On Breaking One’s Neck

Arnold Relman
Arnold Relman in the surgical intensive care unit at Massachusetts General Hospital, the week after his accident. His wife, Marcia Angell, is helping him correct galleys of his August 15, 2013, article in these pages, “Obamacare: How It Should Be Fixed.”

I am a senior physician with over six decades of experience who has observed his share of critical illness—but only from the doctor’s perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.

As background, I should first explain that this was not my first experience as a patient. Over the years I had acquired a multitude of ailments common to the elderly, most of which were minor. However, I have a few more serious health problems, including long-standing atrial fibrillation (an irregularity of my heart rhythm) that requires the daily administration of warfarin, an anticoagulant drug, to prevent the formation of blood clots inside my heart. More recently, I developed aortic stenosis, a slowly progressive narrowing of the heart valve that controls the outflow of blood into the aorta. So far, it has not caused any cardiovascular symptoms, but it could do so at any time.

And some four years ago, I developed a mysterious and very painful disorder of the muscles and joints, called polymyalgia rheumatica, relieved only by the daily administration of prednisone. This disorder, combined with an unsteady gait (caused by a viral infection of my inner ears many years ago), made it necessary to walk with a cane, and difficult to climb the stairs in my multilevel condo. For this reason, a stair lift had been installed to help me navigate the first and steepest flight of stairs from our entrance hallway to the first floor.

Despite all these ailments, I had never needed more than a brief hospitalization—until that fateful morning of June 27. I was hurrying down the stairs to meet a cab that was waiting to take my son to the airport. He had been visiting from his home in Washington, D.C., while my wife was on a brief trip to Santa Fe. Neglecting to use the stair lift, I lost my balance and pitched forward, landing hard on my head on the slate floor of the hall. I heard a loud crack as my head hit the floor, and although I did not lose consciousness and felt very little pain, I knew at once…

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