When I was 12 years old, I had a stupid accident. I was cycling home from town when a colossus of a truck passed too close, causing me to swerve my bicycle. It was over in a moment: I put out my left foot to steady myself, and my heel jarred down hard. The impact tumbled me off the bike and onto the pavement where I lay in the dust, relieved to be alive, but unable to straighten my leg. The truck didn’t stop.
An X-ray showed that the topmost piece of my shinbone, the “tibial plateau,” had splintered, and I was taken to an operating room where a surgeon wrenched the pieces of bone back into place. A cylinder of plaster was rolled around the leg, and I was told to come back in the autumn. It was only when that plaster was removed that my journey of recovery really began. A metamorphosis had occurred: The knee had become bulbous, and my thigh and calf seemed by comparison stick-like and malnourished. When I tried to walk, the knee wobbled and gave way.
When I think of that summer of convalescence (the journey of healing and recovery after illness), I remember afternoons at home reading and doing physiotherapy exercises—at first tentatively, then with more confidence. The days were busy with sounds: of birds in the garden, cars in the distance, wind moving through the barley of the field behind the house. For 12 years, my body had rarely stopped, and it seemed unnatural to have it rendered so motionless, as if with my injury the nature of time itself had transformed. The flow of my life had been stilled, but it was that very stillness that gave me the opportunity to heal.
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It wasn’t my first experience of convalescence: A couple of years prior to my injury I had spent a week in hospital with meningitis, and it had taken many weeks for me to feel like myself again. With a limb it seemed possible to objectify the part that needed recovery, to look down on the leg and say “that’s the problem, right there.” Working to build up the leg was effortful but also visual, my progress inscribed in the bulk of my thigh, and the color of my skin. My recovery from meningitis was far more difficult to grasp—the edges of what recovery meant were far less clear. A languorous exhaustion dominated my days, burnishing the world with the bright haze of a dream or a hallucination. My body was in convalescence, but so was my mind. As I look back on it now, it’s clear that it was my first experience of the complexities of recovery, and how it can and must take very different forms with different illnesses, and between different people.
In 2000, I became an ER doctor, and then in 2005, a primary care physician; all the way through training in medicine I found it curious that the words “recovery” and “convalescence” are generally absent from the index of medical textbooks. The medicine I was trained in often assumes that once a crisis has passed, the body and mind find ways to heal themselves. But after nearly 30 years of practice I’ve often found that the reverse is true: guidance and encouragement through the process of recovery can be indispensable. Odd as it seems, my patients often need to be granted permission to take the time to recover that they need. Illness is not simply a matter of biology, but one of psychology and sociology. We fall ill in ways that are profoundly influenced by our past experiences and expectations, and the same can be said of our paths to recovery. Whether it’s our knees or skulls that need to heal from an injury, or lungs from a viral infection like COVID-19, or brains from a concussion, or minds from a crisis of anxiety, I often remind my patients that it’s worth giving adequate time and respect to the process of healing. We need to take care over the environment in which we’re attempting to heal, celebrating the importance of nature and recognizing the part it can play in hastening recovery. When an illness or disability is incurable, it can still be possible to “recover” in the sense of building toward a life of greater dignity and autonomy.
There is no hierarchy to suffering, and it’s not possible to say of one group of conditions that they deserve sympathy while another group deserves to be dismissed. I’ve known patients whose lives have been dominated, for years, by the grief of a failed love affair, and others who have taken the most disabling injuries, indignities, and loss of independence in their stride. Though it can be tempting to resent someone who seems to be recovering more quickly than us, comparisons are rarely helpful. Neither should we be anxious to set out a timetable of recovery: it’s more important to set achievable goals.
The United States is one of the few developed economies in which there is no nationwide legal requirement for paid sick leave. A 2014 study by the National Bureau of Economic Research found that the Europeans take two to three times more sick leave than Americans. It’s perhaps a sign of American aversion to rest and recuperation, but there must be many thousands of Americans who are forcing themselves to go to work when they don’t feel able.
The pressure to be maximally productive is learned early, and it can be a challenge to unpick inherited notions of what constitutes a successful life. But if we don’t modify those ideas, we are unlikely to make time for recovery, or understand the value of rest and recuperation. Convalescence needs time, and while the value we place on that time ultimately comes down to what our politicians will support, we are better at providing benefits than we used to be. In the U.S., the time we allow ourselves off work has been expanding since the early 20th century. But there is still a long way to go to provide a supportive welfare safety net that allows everyone to recover to the best of their ability.
Three decades of medical practice have taught me a few principles that have helped my patients through the frightening landscape of illness—a place we all visit sooner or later. It’s helpful to find a physician you can trust, but also try to be your own best physician: drugs are the least of healing, and there are many kinds of therapies I’ve seen transform my patients’ lives —singing, walking, eating, dancing, or sitting in the sunshine with a beloved pet. Health is a balance, not a destination: Our bodies are part of nature, and doctors and nurses are more like gardeners than mechanics. Self-compassion is a much-underrated virtue, and it pays to be kind to ourselves, remembering that ideas and expectations about illness can be as powerful as drugs and poisons. And for all its irritations, frustrations, and humiliations, illness may teach us all something of value, even if that thing is only to cherish wellness when we feel it, or see it in others. From time to time, we all need to learn the art of convalescence.
From RECOVERY: The Lost Art of Convalescence by Gavin Francis. Published by arrangement with Penguin Life, a member of Penguin Random House LLC. Copyright © 2022, 2023 by Gavin Francis.
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