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Knobs and Dials

JULIET: You kiss by the book.

— Shakespeare

I went to the hospital for an echocardiogram. I told the technician administering it that I wanted a copy of the video files. If there was nothing wrong with my heart, then I at least wanted to be able to edit the video and make a visual music piece from it. She said, “I’m an artist too.” I asked her what her art form was. I thought she was going to say that in addition to her medical job she was a painter or songwriter. Instead she patted the machine and said, “This.”

Giving an echocardiogram is one of those innumerable tasks that on the surface seem objective and by the book, but in fact there is an enormous range of personal style in how the images are taken. With dozens of knobs and switches on the machine controlling contrast and many other variables in the resulting images, with variations in the placement and pressure of the sonogram sensor on the patient’s body, how it is handled and moved, the possibilities for individual style are enormous, all in the attempt to produce an “objectively” clear picture of how the heart valves are functioning. She said that when she comes into the lab each morning and sees studies done by other technicians, she can instantly identify who did each study. Each has his or her own style. When she was training to do this work, her instructor called these variations knobology.

Such acts are not typically recognized as art, but a fundamentally artistic process is involved in tweaking knobs on a machine or tuning the performance of an engine. These adjustments are not so different from tuning words and phrases in a paragraph, mixing pigments, or playing with gradations of speed, pressure, and point of contact on a violin bow. Knobology is also a term of art on aircraft carriers and submarines.

Back in the days of the telegraph — a simple digital code of dots, dashes, and pauses — a telegraph operator receiving a message could tell who was on the other end of the line, perhaps hundreds of miles away, by his or her “fist.” The rhythm of those digital bleeps and pauses, small variations in tempo, revealed an individual style that was unmistakable to the experienced listener. As recently as World War II, the fist of a telegraph operator enabled us to tell the difference between real messages and those sent by enemy spies. The people who received these messages could identify who was sending it by idiosyncrasies in timing. If sensitive information like “I’m in Northern France” were coded right into the message, it could be intercepted and decoded. Instead, those receiving the communication could rely on the unique telegraphic fingerprint of the agent on the other end.

The echocardiogram technician said that in an earlier part of her life she had been an accountant. Accounting is yet another field that is supposedly objective and straightforward. Yet the choices one makes in setting up and structuring a chart of accounts are not easy to define: how to categorize this or that expense; how to balance often inchoate competing interests such as profitability, viability, legality, and ethics; how to use numbers to represent truth or to obscure it. Even jobs that are nominally uncreative require constant personal interpretation and invention.

Double-entry accounting was invented by one of those Italian Renaissance polymaths, the monk Luca Pacioli. He was also responsible for much of the theory behind perspective painting. Pacioli’s book The Divine Proportion was illustrated by Leonardo da Vinci. Accounting and perspective painting are both arts that revolve around representing a complex, multidimensional reality on a flat piece of paper. In accounting we draw a dividing line down the middle of the page, setting up a zero point so that the debits and credits reflect against each other. To this day every bank statement, every corporation’s accounting, works by Pacioli’s system. Similarly, perspective painting runs an imaginary line down the canvas; we orient ourselves in three-dimensional space by the frame of reference created by that line. Our brain plays with the details and contrasts, balancing the sides so that exceptional items really stick out. We draw that line and then use it to accentuate the interplay of figure and ground. This is the virtuosity of the woman in the cardiac imaging lab. She understands the mathematics and the technology inherent in the ultrasound instrument as elements of her art. She is able to do it simultaneously as a creative form and as a technological task whose results may have life-or-death consequences. The technology depends on her subjectivity, on her interpretation, on her practicing it as an art.

The Art of Is

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