After the Fall

This is what Helen McKay remembers the morning after:

Her boyfriend Peter drove her, fast, from the ballroom at Leisure World to Montgomery General Hospital. He held her up as she limped from the car, stayed with her on the blood-repellent plastic chairs in the waiting room for three hours and sat beside her while she lay on a stretcher in the ER.


It was 1:30 a.m., and she was trying to rest. But she couldn't.

Her boyfriend ought to have been an hour away from there. But he wasn't.


Peter called home with an excuse, told his wife he got tied up and she shouldn't expect him until morning. Helen knows last night has put her boyfriend in a mess, threatened the delicate balance of their affair.

And not just that, but what has happened to her? The devoted ballroom dancer always thought she'd tricked old age - lost it in the folds of her ball gowns, turned it around so it couldn't find her in the confusion of the dance floor.

But it did. And who would recognize her, scared and needy like this? This isn't the Helen who could dance all night, who gushed about her boyfriend like a teen-ager, who couldn't wait for what came next.

Now what's next is pain. And another day making her older than the one that came before.

It all started at the May 24th ballroom affair when someone smacked into Helen, toppling her during her favorite dance. That disastrous cha-cha landed her in the emergency room, dressed in a drab hospital gown, trying to shut out the noise and the bright lights. All she wanted was to disappear inside herself until she could go home.

So she closed her eyes to the cut-outs of spring flowers around the ER - as if anybody could be cheered by paper blossoms pasted to walls that surround death on bad nights. She closed her eyes to the plastic ID band wrapped around her wrist in place of her rhinestone party watch. She closed her eyes to the name "MCKAY" on the board listing all the ER patients - not exactly the kind of company she wanted to keep last night.

But this morning, she cannot close her eyes to the memory of that accident, the tumble through those few feet of space where the line between strength and frailty lies. In this hard light, it's all she sees, slicing across her future like a new horizon.

Helen admits it: Her mornings are consumed with Regis and Kelly now.


Before her fall, the 74-year-old guzzled coffee, downed toast with her arthritis pills and rushed to tap class in the auditorium of this Silver Spring senior-citizens community. For two hours, she did split jumps on the backs of folding chairs and shuffled off to Buffalo in black tights and a T-shirt barely covering her derriere.

But these days the widow sits in her apartment, watching TV in her bathrobe late into the morning, avoiding her closet and the ordeal of pulling on an outfit. She listens to Regis talk about what he did last night. She tries to ignore the ripping pain in her back, but almost all she can think about are the aches and the humiliations, like the other day when she dropped her toast and had to crawl on all fours like a baby to pick it up.

The fracture is supposed to take a month to heal - that's what it turned out to be, a fractured vertebra. So, while she waits out one week, then two, then three, Helen stays sealed inside her apartment. She doesn't join her ballroom dance friends for their weekly dinners. She asks them not to visit.

The Percocet the doctor prescribed is not really working. As far as injuries go, this is not nearly as debilitating as others, but it is the worst pain she has ever felt. She tried walking around her apartment with a cane, then abandoned it in disgust. She is used to living alone, eating alone, waking and sleeping alone. And now, she wants to suffer alone.

Helen worries she has lost some of her old powers, especially where her boyfriend is concerned. Before the accident, she spritzed herself with perfume for Peter's arrival, charmed him with pre-dance cocktails, posed for him in sexy lingerie. Now she has a heating pad and a grimace and nothing but bad news on her mind.

She does the math on her fingers: There has been a death in nearly two-thirds of her building's 30 units since she moved here a decade ago. She doesn't know it, but other daunting statistics surround her - like the one that puts the risk of dying twice as high for older Americans without spouses as for those who are married.


Peter still shows up for their dates - the 77-year-old with a slight stoop appearing twice a week at her door, all gray and rumpled and professorial. But instead of the outings that used to reward his long drive to Leisure World, the two just sit. They don't go out to lunch or take a walk or go shopping. One afternoon on the Lay-Z-Boy loveseat, they try to enjoy the movie Unfaithful, about a cheating spouse. Peter sees the potential for a more plucky ending; Helen sees only darkness. They argue.

"We used to laugh so much together," she recalls telling him later. "What happened to our laugh time?"

