes are bad for my patient, then in cave diving, it can be for myself.

Why breathing is integral to remaining calm under water

Half of the strategy to avoid some of these respiratory issues is to keep your work rate down and keep your breathing very regular and very calm. The moment you have a problem, of course, at 250 meters underwater in a cave, it’s very easy for your heart rate to start coming up, for your breathing to start increasing in speed, and for you to start doing very quick and unproductive movements. So we have a conscious strategy to stop and slow everything down and try and problem solve in a very time-pressured environment where speeding up is actually very counter-productive, psychologically, but also physiologically. If you get the guide line wrapped around your leg, in 10 metres of water, that would be a very minor issue to sort out. But at that depth, when every minute on the bottom means another 15 or 20 minutes decompression time on the way back to the surface, there’s a huge clock ticking in your head. You have to just stop and take a breath, relax, solve problems and be very aware of the speed with which you’re doing it. It’s very hard to go slowly, every nerve is screaming to go fast.

Utilizing imagery

I pre-visualize my dives, usually in my tent the night before and spend a week to 10 days setting up the cave, building up to this exploration dive. We usually only do one dive per trip because A, there’s a lot of setting up time and it’s so mentally and physically exhausting that, by the time the dive is done, that’s kind of it. You’ve lost your mojo for any more diving really for another period of time. I tend to lie in my tent and think through all the steps of the cave and plan what I’m going to do in each phase and how I’m going to respond to different emergencies. That reminds me a little bit of the film with Alex Honnold, Free Solo, which many of your listeners will have seen, and the way he choreographs every move on the face of that wall in his mind and on paper, in fact. It’s an extraordinary performance. I don’t think I’m at quite that level, but I certainly try and think through all the steps.

What inspired the decision to get involved in the 2018 Thailand cave-diving rescue?

I feel like the decision to go to Thailand was the easiest decision I’ve ever made, I wanted to go there. As soon as I heard those kids were in trouble, I wanted to be there, I wanted to be part of it too, because I knew I had some skills that could be of use, and it was a cracking good adventure. And I enjoy performing medicine in strange environments, and I enjoy cave diving. So for me it was doing all the things I love. In addition to that, I’ve spent the last 10 or 12 years pretty much practicing for this event, unknowing that it would be this particular event, but we’ve been running cave rescue training in Australia for some time, as have other people around the world. And I had actually generated a course for fellow cave divers to practice bringing someone who might be injured or medically unwell through an underwater section of a cave, out to the surface, if they had found themselves in strife.

How’d the kids get stuck in the cave?

This all takes place in a very remote, far Northern village of Thailand. It’s right on the border with Myanmar, and it’s a beautiful area, a remote rural area, pristine mountains, and jungle, and so forth, but every year, pretty much at the same time, the monsoon rains start, and when they come, they stick for about three or four months. There’s actually a sign out in the front of the cave saying July to November is the cave flooding season. And these boys went in on the 23rd of June, so they, in theory, should have been okay. They were inside… The weather that day was perfect. There was no sign of any problems… It was raining on the other side of the mountain range, and that happened to be the main catchment area for this cave. So they got all the way to the back of the cave, five kilometers in, and they turned around to come out, and they found that the passage why was blocked by water, and the water was rising pretty much in front of their eyes.

What was their experience like while waiting?

The coach tried to dive through the obstruction, nearly drowned himself in the process, came back and they slept on the beach that first night. Woke up the next day to find the water pretty much lapping at their feet, and so they had to retreat further into the cave until they found this very tall, muddy slope with a small flat platform at the top, about 30 feet above the water. And that’s where they camped for the next nine days until they were found. No food, just drinking the cave water, and pretty cold, I imagine. It was 23 Celsius. I’ll leave you to work that out. So not cold, but sitting there in damp T-shirt and shorts on the wet mud, you’d lose heat pretty quickly, so very miserable. Zero light, pitch dark. And I think they had a watch between them at least. And they all had a headlight, which they sensibly conserved and rotated, but by the time they were found, they only had one or two with any power left. So they were being careful to keep the lights out for much of the time. And you’re absolutely right, having slept in caves overnight for a couple of days, you very quickly become disorientated from a time point of view. And it is a strange experience.

