05/12/2015 12:21 pm ET Updated May 12, 2016

Graduates: Rage Now!

I was privileged to receive an honorary doctoral degree from Quinnipiac University this weekend, and to deliver the commencement address for the Graduate Programs in the Health Sciences. Here, more or less, is what I said.

Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light.

Though wise men at their end know dark is right,

Because their words had forked no lightning they

Do not go gentle into that good night.

Good men, the last wave by, crying how bright

Their frail deeds might have danced in a green bay,

Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,

And learn, too late, they grieved it on its way,

Do not go gentle into that good night.

Grave men, near death, who see with blinding sight

Blind eyes could blaze like meteors and be gay,

Rage, rage against the dying of the light.

And you, my father, there on the sad height,

Curse, bless, me now with your fierce tears, I pray.

Do not go gentle into that good night.

Rage, rage against the dying of the light.

(From The Poems of Dylan Thomas, Dylan Thomas, 1914 - 1953)

To the faculty and administration of Quinnipiac University, distinguished guests, friends and families, and above all to the graduates of the class of 2015- it is my honor and privilege to be here today to tell you... I have no idea what Dylan Thomas was trying to say.

Well, that's not quite right- I have some ideas. Perhaps it was a prayer; perhaps it was a plea. Perhaps an observation; perhaps a lamentation.

I suspect it was all of those, and more besides. But whatever the full array of intended connotations, I think we may comfortably endorse the basic proposition, but repudiate the timing.

And that, then, leads directly to the only advice I feel qualified to offer you today; the one bit of grizzled wisdom I can presume to share. And that presumption is predicated not on the fact that I stand where I am now standing, but rather on the fact that I once sat where you are now sitting- and have gone the miles in between. On that basis, then, I offer you this and only this: rage now!

I am older. Not yet old, perhaps, but older. Old enough to have gone those miles. Old enough to have children older than many of you. Not yet old, but old enough to see the first shadows cast by shadows around the next bend in the trail. Old enough to see the inchoate invitations of twilight around the further arc of the horizon.

I am old enough. And despite all the crap I learned in Med School- I can read the writing on the wall, albeit with glasses now. It says: don't wait.

I would not wait to rage until wizened, and withered and wispy. I would not wait to rage until stooped, and spindly, and sarcopenic. I would not wait until frail, and failing and feeble, and futile. I would not wait, and nor should you!

Rage now!

Rage, while young. Rage, while strong. Rage, while resolute, and resilient. Rage while buoyant, and boisterous. Rage with limbs unwearied by the miles and dead-ends. Rage, with a conscience uncluttered. Rage, with supple hearts as citadels of righteous rage. Rage, while foolish enough to believe in the possible. Rage now.

Rage as the spirit moves you. Rage as your conscience guides you. Rage as your hearts demand of you.

Rage, as the better, angry angels of your nature advise.

Rage against standards of care that fail to meet your standards, wherever and however you encounter them.

Rage against a society that has known for literal decades how to prevent fully 80% of all chronic disease, but has done so little to convert what it knows into what it does. Rage against a perennial, preventable loss of years from lives, and life from years.

Rage against the hypocrisies of a culture that wrings its hands over epidemic obesity and diabetes in children, yet continues glibly to run on Dunkin', wrap its pizzas in ever more copious garlands of bacon, and market multicolored marshmallows to kids as 'part of a complete breakfast.' Rage against the willful engineering of addictive junk food.

Rage against procrastination, and prevarication, and profit-driven predation.

Rage against the pursuit of only those opinions we already own, and calling it research. Rage against the divisive echo chambers of cyberspace.

Rage against the triumph of ideology over epidemiology; dogma over data; diatribe, over dialogue.

Rage - at the confluence of science and sense, evidence and empathy - rage there against the false choice between responsible use of scientific evidence, and responsiveness to the needs of patients that all too often go on, when the results of randomized, controlled trials, run out. Rage, there, in defense of holism, and humanism, and the humility to acknowledge - they are the same.

Rage now, and follow your rage along the road that leads to the difference you hope to be in the world.

What road is that? Ah, there's the rub! No one can tell you.

Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth;

Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear; Though as for that the passing there Had worn them really about the same,

And both that morning equally lay In leaves no step had trodden black. Oh, I kept the first for another day! Yet knowing how way leads on to way, I doubted if I should ever come back.

I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I-- I took the one less traveled by, And that has made all the difference.

Robert Frost (1874-1963). Mountain Interval. 1920.

I cannot direct you to the correct road ahead, and I doubt Robert Frost has been much help either. After all, which road did he choose? Did he ever go back? And most importantly, all those years later -- did he sigh with contentment, or regret?

Maybe the only practical advice on the matter is courtesy of that modern-day sage, Yogi Berra: when you come to a fork in the road...take it.

As is often the case with Yogi, the blatant simplicity of that statement may mask its genuine wisdom. Perhaps the one best hope any of us has to learn what we need to know- is simply by going where we have to go.

I wake to sleep, and take my waking slow.

I feel my fate in what I cannot fear.

I learn by going where I have to go.

We think by feeling.

What is there to know?

I hear my being dance from ear to ear.

I wake to sleep, and take my waking slow.

Of those so close beside me, which are you?

God bless the Ground! I shall walk softly there,

And learn by going where I have to go.

Light takes the Tree; but who can tell us how?

The lowly worm climbs up a winding stair;

I wake to sleep, and take my waking slow.

Great Nature has another thing to do

To you and me; so take the lively air,

And, lovely, learn by going where to go.

This shaking keeps me steady. I should know.

What falls away is always. And is near.

I wake to sleep, and take my waking slow.

I learn by going where I have to go.

Theodore Roethke, "The Waking" from Collected Poems of Theodore Roethke.

Theodore Roethke's poem, The Waking, is, if anything, murkier and more abstruse than Dylan Thomas. But once again, the take away message is clear enough: we can all only hope to learn what we need to know by going where we have to go.

And so, my young friends, we come to it now. For the rage is all within you; and the roads are all before you. And it is your time; and it is your turn; and it is your chance; and it is your difference to make; and it is your road to take.

So let none dissuade or divert you. But expect none to direct you. The road that spends your rage on the difference you need to be in the world belongs uniquely to you, and no one else can find it.

It is your time, and so I call upon my colleagues here on the dais, and I say: it is their time, so if you please...Release the Kraken!

Well, maybe not the Kraken.

Rather, release upon the world this graduating class of 2015, that they may carry our most fervent hopes and great faith.

And to you, my young friends, I say: it is your turn; and it is your chance.

It is your turn. And we have left for you a mess of messes. We have left you the things we have broken, and all that we have failed to fix. And now we have the nerve to say to you: it is your turn. And for that, I can only offer my sincere apology, and my condolences.

But it is also your chance. And the righteous rage is all within you, and the roads along which to spend that rage to be the difference you hope to see in the world -- are all before you. And you are young, and foolish enough to believe in the possible.

And for that, I offer you my genuine envy; my heartfelt congratulations; and the only parting guidance my own road accords me the right to share:

Rage now!


David L. Katz, MD, MPH, FACPM, FACP hopes, when the time comes, to go gentle into that good night. He can generally be found raging now.

Director, Yale University Prevention Research Center; Griffin Hospital

President, American College of Lifestyle Medicine

Editor-in-Chief, Childhood Obesity

Founder, The GLiMMER Initiative

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Author: Disease Proof