Posted by Allen Rucker in Life After Paralysis on June 06, 2018 # Health

About a month ago, at this writing, my older brother in Oklahoma, 76 and walking with a cane and a decided limp because of a youthful sports injury, fell in a convenience store and hit his head, hard. Shortly after, he was examined in the ER, only to be sent home with no sign of internal bleeding, no fever, or only a pronounced neck pain. Forty-eight hours later, he was rushed back to the hospital in a clinical state of delirium. The medical definition of delirium is “a sudden state of severe confusion and rapid changes in brain function.” Initially, my brother only sporadically recognized his closest family, didn’t know where he was or how he got there, and his speech was garbled beyond comprehension. When asked the date, he answered “1912.”

A month later, he seems slightly more lucid and responsive, though his behavior, as is common with delirium, waxes and wanes.

Given the nature and severity of this delirium, his medical staff questioned if it is only the result of a concussion from the fall. Other factors such as an infectious agent complicating matters or a disorder like autoimmune encephalitis or vasculitis – both inflammatory conditions -- remain on the table. At this point, no one really knows either the origin or likely outcome of this terrifying trauma.

When I first got this news, it immediately triggered the distant memory of our father – like my brother, a physician, but only 38 years old – falling on an icy step in the middle of January in 1948, hitting his head, deciding to go to bed and sleep it off, and never awakening. I personally have no memory of this – I was two – but it was the defining story of our family of six.

Concussions are the most prevalent form of traumatic brain injury (TBI), especially among people over 65. According to a New York Times report, one out of three people in this age group fall a year and an estimated 25,000 die of TBI. Though I know of no statistics about the number of people with SCI/D who fall or suffer fatal brain injuries, it only makes sense that it’s a marked danger. Using myself as a sample of one, I have slipped and fallen enumerable times since contracting transverse myelitis in 1996 and had at least one mild concussion (or mTBI) worthy of hospitalization. I have more than my share of inflections, problem wounds, neuropathic pain, and all the other crap that paralytics put up with, but my greatest fear, far and away, is falling.

In another NYT piece I had stuffed in my research file, the famed anthropologist Jared Diamond, himself aging, wrote that what most often kills or injuries us are the kinds of mundane, everyday activities that we perform mindlessly. These are seemingly low-risk but often repeated. Diamond worked out a formula: “low- risk + high frequency = much higher risk.” He puts the odds of falling in the shower, for instance, at 1000 to one. That means, if you take a shower a day, you will fall at least once every three years. Like my father and my brother and 25,000 older Americans a year, one fall is all it takes, especially if there are complicating factors like infection. One scientific study posits that for some as-yet-discovered reason, one concussion “significantly increases a person’s risk of having another.”

We worry, Diamond says, about “terrorist attacks, plane crashes, and genetically modified foods” yet should spend more time focusing on “showers, stepladders, staircases, and wet or uneven sidewalks.” In Los Angeles, where I live, the latter are a daily mine field of concussions waiting to happen. If not a head injury, a sidewalk spill can break your skin leading to a problem wound leading to Lord knows what.

The bitch about being paralysis, or maybe one among many, is that you are forced to forever preplan and plot out your every movement, step by step, transfer by transfer, wheeling surface by wheeling surface. Go on autopilot for a few seconds and that’s when, like my brother, a slight bump at the threshold of the entry of a 7/11 store reaches out and takes you down.

Concussions are weird. There is often no medical means to assess even the existence of one except through its consequences. Most are of the mild kind and resolve themselves in a short amount of time without permanent damage. Others, like my brother’s, may take a few days to show severe symptoms. In some cases, the victim may feel unfazed for hours after a serious fall – called “the placid interval” – then suddenly go into a fatal tailspin.

That’s what makes all falls so frightening and worth avoiding at all costs – you simply don’t know what comes next. It’s far better never having to find out.