Unexpected & unplanned.

What began as a nagging backache turned out to be a weakening of the wall of the aorta (aneurysm) extending from the upper chest into the lower abdomen. The decision was surgery. It would take 5 to 8 hours of surgery, 7 to 10 days in the hospital, and several weeks to months for a full recovery, but a successful outcome offered years of productive life.

Having experienced major surgery before, Jim knew the physical challenges posed by this procedure--the pain, weakness, fatigue, and loss of appetite. He understood the mental

emotional toll associated with a long recovery. And he accepted the possibility of postoperative complications--fever, infection, and delayed wound healing.

The road to recovery

But nothing could have fully prepared him for the surgical insult to his spinal cord, which followed an otherwise successful operation, that left him partially paralyzed. Of course, he had been informed of the statistical possibility of this devastating complication, but its mute reality was difficult to understand, accept,

assimilate. The road to recovery now appeared uncertain, with more questions than answers. What are the rules of this road? Is there a reliable road map? Who can provide directions back to health and productivity? Is the most desired destination (full recovery) a realistic goal? How long is the journey? Do I have sufficient fuel (energy and determination) to make it?

Jim's experience is not unique. Since more serious diseases are being effectively treated today, resulting in lower death rates and prolonged lives, there's a growing need for better understanding of the entire rehabilitation and recovery process. And the answers to Jim's questions are becoming increasingly clear.

Be patient

"Time heals all wounds." The truth of this old adage underscores the need for patience as healing occurs. Certain aspects of tissue recovery simply cannot be hurried. The cells and tissues of the body must have sufficient time for natural restorative processes to develop. Trying to regain a high degree of functional activity too quickly may weaken the body and prolong the healing phase or contribute to a relapse.

Take it easy

Plenty of rest and sleep are essential during the early recovery period. With its energies focused on the healing process, the body requires sufficient relaxation to recharge its energy resources. The common experiences of tiredness and weakness give clear indication of the body's needs for adequate rest. Despite the importance of sufficient sleep, tranquilizers and sleeping pills should be avoided as much as possible to minimize the potential for unwanted side effects.

In addition to rest and sleep, progressive muscular activity is necessary to restore muscle tone and avoid loss of function. Initially, simple range of motion and stretching exercises retain flexibility and prevent tightening or contracture of the muscles and joints. As strength and energy return, you can try more vigorous activity. A physical therapist may be helpful in recommending and supervising a safe and effective exercise routine.

Good nutrition is important--

Good food provides energy-producing fuel for muscular activity and the necessary raw material for repair of injured tissues. Unfortunately, serious illness often causes decreased appetite or even loss of the ability to eat normally and/or digest regular food. Intravenous feeding may be required until the ability to eat returns. Later, food supplements may be added to provide adequate calories, protein, and other nutrients. Carbohydrates (and, to a lesser degree, fat) provide the main source of calories for energy. High-quality protein is needed for tissue repair. And vitamins and minerals help the processes of metabolism and healing.

Reality checks

Unfamiliar hospital surroundings, medication side effects, and mental and physical stress may result in some disorientation. These symptoms ranging from short-term memory loss to confusion, or even hallucinations, are generally short-lived (hours to a few days) and often resolve spontaneously. Close observation and attendance can help relieve anxiety and prevent excessive physical activity and possible physical injury. The support of family and close friends, providing familiar faces and gentle "reality checks," may be particularly beneficial to expedite the return of normal perception and thinking.

Emotional recovery is as critical as physical and mental recuperation. Discouragement, anger, fear, and depression mingle with shattered hopes and unrealized expectations to weaken the resolve to fight. Here, too, family and friends can give invaluable support by helping the recovering individual understand that patience, persistence, perspective, and promise are key elements in the return to emotional health: patience to realize that recovery is occurring, albeit slowly; persistence to work through current discomfort and disappointment;

to understand that recovery is an ongoing process, not an isolated event; and promise to envision an enjoyable and rewarding future.

Why did God allow this to happen? This question and others like it reflect the expressed need to understand the spiritual significance of serious illness. An empathetic pastor may be of great help in processing these basic questions.

A team effort

Optimal recovery from serious illness is not accomplished alone. It clearly requires a team effort, combining the determination and dedication of recovering individuals, those who love them, and those to whom their care is entrusted. The attending physician is the acknowledged captain of the team, responsible for providing direction and bringing together the people and other elements needed to reach each objective of the recovery process. Nurses, respiratory therapists, physical therapists, occupational therapists, nutritionists, psychologists, home-care specialists, and social workers are among the many allied health professionals who contribute to the healing process in important ways.

As this article goes to press, Jim is about mid-journey along the road to recovery. He has achieved virtually full healing from his surgery and is currently involved in a vigorous rehabilitation program, regaining his strength and learning new ways to move around and accomplish the activities of daily living. It has not been easy, but each day brings added confidence and success. His desire for pinto beans and cornbread is encouraging proof that his appetite has returned. He conducts business for brief periods each day from his hospital bed. Jim's faith is strong and he is optimistic about the future. By the time you read this story. we anticipate that he will have returned home, resuming the activities of a full and productive life. Jim will have completed his journey to recovery.

Ted Hamilton, M.D., is a family physician who writes from Atlanta, Georgia.