Part A: Definition
Born from the cold stink of a 1920s British printing house, “cryptic” crossword clues are phrases divided into two main parts. One part is the definition, a simply stated explanation equivalent to a regular crossword clue. The other part is the wordplay, a linguistic puzzle that obfuscates the answer.
The definition is always either at the start or end of the clue, but often it is unclear which words belong to it. Solving a clue requires perseverance, ingenuity, and a willingness to deface His Majesty’s language in a nutty search for truth (and fun).
Let’s try an example:
Lack closure to mend broken heart (6)
Here, the “(6)” at the end means we are looking for a six-letter word as the answer. The uninitiated cruciverbalist may conjure up words relating to heartbreak such as GRIEVE, LAMENT, or even DUMPED. However, these guesses are all far from the true solution to this lexical enigma, which is DEARTH.
Why? Let’s assume the definition here is “lack”, which means the remainder of the clue belongs to the wordplay section. “Closure to mend” might be asking for the closing letter of “mend,” which is D. By the same logic, a “broken heart” might be telling us to literally break “heart” apart and to reorganize the letters. With some troubleshooting, one might eventually stumble upon D+EARTH = DEARTH, a six-letter word which means lack, or scarcity.
Disgusting, right? To newcomers, the logic of cryptics may seem arbitrary, unsound, or even offensive. However, with experience and a good heaping of tenacity, one develops a general sense, a gestalt if you will, of how these things work. Remember that the answer is always justified by the wordplay. Here’s another:
Numbers game with rising odds partly hedged by allies? (6)
Just like the previous one, this clue is original, written as part of a cryptic crossword I made. It’s critical to note that this clue was for a column rather than a row answer.
The solution: “Numbers game” is the definition and “rising odds partly hedged by allies” is the cryptic portion (“with” is a connector word that can be ignored). For a column clue, “rising” suggests that we need to reverse whatever we get from the wordplay section to produce the answer (words “rising” or going up in a column are ultimately in reversed order.) Let’s also assume that “rising” applies to the entire remainder of the clue, and not just “odds.” Then, “odds partly” signals us to take part of “odds”—let’s say OD. “Hedged” suggests that “allies” contains OD. However, the question mark suggests that we might have to think about “allies” in an unconventional way. What about the names of two major allied countries? Using US and UK “rising”, or in reverse, to “hedge” (surround) a similarly reversed part of “odds”, we get SU+DO+KU = SUDOKU, which is a numbers game chiefly played by anesthesiologists during hand surgeries.
It’s a lot of assumptions, I know, but isn’t that what makes it interesting? Each part of a cryptic clue colors the interpretation of the rest, so the same word used in two different clues could have entirely different meanings. Solving each clue properly requires a careful examination of not just semantics, but the physical nature of the words themselves, a specialized fund of knowledge, and the ability to flick through endless rolodexes of definitions and operators in your mind. To the beginner, this all seems frustrating, and frankly, impossible. It feels like digging in a landfill for a pair of matching socks, or like searching for a shred of golden hay in a needlestack. But perseverance is key. When you finally clinch that crucial connection and everything coalesces into a definitive, shining diagnosis, the reward is breathtaking.
Good luck on the puzzle. If you want to, you can look up a guide. Think of it like your first day on IM rounds.
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An aside on doctors:
The word “doctor” in a cryptic clue is particularly perilous. “Doctor” may signal that the answer includes an abbreviation for doctor, which can be any one of DR, MD, DO, DOC, GP, PHD, or if you’re attempting a British setter’s grid, MO. It could also mean to “doctor” or alter the following letters by anagramming them (e.g. “Early version of ‘Doctor Beat’ (4) — BETA”). As such, doctors frequently cause extreme mental distress and sour would-be cozy afternoons for puzzlers.
* * *
But now, we must address an existential threat to this beautiful game. The very nature of how cryptic clues are constructed implies a question, one which appears almost fatal: why spend time “getting” the cryptic part? Among the cryptic speedrunning community, it’s even frowned upon. Just like it is possible to solve the crossword below using only Part A of this essay, it is possible to complete a grid by blindly guessing definitions and trying out different synonyms. Why spend time and energy untangling cryptic wordplay if solving the puzzle doesn’t require an understanding of how it works?
