Every life is formed, shaped, developed, evolved and ends according to its own destiny. The only two things we all share as humans are birth and death. As a human experience, birth and death are mysteries. Either we have no memory of the first moment or we can't share the last event. In between those two monumental happenings, all kinds of choices, decisions, learnings, relationships, accidents happen to us that can alter our trajectory through our life.

I like to think of these things as collisions, sort of like two asteroids glancing off each other in some mystical asteroid belt. Sometimes the asteroids are so big and the collision so direct that our trajectory does get derailed and maybe never gets back on track. Two such asteroids are health and disease.

Some of these asteroids we have control over. My dad was a three pack a day smoker and died when I was young. He could have exerted more control over his health, stopped smoking, lost weight, exercised and altered his diet. He couldn't do much about his genetics. But maybe he would have lived long enough to influence my trajectory as I matured. I will never know.

Some of the asteroids we have no control over. As I sit here writing this brief summary about what I hope to communicate in this memoir, so many examples pop into my head that I don't know which ones to choose to share. President Kennedy's assassination. The same with Martin Luther King Jr. And so many patients (the names of which I have changed to protect their privacy). Tricia who died in her thirties of the worst case of lupus I have ever seen, and I have seen hundreds. Murray, who died of lung infection complicating his scleroderma, a disease that cost him both his legs years before his death. Sally, funny as hell, who developed a complication of the treatment of her rheumatoid arthritis; and the treatment of that complication resulted in her awful death from leukemia five years later.

My thoughts in this memoir are not just about colliding asteroids. They are mostly about me and the twisting road I traveled to reach my present situation. Let me first say categorically, I don't think I would change anything about my life. Well, maybe a few things given hindsight. But certainly not the major things. I am blessed with two wonderful sons and their wives, and four phenomenal grandchildren.....who I never expected that I would live to meet and watch them grow. I am proud to have practiced medicine in the manner that I did. I believe that I have improved the lives of thousands of people suffering with rheumatic diseases, and during the final ten years of my professional life, impacted the growth of health care delivery for the better in my community.

I have been disappointed. Disappointed by colleagues who I loved and respected but proved to be disloyal to the profession. Disappointed by a failed marriage that lasted 36 years and by most measures was very successful but couldn't sustain love. But also buoyed by the friendship and connection with friends recent and past. Yet, at the end of my life, I find myself alone. Too soon.

'So why don't you meet me at midnight, babe, inside The Sad Cafe.' Lyrics by Don Henley, et al.