Dying, Desperate, and Afraid

[Ben Lehman]

This is my game. It's about homeopathic doctors, and it is inspired by Hungry, Desperate, and Alone.

Dying, Desperate, and Afraid.

Ingredients:
Doctor
Mimic
Coyote

Note: Numbers are not balanced at all.

You are a homeopathic doctor. If you like, you can be a practitioner of another form of non-functional medicine -- I pick homeopathy because it's one which has had a fair number of clinical tests. The important thing is that you are practicing medicine which probably doesn't work better than placebo, on patients who are quite sick.

You have the following attributes:
Doctor: Your knowledge of allopathic (or if you like, some other kind of functional) medicine.
Mimic: Your ability to present yourself as an expert healer.
Faith: Your belief in your own treatments.
Heart: Your capacity for sympathy with your patients.

For each of these, roll 3d6 and choose the middle one.

You also have Stress, which starts = 0.

Choose a name:
Carl Frances Smith [+1 mimic, -1 heart]
Sylvia Coyotestrong [+ 1 faith, -1 doctor]
K. Fisher [+1 doctor, -1 faith]
Coral X. Reiter [+1 heart, -1 mimic]

Choose a gender:
Male [+1 Mimic]
Female [+1 Doctor]
Other [+1 Heart]

Choose an age:
Young [+1 Doctor]
Middle-aged [+1 faith]
Old [+1 mimic]

There's probably something about the rest of your life here but lord if I know what it is.

Your business has two attributes: Cashflow and Breakeven. Cashflow is derived from your patients. Breakeven starts as: Mimic + Faith.

If Cashflow is higher than Breakeven, you're taking home cash, you can pay all your staff, and so on.
If Cashflow is equal to Breakeven, you're treading water.
If Cashflow is lower than Breakeven, you are going into debt, or possibly having to sell off parts of your business.

Everyone else makes one or more patients. Patients have the following attributes:

Alienation: Which measures the degree to which they are alienated by the medical establishment.
Placebo: The degree to which your treatments have an effect on their condition.
Cash: The money that they can provide you.
Doubt: Their concerns about you, as a doctor.
Sick: The severity of their illness.

In the case of child patients, alienation, cash, and doubt are refer to their parents, rather than them. Adjust appropriately.

Alienation depends on their reason for coming to you:
New ager: 3 Alienation. +2 if raised that way.
Undiagnosable or Untreatable Illness, such as fibromyalgia: 5 alienation. Sick must be at least 3.
Dangerous Illness, such as cancer: 2 alienation. Sick must be at least 6.
Recurrent, hard to treat illness: 2 alienation +1 per previous failed treatment.
Religious: 4 alienation. -1 if raised that way.
Hypochondriac: 2 alienation.
Medical Skeptic: 4 alienation.
"Just trying it out:" 1 alienation.

Placebo starts at 3 if their disease is very come-and-go, such as depression or migraines. Otherwise it starts at 1.

Cash is randomly determined. Roll 3d6, read the middle die. If their insurance covers your treatment, +2.

Doubt: starts at 6 - alienation. For hard to treat illnesses, +1 per previous failed treatment.

Sick depends on their illness. There are too many illnesses for an absolute scale, but let's try a few:
Cancer (early stage): 5
Cancer (late stage): 10
Chronic pain (mild): 3
Chronic pain (severe): 7
Depression (mild to medium): 3
Depression (severe): 6
Allergies (mild to medium): 1
Allergies (life-threatening): 3

For each illness, also identify whether it is progressive or chronic. Progressive illnesses will tend to get worse over time. Chronic illness will vary, but may come and go.

Each patient is consulting with the main character or using them as a primary care provider. Choose which one to start, it may change over play.

As many non-doctor players as want to make patients. At least two, please.

--
Counting cashflow.
Your cashflow is equal to: 1 per patient, if they're consulting with you. Half the patient's cash attribute if they're using you as their primary care provider. All of the patient's cash attribute if they are using you as their primary care provider and sick > cash.
--

Play.

All play takes place in your office, unless you make housecalls (if you make housecalls, get +1 mimic and +1 heart). Patients come in and consult with you. Play out the conversation and the consult. During this, players who do not have characters in the scene (everyone who is not you or your current patient) should feel free to participate in play techniques, listed below.

Appointments are played in real-time and are 15 minutes (12 minutes), 30 minutes (25 minutes), or an hour (50 minutes). Use a timer or have a rules-lawyering player keep track of time.

Play Techniques for non-active players:
Bird on shoulder: Be the inner voice of one of the characters. Whisper into the player's ear what you think that they should do, or represent their doubts, their greed, or their other emotions.

Play the world: Describe other things that happen around the environment. Horns honk, phones ring, other stuff goes on.

Parents, children, or staff: Play other characters present in the scene. For child patients, this can include their parents. For adults, it may include their children. Also, there are likely office staff.

Appreciative audience: Watch the other players and enjoy their presentation of their characters and situations.

Judging audience: Watch the other players and offer judgement on their characters and decisions. Judging the characters is probably more fun than judging the players.

Rules lawyer: Watch play and keep an eye out for situations which may require a draw (listed below) or where other rules might be triggered. Resolve these, announce the results, and track the attribute changes, while letting the active players continue to roleplay. Keep an eye on the time.