Part B: Cryptic
I have no accolades in writing besides being named the Pennsylvania Student Journalist of the Year in 2018. Since that fateful year in which I wowed the Pennsylvania School Press Association with genius reporting, an airtight portfolio, and an uncompromising interview with the crossing guard who wears silly hats, I’ve stagnated on the awards front.
Things started to go downhill around winter break of senior year, when I had signed up to write an opinion piece for the school newspaper. The question was topical: should Lunar New Year be recognized as a school holiday? As someone with a Chinese-Singaporean heritage, I would have a lot to say. “Great. Try to get it in by Friday,” my adviser said. As the then-managing editor of the paper, I gave her my word with a smile. “You got it.”
Fast-forward to Friday morning and an empty document. God, we don’t even celebrate Lunar New Year! I mean, we buy mooncakes (lotus paste with salted egg yolk are the best), but I never get any hongbao or anything, what’s up with that? Do we even do reunion dinner? Somewhere along the transatlantic journey from Singapore to America, my parents had shed these crucial traditions. Forget about an angle to the editorial—now I’m questioning everything. I realize that I can barely speak Chinese. The only time we use Chinese is when we’re telling the receptionist how many people would be coming for dim sum. And sometimes my dad just holds up five fingers and grunts. Goddamn it!
My eyes wander out the window, passively seeking inspiration. It’s a quiet street, dimly illuminated by the occasional lamppost. There are no people, no animals, no cars—there is nothing but asphalt and the weight of nothingness above. Deep, unfathomable, inky, cosmic blankness. The alarm clock shone an ungodly hour in red, and in that instant, something snapped.
“So like, Jonathan Swift wrote about eating babies, right?” I reasoned aloud, recalling the renowned 17th-century Anglo-Irish satirist. “But he didn’t really mean that. He meant the opposite. No one would ever do that.” My eyes widened. “What if I argue against making Lunar New Year a school holiday, but make it clear that I actually mean the opposite?” Wait, that’s good. That’s really good!
And so, I raised the clarion of overexaggeration and donned the impenetrable chainmail of irony. I lambasted those in favor of formalizing the Asian holiday, comparing the iconic lion dance puppet to a “four-legged Liberace” and “the scaly costume equivalent of a dinner at Red Lobster.” I decried the decadence of Mayor DeBlasio’s decision to add the holiday to the NYC public school calendar, lamenting that this had caused the bustling metropolis to “deteriorate into slums, rife with degenerates lighting firecrackers, wishing others ‘good luck and prosperity,’ and playing yut nori.” As my eyelids drooped ever lower and the logical half of my brain began to fail, I garnished my triumphant 1000-word missive with one final flourish, a title—“Pure Lunacy: the Case Against Holidays.”
Next Monday, my adviser asked to speak with me, one-on-one. I was pleased to find that I had not been kicked out of the school newspaper for egregious misconduct. She had read my piece, understood it, and loved it.
From then on, I wrote satire, and won no more awards. In college, I joined Under the Button (The Onion but for Penn students), started lifting weights, and began listening to some really weird music. Basically, I hit the young adult male trifecta.
One day, perusing the bowels of my Google Drive, I happened upon my old Lunar New Year piece. Huh. I remember that. I scrolled through the document with a smirk. Oh, how far we’ve come. However, as I scrolled, my eyes got caught on a certain sentence. Suddenly, my amusement vanished. “Liberace?” I read further, and pain budded in my epigastrum. “Dinner at Red Lobster?” For Christ’s sake, Ian. Where did that come from? What was I even thinking, writing that? Had I really exploited a cultural symbol, my heritage, for a couple of cheap laughs? I looked over to my collection of Indonesian wax-dyed shirts (batiks) hanging stiffly in a line, all purchased while on ten-day family vacations to Singapore. Through unfocused eyes, their intricate motifs of ocean waves, ornate birds, and giant flowers collided into something unrecognizable—and suddenly, this dense tapestry and its unrelenting, technicolor exotica overtook me. Do I really belong to anything?
I began searching for even more abstract mediums of expression. During freshman year, I took an experimental writing class in which we wrote on ourselves with markers, lipstick, and other fluids. Man, that was really strange. Nevertheless, that class introduced me to Jean Baudrillard, and although the permanent marker on my back faded, I could not shake his postmodern outlook that our reality is composed of simulacra (consider the save icon, fish-shaped fish sticks, and Disney World), symbols that have lost their connections to the original things they represented. From my comfy armchair, I became fascinated by these divorced symbols, these copies without originals, these icons that were genuine in and of themselves.
