There is a pressure gradient between both sides of the heart. This creates an impetus that keeps the pump pumping. But the heart is also active in this process for after the left heart comes resistance that must be overcome. It is through the progression of localized pressure differences that our blood circulates. Riding upon the surface of a single red blood cell, we experience multiple hills and waterfalls through the human body. The falls are what I am most drawn to.

As a kid, I did not spend very much time on sturdy ground – life was constantly in flux. So in response my feet had to learn how to shuffle and balance to the constantly shaking and heaving ground. This is why I dance, this is why I jump, and this is why I run when I need to get somewhere.

Back in our veins, our blood falls from all directions for there is no up and there is no down, there is only through. In life, I often feel there are moments in which I too lose my orientation and it is only through my velocity that I know if I am still climbing or if I have begun to fall. The climbs are frequent in life and are rewarding because of the vantage points you gain at the apex. But the falls are more enticing because they allow you to suspend your obligatory relationship with gravity for just one second and play with the liminal spaces in life.

Some falls are painful and scary. We fall from status, from comfort, from grace. We fall and land hard; it is the end of a fall that is most shocking and painful. I think the lesson to be learned from falling is how to surrender – they say that people who fall asleep during a car crash often are injured less than those who tense up. Abject surrender to falling, abject surrender to loss of control. And in the loss of control, a space opens up for possibility, for hope, for innovation and change.

Let be more concrete: climbing is studying late at night after working 12 hour days to pass a test. Falling is taking the hand of the stranger and listening to their fears and questions. Climbing is waking up early, getting on a bus to get on a shuttle to get to work. Falling is the family meeting to discuss a patient’s goals of care. Climbing is the rush of pre-rounding and collecting data. Falling is the shared tears with a person who has given up hope for getting better. Climbing is endurance, falling is letting go. The circulatory system is a closed circuit – every climb is balanced by a fall of equal amplitude. Life should also be a balance of climbing and falling. I am trying to hold to the idea that at the top of every climb is a beautiful view. If I cannot achieve such levels of zen and acceptance, I will at least accept that for every rise there is a fall.


  • Michael Mangahas