Supreme Court Justice Ruth Bader Ginsburg missed her first oral arguments in more than 25 years on the bench this week as she recovers from a Dec. 21 operation that removed about half of her left lung, including two cancerous growths.
Ginsburg's absence from the bench surprised court watchers, who have seen her quickly bounce back from past ailments, including two previous bouts with cancer.
But it did not surprise cancer surgeons, who say that based on what is known publicly, the 85-year-old's recovery appears to be proceeding normally.
Top doctors with experience performing pulmonary lobectomies expect Ginsburg to be back on the bench in less than six weeks, with more than enough time to return for the court's February sitting.
"She's not even three weeks out. She's barely two weeks out," said Raja Flores, the chief of the division of thoracic surgery at Mount Sinai Hospital in New York. "I think a lot of people are getting scared because they are concerned about the balance of the court, but I'm confident she's not going anywhere. She's going to be back on the court," Flores said.
The nine-member court is currently divided 5-4 between Republican and Democratic appointees. Ginsburg's health has prompted concern from liberals and among her legion of fans, who refer to the former American Civil Liberties Union litigator as the "Notorious R.B.G.," after the late rapper and fellow Brooklynite Biggie Smalls, who went by the name "Notorious B.I.G."
Democrats fret that Ginsburg's retirement from the court would allow President Donald Trump to appoint her replacement, further solidifying the court's conservative majority. The president has wished Ginsburg a speedy recovery.
The Supreme Court did not respond to a request for comment for this article. It has provided no guidance on when Ginsburg may return.
'Tough as nails'
There are a number of factors that go into assessing a patient's recovery from thoracic surgery. Surgeons consider the patient's vitality going into the operation, their age, and how long they spend in the hospital following the operation. The invasiveness of the surgery also has an impact on the length of the recovery.
Despite her age, Ginsburg has a number of variables in her favor. For one, the day before her surgery, she appeared completely healthy, according to Katy Tur, an NBC News correspondent and MSNBC anchor who happened to be on a flight to New York with the justice.
Tur said that Ginsburg was "moving well" and spent the entire ride working.
Ginsburg's physical condition is also bolstered by an unusual workout routine for a woman of her advanced age. She is known to regularly train with a physical trainer, Bryant Johnson, who has worked with Ginsburg for 20 years and describes her as "tough as nails."
Sudish Murthy, the section head of thoracic surgery at Cleveland Clinic, has performed about 9,000 thoracic surgeries. He said the best way to project a typical recovery period is to take the number of days the patient spent in the hospital and multiply by about eight to 10.
Ginsburg spent four days recovering at the Memorial Sloan Kettering Cancer Center in New York, the Supreme Court has said. Given her four-day hospital stay, Murthy's arithmetic puts the upper end of her recovery at the end of January.
"By that time much of the pain from the procedure is gone, much of the shock to the system is gone," he said. "People with desk jobs can often return to their place of employment and do light duty work, often for half days."
Murthy said there are two components to Ginsburg's recovery. In addition to recovering from the loss of much of her left lung, she will also have to bounce back from being bedridden for days. At 85, he said, it is much easier to get out of shape than to get back into shape.
But, he said, the fact that her doctors recommended a lobectomy suggests that an assessment of her health showed her to be in good enough physical condition for a "Plan A" treatment. Doctors don't recommend surgeries that they don't believe their patients can recover from, he said, and there are other less aggressive treatments for Ginsburg's condition.
"The age does not necessarily connote frailty," he said. "Frailty connotes frailty."
Murthy added that based on the court's public statements, it appears that Ginsburg underwent a minimally invasive procedure, likely either video-assisted or performed with the use of robots, that would expedite the recovery period.
Flores, the thoracic surgeon at Mount Sinai, said that it is a positive sign that Ginsburg has not returned to the hospital and has continued to work from home.
"The thing that should not have people worried is that she's not back in the hospital," he said. "If she were not doing well, if there was an issue, she would be back in the hospital."
Murthy said he is looking out for whether any further treatments are necessary. In a statement, Valerie Rusch, the surgeon who operated on Ginsburg, said that no further treatment is planned. But Murthy said that no further treatments would be planned until Ginsburg recovers from the first operation.
"This just seems completely normal," Flores said. "She's not going anywhere. She's with us."
The next oral arguments are scheduled to take place on Monday. The court will also likely decide in the coming weeks whether it will review key cases concerning the president's immigration powers and whether employers can discriminate against LGBT employees, though Ginsburg may participate in those decisions from home.
On Feb. 19, the court will hear oral arguments in its first case of February, in a dispute involving Commerce Secretary Wilbur Ross' decision to add a citizenship question to the 2020 census.