I revived my long-time hobby of sequencing retro video game music. Between engineering classes, I pored over circuit diagrams and sound chip configurations for the Nintendo Entertainment System (NES). I sat for hours at a time, mashing my emotions into the keyboard and then going back to tweak walls of candy-colored hexadecimal. “8-bit” remixes on YouTube were my bane. If you’re going to make chiptune, do it right. Go back and research the original consoles, emulate the actual hardware, play with the envelopes, duty cycles, and waveforms, and produce something authentic. Don’t just use a cheap plugin.
Authenticity. I longed for it. More than anything, I was afraid to look in the mirror and to discover nothing there.
I searched for it in obscure music, subgenres born from niche movements, the underground and the yet unheard. I would shelter in-room, lurking around the recesses of music forums in a tireless search for emotional resonance. I got into DEVO, the zany, plastic ziggurat-wearing nerds from Ohio who boldly decried the “devolution” of humankind through synthpop. Then, Negativland, the snarky, copyright-hating, culture-jamming, tape-abusing satirists from the Bay Area. Then, a few New Wave and Zolo-adjacent outfits grabbed me: the undefinable brothers Mael of Sparks, Oingo Boingo, and Cardiacs. Over and over, on walks and in headphones at night, I would play these favorite records of mine, studying their defiance, angularity, and derisive outlook on technology and human nature.
I attacked convention with rage, leaving my satire increasingly aimless, disjointed, and meta. Years ago, as an Under the Button initiate, I mocked targets like university dining plans and computer science majors. Now, I was targeting no one, and at the same time, everyone. I was lambasting punctuation marks, parodying 2000s instant message leetspeak, and critiquing my sister’s dinner. Continuing to dip into the absurd, I pioneered new formats for content. Could a Qualtrics survey be funny? Or an interactive fortune teller? What about a couple chapters of the Bildungsroman masterwork, Jane Eyre, reproduced on the site verbatim? Ooh, that’s good.
My itch to subvert was insatiable. Perhaps it was a symptom of my fundamental instability, some natural, thermodynamic process that I had to undergo to achieve inner peace. I catalyzed this supposed transformation over the years, striving for depth and exhaustive self-clarity in my output, challenging expectations, and churning out screen after screen of sequenced musical and literary encodings, but it was no use. I was a senior, and I was empty. I had no anchor, cultural or otherwise.
Rather than decoding something profound about the world, or myself, my odd pursuits had only deepened the cracks in my persona and set me further apart from others. Nobody cared about the NES. Nobody liked weird music. Nobody enjoyed reading three-and-a-half chapters of Jane Eyre. It was me against a shallow world. At least, that’s what I saw through my hazy, introverted lenses.
I wallowed in this mire for a while. Then, medical school began, and I was ripped from my mental swamp by a rampaging vortex. I staved off the artistic itch and instead filled my nights with management guidelines, algorithms, and multiple choice questions. The days were motorized: floor, clinic, OR, lectures, clinic, floor, UWorld, home, floor, OR, clinic, grocery store, the VA, shelf. College me scoffed at the idea of a “golden weekend,” but now I finally understood.
Time was limited for art and introspection. Instead, beauty arrived in the form of patients. On dreary 7 a.m. rounds, their stories lit up the sky. And if I thought I was a master of bizarre humor, well… I had nothing on the conversations I had and sights I saw on the floor:
At CHOP: a hastily scribbled sign on a kid’s door reading “DO NOT GIVE CHOCOLATE MILK.”
A quip by a patient during a neuro exam: “I don’t know left and right — I went to Catholic school!”
After I had tried and failed to operate a patient’s recliner chair: “some million-dollar med student, eh?”
On a piece of paper passed to the team by a patient on trach collar: “quiet but effective observer man.” He winked and pointed at me.
On the final day of a rotation, saying goodbye to a patient I was following: “hey, I get it, man. You gotta go where the money goes!” Oh, sir… I’m not getting paid.
Those fleeting moments spoke to me. They were raw, delicate, unusual, imperfect, human moments, and I had the privilege to take part in them.
I was wrong: people weren’t shallow. They were mind-bogglingly complex. Just because they didn’t appreciate my music taste, or chiptune, or long-form satire didn’t make them superficial; everyone operated within a different framework of ideas, and their idea of authenticity was just as valid as my own.
