The last month has been crushing on my surgery rotation. It is extremely fun, however, and somehow the 15 hour days just whiz by. Have had no time for anything else, which is a hard adjustment for someone who likes to play guitar and spend time outdoors.

It is said that a good attitude goes a long way in recovery. This is an understatement, and it is not just old wives tale; there is evidence that time to convalescence is associated with being positive, keeping a sense of humor, etc. There is one patient I have been following on our surgery for the past 4 weeks who typifies this. The gentleman developed necrotizing fasciitis of his shoulder and subsequent septic shock within a matter of hours of presentation to the hospital. A large placemat-size portion of his shoulder was debrided down to the bone and joint. His initial recovery was very slow in the ICU. He was on a ventilator for some days, suffered from massive blood clots in his legs, and is still recovering from kidney failure. For several days he was only hours away from death, but miraculously pulled through. Once he was off the ventilator I began to get acquainted with him and am struck every day by his positive, grateful, carefree attitude, and sense of humor. He has suffered an enormous amount of pain with his shoulder compared to most of the other patients I have seen over the last month. His wound is still open, but healing very well. Eventually he will need skin graft surgery. Indeed a lesser man would have died.

Another aspect of convalescence is support from family and friends. The past week we have had a diabetic elderly woman from India who developed a small bowel obstruction and ischemia that required resection. She was discharged today, a mere week after her surgery. Being old and diabetic in a foreign country are not points in your favor when recovering from major open abdominal surgery, but her hospital course was remarkably smooth. I attribute this to her attitude - she was stoic and always smiling every morning we came in to round on her, although I new she must have been terrified and in a considerable amount of pain. Moreover, her son, who works as a engineer at Intel, stayed with in the room at her side 24 hours a day. This is nearly unheard of in America, and perhaps he did this only because his mother only spoke Tamil. At any rate he commented today that he felt he had lived vicariously through his mom's operation and recovery. I told him indeed he has, and that is a big part of why she did so well.