Fifteen years. Engineering school paid for by framing houses. Medical school. A residency. Fellowship. The first years of practice, where the speed and the skill finally came together.

Then a beach walk with my kids. My foot locked up in the sand and wouldn't release. Just over a mile to go. I smiled and kept the conversation going the whole way. At the top of the stairs Cameron noticed I was walking funny. Brita covered for me.

My last day in the operating room was December 17. Six joint replacements.

If someone had handed me that ending before I ever applied to medical school, would I have gone?

My guess is no. And that would have been the wrong decision.

I would have missed the patient who came back to every follow-up visit and said the same words every single time. Thank you for helping me, doctor. Would have missed the Saturday mornings standing over fractures. The fellows I taught. Teams we built. Thousands of people back on ski hills and tennis courts.

You never really get the full picture. Maybe that's for the best.

This condition has cost me a lot. It has given me a lot too. I never pray for it to be taken away. That call is not mine.

Well the good thing is, you don't have to see the ending to start. If you could, you might trade away the years that defined you to dodge the hardest ones.

This week, start what you've been putting off because you can't see how it ends. Nobody can.

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Second year of residency. Pediatric orthopedics. Worst evaluation I got in five years. It made me furious. I tied knots until my fingers knew them in the dark. Practiced when nobody was watching. Not to prove him wrong. To make sure he was never right again.

Then I went and built the case for myself.

Manuscripts written after call at a program with almost no research infrastructure. Studies nobody assigned me. A keynote speaker I turned into two book chapters. Two trips to Rothman on my own vacation days to shadow in the OR, long before I was an applicant. Hundred hour weeks, and then the papers after that. Out the door between four and five thirty in the morning with the kids asleep. Home late with the kids asleep.

By the time fellowship applications went out, nearly every joints attending at Beaumont was making calls for me. My program director. My chairman. They all picked up the phone.

Fourth year, I was back on his service. Same attending. Same OR.

He was close with the program director at Mayo Clinic. Mayo was my top choice.

I never told him I was interviewing. Never asked him for anything. I had already decided what his answer would be.

He heard me telling somebody else about the Mayo interview. Started asking questions. Where are you interviewing. What programs are you interested in.

I told him Mayo and Rothman.

Then he asked why I had never asked him for a letter.

Told him the truth. I didn't think he would want to write one.

Go to the interview, he said. If you really love it, I'll make the call. My name goes on the line.

He looked me right in the eye when he said it. His reputation. On me.

I promised I wouldn't let him down.

The match came through while I was at a conference. Hotel room. Brita on speakerphone. I opened the email hoping but not sure.

Matched at Mayo Clinic.

The Mayo program director was at that same conference. I bumped into him in a hallway, wearing shorts. He congratulated me on becoming a future fellow. Then he told me to thank my mentors. One in particular.

The man who told me I wasn't good enough had turned around and told Mayo Clinic I was.

I almost never asked him.

The good thing is a single yes in the middle of a hundred nos is the only opening you need. Earn it first. Then ask the person you are sure will say no.

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Cameron had opinions. Teams aren't fair. We're cooked.

Then he went fired up and became the hole man. Bag after bag. Right in.

20 to 20.

Taylor stepped up and locked it in. Took it home.

We went into the long weekend without much of a plan. Saturday, a local parade close to home. The kids came back with candy and a couple of small gifts. Set up some games in the yard after.

For the fourth we looked at options for fireworks. Ended up staying home. From the backyard we could see multiple shows going up around us. Some of the best we've watched.

Sunday, a small get together with the neighborhood. We were the youngest by about twenty years. Our kids were the only kids. Good neighbors and an easy afternoon.

We had a list of house projects. Got through a tiny fraction of it.

Low expectations made the plain parts of the weekend better than I thought. But the one thing I most wanted, time with just Brita, needed a plan. I left it to the weekend to sort itself out. It didn't happen.

This week, take the one thing that matters most and give it a plan. Not a hope. A time and a place.

The good thing is, a weekend can surprise you when you expect little. Yet, the people and things that matter most deserve intention and a plan.

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Tell me your good thing this week. I read every one.

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Royal Oak, Michigan. Residency. I’d leave in the dark before my kids woke up. Come home after they were already asleep. Some days I never saw them awake. Years of that.

Before any of it, I was an engineer on a factory floor. Then I started over. Medical school. Residency at Beaumont. Fellowship at Mayo. My own practice in Southern California. A decade of showing up to build the backbone behind every result that came later.

There was no documentary. No attaboys. By the time the result showed up, it looked like it came fast. Someone says they thought about becoming an orthopedic surgeon. The actual road to getting there is something few outside the field can understand. It looks glamorous. But it’s built on sweat and sacrifice. It gets built in quiet hospitals, cadaver labs, early mornings, and a hundred days you’d rather have quit.

Then what if you did all that, and it just ended? Suddenly. Mine did.

My operating career stopped almost before it started. December 2024. My last day operating. The thing I’d spent twenty years building, the thing I was sure I’d do until I was old and gray, was gone. There was no winding down. It ended in a day.

I’d built everything. Then I lost the one thing I built it all toward. For a while I had no idea what came next. Build everything, lose everything, now what. I looked inside. Found the same core ingredients were still there. I just had to channel them differently. So I started again. Writing. Building. New goals and projects that ask just as much of me. Harder on some days. Different on all of them. The early mornings are still here. So are the late nights. They point somewhere new now. On purpose.

The climb up is slow and quiet. So is the climb back. Picking yourself up isn’t one brave moment. It’s the same dark mornings. I didn’t pick this transition, and I don’t know why it chose me. But it gave me something new to build toward.