Before the fall, their relationship was always fresh, a respite from the rough marriages that defined their lives, contentment made all the sweeter by its limited supply.

Helen met her boyfriend at a tea dance 12 years ago. Gravelly voice. Strong hands. Crackling laugh. She instantly liked him, and two years after she met him - after her near-lifetime of marriage - Helen left her husband.

She moved into her late father's Leisure World apartment and fell even harder for Peter. But this was not some applesauce and denture-cream version of romance, not the sort of senior-center companionship where most of the heat comes from the cardigans. With Peter, there were real intimacies, promises, love. There was sex. There still is.

Beyond the Leisure World gate, the bond between Peter and Helen is maintained only in secret, of course. Peter calls her from his study after saying good-night to his wife, who is in her 80s and suffers from heart problems. Helen uses signals: If the phone rings once in Peter's house, it's her, wanting him to call back. Gifts are forbidden; evidence of Helen's existence must stay hidden, but the pair thrives on letters and e-mails. And, of course, all those Saturday night dances - evenings that are never long enough.


Helen can see how weary Peter is, how he is exhausted not just by the drive to see her but by the life that waits at the other end of that highway when he leaves. She sees the strain on her boyfriend, a caregiver with a wife and a marriage that are both unwell.

Helen used to be the antidote to all that was ailing in Peter's life. But now when he comes here, what does he find? His time is spent talking about her pain, running through each second that led to her fall, frame-by-frame, trying to piece together what happened and assuage her misery. Sometimes she wonders: Does she weigh on her boyfriend any less than the wife he flees?

"He stayed for a couple hours," she says one day after their date. "I'm sure he was glad to get out of this place."

Helen knows what it means to nurse a spouse when alienation has curled up where kindness used to be. She understands the complicated landscape of loyalty. When her husband's bladder cancer set in, Helen drove from Leisure World to the old house in nearby Rockville to help him. Some days, her boyfriend would escort her there. He'd wait outside while Helen checked on Bruce McKay - a man who on bad days refused to eat and railed at Helen to take the rest of her belongings from the house.

Sometimes among the elderly, the desire for new love is as strong as the pull of the past. Married people may even ask their once-secret sweethearts to help them care for a dying spouse. Remarriages are few; blurry entanglements and unofficial commitments abound.

But these relationships can be tenuous. A gentleman friend of Helen's is still reeling after falling in love with a married woman who dumped him at the precise moment a series of bleeding ulcers put him in the hospital, near death. After just one bedside visit, the girlfriend went back to her husband, dashing her wild attempt at a new life with a boyfriend in his ninth decade.


Peter tries to reassure Helen, tells her he wants to hold onto her at every dance so that she will never fall again, but she's still upset. She thinks of the ballroom dancer who caught her heel in the carpet and broke her hip and can no longer rise from a chair without two people helping her. The other men Helen romanced - the ones who can drive at night and do a cha-cha - most of them wouldn't even consider a date with a broken-down woman.

Injury and illness can make a person invisible.

The colorful ball gowns always distracted Helen McKay, but in this new gray life, she can't help but see:

She is a widow. She is hurt. And she is alone.

"Welcome back into the fold!"

Everyone applauds, makes room for Helen at the round table in a corner of the Terrace Room, one of Leisure World's two restaurants. To her ballroom dance friends, it's just another weekly dinner - easy on the spice, heavy on the chitchat. To Helen, it is an event, the first time in weeks that she has ventured out for their Thursday night ritual.


She orders a Manhattan. No pain pills tonight. Let the alcohol do the work.

Since her fall, she has lost five pounds, down to 100 on the bathroom scale. She thinks she has gotten shorter, too. And she wonders if she looks humpbacked, like those doddering ladies who hobble over for dinner at 4 on the dot.

A friend leans across the table. How are you, Helen?

"I'm OK. I'm OK. I'm going to heal."

That's right.

"Tired of feeling sorry for myself."


The old Helen spirit. That's what she's conjuring, thinking maybe there's no room for weakness when you're alone and have to do everything yourself. Maybe you're forced to get better faster then, for fear of where you'll end up if you don't. She can't change her age or the fracture. But, she thinks, maybe she can control the moment when she decides to get old.

