Out of the Chaos

In medical school we are taught the secrets of life. With our first steps into the anatomy lab, we are christened by the formaldehyde-thick air into an order devoted to unraveling the mysteries of human existence. We learn physiology, biochemistry, neuroscience – how our bodies run and breathe and feel. Under the bright surgical lamps, the mundane acts of living are illuminated to a new depth: walking becomes a complex example of synchronous muscle activation, looking at a painting is a neural exercise in extracting images from light and shadow, and eating a sandwich is enchanted by layers and layers of molecular wizardry that turns our PB&J into us. There is a simultaneous bigness and smallness to this: the humility in the awe of nature, and the powerful thrill of knowing we’ll learn to command it.

Normal function mastered, we venture into the darker realms of pathophysiology – why things go wrong and the various downward trajectories our bodies can take. It is here that the forces of nature take us over, and they can move as insidiously as a stream carving out the Grand Canyon or as quick as the tsunami that, without warning, washes out the coastline. It is our job to study these forces, recognize their patterns, arrest their progress, and, hopefully, reverse the course of their destruction.

Our attack is an empirical one. Diligent, we wake each morning before the sun and make our way to the long tiled hallways of the hospital wards. We sit in tiny workrooms cramped with too few computers and too many coffee cups, walls papered with phone numbers and flow sheets and a running list of jokes (Morale! Stay positive, team!). We review our data: detailing overnight events, mapping trends in blood pressure, measuring the distance between undulating lines on brain waves, counting levels of electrolytes and blood cells, liver enzymes and medication concentrations. We are thorough in our calculus – everything that can be quantified is. From the sum of a morning’s work we can make an assessment of the problem. From the assessment follows the plan: we correct what is wrong with doses and volumes and tight control parameters. Squarely in the camp of command rather than wonder, we treat the disorder.


a state of confusion.

the breakdown of peaceful and law-abiding public behavior.

a disruption of normal physical or mental functions; a disease or abnormal

I like to look up words in the dictionary. Like biochem, knowing the definition (the mechanism?) unlocks some new wonder in the word. Unlike biochem, this sort of analysis lends itself to reverie-like free-associations of meaning that my decidedly non-empirical core enjoys a lot more than glycolysis. So, unsurprisingly, considering this state of confusion quickly leads me to:


a thermodynamic quantity representing the unavailability of a system’s
thermal energy for conversion into mechanical work, often interpreted as the
degree of disorder or randomness in the system.

lack of order or predictability; gradual decline into disorder.

Doctors treat disorders. The crux of my day to day, then, is fighting entropy.

This can be exhausting. After all, physics tells us that we need to put energy into a system in order to decrease its entropy. Sometimes, I find relief from all the assessing and planning in the moments I can let the bigness of these forces – of nature – wash over me: running in the forest, feeling the wind whip in the mountains, swimming in the ocean, or, as is the case while I write this, bracing against the fury of a downpour. My smallness in these moments is catharsis, the movement toward the low energy state that nature seeks to reinstate, the righting of my imposition on her microscopic mysteries.


I am no scientist, though they keep trying to train me to be one – through coursework and exams and code and statistical modeling. There’s talk of methods and rigor and peer review. The reality is that though I respect these methods, I am neither terribly inspired nor entirely reassured by them. Others may be in awe of the scientific method – and the discoveries it yields are undoubtedly awesome – but sometimes I prefer not to think about how the science sausage gets made.

But I’m no poet, either, as much as I will myself to be. Too analytical, too concrete, too type-A, I lack both the natural inclination and obsession of the artist. I did end up in medical school for a reason.

Instead, I find myself floating somewhere in between, a schizophrenic middle where my head is eternally elsewhere. On a good day, thoughts in this realm follow some sort of logic: the statistical models run without errors; I can come home and string together a few words on the meaningfulness of the patient I saw. On even better days, my mind runs wild, spinning incoherent webs of ideas, devising research that can validate my philosophies, free-associating the empiric and the ideological. I love this tumult, because every worthwhile thought I have emerges from it. So, I try live in that chaos. Some days I languish in it, others I can ride it. Regardless, I try to make sense of it.


In Isaac Asimov’s story “The Last Question,” characters in advanced future societies ask their increasingly powerful computer how to reverse entropy. Each time, the computer’s output is the same: “there is as yet insufficient data for meaningful answer.”

My friend sent me this story to read after a drunken conversation during a party where I had gone around weirding out my guests by asking about their thoughts on entropy.
“What’s with this entropy business?,” he asked at the end of the night as we sat on the couch, eyelids drooping, feet propped on the coffee table littered with empty beer bottles. “Have you been staring down the void? You know I went to the counselor in my freshman year of college because I was worried about the heat death of the universe.”
“It’s not a heat death thing,” I said, “I just think entropy motivates everything, like everything we do comes out of dealing with it in some sense.”

The next day I texted him:

Asimov’s story ends in some distant millennium where humans have advanced to some disembodied form and then, at last, faded away altogether much like the starts and the rest of the stuff of the universe. The AI, alone in the cosmos and still diligently contemplating entropy, finally computes the answer to the reversal problem:

And the AC said, “LET THERE BE LIGHT!”
And there was light—

And then, with strange clarity, there were words for it, a way to articulate that niggling dissatisfaction with running the numbers, with planning to put the numbers within parameters. The compilation of data is only part of it; at the end, the chaos begs for something more to come out of it – some synthesis, some creation, some meaning.

If we look closer:


en- (inside) + tropē (Greek, transformation)

(coined in analogy to energy, replacing the root of Ancient Greek érgon, work, by Ancient Greek tropē, transformation)

Maybe it’s a stretch, but bear with me: rather than work, transformation. Rather than fighting, adapt. It’s a fact of nature that we change, and, as far as I’m concerned, where there’s change there’s a story to be made. In a sense, my friend nailed it: There are no answers except fiction.


Consider this my hypothesis: We live with the white noise of entropy always in the background, the static through which we must learn to calibrate the dial in order to find a signal. The disorder is where my worlds can come together: a chemist, a painter, a physicist, a novelist – aren’t we all trying to find some truth that exists in this mess? My days are filled with understanding how people work: dissecting through the minutia of what’s gone wrong to set it right, sitting under the fluorescent bulbs of the clinic to help scrape together some reason, some meaning, for the decline of the body into a molecular jumble. Is it that different from painters Seurat, who finds figures in messes of dots, or semioticians like Barthes, who gives importance to the arbitrary objects of everyday life?

So here I am, like a good scientist, to test my hypothesis. Here I am, to chase this catharsis with stacks of books and free associations and obsessive meditations on words and half-written essays and stories from in his hospital and out. This will be the ground for experiments in drawing constellations in the dim light of the stars, painting my mythologies onto the skies, finding meaning in the disorder.