If you are here for clinical trials data and hardcore science, this is not that post. It is personal, but also philosophical and, I hope, strategic. Keep following for more IBD content in the build-up to ECCO, analysis of the latest data, and much more.
“If today were the last day of my life, would I want to do what I am about to do today?”
Steve Jobs, Stanford, 2005
In eight days I turn fifty.
I am writing this from my desk in Edinburgh on a winter morning. Bach is playing on vinyl. The light outside is grey and honest in the way that February here always is: no performance, no flattery, just stone and rain and the slow promise that the days are getting longer even when it doesn’t feel like it.
I have been thinking about focus. Not productivity. Not the morning routine that will change your life. I mean the deeper kind: knowing what matters, pointing yourself at it, and staying there long enough for it to become real.
I have not always been good at this.
I spent my thirties and forties moving between versions of intensity: clinical medicine, research, endurance sport. Each one producing something I am proud of, each one leaving something else unattended. That is the subtle cost of focus. Not the missed dinners. The parts of yourself that quietly atrophy while you are busy building elsewhere.
Somewhere in my late forties, patterns I had carried for decades became impossible to ignore. The effect was clarifying. I stopped fighting a version of myself that was never going to work, and I started asking a question I had never properly asked.
What happens when you stop going all-in on one thing at a time and try to hold all of it?
Because that, I think, is what this stage of life asks of you. Not a crisis. Not a cliff edge. A reckoning with the full inventory of who you are, all at once.
I am a clinician-scientist who cares for people with inflammatory bowel disease. I am a father to two young adults, step-father and grandfather besides. I am a runner who has not yet given up on the mountains. And I am someone who needs the quiet as much as the intensity.
None of these is optional. None of these is the whole picture. And none of these will survive if I do what I have always done: go all-in on one and let the others fade.
The project of the next decade is integration.
Not balance — I have always hated that word. Balance implies equal weight, carefully distributed. It implies stillness. Life is not still. It oscillates. Some weeks the work takes everything. Some evenings the loneliness arrives uninvited. Some days the body demands attention the mind would rather not give.
Integration is different. It means none of it goes to zero. It means the runner is still there on the weeks when the scientist is working late. It means the father is present even when the leader is exhausted. It means you design your recovery before the collapse, not after.
High performance requires imbalance. To build something meaningful, to care for patients deeply, to lead a team, you have to go all in. But you have to build the rhythm that lets you sustain it. The goal is not equilibrium. The goal is a rhythm you can live inside.
For me, right now, that rhythm is still taking shape. It involves protecting the mornings, training even when the body would rather not, and leaving space for the quiet that lets everything else work. Small architecture, not grand plans.
There is something else I have been thinking about, and I find it harder to say.
People who lead and build and carry responsibility are often remarkably alone in midlife. Not all of them. But enough. The ones who find themselves sitting with the gap between professional visibility and personal invisibility. The ones who are witnessed intensely — in the lecture hall, in the clinic, on the platform — and then not at all.
An audience is not a witness. A follower is not a witness. A witness is someone who sees the cost of the work, not just the result.
Travelling for work, I once watched men gather at a barber on a Friday evening, not for a haircut, but for connection. They sat together. They talked. They were present with each other in a way that required no agenda, no pretence. It was infrastructure, built into the rhythm of the week. We have lost something like this, or perhaps we never built it outside of the pub.
Leaders don’t need more followers. We need more witnesses.
That same week I will be in Stockholm for ECCO, the largest inflammatory bowel disease meeting in the world. I have attended every year for two decades. Two decades that saw my children grow up, relationships change shape, and a career that has rebuilt itself more than once. Deep friendships in this community, developed and deepened over the years, and every year new ones.
This year I am not speaking, which is unusual, and I notice myself negotiating with what that means. But walking into that conference surrounded by colleagues and friends, many of whom are reading this now, I am reminded that the work is not the talk. The work is the care and curiosity and collaboration that brought me here. The talk is just the visible part.
The work continues whether anyone is watching or not.
Steve Jobs gave that commencement speech when he too had just turned fifty, after his cancer diagnosis. He talked about death as a clarifying force. The mirror question: if today were your last day, would you be doing what you are about to do?
I used to hear that as a motivational line. I hear it differently now. At fifty, you stop being abstract about mortality. You see friends get diagnoses. You notice your own body negotiating with you in ways it never did before. I am thankfully only recovering from a humbling back injury, not anything worse, but even that has been enough to sharpen the question. And it stops being motivational and starts being existential.
Am I spending my days on the things I believe in?
Not every day. Not perfectly. But enough of them. The patients are real. The science matters. The team believes. The words I write occasionally reach someone who needs them. The mountains are still there when I am ready.
I don’t know what fifty looks like yet. I will find out in eight days.
But I know what I want it to feel like. A life that is inhabited rather than performed. Where the hard days are in service of something I believe in. Where the loneliness, when it comes, is space rather than void. Where I am building things that matter now and into the future, not chasing legacy, but doing work that earns the right to last.
Care for people who trust me. Run so far into the mountains that everything else dissolves and the only battle left is to keep going, stay in the moment, eat, endure. Photograph strangers in honest light. Write what is true, even when it is uncomfortable. Design recovery before collapse. Build the rhythm, not the monument.
I am still becoming.
“Stay hungry. Stay foolish.”
Stewart Brand, The Whole Earth Epilog, 1974
And if you are reading this on a quiet evening, wondering whether anyone else feels this way:
You are not the only one.
Happy 50th birthday. For my 50th birthday two years ago, my quote was "We live our whole life making memories, let's make them unforgettable".
Just beautiful writing.