Our new first year Medicine students attended their welcome ceremony at our University yesterday, and it was wonderful to witness and experience their excitement at starting studying the career of their dreams. Watching them and being involved in the ceremony got me thinking about medicine as a career, and I was reminded of an excellent piece of philosophical writing published at the time I was training to be a medical doctor myself, by Professor Johan Koeslag, a Physiology Professor at the University of Cape Town whose teaching had a profound positive effect on me. In this article he compared a career in medicine to the Myth of Sisyphus, with the role of clinician being likened to that of Sisyphus in the myth.
In Greek Mythology, Sisyphus, who was King of Ephyra (modern day Corinth), attempted to cheat death, and for this and other roguish behaviour he exhibited during his reign as king, Zeus punished him by forcing him to roll a heavy boulder up to the top of a hill. Each time he reached the top of the hill, the boulder rolled down again, and the task had to be repeated continuously for eternity. Therefore, Zeus by this punishment had consigned Sisyphus to performing what was an inherently useless action for eternity, the goal of which was to create an eternity of frustration for the miscreant Sisyphus. With time the Myth of Sisyphus became representative of any activity that is inherently pointless, repetitive and interminable. An analogy was drawn by Johan from this to the daily work of a medical doctor, namely that no matter what a clinician does, they can never ‘cheat death’ / permanently cure anyone, as even if they cure a patient of one disease, they will eventually die of something else. From this perspective, if saving life is the job description of a clinician, then medicine must represent the ultimate failure as a profession, with a one hundred percent long term mortality and therefore failure rate. As in the Myth of Sisyphus, clinicians are thus caught in an absurdist paradigm, as they are ‘saving’ people to face certain death. In his article Johan described this as the Sisyphus Paradox of Medicine, namely that because they wage a losing battle against death in all those that they treat, all clinicians resemble Sisyphus, eternally condemned to perform an impossible task in a repetitive manner until their own point of eternity, or to be more moderate, their retirement day.
This may sound a somewhat depressing view of medicine, but Johan did not stop there. He (and others who have taken forward these ideas) then went on to clarify what clinicians should do to maintain ‘faith’ while having awareness of this Sisyphus paradox in their daily working life. He suggested that clinicians need to accept this perspective, and understand that their ‘lot in life’ is to maintain commitment to their work, and to their patients, even with this awareness of its ultimate futility, and by doing so they would make themselves as clinicians more balanced and more close to their own state of perfect grace. Second, the clinician would need to focus more on creating a pain or illness free environment for their patients, to the best of the clinician’s ability. While there may be a teleological reason for pain and suffering, possibly in the context of learning some perspective or self-understanding that would not occur in pain-free routine existence, there would clearly be comfort produced in a clinician’s patients by reduction of their pain and suffering, even if at some point in the future the patient’s death is inevitable. Thirdly, there would perhaps be benefit in clinicians incorporating scientific analysis into their work life, in order to try and understand better (if possible) such difficult concepts as ‘life’ or ‘death’. Science, as opposed to medicine, philosophy or theology, is likely to be the only method we have which can potentially explain such complex issues as life and death in a ‘material’ manner, or at least the physiological and anatomical mechanisms related to these ‘big’ concepts. Fourthly, and finally, clinicians perhaps need to concern themselves more with educating their patients on the certainty of death, in order to better prepare them for this inevitability. In modern times death and dying are almost ‘taboo’ subjects, and death occurs usually ‘behind closed doors’, which may in effect be creating an increased fear of death and dying either due to ignorance or avoidance of the issue. if clinicians educated patients (and healthy individuals) about their own inevitable mortality, and that dying is in itself the culmination of life, however paradoxical this observation may be, they may potentially remove their patients fear of death, or at least make them be more comfortable with their own dying, when their time eventually comes, as it does for all of us.
So watching those folk yesterday at the start of their medical careers, with my own awareness of the Sisyphus paradox inculcated in me by Johan’s thought-provoking work, that would likely be an absolute contradiction to the inherent reason most of them probably chose medicine as their preferred career choice, I wished them luck on their own clinical journey, and hoped that by working daily rolling their own ‘boulder up the hill’ in a never-ending way, that they would all eventually understand the Sisyphus nature of their work, and by doing so attain their own state of perfect grace, and become the best doctor they can be, doing medicine for the right reasons in the best possible way.