F is for Falls

“Tell me about the fall,” the Physician’s Assistant asked as he removed the stitches from my father’s forehead the other day,.

“It’s a long story,” my father deflected.

“I’d like to hear it,” the PA said.

My father launched into his very short story — “I was standing at the foot of my bed and I fell. I’m not sure how or why.”

“Have you had other falls that require stitches?” he asked.

“I’ve never had stitches before,” my father replied.

I don’t know if he’s never had stitches before, but he hasn’t required stitches in recent years.

His last serious fall was early October 2015. I was making my annual pilgrimage to Nashville, and my father could still be home alone at that point. He wears a Lifeline pendant which can detect falls, so when he fell that night, my brother next door was notified.

Peter came down to the house where he found that my father had fallen and hit his head on some bookshelves in his bedroom. My father was quite insistent that he was fine. The ambulance came, checked him out, and he refused to go to the hospital.

“I’m fine,” he said.

But he wasn’t fine.

A few days after I got home, he said, “That fall must have done something to me. Something’s not right.”

I took him to the hospital, and, sure enough, something wasn’t right. He had a subdural hemorrhage that had bled into the ventricles of his brain. Because he hadn’t gone to the hospital, no one had told him to stop taking his Warfarin, a blood thinner, and the bleeding had gone on for nearly a week.

This turned out to be a good-news/bad-news situation. The bad news was that his injury was pretty serious and would take some time to resolve. The good news was that the scans of his brain also revealed another condition called Normal Pressure Hydrocephalus (NPH). The NPH may have been present for some time, and had probably caused the instability that led to the fall.

The next summer a neurosurgeon put in a ventriculo-peritoneal shunt that relieved the pressure in his brain by draining fluid into his abdominal cavity. It greatly improved his motor stability.

Of course, he doesn’t remember any of it now.

When we were in the ER for the latest fall, the nurse asked if he had ever fallen before.

“No,” was the immediate answer.

“Don’t you remember the fall when you hit your head on the bookshelves?” I asked him.

He looked at me blankly. “No, I don’t,” he replied.

It was a lifetime ago. In the intervening two years, my mother had died, he had had the surgery, gone to rehab, and started having a home health aide come to help care for him. He had lost his driving privileges. He couldn’t live alone.

When he fell most recently, I was downstairs to help him immediately. I could see the gash on his forehead.

“We need to take you to the hospital,” I told him.

“No, I’ll be fine,” he said.

Some things don’t change.

Or perhaps they do.

We overrode his wishes and took him to the ER.