The Aftermath of a Fall

As I helped him keep his balance, my grandfather lifted his leg unsteadily. The stench of urine in the train station stall was overpowering. My grandfather, age 88 and incontinent, had wet himself on the train. I fortunately had packed an extra pair of pants, which I was now struggling to get him into. I remembered that he was not always this helpless. He had been a robust man, solo-hiking the tallest peaks of Japan at age 65, teaching me to play ice hockey at age 77, and even holding out until age 85 before retiring from his profession as a carpenter. The sudden transformation he had made into this declining old man, aged and embarrassed, was astonishing.

Kneeling on the tiles of the foul public restroom, I did not seek his eyes. I was fighting hard to find a way to guard his dignity. I kept my eyes low, watching him only to make sure that he did not tip over. But our eyes had to meet eventually when I finished tightening the belt around his pants, too large on his lean waist. When I peered up, his eyes were still downcast. He dropped his shoulders, then furrowed and lifted his brow, giving an expression that was unmistakably apologetic. As in a kid who senses guilt after spilling his juice, the contrition in my grandfather's expression evoked sympathy. Or maybe it was pity. I sought for something to say—something to let him know that it was all right. I rolled up the soiled pants, took his arms, and together we left the station stall.

These moments I spent with my grandfather were awkward to say the least. I felt remarkably clumsy because there was nothing I could do to make him not feel ashamed. The humiliation of a grown man wetting his pants was too obvious to mask with kind words or thoughtful gestures. I could only resign myself to acknowledge two things in that moment. The first was that the eventual decline of our physical and emotional integrity is inevitable. It happened even to this very strong man. Second, compassionately attending to him may have been the most that I could have done. Stripping him naked neither preserved nor protected his dignity, but it affirmed his significance to me even when circumstance wrested his dignity from him. When there was no poise left in him even to pretend, simply attending to my grandfather distinguished him from just any old man. Moreover, aiding the man within his ailing body allowed me to see his heroic struggle for dignity in light of unchangeable human frailty.

Since this happened 1 year ago, I have been receiving news often of his gradually deteriorating condition. Mindful of the bad news, I see in my daily encounters with the fallen elderly in the hospital how abruptly life can change. Falls often cripple and can sometimes even herald death for the infirm. The subsequent decline is unavoidably personal as one's bodily functions are lost one by one. Healers need to believe in the nobility of the human struggle against debility and dying, but fear and shame are forces too naturally embroiled in death for any of us to forestall. My grandfather, like many, endures the indignity of falling apart. I am powerless and cannot prevent him from falling further. I can only prevent him from falling alone.

• Copyright ©2004 by the American College of Physicians