How did he manage the pressure involved with rescuing these children?

I just took it one step at a time, and I think that’s the way you have to approach any very complex, or very difficult problem. The way to eat an elephant is one bite. It was intense, and the pressure from the British, and other divers to carry on and perform this meant that, I had to stand up and basically said no, I’m not doing it. I need 24 hours to A, dive the cave myself, visit the children and see the environment that they’re in, with a view to looking at it as my operating theater. Is there a place that I can do this? Is it possible? And thirdly, to look at the children themselves, were they panicking, were they calm, what physical state were they in? Were they all sick with chest infections or diarrhea? What sort of patients would they be? From a purely medical point of view. And until I’d done that, I couldn’t even conceptualize going to the next step, and performing the anesthesia. But equally important, I had to make sure I was safe in that environment. So I asked them for 24 hours.

Is he inherently calm by nature?

I suffer from anxieties like anyone, and there are some things that frighten me, and there are some places, or scenarios where I find I can at least exude calm. And I think in critical care medicine, that can be a learned behavior. And it’s very important behavior, because if you’re leading a team in a resuscitation, for example, and you’re panicking outwardly, then it’s very hard to get people to be coherent and follow, and stick to the plan. My anxiety, but it tends to be from things that aren’t important. It tends to be from social anxiety, or public speaking, or things that actually don’t have a significant outcome apart from myself. How I look or appear, and so that probably again goes back to that insecurity of my own self, rather than genuinely difficult situations, when I tend to actually feel better and step up perhaps.

What is it about other people’s opinions that is scary?

I think I do worry a lot about what other people think of me, and the older I get, the less important that becomes to me. I think that’s a natural part of aging, but as a teenager and man in my 20s, I’d say I had a very thin skin. I was easily wounded by words and opinions. Whereas as I get older, I care less. And I guess, it’s easier to care less, when you’ve had some recognition for doing something, which Thailand… That was one of the outcomes, I guess, is that, suddenly we’re in the media in Australia, and we’re getting that recognition and awards, and people are telling us that we’re wonderful blokes, all of a sudden. And I’d never, ever had that in my life, I was always terrible at sports, and just did my own thing. I didn’t have a shelf full of trophies and medals behind me. Whilst I didn’t go out looking for recognition or reward, I think it’s been good for my self-esteem certainly.

Why passion shouldn’t be overlooked

I was very lucky to find a single passion in life, which was the ocean and scuba diving. And if any of you are lucky enough to have a passion, however kind of unusual, or potentially useless in terms of a career, or furthering your life, it appears you’re incredibly lucky, if you just have one thing that you’re passionate about. And you should absolutely pursue it, because you never know where it will lead. So, I’d encourage young people to cling to one little thing that they’re good at, or that they love, and build a base from that. And I think the scuba diving turned out to be very important in my life for that reason.

What concerned him most about the mission?

The overwhelming concern was that it was the duration of the dive, rather than the complexity of the dive, that was the big hazard for these children. Three hours under water, it doesn’t matter whether it’s in the swimming pool, or a difficult cave. They’re just not going to survive that period of time. And I knew that we had the best cave divers in the world there to help navigate these kids. So if anyone could, they would get them through this particular cave, but that wouldn’t help the fact that they were being immersed for that period of time in an unconscious state.

The dilemma he faced…

In the end, people keep saying to me, if you genuinely believed that it would 100% fail, what you were proposing, why or how could you possibly have entertained that? And to me the decision became very binary. It was either leave them to die, a very slow, awful death from starvation, exposure, or infection, let alone, the psychological terror that, that would impart upon them, or you’d take them out and probably they’ll die, but they’ll be anesthetized and asleep when that happens, so essentially euthanizing them. I think there’s a very pragmatic answer to that question, one or the other? And for me, the answer was simple. We had to give this a try, and if they died, at least they wouldn’t know anything about it. It wouldn’t be good for me, but it’s a better option for them, that kind of made it simple. And once I made the decision, then I went with that, and I started to believe that it had to work.