Teasing apart these frameworks felt like targeted introspection, a reflective form of study less lonely than looking up sound chip architecture at two in the morning. Accurate diagnosis was good, but it didn’t completely do the patients, nor I, justice. For instance, it was effort put into understanding systems, from socioeconomic hierarchies to jagged medical codes, that elevated care. Learning the pathophysiologies for my patients’ conditions enhanced otherwise mundane check-ins. Spending time listening to patients’ stories, hopes, and dreams was therapeutic in its own rite, providing valuable insight that advanced care and even helping to soothe my own cultural confusion. The extra energy spent deciphering the abstract was crucial. It was what made medicine beautiful, fun, and rewarding.
During clerkship year, I picked up my newest hobby: cryptic crosswords. I learned about them on Instagram of all places, but nonetheless, I was captivated by their cleverness and absurdity. I liked the format, the style, the personal touches an author could make with word choice. I liked how each clue demonstrated both the beauty and the imperfection of language. I liked how it was a hobby dedicated to cheekily untangling the arcane—could there be anything more attractive to a misunderstood comic? I immediately searched for cryptics online and began solving. Weeks later, I had exhausted the archive, and I turned to a new challenge: setting my own puzzles.
The first cryptic crossword I made was jank, but it didn’t matter. I was full of energy and pride. My skull swarming with ideas, I feverishly began to work on more puzzles. I read up on legendary setters like Ximenes and Araucaria on the bus, daydreamed about anagram indicators during rounds, and jotted down clues during lunch breaks. With each completed grid, my wordplay became more subtle, and my concepts, wittier.
One day, a baggy-eyed man in sapphire scrubs waved and walked up to me. Wow, I haven’t seen you in months. Head nods and small talk ensued. “So… have you been doing anything for fun lately?” he asked. I paused. I considered the implications for just a second. Then, I smiled and looked him in the eye. “Actually, yes. Crosswords. I’ve been writing crosswords.”
God, that sounded so nerdy. Well, whatever. I clamped my teeth shut, bracing myself to be judged, but my defenses were swiftly disarmed by a look of awe. His next words were like tiny bolts of electricity, an IV push of hot pink lemonade into my system. I couldn’t believe it. People actually wanted to play the puzzles.
Part C: Crossword
Answers:
1A: SACRAL. A double definition—the sacral plexus, and a descriptor for all things holy. In fact, the term “sacrum” originates from the great physician-philosopher Galen’s writings on the anatomical structure, which he called a “sacred bone.” No one knows why.
4A: STRESS. It can certainly lead to burnout. As for the wordplay: make “says” eccentric by removing the center to give SS. Put that about (or around) a word for sleep (“rest”) which has been disturbed to reconstruct S(TRES)S.
9A: TACO. Take the letters of “coat” and ruin them to yield TACO, or transfusion-associated circulatory overload.
10A: PERNICIOUS. A faithful person might be “pious,” and if this word houses “nicer” after being cured (implying that we have to rearrange the word to recover it from its diseased state), we get P(ERNIC)IOUS, a word describing a type of insidious and deadly anemia.
11A: GUNNER. Genitourinary can be shortened to GU, as in a GU exam. In chess notation, knights are denoted using the letter N. If two knights are contained by GU and ER (for emergency room), we get GUNNER, a term possibly describing someone who refuses to go home despite their senior resident’s most gracious blessing.
12A: VISCERAL. The sources of “visual impairment” are the words’ first letters, V and I. Place those before an inflamed and irritated “sclera” to find VI(SCERAL), a word which can also mean “organic”—relating to organs.
13A: PATIENTLY. “Aptly” gets agitated, surrounding the Roman numeral I for “one” as well as a short name for an otolaryngologist like so: (PAT)I+ENT(LY). If you do something like a clinic-goer, you might do it like a patient: patiently.
15A: EMMY. The first to “elucidate” is just E, multiple myeloma abbreviated is MM, and an antibody is kinda shaped like a Y. So, E+MM+Y = EMMY, a TV award.
16A: UNIT. A little stretchy, but bear with me—the “bed” of the word “put” might be U, just like how a river bed lies between its banks. Reverse “in” to get NI. Then, “Trendelenburg” can be shortened to just T, as in a surgeon’s request: “can we get some reverse T?” String together the pieces: U+NI+T = UNIT, a measure of blood.
