On the beach this summer, reading an old book of poetry, I looked up and saw a sign like the one below.

photo from NOAA

Maybe it was heat stroke or the daiquiri I was sipping, but I came to appreciate an odd relationship between the poem in front of me and that sign. The poem was Dylan Thomas’s famous meditation on struggling against death, Do not go gentle into that good night. I read it and imagined what I would do if I got caught in a rip current. As that current started to pull me out and under, I’m sure I would rage, rage against the dying of the light, as the poem implores. I’d give it all I had. My first instinct, though, wouldn’t be to swim diagonally, as the sign recommends. Instead, I would swim as hard as I could straight toward the shore. And chances are I’d eventually become exhausted and drown.

The sign promised a better way to burn and rave. Though this counter-intuitive approach couldn’t guarantee my survival, it certainly would increase the chances of it.

Later, back at work in the Duke ALS clinic and nursing a sunburn, I thought about my day at the beach and how it related to my experience with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). What would I do if I received a diagnosis of ALS, or if one of my loved ones did? Like most of the 1,000 or so patients with ALS and their caregivers that I have seen over my last decade in this field, I’m sure I would fight it-in Thomas’ words, blaze like meteors against it. But without all my years of scientific and on-the job-training, would I know the best direction to go in?

The rest of the article can be found here.