Did he experience imposter syndrome?

For the first time in my life, perhaps I actually believed I was the right man for that job. I had years of working in medicine, in difficult, remote, unusual environments, expedition medicine, working in the Pacific Islands for two years, with very rudimentary equipment and assistance, and holding a torch for the surgeon into the abdomen, that kind of experience. I mean, that gives you some experiential credibility. I guess if that’s a word, to have faith in yourself in some situations.

What is the key to being a great leader?

The ability to make a decision. You need to look at an impossible decision sometimes and you have to choose, because to not decide is to be paralyzed, and nothing will happen. And certainly nothing good will happen. So, in anesthesia where, the old adage about, three minutes without oxygen, three days without water, and so forth… Well, we work in the three minute department. And so you have to make quick decisions sometimes, when suddenly there’s a problem, and the patient has three minutes before you start to hurt them, or hurt their brain. So you can’t be paralyzed with fear. You have to move forward to always move forwards. And that comes from being well-prepared and having plan A, B, C, D, and E in your mind. And sometimes even vocalize before you start, to the rest of the team members. So good communication, preemptive communication, and ability to make a decision, even though it might be a bad one, but the alternative is even worse.

How did he manage the moment

I recognized that this was a pivotal moment in my life and I had agreed to do it and I wasn’t going to turn away from it, but I knew how impactful it was at that moment. And the same for the four British guys who were with me observing this. And we were talking out loud. I usually talk out loud when I’m doing something in medicine that is difficult or I need to share with the team. So I was probably verbalizing what I was thinking. And yeah, it was tough, but isn’t it incredible how the most appalling things in the world can become familiar and even routine, because I can tell you in three days time when I was doing the last child, that this was becoming a familiar and almost interesting thing to observe, like I was starting to make observations about physiological changes in the kids as I was putting their faces in the water and commenting again on some academic stuff to the British divers rather than the horror of this moment. So we really are very good at adapting and normalizing what should be never normalized, I think.

What did he learn through the rescue experience?

We are capable of so much more than we think we are. There’s no doubt. And you see that every time someone runs a marathon for the first time, I’m sure I didn’t get out of bed when I started, they jumped me in Korea and thinking I’ll be able to run a marathon. I do keep coming back to this thing, you’ve just got to put one foot in front of another and you never know how far you can go and what you can finally achieve. And I am a bit obsessive compulsive in terms of when I take something on, I will see it through to the nth degree. I will learn everything about it. If I start a podcast, I will become a podcast expert and research all the audio equipment and try and be the best podcaster I can possibly be. That’s just the way I roll. If I start a project, get out of the way, cause I’m coming through, I’m going to be the world champion all the time I finish it and then I’ll probably discard it and move on and try something else. So I tend to operate that way. And so I think we have great potential and we can achieve things if we decide we want to. And if, of course we have the resources to enable us, you have to have food on the table and a roof over your head. But given those basics, it’s unimaginable what we can achieve as individuals.

How does he describe mastery?

Maslow’s steps about reaching that point of unconscious competence, where you don’t even have to think about what you’re doing and you’re doing it very, very well at a very high level. And I think I’ve achieved that in the sphere of anesthesiology. In my routine practice, I go to work, I can be very comfortable and assured that my patients are going to go to sleep and wake up safely and have good outcomes. But there’s always the challenges that come from left field. And when those moments occur, that 1% terror, which I started out by talking about with cave diving and anesthesiology, sometimes that’s when you know whether you’ve mastered it or not. Whether you resolve that situation quietly, confidently, and efficiently, or if the cracks start to open in what you’re doing. And I think there’s a level of difficulty that can pop up, which will test all of us and prove to us actually, maybe we never fully have mastered this thing that we think we’re good at. So you always have to be on your guard. You always need to look for the traps and whether it’s in cave diving or anesthesia, when the outcomes can be very significant in terms of life and death, then you can never relax and assume you have reached that level of mastery. So mastery is about keeping your eyes open and watching out because you never know when it’s going to come and bite you.