This book is about the nature of life, as I see it. I offer my reflections on a wide variety of subjects: on sex, death, love, God, and the importance of music, and art in general, in our lives.

I am a heart surgeon. For the last 25 years I have lived in Seattle, practicing and teaching heart surgery at the University of Washington and at Swedish Medical Center. Several things happened during these years that led me to write this book.

First there was an untimely death. My sister Nancy died in 1978 when she was 31 years old, from breast cancer. I was 38 years old at the time.

Then, six years later, I was changing out my scrub clothes in the surgeons locker room after doing a coronary bypass operation on an elderly woman and talking with a surgical colleague, Dr. Alfred Blue, when he happened to notice a mole on my unclothed shoulder. He said, pointing to the mole on my shoulder, how long have you had that thing? Dr. Blue is an outspoken, no nonsense plastic surgeonqualities usually not seen in that breed of physician. I told him that it had been there for awhile and that one of the other surgeons on the staff looked at it a year ago and said that it was nothing to worry about. Dr. Blue said, in his usual blunt fashion, it oughta come off.

He excised it in his office later that afternoon. Much to my surprise, and his, for that matter, it turned out to be cancera malignant melanoma. I went back to his office a few days later and he did a wide excision of the skin, fatty tissue, and lymph nodes around the site under local anesthesia. While he was cutting away a large pizza-sized wedge of skin and subcutaneous tissue from my shoulder, Dr. Blue made a comment that forever after endeared him to me. He said, Im glad youre the one whose got this problem and not me!

The reader might think that this statement is a bit crass, an unfeeling thing for a doctor to say to his patient. But I took comfort in what he said and looked at it this way: one does not often encounter such stark honesty in a physician. To me, his being that honest meant that I could fully trust him, no matter what.

All of a sudden, at the age of 44, I had to confront the prospect of an early death, like my sister Nancy and my grandfather, Louis Hicks Williams, had to do. He was a career Navy surgeon. He died at the age of 41 from viral encephalitis, which he contracted in Haiti when he was stationed at a hospital there with the US Marines in the late 1920s. I was in the prime of life, with a successful practice and my second book on heart surgery just published. I had been appointed to the Board of Directors of the Seattle Symphony and was a member of their six-person search committee formed to select a new conductor for the orchestra. This couldnt happen to me. Suddenly, I was faced with the realization that death was not just something that happened to other people, it was also something that was going to happen to me, and perhaps very much sooner than I had ever thought possible.

My sisters breast cancer was diagnosed when she was 26 years old, soon after the birth of her second child. She knew how bad the prognosis wasbreast cancer that arises during pregnancy is highly lethalbut she nevertheless fought it valiantly. She lived five more years, several years longer than any of her physicians thought possible with the kind of cancer that she had. Two years before her death she came to Seattle with her husband and two young daughters and we went on a day hike together on Hurricane Ridge in the Olympic Mountains in Washington State, on what turned out to be a beautiful, warm day.

Although I cherished that time with her, I generally treated my sisters death with denial. My basic approach was dont think about it, go on with your life and it wont bother you too much. I wa