Folmsbee: Why futility matters in medicine

Sai Folmsbee, Columnist

From the perspective of a student interested in a future in health care, medicine is a difficult career to imagine. Perhaps some had a close family member suffer some major illness, and maybe others had the opportunity to shadow a physician in the hospital.  More often though, premedical students have a vague interest in human biology and the challenge of medicine, and, like anyone, they have a healthy fear of death.  And to fight death, what better to become than a doctor?  But here is an important truth for anyone planning a career in medicine: The medical fight against death is an exercise in futility.

The career path for a future physician parallels the Greek myth of Sisyphus. According to legend, his greatest trick was paralyzing Thanatos, the personification of death, thereby preventing any mortal from dying. For this and many other transgressions, the gods set upon Sisyphus a unique and tortuous punishment. He was forced to roll a large boulder up a hill, only to watch it roll back down again. He was to repeat this task for all eternity — the perfect embodiment of futility and uselessness. Unfortunately, most new medical students find themselves playing the role of Sisyphus, angered by the futility of their actions without realizing their own sin: desiring power over death.

Futility is first seen in medical school, which is hard enough. Naturally, the sheer volume of material to learn and the number of exams are staggering, but within the medical school, the paradigm of the physician’s fight against death thrives.  The value of all the drugs and procedures we learn are quantified only by their marginal reductions in mortality.  Like Sisyphus, we all are trying to cure death for everyone.  Medical students expect this power over Thanatos himself to arrive, but it never comes.

In this way, Thanatos may be the enemy of medicine, but he knows something most of us do not accept: Death cannot be cured.  Death is the inevitable end to life.  But more importantly, choosing the elimination of death as our primary pursuit leaves us with nothing but frustration and doubt.  All we have left is the tedious management of regimens of medication and novel arrays of diagnostic tests, but even these can become sunken in futility.  This forces physicians into a barrage of repetitive, Sisyphean tasks: rearranging the dosages on heart failure medications, ordering another blood test with no clear purpose or reflexively adding new drugs without a concern for the evidence of their efficacy.

To further the strain, patients too can become similarly lost in futility.  Some will never take their medication, never show up for their appointments or never even understand their own health care. Others will never quit smoking, never exercise or never change their diet. For physicians trying to help as many people as they can, it is easy to watch the boulders roll away over and over again.

But importantly, there is still hope in futility. Someone must be there to roll the rock back up, and this is the truest value in what physicians practice. Even the philosopher Albert Camus, in his essay “The Myth of Sisyphus,” wrote that Sisyphus should be able to find happiness in futility. He argues that the struggle alone should be enough to fill one’s heart. And there is no greater struggle than the one between life and death. By embracing and understanding this inherent challenge to medicine early, we can achieve a real kind of personal satisfaction operating within the health care system. Small gains in the quality of a person’s life and comfort in times of illness are an important part of any physician’s practice. Accomplished doctors do not measure their success in the number of lives saved, but rather in the struggle itself to improve the quality of the lives of patients.

Understanding and accepting futility is the most vital task for anyone planning a career in medicine. If medical students and physicians face this futility without accepting it, all that is left is frustration and the inevitable burnout. This can manifest in potentially damaging ways, such as losing respect for patients, feigning interest in their care or forgoing common courtesy because of blase disregard for the consequences. We are all brave enough to face an infinite number of boulders to push up a hill, but future physicians need to be strong enough to witness them all falling back down.

Sai Folmsbee is a Feinberg graduate student. He can be reached at [email protected] If you would like to respond publicly to this column, send a letter to the editor to [email protected]