The Long Fall

by josh liba/via flickr

In the ICU, admissions due to falls are very common. Usually the falls are accidental, from ground-level slips or unsteady ladders. Sometimes, though, the falls are from greater heights and not accidental at all.

I once had a patient who tried to kill herself by jumping from a very tall bridge. She failed, and her survival seemed miraculous. She not only survived the impact of hitting the water after falling from a great height, but also avoided drowning. She’d lost consciousness, but had landed so close to a tugboat that she was plucked almost immediately from the water. She was rushed to our trauma center and treated for multiple serious injuries, including a ruptured spleen.

We were amazed at her survival. Maybe, we thought, it “just wasn’t her time to go.” Some even ventured the theory that God had intervened and spared her, that there was “a plan” for her.

After several weeks in the ICU she was transferred to the floor. Her injuries were healing and her family had rallied around her to provide emotional support. But during a visit with her parents she suddenly became extremely short of breath. A rapid response was called. She was intubated, scanned, and diagnosed with massive bilateral pulmonary emboli. Exhaustive measures were taken in a desperate attempt to save her, but she died several hours after returning to the ICU.

We were as stunned by her death as we had been by her survival. It seemed to be an especially cruel twist of fate. I remember hearing someone say, “Well, I guess her family got a few extra weeks. Maybe this was their chance to say goodbye.”

Last weekend I was expecting a new trauma admission. The hospital bedboard listed only that it was a male being admitted for a “long fall.”

As we prepared the room in anticipation of his arrival, the nurses and respiratory therapists ventured guesses at what a “long fall” could be. The most popular choices involved skydiving or parasailing. Other suggested a trampoline accident or fall from a balcony. The phrase “long fall” made me think of the bridge jumper, since I couldn’t think of a longer fall than that. But we were all wrong.

The 87-year-old man had fallen down a single flight of steps. We worked as desperately to save him as we had for the young bridge jumper, but perhaps with slightly less hope, for it was clear that his health was quite poor even before his fall, and his advanced age cast the odds against him. He was never stable, never regained consciousness, and died before his family got to the hospital. They never got to say goodbye. According to his wife, he had only opened his eyes briefly after he fell, then vomited and had a seizure.

It feels like poor taste, to give those details. In truth, I wish I hadn’t even talked to his wife. I’d rather not be left with the image of her seeing him tumble and land, vomit and seize. It must have happened so fast and been so ugly.

I wish I could make sense out of why these events unfold on days that start out completely ordinary. I suppose what I’m trying to say is that our lives and goodbyes are completely unpredictable. And it occurs to me that, regardless of the starting height, all falls are “long falls,” and they all happen way too fast.

Marcy Phipps is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN, and her post, “The Little Superstitions of Nurses,” appeared on this blog a few weeks back. She emphasizes that all important identifying details of patients in the current post have been changed to protect their anonymity.