This week, look at the thing you think you lost for good. Then do one small piece of whatever comes next. Today. Before anyone is watching.

The good thing is, the work you do in the dark belongs to you. Nobody can take it. And nobody can stop you from doing it again.

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One of the hardest workers I ever knew. Could never cut a straight line on a sheet of plywood. He'd look over and ask, how do you guys do it.

But he hadn't fully given up his old ways.

I forgot my jacket on a job site one day. Came back the next morning and it was gone.

Months later I was eating lunch in Ray's truck. Looked in the back seat and there it was.

Hey, is that my jacket.

No, he said. Probably just looks like yours.

I pulled it out and reached in the pocket. Hey, this is one of my receipts.

He looked uncomfortable.

Kept right on going. Must have left it on the job site. Thank you for grabbing it. Otherwise it would have gotten ruined in the rain.

His expression relaxed.

You're welcome, he said. Saw it looked like a nice jacket and didn't want it to get wrecked.

He never took anything of mine again.

The jacket was not worth a relationship. Some battles are. Most are not. You have to read the situation before you decide.

This week, before you corner someone, ask if it is worth it. If it is, hold the line. If it is not, give them a way out.

The good thing is, the fights you walk away from leave room for the ones that matter.

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Around 5 AM, early in my practice. Trauma call at Hoag. The ER wanted me to see him right away.

I examined the leg. A little mottled. That was it. Everywhere I touched he was in significant pain, way out of proportion to anything I could see. No broken skin. Compartments soft. No fever. Vitals normal. He was with it, just hurting.

Three add-on trauma cases that day.

After the first one I went to check on him. The hospitalist was at the bedside. He was moaning. Less coherent, but still interacting. His vitals starting to sag. The hospitalist wanted him in the ICU. I agreed.

After my second case I saw him in the ICU. Worse.

It didn't fit necrotizing fasciitis. It didn't fit compartment syndrome either. The indications weren't clear. I had to do something.

He wasn't coherent enough to consent. I called his mother. I told her I don't know exactly what's happening, but your son is very sick, and if I don't open up his leg I think he's going to die.

Held the last case. Rolled straight back.

I started with fasciotomies. Cloudy fluid everywhere, like dishwater, all through the fascia. Infected.

I extended the incisions down into the foot. Debrided. Then extended up toward the groin. The dishwater kept coming. Got close enough to wonder if I'd have to go into his abdomen, well outside where I usually worked.

I was already planning the approach. It stopped just below his pelvic crease. Long incisions on both sides, hip to foot.

The muscle underneath was healthy.

It was the weekend. No other surgeons operating. And no time to wait. Just me and a scrub tech. And a twenty year old running out of time.

I irrigated the leg thoroughly. Put the wound vacuums on. He went back to the ICU.

My partners picked it up after. The trauma surgeon did a couple more washouts and the closure. He followed up with my partner in the clinic.

Weeks later I was covering his clinic while he was out of town. The patient came in for his six week follow up. I introduced myself.

I'm Dr. Siljander. Covering for my partner today.

He heard my name and went still. Then slowly turned and looked at me.

You're him. You're the one who saved my life.

He shook my hand and held my eyes. Thank you for saving my life. I got the chills.

Patients had told me that before. After a hip or a knee. They meant it. But they weren't dying. This was a twenty year old who was crashing, no clear diagnosis, nobody around, and a phone call to his mother where I said he might die if I didn't go in.

And I went in.

This week, make the call before you feel ready. Wait until you are, and there's nothing left to be ready for. Go in.

The good thing is, you can be unsure and still be useful.

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A young gentleman, late fifties. Big bone guy. His femur needed one of the largest stems that we make. Tight going in. I got the broach and the trial seated where I wanted them. Leg length matched. Everything looked great.

Then I went to implant the final stem and it felt way easier than the trial.

That's not a good sign.

The X-ray looked reasonable at a glance. Look closer and I saw it. A crack running down the calcar, past the lesser trochanter.

Took the stem out. Extended the incision. Cabled above and below the lesser. Put the stem back in. It fit well. He had a longer curved incision now, and because of the cables, I held him to toe-touch weight bearing.

I went to see him after. He was resting in bed. I told him what happened.

The good news is we fixed your fracture. Unfortunately, when we were putting in your stem, I broke your femur further down than it already was.

Oh, was that there from the original break? he asked.

No. That was one I caused during surgery when I was putting in your hip replacement. But I fixed it. Everything came out well. But now you have a much longer incision.

Hey doc that doesn't matter, he said. I don't care about that.

Then he patted me on the arm. Thanks doc.

I was carrying the weight of that one a lot more than he was.

I thought about that fracture every day. Right up until his first post-op visit.

I was in the middle of clinic when he came strolling in. And I mean strolling. He had a cane. Not a walker. And he was carrying it, not using it.

Hey doc. How you doing? I feel great.

My heart dropped. Where's your walker?

Oh, I don't need that anymore.

Quick. Get him an X-ray. I feared the worst.

I shouldn't have. He was walking.

The film looked great. I told him to take it easy and kept him going.

After that two-week visit, I never saw him again.

I wondered how he was doing. I rationalized that if I wasn't hearing from him, he was doing okay.

Who knows where he is to this day.

Mistakes happen. Complications happen. Operate long enough, live long enough, and you'll cause some.

Well the good thing is, the mistake you catch and fix is rarely worth the worry you give it. But that worry means you care. Use it. Let it make you better at the next one instead of carrying it for nothing.

Good Thing Monday goes out every Monday. One story, one good thing.

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Tell me your good thing this week. I read every one.