I come home late so often that it’s a wonder my wife is still married to me. I have missed anniversaries, birthdays, concerts, dinner. Strangely, Carla still loves me. Oh, she still gets mad (what kind of Italian woman doesn’t get fired up from time to time?).

Of course, we both always knew that if it ever came down to a choice between the hospital and my family, I would choose my family, hands down, no discussion needed.

But it’s never a choice that is so clear and simple. It’s always just one more patient, one interesting case, one really nice old guy who needs to be tucked in, medical orders written, pacemaker scheduled for the morning. My family will understand this time. And, lucky for me, they did and they do. But my kids are grown now, and they’re not the cuddly little monsters anymore who would meet me at the door for nerf gun wars or get me on rollerblades for street hockey games or sit on my lap to hear Harry Potter. How many games and laughs did I miss out on, I can’t say. The kids are doing their own thing, busy with their own lives and working crazy hours. As Harry Chapin sings, “They’ve grown up just like me.”

I saw a diabetic man today who was wearing topsider shoes without socks. He knew that diabetics need cushioned shoes with socks because, once diabetic neuropathy sets in and they don’t feel their feet, they can get infections down to the bone and not even know it. I like this fellow, so I said, “Dude, what the heck?” He got a bit squirmy and said he usually wears comfortable shoes and socks, just not today because he was rushing. I took off his shoe, and there was a black toe nail from wearing shoes that were too tight last week.

Another woman, also diabetic, knows she has to cut down on her carbs. She is constantly dieting but constantly having, just this one special occasion, someone’s birthday cake or some pie that a coworker brought into work. Her blood sugars aren’t coming down.

And how many smokers do we all know who want to quit, but not now because of financial stress, marital problems, a new job, a new school.

My favorite hobby is woodworking, and I know I should be wearing a respirator and hearing protection when I use my tablesaw. But how many times do I make the quick cut without worrying about it, “just this once”? If you answered me, I might not hear you because I am, indeed, losing my hearing.

Again, the choice is never laid out plain and in immediate terms: stop now or … lose a limb/suffer a heart attack/stroke/debilitating lung disease/die. If it were, most would, of course, stop their binge eating, their smoking, wear their respirators and hearing protection. But “just this once” becomes recurring, and the arc of time is not forgiving or forgetting.

Patients who survive their first heart attack suddenly wake up from the “just this once” numbness and are jolted into action. They have been given the ultimatum: Stop smoking/eating garbage/taking poor care of yourself or die.

Surviving a heart attack is kind of like a do over. But not really. It’s kind of like me telling my kids and my wife I’m sorry for missing so much. They graciously forgive me and know I love them, but it’s time I’ll never get back.