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How serendipitous life can be! When I was a little boy, I had a pediatrician I wanted to emulate. He drove around in his early 1950s era Volkswagen Beetle making house calls and was the kindest, most caring gentleman you would ever want to meet. So I thought that my specialty track would logically take me on the road to becoming a pediatrician.In the third year of medical school, one of our rotations was pediatrics. While most of pediatrics may be comprised of minor health problems, preventive visits like immunizations, and routine physical exams, we didn’t really have much outpatient, “real world” exposure to kids coming into clinic. Instead, we were assigned to a large, well-known children’s hospital, in fact, the very hospital where my tonsils and adenoids had been removed back when I was five years old and still in kindergarten. A lot of the kids at that pediatric hospital were really ill.Back in those days, in the early 1970s, pediatric oncology was just in its nascent era and quite a few children in that hospital were there to receive early attempts at chemotherapy and to treat the side effects of those often toxic agents. Sadly, several of the kids who were assigned to our team of an oncologist, oncology fellow, pediatric resident, pediatric intern, and medical student never made it out of the hospital. After that experience, seeing youngsters, who should rightfully be outside frolicking in the playground or at the beach, suddenly pass away, I decided that I could no longer bear the thought of becoming a pediatrician.Between my second and third years of medical school, I spent the summer as an extern in family medicine at a hospital in a small city about 100 km (60 mi) from the large city where my medical school was located. It was a really positive experience, shadowing a family doctor in his private practice and making hospital rounds with him. During my third year internal medicine clinical rotation, I also had a memorable and meaningful experience at a hospital, actually not too far from the pediatric hospital, where they allowed us to have a significant participatory role in the care of the patients to whom we were assigned, under the supervision, of course, of the interns, residents, and attending physicians. So it was as a result of these two affirmative and productive experiences that I decided to become a primary care clinician and did my internship and residency in general adult internal medicine.[New E.D. at the hospital where I did my internal medicine residency many years earlier, Baystate Medical Center, Springfield, MA, USA]After residency, I did a fellowship in emergency medicine, thinking that I might enjoy the excitement of the E.D., not to mention the more regular hours. Truth be told, back in those days, before the advent of electronic health records (EHR), it was pretty rare to get follow-up on patients that I had treated in the E.D. So, after three years of doing emergency room medicine, I found that I was really missing the continuity of care that primary care specialties, like internal medicine, family medicine, pediatrics, and gynecology are able to offer. And that’s when I decided to open my own private practice in San Francisco.But something strange happened. From my first weeks in practice in late 1979, I found myself attending young gay men who were consulting me about unusual symptoms and physical findings. Some were having unexplained fevers, others had malaise and fatigue, and still others had diffuse enlargement of lymph nodes all over the body. I went back to my voluminous internal medicine textbooks to try to figure out what was going on and ordered every imaginable test, imaging study, and biopsy. But all of these tests proved to be fruitless.[Two of my UCSF contemporaries in the early years of the AIDS epidemic who are still practicing as of 2017, Drs. Marcus Conant (left) and Paul Volberding (right)]Fortunately, the San Francisco Bay Area has a couple of world-renowned medical faculties. So, in a state of total puzzlement, I referred several of my patients to one of those august institutions. After evaluation by teams of medical students, interns, residents, fellows, and attending physicians, the academic hospital was unable to determine anything. You can imagine how frustrated both the patient and I were at that moment!But wait - there’s another highly regarded academic medical center in this area. So I referred some of the patients to that institution. Again, after evaluation by teams of medical students, interns, residents, fellows, and attending physicians, this “mecca” was unable to determine anything either. At that point I thought that my entire medical education had been for naught and that my world had turned upside down because we were not able to provide my patients with any answers to their problems.Then we fast forward to June 1981. In that month, on June 5th 1981 to be exact, the U.S. Centers for Disease Control (CDC) reported in its Mortality & Morbidity Weekly Review (MMWR) about a cluster of cases in New York and Los Angeles of gay men who had come down with a rare form of pneumonia, caused by an organism called Pneumocystis carinii.[1] This was shortly followed by another report of a rare cancer, Kaposi’s sarcoma, that was being identified in men who have sex with men.[As one of the first AIDS doctors, I was interviewed by several publications, including this series that appeared in American Medical News.]From that moment, my colleagues who also treated large numbers of gay men and I knew that our career trajectories would be changed forever. If you have just read my whole treatise about why I decided not to become a pediatrician, you will realize the incredible irony in what became my career path, as a doctor for patients who had what would later be called AIDS and HIV disease. I had avoided seeing young people die in pediatric oncology units. And yet, a majority of the first 17 years of my career was spent helping hundreds upon hundreds of young people through the process of dying, whether in hospital, hospice, or home.[William Owen, M.D., treating patient in hospital in 1980s, while partner looks on. Photo courtesy Chronicle Books]Although serendipity rather than choice brought me to my career pathway, and with the ability now to be able to view my medical career through the “retrospectoscope”, if I had to live my life over again, I would consciously choose to become a primary care doctor and an HIV specialist. Although my career has been an emotional roller coaster at times, I cannot imagine a more intellectually satisfying and, more importantly, personally gratifying four decades being privileged to care for so many amazing, grateful, and truly heroic patients, even during a pre-treatment era when that care was limited to the simple act of holding my patients’ hands in my own.Footnotes[1] Pneumocystis Pneumonia --- Los Angeles