Sometimes I well up a bit whilst watching 24-hours in A&E, which I never do during my actual, real-life job in A&E. The settings and stories are all familiar, but here they’re framed from afar and from : with montage and music and surprises. The nose starts sniffling and the eyes start prickling and now: now something’s happening between me and the screen that doesn’t happen between me and a patient.
An A&E consultant once told me that the emotion of a case could catch up to him later, unexpectedly. You’re casually recounting something in the kitchen – I don’t think it has to be the kitchen – and suddenly out of nowhere there’s a slight shake in your voice. Where did come from?
This is all fine, of course. The day job (often, the night job) isn’t to emote in the moment, it’s to help. To be of use. Is it just the case that’s so affecting, or the recounting? The story or the telling?
10 minutes of Two Point Hospital Gameplay – From the makers of Theme Hospital! Watch on YouTube
It’s actually harder than you think to pin down where and when exactly the of medicine happens. There are so many instances of on-the-fly translating, re-ordering, re-appraising, sense-making. Is it when you first ask a patient questions, knowing where to add the stresses and leave the pauses to carve their experience into a story you can work with?
Or is it when you go away to take stock and zoom out, writing up the notes with an order and shape that will hopefully justify – to yourself? to colleagues? to the General Medical Council? to the universe? – a differential diagnosis and a plan at the end. Part thinking, part your way to something neat and treat-able.
Is the ‘real’ drama at the bedside, easing a needle into a difficult vein and hoping for the happy thrill of red ‘flashback’ in the chamber?
Or is it by the blood gas machine afterwards, idly standing whilst the printed result curls out like a receipt: then a quick grip of pre-panic and focus as you realise just how low the patient’s blood’s pH is and that yes, they must be in diabetic ketoacidosis – their sugar levels so high and their Insulin so low that their blood has turned acidic.
(I had that one just last week!)
Worse is when these invisible, internal pivot moments don’t even happen in hospital. The self-doubt as you’re driving home, as the details of the day settle like sediment in a glass, so different and clear when unstirred and afar. Then it irks and bugs and niggles away until you ring up to ask an on-call colleague if they wouldn’t mind double (triple) checking it’s not something serious.
You could make a game out of any of this stuff! (Note: I have never made a game)
You could let players perform some verbal surgery, that slicing just-so between two possibilities with a precise, well-chosen question. Or capture the slight give as you strike into a vein, with a tremble of HD rumble and a voice sample. Or make the internal dramas external, animating medical note-writing with the anime flourish of a Death Note sentence scrawl.
But whatever happens, do make sure to nail the sense that the of medicine isn’t always obvious or elicited in the moment, but often sounded out and shaped, shuffled and dealt and interpreted and changed.
I wonder if the best video game might just emulate what happens whilst at a hospital monitor, which probably sounds a bit crap. A bit A bit edutainment.
But hear me out: there’s all the satisfying detective work that happens, the way you read through previous clinic letters and scanned in notes to build a sense of a person’s history. There’s the abstract, visual puzzle-solving: playing spot-the-difference with old ECG traces, making sure the camel hump on the line that comes after the heart contraction isn’t a newly inverted T-wave; that it isn’t a new heart attack. And just try and tell me there isn’t game-ic fun in the way people read X-rays, hyperactively zooming in and out and in and out to decide whether or not a suspicious jut in a wrist might in fact be a fracture –
It might not be , but this kind of work is its own kind of reward; thorough and detailed and attentive to small details. An unshowy, quiet kind of care.
You could make a whole game – again, I have never made a game – just about lab results. The way our blood both soaks up the story of the body but also is the story: And then how you then triangulate the values – – into something real, something physical. You should see doctors regale each other with crazy-high blood results they once saw, like it’s a big fish catch, or a personal high-score.