Between bird-bites of salad, Helen summons some hope, thinking that the fracture was supposed to take a month to heal and by week's end that sentence will be up. She ignores the back brace that pinches. Instead, she steps back into character. Someone talks about a dog that went to the bathroom in a Leisure World elevator. "They should take that dog away in handcuffs," she says, then laughs at her own joke.

Another sip of her Manhattan. Conversation flows around her.

She tries to act normal.

But her mind moves backward, to yesterday, what would have been her husband's 75th birthday. Helen asked her two sons, Don and Bill, to take her to Arlington National Cemetery, where her husband was buried almost a year ago. After standing for a spell before a box labeled "Bruce McKay" set into a memorial wall, she walked to a bench and waited for her boys to finish. She was ready to go before they were.

Fights that started small, when Helen and Bruce began dating, deepened over the course of their marriage. Helen tried to divorce her husband, went to a lawyer twice, had the papers drawn up. But she could never bring herself to end it, not after the kids grew up and moved out, not after she built another life for herself, not after 55 years as Bruce's wife.


She loved him, even after she thought she couldn't anymore.

At the beginning, he was all she could see. The Louisiana belle was raised in a Baptist tradition where teen-agers were scolded for anything as frivolous as dancing, but when her family moved to Northern Virginia, she found a dashing partner who knew no such self-denial. Bruce was the high school heartthrob who chose her over all the other girls.

Her father never wanted them to marry, but one day Helen cut school, and before she really knew her boyfriend - before she really knew herself - she and Bruce eloped.

Helen was 18. She had the two boys by the time she was 20, bought the family's first house in Rockville with a loan from her father and found a job as a secretary. The marriage was rough, then smooth, then rough again. Bruising arguments erupted over things as small as a mess in the sink. Bickering turned to bitter threats, like the one Bruce made about smashing apart Helen's pink kitchen when she got a new dishwasher without his approval.

But this was also the man who slept with Helen on the porch on hot August nights, the partner who tended her prized azaleas in the yard, the father of her children. This was the man who could always romance her with flowers and wry jokes and trips to places made more interesting by his presence.

Bruce was in his mid-50s and sick with emphysema when he retired from his management job at an electronics firm. He stopped going out, embarrassed by his coughing fits. As he grew sicker, Helen left her secretarial job and their fights found a vigor they'd had only in youth. When there weren't crushing arguments, seething silence chased her around that house. By then, Bruce would communicate only by writing her notes on scrap paper.


Helen took refuge in her books and soap operas. And, finally, in Peter.

Yesterday, she saw a rose on the ground and thought about placing it by her husband's grave, but she was afraid the thorn would cut her. She left the blossom where she found it and got ready to go home. Soon, Peter would be waiting outside her apartment. They had a date.

Helen knows what it looks like, this affair. As a younger woman, she never would have condoned such behavior in her friends, much less herself. A marriage was a bond, no matter the misery, and it would be honored. But when that last chance for a new life came along - a grasp at happiness in the form of a married man whose warmth wrapped around her like a shield - she reached out and held on tight.

Peter returned the embrace. Though he keeps much of his identity cloaked when he comes to Leisure World, his desire to be with the extravagant Helen McKay draws him out. The private Peter becomes public this way, still quiet and mysterious, but a steady presence in his girlfriend's outspoken world.

The friends around this dinner table tonight know about Peter. They know about Bruce. Helen doesn't ask if they judge her. She doesn't need to. She has made up her own mind about her life story.

There's so much she keeps to herself, so many days like yesterday, burdened by what love can cost, filled with a sense of what it can redeem.


Helen turns to a girlfriend, describes Bruce's grave.

It's just the mundane details now - she leaves out all the history.

But the tears spill over anyway.

Her voice quakes.

"So," she says softly, "that was yesterday."

"Number four, dear," the nurse tells Helen. "Back on the left."


Helen walks to the examining room in the medical building just outside the Leisure World gate, fresh from a hair appointment. She waits for Dr. Charles Mess, the orthopedist who diagnosed her back fracture after her fall.

She doesn't feel much better, but she is excited. She believes today the doctor will declare her healed.

