Preventive Medicine Column

Dr. David L. Katz

Memorial Day reminds us to honor those who gave all, so that all of us might know freedom.  Three-day weekends inevitably turn to the festive, but this really is a time to think about death, and loss, and the selfless sacrifices of our Veterans.

But this also happens to be the season in which our kids graduate from college, and high school.  And so we have cause to look at losses past, and future promise.  We have cause to reflect on death, as our children dream of how their lives may unfold.

I was privileged to address those recently gathered for the University of Bridgeport Division of Health Sciences Commencement-and my own thoughts turned to the interface of death, and dream.

Through the medium of “Hamlet,” William Shakespeare famously invited us to consider: “What dreams may come when we have shuffled off this mortal coil? None can say. But we can, perhaps, constructively contemplate: What may come of our dreams, while by this mortal coil we remain bound?

Writers and philosophers, poets and theologians have long pondered that restive interface of reality and dream.  In the poem “If,” Rudyard Kipling warned against undue subordination of our sobriety to dreams. Dreams, unconstrained, might run roughshod over the best roads to better destinies. We should dream, but must remain the masters of our dreams, and destinies.

Kipling, presumably drawing from the less pleasant of his own experiences, cautioned us against the undue dominion of dream. We can get lost in dreams. Dream can make us dreamers — fatuous, and futile. Rather than leading us toward our best hopes fulfilled, they can lead us astray. So Kipling encouraged a practiced pragmatism- a certain, steady stoicism.

For those of us in the healing arts, there is an alternative peril in Kipling’s time-honored advice. If we too successfully stifle the impulses of dream, if we silence the better angels of our nature, and if we repudiate our passions — we risk an unfeeling reality. This may be a menace to all humanity, but certainly it is so for those of us whose careers are about care. There can be no genuine care without caring. There can be no caring without feeling. There is risk in feeling; there is far greater risk in failing to do so.

I have long had my own dream about science, and softness. I have a dream of health care carried unfailingly in currents of deep caring. I have a dream of medicine based on both evidence and empathy; where responsible use of science, and responsiveness to the needs of patients—that all too often go on when the results of randomized controlled trials run out—are fully reconciled.

I have a dream of medicine unencumbered by territorial disputes, uncompartmentalized into this kind, and that kind. I have a dream of our collective best efforts to find what works best for any given patient across a full spectrum of plausibilities.

I shared my dream with the graduates and their families.  But I was quick to point out it was not a day about Hamlet’s dreams, Kipling’s dreams, or my dream. It was a day for them, and their dreams.  What may come of such dreams?

That depends, at first, of course, on the dreams.  For they must be good dreams to do good in the world. They must be dreams sized to suit a world of challenge and opportunity. We listened in as Hamlet told Horatio: There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.”

If that was true, then Horatio’s philosophy was too small; his dreams, too pinched. Nothing but the full expanse of possibility should pinch our children’s dreams. I am sure those who gave their all for a future they fought to protect would agree.

Graduations are a lovely pause — deep with meaning and emotion. Such days are redolent with promise. But the service of those who died defending our common dream of just freedom remind us that they are also times to contemplate our obligations to the body politic. They are a time to think of promises we should make to advance the human condition, and what it will take to fulfill them.

Memorial Day obliges us to look back.  Commencements invite us to look ahead.  Our dreams of best possible futures should be informed by our shared history.  There is no need for dreams to make us dreamers, fatuous and futile.  We may dream even as we remember— and draw that informed, preparatory deep breath: one part resignation, one part resolve, and one part restless delight.

Here’s to the memory of all who have defended the freedom in which our children dream of their futures.  And here’s to the promise of those dreams, and all that may come of them!




Dr. David L. Katz;