I have decided that, as an emergency medicine physician, I have a sub-specialty. Henceforth I will refer to myself as a "gravitologist."
My darling wife used to say, when she tripped, that she had experienced a "gravity storm."
I feel as if every day in the emergency department the staff fight a running battle against gravity.
In fact, I see young patients complaining of falls more than ever. Perhaps an endless diet of streaming videos and sedentary existence causes young brains and bodies to just stop trying. An ankle sprain, a knee contusion, not even a fracture, and younger and younger people seem incapacitated. As one young woman said to me, after a fall onto her knee with a negative x-ray, "Well, if it's not broken, then how come it hurts, huh?"
I responded, not without sarcasm, "Well, it's bruised. You know?" But I really don't think she knew.
Sadly, we have so many sedentary young people glued to phones, raised on screens, that it may well be that many of them just honestly never learned that bruises hurt. (It was a thing that we learned from an ancient technology called grandmothers back in the day. "Get back outside, it's just a bruise. You're fine. Have a cookie." Now THAT was medicine!)
The situation is much worse, however, because we have an aging population. And not only so, an aging population with many physical ailments. This is partly the result of the excellent medical care that allows them to survive and endure serious physical illnesses and injuries and live longer and longer lives. But I believe we have more falls in the aged because of the hard reality that as a nation, as a civilization, we're just out of shape and weak.
The "system" isn't prepared for this. Medicare, private insurers, and hospitals struggle with the idea that a person who can't walk can't go home. Family members are also in a difficult situation. I frequently hear patients say, "She needs to be admitted." And when I can't find a good reason, as hard as I try, they say, "Well, we simply can't take her home."
In particular, a person can't go home if he can't walk, or even pull up into a chair, and is very large. A 70-kg wife simply can't manage an unstable 150-kg husband when both are in their later years. Likewise, a skinny husband can't handle an amply proportioned wife. It's not judgment. It's not "fat-shaming." It's not policy.
At some point, it's simply physics.
All day and night we hear ambulances toned out for fall assistance. Ambulance calls for falls with injury. Seniors with falls from a standing position are sicker than ever with neck and head injuries, rib fractures, and other significant trauma. Many of them are also taking sedating medications as well as potent anticoagulants, both literally prescriptions for disaster.
This was highlighted in a 2010 confirming that, over age 70, mortality from low-level falls goes up dramatically compared with younger patients. (The full study is behind a paywall, but .)
Healthcare as a whole must come to terms with this. However, we can only add so many nursing homes, so many fall-prevention devices, so much home health care. Our ability to deal with diseases that come with age, such as heart disease, stroke, and cancer, is remarkable and constantly improving. But humans are going to have to decide to stay fit and get strong in order to navigate the gravitational ravages of age.
We need to encourage everyone to see obesity as a deadly disease and incapacity as a thing to be avoided as long as possible, to be struggled against rather than embraced as the relaxing reward of a long life.
There are those who can't help it; those simply unable to engage in any fitness-related activities; unable to get stronger for myriad reasons. But there are all too many who choose not to bother.
Our ancestors knew that if you were too weak you would die. Modern man loves the idea of evolution in the abstract, failing to realize that part of evolution is being removed from the gene pool; a thing which gravity has done quite nicely since, well, forever.
It is indeed a blessing that we can delay death so handily with our incredible science. And yet, a curse. Because humans in modern societies simply rely on medications and hospitals and their workers to do for them the things their bodies are already equipped to do, with only a little attention.
Gravity is a killer, but it doesn't have to be a killer.
All human beings who can should walk, work, move, lift. Get a trainer. Work hard to get stronger. Limit calories. Stay mobile. All of which will allow them to live better. As physicians, we should encourage this with all the passion we urge vaccinations, seat belts, and smoking cessation.
Without fitness, without strength, that gravitational acceleration of 9.8 m/sec2 will land more and more people in the hospital; and finally in the ground. Where, of course, gravity will continue to pull, they just won't notice.
I know what I'm talking about. I'm a gravitologist, after all.
Edwin Leap, MD, is an emergency physician. He practices full-time in a rural community hospital in South Carolina. He has spent many years practicing in rural and critical access facilities, including work as a locums provider for Weatherby Healthcare. He is a writer and blogger. He and his wife have four children. See more at .