“Nature is not only stranger than we suppose, nature is stranger than we can suppose.” ― J.B.S. Haldane, Possible Worlds, 1927
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This story concerns my best recollections from late 2011 through the spring of 2012, nearly seven years after my wife Lynn’s stroke.
At that time my Dad was living in a retirement community in the midwest. One day we got the dreaded phone call – at age 91, my father had broken his hip. The person on the phone sounded very concerned. She told me in no uncertain terms that for a man of his age, this was indeed a serious injury.
We soon learned that, in fact, it wasn’t that “he fell and broke his hip.” Instead, the evidence suggested quite the opposite: as he was walking in the hallway, his hip broke, so he fell down. We started right away making plans to go visit.
Regardless of how it happened, our concern was his path to recovery: How resilient could he be? Even though Dad was remarkably active and fit (he was still playing ice hockey in his early 80’s) we knew the odds were stacked against him.
The statistics are grim. In one study of over 400 elderly hip fracture patients during 1999-2000, 84% of men died within seven years of the repair surgery. Among men who suffer a hip fracture at 65 or older, life expectancy declines steadily with age: at age 70, men live about four years beyond the fracture, roughly two years at age 80, and at age 90, men survive just slightly over one year.
Recovery from a hip fracture can take months. There can be significant loss of muscle in the legs and hips, impaired balance, and as a result, increased risk of another fall. In addition, decreased mobility, loss of independence and other long-term complications such as infection, pneumonia, or blood clots can make matters worse. So, for most older men, breaking a hip is essentially a death sentence, a matter of how soon the collective stress of injury becomes insurmountable.
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When we arrived at his room, Dad was dozing, but our voices woke him up. His eyes scanned the room to make sense of the scene before him. The last time he had seen Lynn, she was in her wheelchair, paralyzed on her left side. Now as she walked in with a cane under her own power, his jaw dropped. After a moment of stunned silence, he stammered, “If she can do it, I can do it!”
That must have been a moment of deep clarity for him, a sharp flash of reckoning about his own predicament: he could let nature take its course, or he could put his shoulder to the wheel of recovery insisting “Not yet, not now!”
How does the human body actually heal itself after a fall?
One widely-held view is that, when it comes to healing living tissue, recovery is basically analogous to repairing a car or some other mechanical device. When a part has been damaged or has failed, replacing or repairing that part usually restores normal operation. By analogy, then, living organisms simply “flip a switch” to activate repair processes (control inflammation, reduce swelling, seal the surface wound…) that ultimately lead to recovery and restore function. As it turns out, this notion is rather simplistic and misleading.
In fact, living organisms constantly rebuild and renew themselves, even without any injury. As a matter of course, living creatures continually produce new components to replace old or damaged ones. This ongoing replenishment1, a hallmark of life, enables a vast array of responses to stress or injury.
For example, in healthy human skin, a layer of hardened, packed dead cells on the skin surface helps to seal the skin. Old surface cells (epidermis) are shed, and replaced by new skin cells from the dermis layer below. This cycle of renewal contributes to the body’s defenses against infection, injury, or skin damage.
This situation bears little resemblance to a car. A car does not replace its own surface from within. A car does not have a basal metabolism while sitting in the garage. The car does not burn fuel constantly to make its own new parts and replace them. It is not alive.
Initially, just after the hip replacement, Dad was bedridden, except for physical therapy several times each day. But within a few weeks he was able to walk 400 feet with a walker, and he was walking with a cane by the time he returned to his apartment some six weeks after the surgery.
On subsequent visits, Lynn and I saw that on the walls of the den in his apartment he had posted photos of her riding her 3-wheeler. And during those last years he remarked more than once, “Lynn has taught us all a great deal about what it means to be disabled,” or words to that effect.
After his hip surgery Dad lived more than five years, almost to his 97th birthday, and it was only very near the end that he lost his mobility. So much for statistics.
I regret that before he passed away I never was able to discuss with Dad what went through his mind on that day, nor how his thought processes shifted in the coming years. But Dad was a private, reticent person, and he rarely talked about personal matters or revealed his inner thoughts. I am certain, though, that seeing Lynn walking again after nearly six years in a wheelchair was his impulse to take one more drink from the fountain of youth.
- Odd as it may seem, perhaps the best metaphor is that living organisms are fountains: Their form and vitality derive from an ongoing flow of materials and energy through the living body. This insight – that living organisms resemble fountains, and they are not statues with moving parts – was something I first learned in graduate school from Professor A.K. Harris, a developmental biologist. There is much more to say about these differences between mechanical objects and life forms, something I hope to explore in other stories. ↩︎
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