After The Fall

This, from the book editor of The Guardian, Robert McCrum, on the consequences of a stroke he suffered in 1995, and then a traumatizing fall three years ago.  Having fallen a multitude of times in my life, I can give earnest, experientially-based, and expert testimony that you will never read a more accurate description of what it’s like to fall than this one:

“The fall itself – my fall – occurred in an instant, but also in a kind of slo-mo. That old weakness on my left side, the residual deficit from my stroke’s paralysis, had long been a source of vulnerability, and now my worst fears from two decades were coming to pass. My first thought as I hit the kerb with my face was Tintin not Kierkegaard: “Oh, *@?%$*!” Then the menace kicked in: this was what people meant by “a fall”, an Anglo-Saxon word that’s as old as the hills, rooted deep in our past, and edged with fear.

It’s just a tumble to a child, or a pratfall to a clown, but falling is the curse of our later years, and a troubling one, too. The failure of the human frame, even in a fall, is a deep humiliation to our sense of ourselves. In the UK, per annum, about one in three people over the age of 65 will thereby break a leg, or a wrist, or, worst of all, a hip. That fall can be a gateway to incapacity and decrepitude: about 40% of these fallers will end up in a nursing home; 20% may never walk again.

In khaki shorts and scuffed trainers, it was not until I saw the blood splashed on the pavement as well as on my white T-shirt, and found its sinister metallic taste in my mouth, that I realised how badly I was bleeding from my head. Just a few days before my 61st birthday, here I was passing into a new world in which (as I lay full-length on the pavement) concerned passers-by were bending over me with “Are you all right?”, and a smiley young West Indian woman on a quad bike was phoning for an ambulance.”

***

In humanity’s long evolutionary path to the present moment, we made one serious choice that has had an extraordinary impact on the vulnerability of our bodies.  We now stand on two legs, rather than move about on four.  We gave up the solid stability all quadripeds have in exchange for the ability to see and reach up into the distant leaves of a tree or to cast our eyes upon the horizon.

The cost of that exchange is at least two-fold.  Humans place extraordinary pressure on their hip bones–every hour, every day–just to stand in one place, let alone move.  When we fall–either because we slip, or because we’re hit by something–it’s a long way down, a distance not to be measured by the brain’s ability to record the space around us in the physical world, but rather by the distance we measure in the body itself, from cell to cell and muscle to muscle as it copes at every level down to the microscopic with the sudden, inexplicable, and potentially-fatal shift in the biological geometry by which we live.  In that geometry, both time and distance are measured in fractions of a second and an inch.  How quickly may a man or woman shift a foot to recover balance?  How far away is the brick wall of that building, and can my hand reach it in time?  We make these calculations and answer these questions every moment that we live, but a fall forces us to make them while under attack.  The surface below us and the air around us, coupled with the relentless pull of gravity itself, all work against the nearly-instantaneous body response of our millions of cells and hundreds of muscles as we fight to stay upright.  The response we offer comes as quickly as we can make it, but the surprise involved in using parts of our body that we weren’t expecting to use, and the strength we instantaneously use to slow our bodies down on their descent to the surface to prevent damage means that the event does indeed happen, as it appears to us, in slow motion.

In preparing for a vacation to New Orleans last October, I ordered a pair of Croakies, a thin piece of cloth with holes at either end that one can slip on to the frames of one’s eyeglasses to hold them firmly on the head:  good protection against the rigors of a walk and protection, too, against the consequences of NOLA’s year-round heat.  The Croakies came on a rainy night about a week before my departure via Fed Ex in a big letter envelope.  I stepped out onto the porch to pick up the package, but also stepped onto the envelope itself.  Instantly, my body slid in the same direction as the envelope, yet the speed with which this happened must be described as slow motion.  I had stepped onto the envelope and knew that I had made a mistake in doing so (I said “Damn!” or “Shit!” or somesuch to myself, I can’t remember), but there was no way to get off the envelope.  I was going–slowly and inevitably–down.  The only thing I could do was to turn to my left slightly, and lengthen my body–as if I were trying to stand up, even though I was actually horizontal, to spread my body out on the porch and allow as much of my body as possible to absorb the impact with the porch.  The glasses I happened to be wearing bounced off my head, open and unbroken, about six inches away.  My head remained upright, as I intended, and I sustained only very minor bruising to my left wrist and my right side.  My body as a whole, however, was traumatized by the shock for about the next three hours.  We call such people “shaken up,” and that’s what I was.  We spend a lifetime learning, mostly unconsciously, how not to fall.  It’s deeply unsettling to be reminded, either by accident or by the deliberate act of someone who means us harm, that we can and do fall, that our bodies can sustain injuries when such a thing happens.  It’s frightening to be told, by a force that means it, “You are mortal.  I will decide how much you will be hurt, and when.  Not you.”

