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May 2, 2016

Health : Taking Falls

Falls are one of the hardest issues in the care of elderly patients, because there are so many things that can contribute to them and many of these factors can be difficult to control.  Past strokes and past substance use can change the brain's landscape, smoothing essential grooves or making new unwieldy paths.  Chronic pain and depression--and the medications we use to treat them--fog the senses of sight, touch and balance. Fractures and infections impose immobility, weaken muscles, and disrupt the habit of movement.

I spend a lot of my time with some patients trying to prevent falls and managing the consequences of falls.  But in my time outside of work, one of my main goals is to take more falls.

In order to climb most rocks outside, you attach a rope to yourself and bring it up with you as you climb.  You tie the rope into the rock at certain intervals as you climb up.  Once you tie into a spot, you're anchored there and if you let go or fall, you won't go very far; you'll stay stable at that spot.  But once you go above this spot, you can fall far below it until you reach the next spot to tie your rope.  Eventually your rope will catch you and you'll stop, but in the meantime you'll have gone a long way.

For a visual, here's a climber who's tied the rope into the rock at a few spots as she's climbing up.  Here's the last place that she tied the rope:



She hasn't gotten to the next place to tie the rope yet.  If she falls here, she would free fall from where she is down to this spot:



As easily imagined, it's really scary to fall, and even scarier (for me) to anticipate the fall.  Especially when outdoors, it can be hard to predict where exactly you'll land on the rock, at what angle, and how hard.  It's always best in the beginning to do climbs you can comfortably finish, so that you can focus on gauging all these other elements.  As you gain more experience, you can better judge the risks and benefits of pushing your comfort level.  I don't think it's a good idea to push anything that relies on your knowledge of the rock quality, equipment safety, weather conditions, or natural obstacles that make a climb unsafe.

But for me it is important to push myself in areas of mental courage. I want to be able to try things where I know the fall will be safe, but scary.  I want to try things where the limiting factor is my fear, routes that may require falling several times before reaching the next hold.

Last weekend we went rock climbing at Table Mountain in Sonora.  On a route that I thought would be difficult but doable, I unintentionally took my first fall while climbing outside.  It was terrifying.  I was terrified.

But I was okay. It took a while to calm down enough to try again, and several more anticipated falls, to get going and finally finish the climb. And the biggest victory was the initial fall.

I think taking different kinds of falls prunes your mind to explore more. These unexpected sensations, and the new motions you let your body experience, rearranges things inside.  So it's not a shock to feel mentally shaken.

But the pieces slowly come back together, and when they do, they've known what it's like to be apart, to connect to other pieces, to be upside-down.  This plasticity builds a certain resilience. It makes you better able to seek and confront new things, and to remain stable in the midst of them.

So I've found that a huge part of gaining balance is putting yourself in (relatively safe) situations where you might lose it, knowing that you'll remain in tact and likely more so.

And I know, from seeing so many patients lose this balance in their lives, how essential this feeling is to our functioning.  I feel lucky to be able to choose where I place myself, and to see the rewards of maneuvering myself.  When overcome with nerves while climbing, I often ask myself, "Why do I do this to myself?"  Then as fear shatters all the things I've built up inside, and then re-settles them, I learn over and over that it's that I do this for myself.



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