Author: Neha Sahota, USC Keck School of Medicine/MS1
Since starting medical school, I couldn’t help but notice that medical training seems to be a Sisyphean task of sorts. You roll the proverbial boulder up the hill throughout college, to reach the summit once you are accepted into medical school. Classes start and the boulder rolls right back down again, at a speed that you never saw coming. The pattern repeats, every time you fall for the mirage that things will be ok after you “pass that exam,” “get honors on this rotation,” or “match into residency,” reality inevitably comes tumbling down the hill, akin to gravity. It is only natural, then, that physicians and trainees experience burnout. The boulder becomes too much of a burden to bear, to the point where one would rather lay down and simply let it crush them than even begin to consider the prospect of having to push it back up yet again. However, my perspective has shifted after reading Albert Camus famous essay, “The Myth of Sisyphus”. Perhaps in Camus’ work we can find some respite from the hamster wheel that the medical training process can begin to feel like.
The first idea that may help placate burnout is an acceptance that the nature of life is simply absurd. Many of us go into the field of medicine because it is a career laden with meaning and purpose. The actions we take as physicians aren’t in the name of a faceless conglomerate but rather (largely) in service of the greater good of the individuals we call our patients. We can derive meaning from our patients and their stories. However, this motivation may be a double edged sword as we can become excessively attached to the notion of meaning. When the inexplicable happens, our thoughts circle in an attempt to find some meaning, “Why did the patient code? Was it my fault? Did I do everything possible?”. For our well-being, and that of the patient it may be necessary to potentiate our love for meaning with a healthy dose of absurdism. Acknowledging there isn’t always a bigger meaning, or takeaway. We can do our best to learn and practice but at the end of the day there is only a limited amount of control and influence we have over any given situation. The nature of life is so absurd that sometimes things will happen despite our best efforts, and the understanding that our control over life is limited is a painful but simultaneously liberating realization that can enable us to focus more on what we
can do next time as opposed to what we couldn’t do last time.
Second is the idea of embracing this absurdity and finding joy in it. In Camus’ essay he focuses on the brief moment in which the boulder rolls down the hill, and Sisyphus makes the decision to go back down for what must be the thousandth time, and decides to push it back up. He writes “At each of those moments when he leaves the heights and gradually sinks towards the lairs of the rocks, he is superior to his fate. He is stronger than his rock”. For Sisyphus, a radical acceptance of his fate and the present moment is his only escape from the pain of the task. In medical training this may be a necessary mentality to adapt to prevent burnout, or simply to ensure we can persevere. We can do as much as we can to advocate for ourselves but at some points complete acceptance of how things are in the moment can provide relief from thoughts that may only serve to exacerbate the frustrations during training. Thoughts like, “I can’t believe I have to do this again!”, “How long will it take? Haven’t I been here long enough?”. Camus notes that the fate of Sisyphus is only tragic “at the moment which it becomes conscious” and it is his attitude walking down that hill that draws the line between the experience being a punishing fate, or simply fate. If we wake up on a Sunday, immediately dreading Monday, the tone of the future is already set and the anticipatory pain only exacerbates the challenges we face.
Perhaps in embracing what is, and acknowledging that the training process is difficult, but not ruminating on it, we can create space for joy. Instead of spending our time in anticipatory dread or frustration, we are afforded the opportunity to shift our focus to the present moment and in doing so we create the space for the joyful moments. The moments that remind us why we went into medicine in the first place. Perhaps it is a connection made with a special patient. A “thank you”. A laugh shared with colleagues at 2am. The realization that you know more than you think. That you have done something special for someone else. All of these moments, from the start of our medical training to the end of our careers, add up to create a professional who is a reflection of these different moments. Of the people they have interacted with, and the patients they have cared for since the first day. Perhaps on the 1000th time we see a patient, on the 1000th time the boulder rolls down the hill.