"The Hour of Consciousness"

The leaves were just beginning to change color when Charles went to turn and his left leg refused to follow. He tumbled awkwardly onto the grass and sat for a moment, stunned, before embarrassment flushed his cheeks. A student rushed forward to help him up, but he waved her off nonchalantly. 

At dinner that night, he recounted the event to his wife, chalking it off to the strange twist of the path. A wandering mind. Old age. Judy scolded him for being absent-minded. They laughed over wine and forgot about it almost immediately. 

But the falls continued. A week after Easter, Charles looked down in the midst of grading papers to find the muscles of his hand twitching, as if they had a mind of their own. He watched in morbid fascination. Caffeine, his coworker said the next morning, could be the problem. So Charles switched to tea—a lovely jasmine his daughter, Marie, had bought him a few months prior, while on a trip to Japan. 

Eventually his wife insisted he see a physician. One visit turned into two, then three. There were a string of tests, most of them a blur. Judy kept track of them in a small blue notebook. The only test he remembered clearly was the painful one. They’d been referred to the nearest place that did nerve conduction studies and electromyography, about an hour away. It had started with a series of shocks, followed by painful needle sticks into various muscles throughout his body. 

“What are you looking for?” Judy asked cautiously, her blue notebook open to a new page. 

The neuromuscular specialist, Dr. Liu, removed the needle from Charles’ hand, holding a cotton swab to the puncture site. “Electrical muscle activity,” she explained matter-of-factly. Then, as if to demonstrate, she removed the cotton swab, turned his hand over, and promptly stuck him again, this time in the forearm. The machine began to make a terrible static noise as she poked the needle around. As she watched the monitor, her face was drawn and focused, in an eerie way. She shook her head. Charles closed his eyes after that, trying to will the test to end sooner. 

After Dr. Liu was done, perhaps anticipating Judy’s barrage of questions, she informed them she was just the person who interpreted the test—that she’d need to sit down and review the data before coming to any conclusions. The final report would be sent to his neurologist within the week. 

“Dr. Singh—he’s a good doctor. I knew him from residency,” she said primly. Then she was gone, replaced by medical assistants who kindly reminded them how to get back to the parking garage. On the walk there, Charles thought Judy might try to cheer him up. But even Judy, the optimist between them, could sense there was something terribly wrong. 

And so the diagnosis came a week later, on a bright August afternoon, not long after they’d sent their daughter off to college. His neurologist, Dr. Singh, explained carefully that his nerves were dying—in his spinal cord, motor cortex, and brainstem. Then he started to say the words which Judy had begun throwing around, too, after all her WebMD and PubMed searches. “ALS.” “Lou Gehrig.” “Motor dysfunction.” 

Charles couldn’t bear to listen as she asked about prognosis and treatments. His head started to hurt. He wondered if his daughter had gone to class by now. Charles stared at the neurologist’s shoes as he began rattling off a short list of medications, things they could do to preserve his current function. ‘Delay symptom progression’ is how Singh phrased it. Judy jotted the words down in her blue notebook. The words rolled around in Charles’ head. Delay, he repeated, not fix. He wanted to yell. What was the point of writing that down? 

The car ride home was quiet. Outside, the light had shifted into something unfamiliar and dreary. He put on some Chopin to fill the silence, but the piece’s minor key seemed only to punctuate their sadness. Judy turned it off, and he settled on watching the cars pass by. 

He continued teaching at the local college. The routine he’d kept for the last twenty years seemed like it might disappear at any time. Sometimes, when he closed his eyes, he imagined a thread burning at one end, picking up speed, on its way to becoming dust. He wondered what was on the other side of it—nothing, everything? If the Buddhists had it right, perhaps he’d reincarnate into the body of a cow, or a chicken. 

Or, perhaps he would reincarnate as another human, one where the nerves weren’t dying. 

This was what preoccupied his mind, at least, the morning he went to lecture on Albert Camus’ The Myth of Sisyphus. It had been one of his favorite readings from college—a study of the Greek king condemned to rolling a rock up a hill every day, only for it to roll back down. Charles set up his powerpoint and waited for the kids to wander in. Some listened; some others disregarded him and surreptitiously pulled out their phones. No matter, he thought, the paycheck was the same whether they listened or not. Charles shook his head, cleared his throat, and turned the class’ attention to an excerpt: 

“That hour, like a breathing-space which returns as surely as his suffering, that is the hour of consciousness. At each of those moments when he leaves the heights and gradually sinks towards the lair of the gods, he is superior to his fate. He is stronger than his rock.”

And then, the famous line: 

“One must imagine Sisyphus happy.”

As always, there was a student who pushed back. “There’s no hope in sight,” said a young woman in the front row. “How can we imagine him superior to his fate? Let alone, happy?” 

The academic argument, which he used to take great pleasure in explaining, was this: Sisyphus’ punishment for outwitting the gods was an endlessly futile physical labor, a constant asphyxiation of the mind. By finding peace in that hour of descent—by willing himself a moment of reprieve—he rebels against the gods. He triumphs against them and the rock. 

But the words soured on his tongue now. 

