Is Hillary Clinton's break-neck pace taking a toll?

WASHINGTON - When Secretary of State Hillary Rodham Clinton fractured her right elbow after slipping in a State Department garage in June 2009, she returned to work in just a few days. Her arm in a sling, she juggled speeches and a trip to India and Thailand with physical therapy, rebuilding a joint held together with wire and pins.

That was vivid evidence of Clinton's indomitable stamina and work ethic -- as a first lady, senator, presidential candidate and, for the past four years, the most widely traveled secretary of state in U.S. history.

But after a fall at home in December that caused a concussion, and a subsequent diagnosis of a blood clot in her head, it has taken much longer for Clinton to bounce back. She was released from a hospital in New York on Wednesday, flanked by her daughter, Chelsea, and her husband, former President Bill Clinton. On Thursday, she told colleagues that she hoped to be in the office next week.

Her health scare, though, has reinforced the concerns of friends and colleagues that the years of punishing work and travel have taken a heavy toll. Even among her peers at the highest levels of government, Clinton, 65, is renowned for her grueling schedule. Over the past four years, she was on the road for 401 days and spent the equivalent of 87 full days on a plane, according to the State Department's website.

In one 48-hour marathon in 2009 that her aides still talk about, she traveled from talks with Palestinian leaders in Abu Dhabi to a midnight meeting with Prime Minister Benjamin Netanyahu in Jerusalem, then boarded a plane for Morocco, staying up all night to work on other issues, before going straight to a meeting of Arab leaders the next morning.

'She doesn't spare herself'

"So many people who know her have urged me to tell her not to work so hard," said Melanne S. Verveer, who was Clinton's chief of staff when she was first lady and is now the State Department's ambassador at large for women's issues. "Well, that's not easy to do when you're Hillary Clinton. She doesn't spare herself."

It is not just a matter of duty, Verveer and others said. Clinton genuinely relishes the work, pursuing a brand of personal diplomacy that, she argues, requires her to travel to more places than her predecessors.

While there is no medical evidence that Clinton's clot was caused by her Herculean work habits, her cascade of recent health problems, beginning with a stomach virus, has prompted those who know her best to say that she desperately needs a long rest. Her first order of business after leaving the State Department in the coming weeks, they say, should be to take care of herself.

Some even wonder whether this will -- or should -- temper the feverish speculation that she will make another run for the White House in 2016.

"I am amazed at the number of women who come up to me and tell me she must run for president," said Ellen Chesler, a New York author and friend of Clinton's. "But perhaps this episode will alter things a bit."

Given Clinton's enduring status as a role model, Chesler said women would be watching which path she decides to take, as they plan their own transitions out of the working world.

"Do remember that women of our generation are really the first to have worked through the life cycle in large numbers," she added. "Many seem to be approaching retirement with dread."

For now, aides say, Clinton's focus is on wrapping up her work at the State Department. She would like to take part in a town-hall-style meeting, thank her staff and sit for some interviews. But first she has to get clearance from her doctors, who are making sure the blood thinners they have prescribed for her clot are working.

Speaking to a meeting of a foreign policy advisory board from her home in Chappaqua, N.Y., on Thursday, Clinton said she was encouraging her doctors to let her return next week. "I'm trying to be a compliant patient," she said, according to a person who was in the room. "But that does require a certain level of patience, which I've had to cultivate over the last three and a half weeks."

'The height of mental acuity'

While convalescing, Clinton has spoken with President Obama and has held a 30-minute call with Sen. John Kerry, D-Mass., whom Obama nominated as her successor.

Clinton also plans to testify before the Senate about the deadly attack on the U.S. diplomatic mission in Benghazi, Libya, making up for a hearing in December that she missed because of her illness.

"She would have vastly preferred to testify that original date than go through the last 27 days," said her senior adviser, Philippe Reines. "Only an imbecile would say otherwise," he added, referring to charges by some conservatives that Clinton faked her illness to avoid the hearing.

But her illness has scuttled further travel, including hopes for a valedictory tour of Asia or the Middle East. Clinton holds the record for the most countries visited by a secretary of state, 112, though her total of 956,733 air miles will fall short of the 1.06 million logged by her predecessor, Condoleezza Rice.

The travel demands caught Clinton by surprise, especially in an era in which U.S. officials can communicate via videoconference calls. But the technology, she has said, paradoxically puts a bigger premium on showing up. And Obama has traveled abroad sparingly, raising the pressure on her to do more.

On many trips, Clinton flew overnight and, after landing, went straight into a 12- or 16-hour day, sometimes getting a quick shower. On a visit to South Asia in 2009, she spent three consecutive nights on her plane, an Air Force Boeing 757, which is equipped with a a rollout bed.

"On these trips, you're in all these different time zones, your body clock is way off schedule, you're not routinely getting exercise, and you're not eating healthy food," said Lissa Muscatine, a former speechwriter who traveled with Clinton. "On top of that, she has to be operating at the height of mental acuity at all times."

Given Clinton's temperament, friends say there is little likelihood that she will ever take it easy. Muscatine recalled that when Clinton was racing to finish her memoir, she often spent a full day in the Senate, worked at home until 11:30 or midnight, and then held meetings about the book at her dining room table that stretched past 3 a.m.

"While we always thought of her as invincible and indestructible," Muscatine said, "we all just really hoped there would be a point where she could stop going at that breakneck pace."