For the disabled, falls are different.  The body’s built-in responses to falling are still there, but altered because of brain damage, broken limbs, or all manner of other conditions that must be accounted for in preparing the body to survive a descent.  Many of the disabled, especially those who can use crutches to get around, are taught from an early age how to fall.  If they are wearing leg braces, they are stood in front of a mirror, with a mat on the floor before them, until their legs give way in tiredness, and they fall.  They are taught to stretch their arms out and catch themselves, as if they were doing pushups.  They keep doing this drill day after day until their legs are much stronger and the act of catching themselves with their arms in a fall becomes almost second nature.

Such training is meant to make life on those crutches easier, and it does; but, even here, differences must be taken into account:  underarm crutches are usually made of wood, and they can be easily tossed aside as their wearers move at high velocities, trip, and fall toward the earth.  He who falls as the crutches go flying may curl his body up as he descends, thereby limiting the surface area that can be impacted by the ground.  You can see this happen as the disabled move among their friends on the playground, laughing and exploring their worlds, even using the crutches as faux weapons or, more practically, as extensions of their bodies, as they pull a needed object toward them.  The wooden crutches are cheap, and they are used most often by the very young who wish to move at high speed (much to their parents’ dismay) or by the non-disabled, as they recover from the trauma of a broken leg or ankle.

As one becomes older and more confident in moving the body (and in learning how the body can move when it needs to), the choice of crutch may change to the Canadian model, with a cuff through which the wrist and hands fit.  Such crutches are often made of sturdy aluminum.  You won’t see those with temporarily-broken limbs wear these too often.  They are used, rather, by the permanently-disabled, who must become, perforce, professionals in their use.  The crutches do offer a comforting stability that wooden ones lack, and if one is knowledgeable about how to prevent a fall, they’re a fine choice for daily use.  But the threat of a fall is still there, and must be dealt with.  In a fall, the cuff will prevent the arm from moving.  The crutch cannot be thrown away.  Because this is so, the body cannot be curled up to absorb the impact.  The wearer must learn to fall with the crutch, fall as it falls, and she must take the cuts and bruises that cannot be avoided as a result.  The crutch’s  shaft and its reach can be a godsend in a slip, as it will seek and often find the support of the rough texture of a sidewalk, or that of the base of a building or a door frame–anything to give the wearer time enough to recover the body’s balance.  In a full-blown fall, though, the heavy metal shaft of a crutch can become an enemy, even if one has learned to fall with it.  Man or woman can fall on top of it, and sustain an unintended injury that way.  The inflexible cuff can be and often is bent out of shape or broken by the sudden, tremendous force of human strength applied to it as the wearer strives to stay upright.  Nothing’s more frustrated than the face of someone who possesses in an instant a shaft strong enough to be used as a cudgel but otherwise useless because the cuff has been bent too wide to fit the arm it was meant for or has been broken off.

A fall is the most basic reminder of the frailty of human flesh that there is.  As children, we don’t mind such falls because they bring us into immediate, intimate contact with the world we’re just beginning to know.  In a very real sense, we believe we belong down there.  The skinned knees or busted lips we might get out of such encounters are a price we are glad to pay because our injuries heal so quickly.  But as life goes on and our bodies age we learn, grimly, that our flesh heals far more slowly than it did in our youth.  Our bones may knit, but they don’t necessarily resume the shape they once had.  It hurts to take a blow we once laughed about on the playground.  We slip more easily, and a disturbing sense of vulnerability begins to grow upon us.  Though not debilitating in itself, that sense becomes embedded into our being like a new strand of DNA, and the fearlessness of our youth fades away like a childhood virus, and we are left more cautious, despite our accumulated strength and experience, both of which carry us through many potential daily disasters with the earth.   Years may pass, and here and there we attend the funeral of a friend who has passed away.  We see him lying in state in his horizontal box, but some part of us may not quite grasp the reality of human mortality his corpse represents.  We lower him into the ground, and walk away.  Perhaps we will remember him, perhaps not, but we walk away, upright in body if not in spirit, and go about our business.

A fall, however, reminds us in the most intimate, brutal, terrifying way that we will share the fate of all frail flesh.  We will fall; we will be injured; we will die.  It is inevitable.  Nothing can prevent it.  Final contact with the ground, when it happens, will be a unique experience, as it has been all of our lives.  We all fall, but none of us falls in the same way.  Our hands, arms, and legs suffer the blow, but we twist and turn and strike the ground in ways no one else does.   We may smell our own blood or feel the scratch of a tree limb against our skin or we may not.  The only commonality to the experience is that we will all go through it.  And the frightening thing is–the thing that makes a fall traumatizing in the first place–we will know what the experience means when we have it.  Dust thou art, the Bible says, and unto dust thou shalt return.  But the Bible speaks of the dissolution of the body after death, and thereby misses the fundamental terror of dying itself–the unexpected stumble, and the rush of our hands and arms and legs and heart toward a horizontal fate.  It is the death we all die, maybe a dozen times in our lives, in practice for the last one.

 

 

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