His student was appeased; Charles was not. He dismissed the class a few minutes early and stared out the window. On the grass where he had fallen a few months ago, a group of athletes were playing spike-ball, laughing merrily. It dislodged something in Charles’ ribcage, a bitterness he had tried to hold back, for Judy’s sake. He contemplated Sisyphus rolling his rock—and now, the rock before him. The neurologist had warned him he might lose control of his limbs, his tongue, his capacity to swallow. Breathe. He considered himself proud, and yet as Charles reached into his mind, he could not procure even an ounce of peace or happiness to spite the gods. He scoffed. Camus was wrong. The rock was bigger; it won every time. 

Marie came home for Thanksgiving break. She talked about some of her classes, some clubs. Charles waited until the morning of her flight back to break the news, trying not to watch the way her face fell. She was young and unable to mask her shock. 

“How much time?” she asked. 

He didn’t know how to respond and eventually said, “Could be a long time, could be a short time.” 

Across the table, Judy looked at him pointedly. 

“Well, maybe not a long time,” Charles amended, and this time, he couldn’t keep his voice from catching. 

He managed to get through the holidays, hobbling around on a cane, and then a walker, but by February his legs had given out. In one of the pamphlets Judy read to him, it had said a small minority—something like five to ten percent of ALS patients—lived longer than ten years past their diagnosis. So Charles prayed this might be a temporary malfunction, that his nerves would sort themselves out and spur back to life. His body was more resilient than this, he thought, it must be. But to his despair, everything in life moved on except for him. The leaves fell, then grew back again. His legs grew increasingly atrophic. It was insidious, this disease of plateaus and precipitous drops. When one deficit seemed manageable, another would rear its head. His deterioration marched on, relentless. 

Eventually, Judy ordered the wheelchair. Marie happened to be home when it arrived; she showed him the various remote features, but her enthusiasm irked Charles. It wasn’t a toy. He unceremoniously threw the remote at the wall and turned away. 

“You’re upset,” Judy said matter-of-factly, after Marie had left the house in tears. 

He exhaled tiredly. “Wouldn’t you be?” 

Charles could sense she had a lecture for him, but in the end, she turned into the bedroom and didn’t emerge for the rest of the night. Marie didn’t come home, either. The house was painfully quiet as Charles’ thoughts hung over him into the early morning hours, when light began to slant across the living room. 

The next afternoon, Judy suggested they go on a trip. An olive branch, he knew. They needed a change of scenery. She suggested San Diego, or maybe San Francisco? 

“Monterey,” Charles said, without thinking. 

Judy looked thoughtful. She knew he had grown up there, until his mother passed away and his father’s new job landed them in Chicago. She didn’t pry. “Sounds lovely,” she said, and went to make the bookings. 

They arrived in Monterey a month later. He stopped by his childhood home, which happened to be a few minutes from the hotel. It was painted a different color now and, by the stickers on the car parked out front, belonged to a family of five. The sparrow nest from his childhood was still there, beneath the east window. He couldn’t tell if it was abandoned now. A sparrow only lives so many years. Three, based on his Wikipedia search. If the statistics were to be trusted, he had one sparrow’s lifetime left in him. 

On their last day, he brought Judy to Moss Landing. It was late afternoon. They’d scheduled a whale watching tour, but it had rained the entire morning and looked as if it might rain again.  

They boarded the boat at four and departed soon after. Monterey looked very much the same after all these years. There was a knot in his stomach every time the boat tipped; he didn’t know what he’d do if the wheelchair tipped as well. He held on feebly to the upper deck railing. 

It was cold and beginning to sprinkle again. Half the party, including Judy, turned inside to watch through the glass. Charles stayed, wrapped in a poncho and Judy’s scarf. An hour passed without fanfare. Then two. The sun began to set, a long descent across the sky. The boat began to turn back around. 

As he waited, he recalled the time his mother brought him whale watching for his twelfth birthday. They’d eaten french fries and watched the line of the sea. He’d been obsessed with whales that year—drew them in art class, knew just about every species, their migratory patterns, feeding habits. 

Suddenly, breaking his reverie, there was a great spray of white sea foam in the distance. Then another. A pod of gray whales weaved through the water, approaching slowly. One of them, a calf. He fumbled for his camera and let out a whoop of excitement, as if he were that same schoolboy from forty years ago, his mother beside him, ruffling his hair. He snapped a few photographs and planned to send them to Marie. 

Such was Charles’ hour of consciousness. 

The rock had rolled down the slope. He watched it go—all the efforts of the day: Judy washing him, taking his meds, getting into the wheelchair, the spilled coffee on his shirt as his hand had trembled. Tomorrow he’d wake and get into the wheelchair again. Perhaps his right arm would give, or perhaps his lungs. But he had made it to Moss Landing today; he’d seen the whale and its calf surface, like magic. He’d felt his mother’s presence beside him. 

They reached shore ten minutes later. His hand was pulsing again, but there was a content look on his face when Judy wheeled him down the ramp to land. It was as Camus said: in that hour of descent, Sisyphus was superior to his fate. 

Today, Charles thought, so was he.

An abridged version of this piece won the 2025 American Academy of Neurology Grand Prize for Best Medical Student Essay.