Devil’s Pocket, South Street Bridge, side entrance, freight elevator, JMEC.
I can trace the path I walk to and from medical school every day using the tip of my finger. It forms the shape of a staple, tilted 45 degrees to align with the blue stripe on my monitor that is supposed to represent the Schuylkill River.
To me, this is a funny exercise. Grinning to myself, I place my greasy finger back on the computer screen. My finger traces from JMEC to GIANT Heirloom Market, reducing the arduous 20 minute weekday walk to a cursory movement of my most distal phalange. After a quick trip back home to drop off groceries, I enter the great Schuylkill River Trail, and with a swooping, banana-shaped arc, make it to Fairmount Park. I trace my finger back, encapsulating river-side loungers, near-miss bicyclists, and sweat-clad trotters in an effortless smudge. I visit Rittenhouse to buy peaches for cheap, and I head eastward to Old City to see an old friend. I let out my inner child in a frenzy, finger-painting Philadelphia with dead skin cells and oil. At day’s end, I go back home, as I always do.
I switch off my computer screen, destroying the world to reveal in its place the persistent patterns of unguent residue which now decorate my monitor. There are loops where I find myself taking a different route than from whence I came. There are branch points at the junctions of major roads. There are U-turns, when I realize a little too late that I need to go pick up scrubs. From the comfort of my swiveling armchair, I find it rather amusing to think that these oblique forms are the abstract, characteristic patterns which define my living, breathing, bona fide, 9-to-5 life. I get up from my chair and reach for a wet wipe.
8 a.m. on a Monday. I am now tracing my finger through Netter’s awesome design, attempting to engrave in my insomnia-addled brain where this damned nerve comes from and which muscles it innervates before the cloying yet strangely enticing smell of formaldehyde delivers me to oblivion. I slowly realize that I am looking at the wrong plate number. Disorientated, I flip back to the front of the celebrated tome, only to be greeted by Netter’s perfect human giving me the side-eye from between layers of peeled-back fascia and exposed facial muscles (Plate 24). I flip forward, and luckily I reach a deep dissection of the posterior thigh (Plate 511), a muscular monolith adorned with conveniently candy-colored arteries and veins and slender lemon-yellow stalks. I glance at the diagram. I look back at the cadaver. Reaching out, I palpate some of the tubes. It all looks the same to me.
I switch on my computer screen, navigate to YouTube, and begin listening to the soundtrack from an obscure 80s video game that never saw a release in the States. These blissful, contemplative moments at home, when I get to indulge in a hobby I enjoy, bring me peace during an otherwise demanding and fragmented medical school schedule. Whenever I am able to catch the delicious drippings of leftover time, I compose my own chiptune music, dreaming up new melodies, typing out precise strings of notes, and applying effects—all in glorious hexadecimal.
In its most original form, chiptune music is simple—almost barebones. It is unforgiving, boiled-down, angular music. The Nintendo Entertainment System, the game console known for the first Super Mario Bros. as well as Tetris, famously utilizes the steadfast Ricoh 2A03 sound chip. In its ambitious quest to emulate orchestras, this microchip is able to produce a staggering five different sounds at once through five distinct sound channels. The first two channels are dedicated to producing “pulse” waves—buzzing, mosquito-like tones which could be confused with the sounds of a toy piano or a half-price electric guitar given the proper parameters. The next channel, dedicated to the smooth, ever-hardy triangle wave, brings to mind a primitive representation of a pan flute. The noise channel, naturally, is used to replace drums, and the final channel is dedicated to replaying short audio samples, often low-quality, bit-crushed reflections of real-world sounds. These channels, these five most rudimentary components of music, form a legendary auditory quintet through which the wild imagination of glasses-clad chiptune composers could flow.
I humbly carry on this storied tradition. It is a tradition of reductionism, of taking the entangled and heterogeneous idea of “music” and attempting to sequence and distill it into voltage-carrying signals. It is the art of searching for the perfect abstraction of real instruments, relaying their interplay, and painstakingly capturing the soul of a live performance. It is a practice which playfully teases at the underpinnings of the human experience, using nothing but the unadulterated buzzing of electronic oscillators as its tools. Waveforms weave and collide, leaving nothing but raw emotion in their wake. There are no tricks to pull, no hidden trompe l’oreille in the back pocket, simply musical essence. It is an amazing privilege to be able to invent this essence.
My atlas sits on my desk, opened comfortably to the unassuming yet life-giving lumbosacral plexus (Plate 506). I would not be surprised if Dr. Frank Netter felt similarly about his craft as he translated complex, three-dimensional, and often inconsistent anatomical structures into masterful strokes of gouache on an illustration board. Reduction is art, backed by the philosophy that there exists an essential, comprehensible structure which underlies reality.
But as much as parsimony is beautiful, our representations of reality are necessarily absurd. I lift up a rib, searching for a vibrant, dramatically-shaded neurovascular bundle only to come out strangely slimy and empty-handed. I make small talk with a standardized patient and feel like Jim Carrey if a stage light had mysteriously fallen from the JMEC ceiling just a couple days earlier. I stare at OASIS and muse about my daily existence, neatly condensed to an array of technicolor blocks.
Perhaps such absurdity is inevitable. We must conjure narratives to make sense of the chaos. We regiment our schedules and reduce with glee. We simplify and see the big picture. We conceptualize the future and process our past. We see knowledge as multiple choice. We notice things that are not really there. We satirize and dramatize. We ascribe meaning, and we celebrate. Structure is essential but also necessarily flawed and human. In order to grasp the underlying structure of any entity, the structure must first be invented. In turn, this structure fundamentally shapes us by virtue of our participation in it.
Some may argue that a perceptual reliance on our own systems, signals, signs, symbols, social norms, semantics, and simulations will lead to dehumanization and the destruction of self-concept. I instead argue for the contrary. In my view, this two-way flow of information between human and invention is rehumanizing. We are constantly reinvented and reimagined, as we continue to invent and imagine ourselves. Our understanding of reality is constantly in flux, subject to the tides of our own aspirations.
As future physicians, we must contend with this fact. We will necessarily stand in the eye of this ontological hurricane as arbiters of the relationship between human health and medical technology. What is life? What makes it worth living? How does technology impress upon our humanity and upon our culture? How does culture shape technology? Who decides which technology becomes widespread, and how does that shape our behavior on a national level? Is health subjective? Do we really want to live forever? Does life without death have meaning? How do we identify what is ultimately important, and how do we redefine it?
Throughout our careers, this monstrous hurricane will only continue to grow in size. Concrete connections between common concepts will become increasingly occult. Ideological debris will swirl incessantly with cyclonic fervor. Soon, we will no longer be able to see clearly through the margin. The secrets of the human condition lie tragically therein.
8 p.m. on a Monday. I am crossing the South Street Bridge hungry, on my way back home from a long, tiring day at JMEC. My eye is drawn to the water’s reflection of the light from the headlamps of freeway-bound automobiles, decorating the Schuylkill with motes of tangerine and sky. Intrigued, I turn and walk up to the railing. I look out over the expanse and decide to share a quiet moment with the pieces of driftwood and trash as they regally float by.
I stand for just a minute, considering my position in the grand scheme of things. I give a deep sigh, and I absorb the night in all of its sublime, universal beauty. I realize that I forgot to put the beef in the fridge yesterday to let it defrost.
I move on.
Ian Ong is an MS1 at the Perelman School of Medicine.
Image also by Ian Ong.
