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AFTER THE FALL

Determination against the odds

Ten days after a fall, operating room nurse Andrea Garipay checked to make sure Joseph Smith's broken right leg was marked for surgery, as his older daughter, Ginnie (left), and wife, Brenda, comforted Joe.
Ten days after a fall, operating room nurse Andrea Garipay checked to make sure Joseph Smith's broken right leg was marked for surgery, as his older daughter, Ginnie (left), and wife, Brenda, comforted Joe. (Globe Staff Photo / Bill Greene)

The words were barely audible, but there was no mistaking the meaning.

“I want to walk.”

Seven hours after hip surgery at Beth Israel Deaconess Medical Center in late February, Joseph Smith was groggy from morphine, but he was already trying to take charge of his recovery.

No matter that while waiting for his hip operation, he suffered a mild heart attack that led to quintuple bypass surgery. No matter that Parkinson’s disease stiffened his muscles and hampered his balance. Joe, a 77-year-old stoic, showed no signs of invalid mentality.

His steely blue eyes flashed when the nurse told him he’d have to wait a day for the physical therapist. Then he shut his eyes and gestured for silence with a wave of his hand, determined to rest so he would be ready to walk.

When the time came, he was so weak from two surgeries and 11 days in bed that therapist Corrine Fairweather and a nurse had to push him into a sitting position. When they lifted him to his feet, he flopped over Fairweather’s shoulder, clinging to her arms as she braced his knees with hers to keep him from falling. Joe’s jaw was set, his eyes wild. They gently lowered him to the bed.

A minute later he wanted to try again. This time, he straightened a bit, but the women were supporting most of his 160 pounds.

“It may be a week before you can take a step,” said Fairweather.

Delaying walking that long worsened the odds of Joe's recovery -- and those odds were already stacked against him. Thirty-five percent of men his age who fracture their hips die within a year, compared to 21 percent of women, according to a study by the University of Maryland School of Medicine that was commissioned by the Globe.

Men's muscle and bone strength provide protection from broken hips, but that advantage can be stripped away by serious illness like that Joe endured. And when a fracture occurs, that illness can derail recovery. Men are also more prone to life-threatening infections after the fracture, according to a study by University of Maryland professor Jay Magaziner.

But Joe was used to tough situations, and he had his own goals.

“I’m a farmer’s boy,” he said. “You get up in the morning and do what needs to be done.”

Born in Derbyshire, England, he won scholarships to exam schools by studying old tests and reading science textbooks. He earned a doctorate in physics from Cambridge University and moved to the United States in 1951 with his wife, Brenda. By 1960, he was a tenured professor at the University of Chicago, specializing in the crystal structure of minerals. In recent years, as he phased out his teaching, he began a book that is part memoir, part ecological manifesto.

Joe retired in September 2005, and he and Brenda moved to Brookline two months later to be closer to Ginnie, the older of their two daughters. In mid-February, Joe was fixing Brenda’s computer so she could get back to working on her own book –- a mystery -- when he stood, felt a little dizzy and fell.

In his first days at Spaulding Rehabilitation Hospital, Joe walked several times and asked for extra therapy sessions. He was awkward and unbalanced, but unafraid.

Joe was always two steps ahead of his therapists. He was standing before they were ready to help him, moving before they had a safe grip on him. The therapists knew what many patients don't -- that those who fall once are likely to fall again and are at greater risk of suffering another fracture.

The day before Joe planned to go home –- at the end of March -- he called for an aide to help him use the commode. It was 7:30 a.m., a busy time on the floor, and Joe grew impatient waiting. From the bed, he reached for the commode. Suddenly, the bed slipped out behind him and he sprawled on the floor.

The crash sent his roommate scurrying for help. A nurse checked Joe over. He was mercifully unhurt, but his family was livid.

“You can’t do this to me,” said Brenda, the wear and tear showing in her face. “I can’t take six more weeks of this.”

Joe’s jaw was set, his face red. But he was chastened, temporarily.

At home, anytime he got up from bed or a chair, he waited for Brenda or Ginnie to escort him. He quickly got back on his computer, e-mailing colleagues at the University of Chicago and working on the book. In three weeks, he had mastered the stairs from their condo to the street and, with help from Brenda and his walker, was regularly strolling the nearby park.

Emboldened, in early June, he decided to walk the quarter-mile to the Brookline library, a favorite haunt. But it was too far, too fast. Blue from lack of oxygen, he was rushed to Beth Israel suffering congestive heart failure and another heart attack due to a failure of his bypass.

Two months later, shortly after turning 78, he was felled by a third heart attack. The drug-coated stents in his chest were likely a factor, his cardiologist said, since new research shows they inadvertently promote blood clots in some patients. Another possible cause of the heart attack, the doctor said, was Joe's inability to get intensive aerobic exercise because of the hip and the Parkinson’s, which was progressing.

Another man might have given up, but Joe’s determination hadn’t wavered. With help again from Spaulding’s therapists, he was soon back on his feet, even balancing on one foot, and giving the therapists heart palpitations.

He began taking more risks at home, getting up at night without calling Brenda and rushing to the bathroom without the walker. Then, last month, he fell three times in two weeks, gashed his head, developed an infection that landed him in intensive care and suffered another heart attack.

With heartbreaking sadness, the family talked about how much time Joe had left.

Joe’s own words were nearly incomprehensible, garbled by Parkinson’s, but his intentions were clear. At Spaulding once more, he willed his legs out of a Parkinson’s shuffle and stepped gamely, if unsteadily, around his room.

Photo Gallery PHOTO GALLERY: Joseph Smith's hip surgery
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