The Southern widow puts some steel in it and smiles. She only just recovered from her last accident, when she lost her footing on a trip to Ocean City and broke her arm. That's two breaks in two years. She figures it's a fluke.

"I look OK," Helen says, gazing into the examining room mirror. "My hair looks beautiful."

Few things are more dreaded in Leisure World than a fall. It can signal the onset of nursing care, the loss of independence, mobility, purpose. As the body's reflexes slow, as bones turn more delicate and strength and balance deteriorate, a fall becomes almost inevitable. A commonly cited statistic says that anyone over 65 is likely to fall once every three years - accidents not always serious enough to send victims to the hospital, but bad enough to ratchet up the fear of another fall among people like Helen McKay.

And fear, Helen is learning, never heals.


Dr. Mess enters the room.

"How's your back doing?"

"I'm not in excruciating pain anymore."

Helen smiles a little at her sarcasm, then gets serious.

It still hurts, she says, when she tries to get up, move around, do a few things.

The doctor runs his large hand down her spine, bends her, asks if it aches. She yelps. He stops.


He sends her to X-ray.

A few minutes later, Helen is back in the exam room and eyeing the film - a row of perfectly square vertebrae stacked like ice in a tall glass of sweet tea. Looks fine to her. She doesn't study that segment of spine that is unlike all the others - the vertebra squashed into the shape of a lemon wedge amid all those perfect cubes.

The lightbox illuminates that neutral expression doctors have perfected for the delivery of bad news.

"It really shows up," Dr. Mess tells her.

Helen's eyes bore into him. Come again?

"This is the side view of the spine. This is where the vertebra collapsed."


On the wall, a poster for an arthritis drug teases Helen. "One great day after another," it promises.

"This one, you broke," the doctor continues. "It has lost 70 to 80 percent in its density."

Today, almost exactly four weeks since Helen's fall, he is supposed to be talking about things getting back to normal.

One month. That's what she heard him say during her first visit. She'd be better in one month.

The doctor's forefinger traces the line of bones down the X-ray.

"That's quite a collapse there."


Helen knows that beyond the infirmity a fall brings, making a second tumble more likely, there is yet another threat: the way a fall will be perceived. In retirement communities, some people hide the evidence, worried their autonomy will be compromised if anyone finds out.

A fall can break a person's faith, right down to the marrow.

Dr. Mess takes out his pad.

He prescribes Vicodin, because, unlike the Percocet she was taking, this prescription is refillable. Refillable painkiller for refillable pain.

The doctor tries to explain that her fractured vertebra is worse than he first thought, that once a bone is crushed like this it will always be damaged, that she can have an active life but there will be limits.

That pain will be moving in with her. Better make room.


Helen knows she is lucky; she understands it could be worse. But she can't feel grateful today.

Her recovery is not light and dark, like that X-ray, but covered in shadow.

Outside in the parking lot, prescription in hand, Helen spits out her gum. She doesn't like gum. She chews it because her mouth is always so dry from her osteoporosis drugs, her blood-pressure drugs, her cholesterol drugs, her arthritis drugs.

And, now, her painkillers.

Helen stands in the model of her new living room.

She grabs a remote control and flicks it.


"There it is!"

Fake fire roars in the hearth.

For a little exercise - and to boost her spirits a week after her depressing doctor's appointment - Helen walks around the Leisure World sales office, studying a replica of her new home in the high-rise now under construction on Leisure World Boulevard.

She knows Peter loves this side of her - the woman who won't be ruled by caution, the woman who is supersizing her life when other widows are getting rid of everything, the woman who just paid nearly $500,000 for a three-bedroom condominium in the Overlook with all the best upgrades, including her first-ever fireplace. It's no wonder talk of the building dominated their date the other day, when she was feeling well enough to greet Peter in a Hooters T-shirt, just for laughs.

This is how things go now - her route out of injury is always changing. It's like a roller coaster, rising with confidence, falling with doubt. More pain one day, less the next.

Helen moves carefully through the Leisure World sales office, one arm on the wall for balance.


She passes giant promotional photographs. A woman painting. Men golfing. Full-color neighbors grinning at her. Look at all these people enjoying life. In her new place, Helen thinks, she'll be one of them.