Draw:
From time to time, a situation will arise that calls for a draw. Draw cards equal to the numbers on either side, highest card wins. In the event of a die, the doctor player decides the result. Ideally, a rules-lawyer players should handle the drawing and record the results.

These are not mutually exclusive: a single bit of dialogue can call for more than one draw.

At the beginning of every appointment, roll for patients' impressions. Mimic or Alienation, whichever is higher vs Doubt. On a win, -1 doubt. On a loss, +1 doubt.

When a patient tells you about their problems, heart vs stress. On a win, +1 stress.

When you listen to a patient, heart vs. doubt. On a win, -1 doubt.

When you trash the medical establishment, Alienation (whichever is higher) vs. Doubt. On a win, +1 alienation.

When you recommend mainstream medical treatment, Doctor vs. Alienation: on a win, they take your advice and -1 stress.

When you recommend against mainstream medical treatment, despite knowing it could do some good, Faith vs. Doctor. On a lose, +1 stress.

When you give a new prescription, Faith vs. Doubt: on a win, +1 placebo.

When you insist on your expertise, Mimic vs. Doubt: on a win, -1 doubt.

When you explain how your form of medicine works, Faith vs. Placebo. On a win +1 placebo. On a lose +1 doubt.

When you dismiss a patient's questions or concerns, mimic vs. doubt. On a win, +1 placebo. On a lose, +1 doubt.

When you encourage a patients weird beliefs, faith vs. doubt. On a win, +1 placebo and +1 alienation. Regardless, +1 stress.

When you encourage someone to use you as their GP, Mimic or Faith (whichever is higher) + Alienation vs. Doubt + Sick. On a win, they are convinced to switch over to you as GP. If they do, they can't also be in mainstream medical treatment.

When you act like a jerk, Heart vs. Alienation. On a lose, +1 doubt.

When you drop a certain amount of real medical knowledge into your treatment, Doctor vs. Alienation. On a win, +1 placebo. On a lose, +1 doubt.

When a patient is doing better than last time you saw them, Faith vs. Doctor. On a win, -1 stress.

When a patient is doing worse than the last time you saw them, Doctor vs. Faith. On a lose, +1 stress.

At the end of an appointment, if you the players think that you could do it better another time, play it out again, from the top. Keep all attribute changes from the first time, though, and just let them grow the second time.


Between appointments, do the following:

For progressive diseases: Placebo (+doctor if they are also taking mainstream treatment) vs. Sick. On a lose, sick +1, unless sick is 5 or higher, in which case sick +2. If they are also taking mainstream treatment, on a success, sick -1.

For chronic diseases: Placebo (+doctor if they are also taking mainstream treatment) vs. Sick. On a lose, sick +1. If this is the second time you've won in a row, sick -1.

Time to pay up: Cash vs. Sick. On a lose, cash -1.

Life or Death: Placebo + Doctor vs. Sick. On a loss, the patient dies. +3 stress.

Reconsidering their options: Alienation vs. Doubt. On a win, alienation +1. On a lose, doubt +1. Then Doubt vs. Cash. On a lose, they drop you as a doctor (move from GP to consulting, consulting to gone.)


At the end of each round of patients, do the following:
New Patients: Draw cards = Mimic. Each A or K is a new patient.

Breaking even?: If cashflow > breakeven, lose stress equal to the difference. If the other way around, gain stress equal to the difference.

Vent Stress: If stress > heart, vent stress.
1-3 Yell at people, over-react to small things.
4-6 Anti-social behavior or drinking.
7+ Personal violence or quitting practice.

After venting stress, drop stress to zero.

Change attributes:
Night school: +1 to doctor or faith. +3 stress, +1 breakeven.
Sprucing up the office: +1 Mimic. +2 breakeven.
Therapy: +1 or -1 heart. Drop stress to zero. +2 breakeven.

[David Berg]

I love this set of dynamics.  Take something that might work, but can't be proven, and throw it in the crucible of monetary and self-identity incentives.  I could see this game engine working for anything that, to a given group's knowledge, might or might not work: prayer, meditation, various diets, hypnotic regressions, etc.

I'd be very curious to see whether players would play to the character/story or to the numbers.  Being clear on what the risks and trade-offs are seems destructive of the sort of denial such situations can engender in real life.  Whether that's a welcome teaching tool or an unwelcome simulation-breaker, I don't know.  I imagine with the right character creation process and style of narration, you could probably get folks caught up in the fictional moment if that was your aim.

Looking forward to see where you go with this!

[Ben Lehman]

Hey, David!

I'm not sure I'm going to do anything with this, unless I find a different mechanical heart for it. As it is, it's very much a "must be very, very fine-tuned" game, which is a lot of work, and I'm not sure I care enough about it to put in that work.

If you'd like to work with it, it's all yours!

[David Berg]

Thanks, Ben.  I too may come to the conclusion that the fine-tuning is too much work, but I'll at least give it a pass and see how it goes.  I dig the set of quantities and the basic ways they inter-relate.  I might try for a simpler or more flexible method of computing and tracking everything, but we'll see. 

If I actually play some iteration of this, I'll let you know how it goes!