17A: SARCASTIC. Consider “sarcomas” with OM (the edges of “omentum”) removed, then add another word for “twitch” to get SARCAS+TIC. Certainly, a cutting remark could be a sarcastic one.
22A: DID IT ALL. The foxglove plant, Digitalis lanata, is a purple-flowered plant from which the medication digoxin can be extracted. Start with the word “digitalis” and make some substitutions: replace gram with dextrose (“g” becomes “d”) and “is” with liter (“is” becomes “l”). Thus, the answer we have derived from the wordplay is DI(D)ITAL(L) = DID IT ALL, and if you did it all, you tried everything.
23A: PODIUM. Postoperative day one = POD1 = PODI, and an expression of hesitancy might be the noise “um.” PODI+UM = PODIUM, a fixture also referred to as a stand.
25A: SOFT TISSUE. Reorder “to fussiest” to get SOFT TISSUE, and muscle, say, is soft tissue.
26A: GREW. The 43rd president of the United States, George W. Bush, is originally from New Haven, Connecticut. We’ll call him GW for short. Now, GW contains a term meaning “about”—try RE, as you might see in the subject line of an email. G(RE)W = GREW, and if something grew, it developed.
27A: SCREEN. Right can be shortened to R and if you distort “scene” you mix it up. SC(R)EEN = SCREEN, or check, as you might do for the early detection of a disease.
28A: ASIAGO. The manipulative and crafty soldier Iago from Shakespeare’s Othello is the character referenced here. AS+IAGO = ASIAGO, a cheese made from cow’s milk. Couldn’t make them all medicine-themed, sorry.
1D: SCAPULA. To a texter, you is simply U. Let’s take U and the letters of “Pascal” and replace them to find SCAPULA, the triangular bone of your shoulder blade.
2D: CROWN. “Grown” is without limits, so let’s remove the ends. Then, CN (for cranial nerve) has (or contains) this: C+ROW+N, a head, perhaps in the sense of “monarch.”
3D: ASPIRIN. If you hope to do something, you ASPIRE to it. Lose the ending letter and add IN to manufacture ASPIRIN, a type of medicine.
5D: THIRST. Half of “to” is T and heart rate can be written as HR. Then, HR is placed over one in Roman numerals. The name of a particular EKG segment finishes the answer: T+H(I)R+ST, and if you thirst for something, you desire it.
6D: EPIDERMIS. An interview invite to a medical school might be written as II on a number of neurotic forums; we can pluralize this by adding S. Arranging the letters of “premed” and “IIs” gives EPIDERMIS, which is what guards the body.
7D: SQUEAKY. Use abbreviations of “upper extremity” and “subcutaneous” followed by “yak” mixed up (or shot): SQ+UE+(AKY) = SQUEAKY, or shrill.
8D: DRIVEL. Doctor is DR and intravenous is IV. Now, if we imagine what the cannula of the word “line” could be, we might retrieve the outside letters of the word (LE), just like how a cannula frequently contains a trocar needle. Finally, let’s send that supposed cannula backwards and paste everything together to get DR+IV+EL, or complete nonsense.
14D: INITIATOR. TIN “sent up” in a vertical clue is NIT. Place that between two Is (“lines”) to get I+NIT+I+AT+OR, the catalyst to a reaction.
16D: UNISONS. Another name for ampicillin/sulbactam is Unasyn, and if you discuss this word, or say it out loud, it might sound like UNISON. Add an S for subjective, as in a SOAP note, and you get UNISON+S, which are agreements in a musical sense.
18D: AT LAST. Take two liver enzymes, overlap them, and reverse the direction of one of them: (A)(TLA<)(ST) = AT LAST, the answer, finally.
19D: CAPLETS. More Shakespeare. Juliet, the passionate Veronean, belongs to the Capulets; expel a U for uracil from that to get CAPLETS, or pills.
20D: IN UTERO. Review and reconsider the letters in “URI note” to unscramble IN UTERO—before birth.
21D: SALINE. “Refusal in Epic” is literally obscuring a type of solution: refu(SALINE)pic = SALINE, or a salt solution.
24D: DOGMA. Here, doctor is DO. Then, take the sources (first letters) of “Good Morning America” to get GMA. DO+GMA = DOGMA, or unquestioned beliefs. I’m glad we don’t have those in medicine.