She doesn't know their stories. The blown-up shot of a couple playing cards? The man went to a nursing home after his Alzheimer's disease got too bad. That woman is alone now.

Time to leave. Helen is meeting her friends for dinner soon. By the door, she passes one last picture, a larger-than-life photograph of a man in a tuxedo holding onto a woman in a black strappy ball gown. The woman looms over Helen, smiling, her head thrown back, triumphant.

A blind curve. The roller-coaster dips.

"I'm so afraid of my body now," Helen says, a little stunned. "I mean, I fell."

That is the hierarchy here - not who owns the half-million-dollar home, but whose life has tumbled and whose is still standing.


Helen leaves the air-conditioned sales office and walks into the warm evening, watching her step.

She never used to fear much before. That's not who she was then.

"I felt I was invincible."

But something was lost in that fall.

Or rather, someone.



For the Olivers, a visit to the end of life, and a ghost. In the Today section.

A Step Back

c. 1938

Helen McKay has always loved dancing - and dressing for the occasion.

"My little girlfriend next door to me took tap dancing, and I begged and begged and begged to take tap lessons, and my parents wouldn't allow it - they were strict Baptists, and dancing wasn't allowed. So I got her costume and dressed up, and my mother took my picture. I was so proud of it."

Life in the slow lane



Sometimes the kids have to wrest the keys away.

That's what happened to Dick Brown, an 86-year-old retired banker who suffered too many strokes to continue driving safely. But he still visits the garage under his building to gaze wistfully upon his gleaming new Cadillac. It only has 1,000 miles on it.

Driving means independence at Leisure World. Some who are not well enough to drive outside the community gate still take their cars on the three-mile Leisure World Boulevard loop - they figure this isn't as risky, what with the extra-wide road and the absence of traffic lights.

Many residents who can't drive still carry their keys for comfort and renew their licenses faithfully.

But there is another solution for the carless: golf-cart driving. It is Dick's liberation now. One afternoon, he pushed his cart to 15 mph across the course, speeding past the ducks and forgetting his troubles.


"Ha, ha, ha!" he said as the wind ruffled over him. "Never say die!"


The Stats

One in three Americans over 65 falls each year; the older the senior citizen, the more likely it is the injury will send the victim to the hospital.

Falls prompted 1.6 million emergency room visits in 2001 and 373,000 hospitalizations.

Elderly people over 75 are nearly five times more likely than younger seniors to require a year or more of nursing care after a fall.


Falling is the leading cause of injury deaths among older Americans.

Some estimates put the total health-care cost of falls at more than $20 billion a year.

A broken hip is the most feared injury among the elderly, killing about 25 percent of its victims in the year following the incident.

Senior citizens often keep mum about falling because the mishaps can threaten their independence and image of vitality. In focus groups conducted by the Boston University School of Public Health, retirement community residents admitted to retaliating against seniors with whom they didn't get along by spreading false rumors that their offending neighbors had fallen.

SOURCES: Centers for Disease Control and Prevention's National Center for Injury Prevention and Control; Jonathan Howland, professor of Social and Behavioral Sciences at the Boston University School of Public Health

About the series


In 2003, Sun reporter Ellen Gamerman spent nine months inside Leisure World, a seniors-only community in Silver Spring, learning about what it means to grow old.

She observed every scene described in this six-part series except one. The scene she did not see first-hand - in the emergency room at Montgomery General Hospital - was reconstructed through interviews and is clearly attributed to the memories of the people involved.

All direct quotes in the story were heard by Gamerman; descriptions of what people thought or felt are based on what they said at the time or what they told her in interviews later. During the course of her reporting, Gamerman also reviewed private letters, an audiotaped memoir and home movies.

The Staff

Ellen Gamerman, 35, joined The Sun in 1994. She has been a correspondent in the Washington Bureau for the past eight years. Her e-mail address is

Chiaki Kawajiri is a native of Japan who came to the United States to study journalism. She became a photographer for The Sun in 1995. Her e-mail address is


On the Web

To read previous stories in the six-part series "Dancing in the Twilight," or to view a photo gallery, go to