|The warrior king Gilgamesh grasping a lion in his left hand, and a snake in his right.|
(Assyrian palace relief on display in the Louvre)
“O Uta-napishti, what should I do and where should I go?
A thief has taken hold of my [flesh!]
For there in my bed-chamber Death does abide,
and wherever [I] turn, there too will be Death.”
-From The Epic of Gilgamesh, The Standard Version, Tablet XI1
“O Uta-napishti, what should I do and where should I go?” Gilgamesh’s plaintive cry still rings out, three thousand years after it was captured in wedge-shaped cuneiform script on tablets of clay. The first known versions of the epic of Gilgamesh were recorded even earlier, when Sumerian scribes carved the story of the legendary Mesopotamian king on tablets four thousand years ago. The enduring power of its themes kept it alive in common imagination and oral folklore, and a thousand years later, novices in scribe school were still painstakingly copying its verses onto what are known today as the Babylonian tablets. The rediscovery of these tablets after eighteen centuries, in the library of the seventh century B.C. Assyrian king Ashurbanipal in Nineveh, led to their being deciphered and translated by a long line of scholars.2 Fragments of the epic are still being discovered, and the work of translating and interpreting its verses continues.3
At a seemingly unbridgeable distance of four thousand years, this epic story still holds relevance because its themes are about unchanging aspects of the human condition: the fear of aging and death, the wish for immortality, and the need to understand the meaning of human existence. Reading the epic, I was struck by the parallels and contrasts between modern medicine’s attitudes to aging and mortality, and Gilgamesh’s quest to defeat death and live forever.
Gilgamesh was a powerful king; one part mortal, three parts divine. At the start of the epic, he was an arrogant tyrant who instead of serving his people caused suffering. Then the gods sent a friend called Enkidu, who became Gilgamesh’s inseparable friend and companion. Enkidu’s tragic death first made Gilgamesh aware of the certainty that he too would die some day. The fear of death drove him to leave the kingdom of Uruk and search for Uta-napishti, a revered ancestor and the only man who had been given immortality by the gods. Through him, Gilgamesh hoped he would learn how to conquer death.
In his quest for immortality, Gilgamesh walked paths no one had trod before, walking alongside the sun and across the Waters of Death. His quest was personal but his motivations were similar to those that have shaped modern medicine: the quest to prolong life and conquer death. Developments in medicine such as the miracle of penicillin and organ transplantation transformed lives. At the same time medicine underwent its own alchemy, changing in part from the art of healing to the science of extending life. As new technologies created new possibilities for survival, the physician’s ancient role of curing and relieving suffering became less important than the goals of saving and extending life.4
This dramatic shift in focus meant that the physician was seen not just as a healer and comforter, but as a warrior wrestling with death and subduing it with technology. The body came to be viewed as a machine, death as a technological problem, and medicine as “a branch of technology.”5 Seen from this perspective, death had become the failure of the dying body to cooperate with the ends of medicine and a defeat for the physicians engaged in battle. As Philippe Ariès wrote, “One dies in the hospital because the doctor did not succeed in healing.”6
Medical advances have raised unprecedented dilemmas for physicians. Gilgamesh was a hero, just as modern medicine has been heroic in its fight against death and disease. But a time comes when heroes must lay down their swords, their shields, and their battle axes. Gilgamesh began his journey believing he could wrest the secret of immortality from Uta-napishti. But when he finally found his ancestor, he laid down his arms and found his quest for immortality futile. Unable to give Gilgamesh the secret of immortality, Uta-napishti directed him to a plant that could rejuvenate a person but not defeat death, knowing well that Gilgamesh would not be able to keep the plant for long. Indeed the plant was soon stolen by a snake that shed its old skin and slithered away, renewed in its fresh, young skin. The snake’s destiny was to renew itself, but the lot of humankind was to face aging and death.
The Sumerian sages who wrote this epic knew the poignant reality of human existence, likening it to “the mayfly floating on the water” that has a moment in the sun and then disappears. Having failed in his quest, Gilgamesh returned to Uruk, saying, “I have filled my sinews with sorrow, and what have I achieved by my toil?” But although he returned without the secret of immortal life, he came back with self-knowledge and an acceptance of his own mortality. Within medicine too, there has now been a push against the medicalization of death and towards reconciliation with our mortality.7
The direction medicine will take depends on the ends we assign it. The quest to always extend life and conquer death obscures the moral core at the heart of the physician’s work, turning the patient into a technical problem, a faulty machine.8 Death will always be there, and the secret to a good life is not to live forever – but to experience the beauty of the world during our brief existence. The arts of healing and alleviating suffering are as important to this good life as the science of fighting disease and preventing premature death. In the epic, a wise alewife gives Gilgamesh wonderful and moving advice:
“Let your clothes be clean,
let your head be washed, may you bathe in water!
Gaze on the child who holds your hand,
let your wife enjoy your repeated embrace!
‘For such is the destiny [of mortal men,]”
All quotes are from The epic of Gilgamesh: the Babylonian epic poem and other texts in Akkadian and Sumerian: translated and with an introduction by Andrew George, published in 1999 by the Penguin Press.
- A. R. George, The epic of Gilgamesh: the Babylonian epic poem and other texts in Akkadian and Sumerian: translated and with an introduction by Andrew George (London: Penguin Press, 1999), 97
- Maureen G. Kovacs, The epic of Gilgamesh: translated, with an introduction and notes by Maureen G. Kovacs (California: Stanford University Press, 1989), xvii
- A. R. George, “The Epic of Gilgamesh,” accessed April 15, 2019, https://core.ac.uk/download/pdf/2791031.pdf
- Mark J. Hanson and Daniel Callahan, eds. The goals of medicine: The forgotten issues in health care reform (DC: Georgetown University Press, 2000), ix
- Sean Illing, “Scientists are waging a war against human aging. But what happens next?” Vox, May 6, 2017, https://www.vox.com/conversations/2017/5/4/15433348/aubrey-de-grey-life-extension-aging-death-science-medicine
- Philippe Ariès, Western attitudes toward death: from the Middle Ages to the present (Baltimore: John Hopkins University Press, 1974) 88
- Sunita Puri, “The Lesson of Impermanence,” New York Times, March 7, 2019
- Emily E. Anderson, “What We Talk about When We Talk about Goals” Virtual Mentor 9, no. 6, (2007): 407-409, doi: 10.1001/virtualmentor.2007.9.6.fred1-0706.
ANIKA KHAN, MBE, works as faculty at the Centre of Biomedical Ethics and Culture, SIUT, Karachi, Pakistan. She has a Master in Bioethics and is involved in the Centre’s research and educational activities.