In my third year of medical school, I was taking care of an elderly patient who had been in and out of the hospital multiple times in one month. Upon his third admission, my exasperated attending threw up his hands and said, “Who am I, Sisyphus?” I understood how he felt. Like the mythological Greek king rolling his boulder up the hill — only to have it roll back down again, ad infinitum — no matter what we did to manage this patient, he always returned to the hospital sicker than before. We were fighting a losing battle. This poor man suffered from diabetes, kidney disease and heart failure, the kind of chronic problems that brought many patients back into the hospital again and again. Treating him didn’t just seem futile; it felt absolutely hopeless. Death would inevitably win, just as it did with all our patients.
That, I thought, was the true Sisyphean effort. Not the endless cycle of treating the sick, but the madness of treating patients at all. No matter what we did, they would all die. The boulder would inevitably roll back down the hill. And we would have to all start over again, picking up new patients and straining against the weight of that stone. There was no end in sight, no completion to our task — nothing but a long string of failures.
So, why do it? Why practice a craft that can never achieve its true purpose? I suppose we must ask the larger question: why do anything in life, knowing that we will someday die?
For me, the answer lies in the philosophy of Albert Camus. The French-Algerian thinker argued that all of life is a struggle to reconcile what we innately desire and what we fully know to be true. At its heart, this is a fundamental conflict between life as we want it — governed by order, meaning, and hope — and life as we know it — governed by chaos, death, and chance. In Medicine, this means that we view Death as both an unacceptable defeat and an unavoidable truth. We want to believe that we can prolong life indefinitely, but we know that every patient will inevitably die. We want to believe that we have ultimate control over Death, but we know this is laughably untrue. Camus calls this internal conflict “the Absurd,” a paradox that can never be resolved. We encounter the Absurd as we simultaneously search for meaning in life and realize that life is inherently meaningless. We cannot help ourselves; Camus explains that it is in our nature to search for deeper meaning to life. However, because no such truth exists, our quest is, simply put, absurd.
But take heart. Camus is quick to point out that a “futile” struggle need not be a hopeless one, nor one unworthy of our time. Quite the opposite, he argues that the greater the futility of our struggle, the greater our chance of achieving true happiness in life. If we can learn to embrace the futility of our daily lives, we can learn to embrace the futility of Life itself. If we can become conscious of the paradox we are trapped in, we can choose to transcend it and be happy in spite of it.
In this spirit, Camus beckons us to embrace the struggle of “the Absurd” and do everything in our power to rebel against simple solutions. He bids us to reject escaping the Absurd through suicide, religion, love or legacy. None of these allow us to live our life to the fullest, because they inevitably quell our curiosity, along with our thirst for deeper purpose. Rather, Camus asks us to fight to keep our minds sharp and open, suspended on the heart-pounding precipice of that unbridgeable chasm. We must remain hungry for purpose, for answers. It is only through our awareness of the Absurd — of that irresolvable struggle between what we want and what we know — that we can obtain lasting happiness.
Let me explain further by returning to our tragic hero, Sisyphus. In his seminal essay, “The Myth of Sisyphus,” Camus describes the ancient Greek as the “Absurd hero,” condemned to a fate that mirrors the very struggle of Absurdism itself. “His scorn of the gods, his hatred of death and his passion for life,” Camus writes, “won him that unspeakable penalty in which the whole being is exerted toward accomplishing nothing.” The author acknowledges how horribly Sisyphus’s fate must strike us, noting that, “[The gods had] thought with some reason that there is no more dreadful punishment than futile and hopeless labor.” Camus adds to this a vivid description of the hero’s suffering, “…[seeing] the face screwed up, the cheek tight against the stone, and the shoulder bracing the clay-covered mass…” We can feel his pain in our bones. Thus, when Sisyphus finally reaches the peak of his struggle, cresting that mighty hill, our hearts plummet as the boulder goes barreling back downwards. Sisyphus is hopeless, eternally doomed to the bleakest of fates.
And yet, there is a silver lining. At that very moment, when the rock rushes back down the hill, something awakens in Sisyphus. He pauses. He reflects. He awakens. “It is during that return, that pause, that Sisyphus interests me,” writes Camus. “That hour like a breathing-space, which returns as surely as his suffering, that is the hour of consciousness.” Indeed, that is the moment in which his act of rebellion occurs. That is when Sisyphus awakens to the Absurd and chooses to claim his fate as his own.
“If this myth is tragic, that is because its hero is conscious,” Camus states. “The workman of today works everyday in his life at the same tasks, and his fate is no less absurd. But it is tragic only at the rare moments when it becomes conscious.”
In Medicine, we are deeply conscious of our own endless plight, of our Sisyphean struggle, against immutable Fate. We are sharply reminded again and again that we are fighting a losing battle. In the wake of each patient death, we awaken to the Absurd. We become aware of our struggle, of our place within it. Then, like Sisyphus, we must choose whether we will surrender to the futility of our fate — or rise above it.
Our struggle is not in the task of treating patients, as my attending believed. To heal is merely an act of labor, with our muscles well-trained to push the boulder onwards. Rather, our struggle is in that final moment, when we must let go and watch life slip through our fingers. That is the hour of consciousness. That is the moment when we awaken to our own mortality and see the world with absolute clarity. That is when we return down the hill with hearts filled with resolve — knowing once more that life is precious, that we will certainly die, and that we are happy nonetheless. It is the joy of knowing that our fate is our own.
I find it fitting that Camus should end his essay with Sisyphus at the foot of the mountain, facing his task once more. As physicians, we, too, must end our days at the foot of the mountain, preparing to carry the next soul up the hill. Now more than ever, we must ensure that our burden never eases. We must feel death’s defeat every time it comes, and we must feel it as if it were our own. In those precious moments, we awaken to the Absurd. We experience our hour of consciousness, when we are free to choose joy in spite of death. We find something to live for — our countless triumphs over our endless struggle.
Camus gives us a simply and powerful message of hope. To practice medicine, we must imagine Sisyphus happy.