Last weekend, I ran PTA at a local con for three players. We settled on a supernatural forensic medical drama. I’d watched two seasons of House recently, so I was right into this.

The show emulated House very strongly – the 3 leads were the three sub-ordinate doctors on the team. However, the universe was one in which supernatural occurrences were accepted but tended to be uncommon. We decided that normal everyday supernatural occurrences (vampires, zombies, etc) wouldn’t be interesting to this team. They’d be like colds or polio are in House – diagnostically obvious, easy to treat, and therefore boring. It was only the really unusual and difficult-to-diagnose afflictions that this team would get involved in.

The show was called Ward X.

What I loved was that the logic of how to run a show like this became very clear very quickly. The show ‘House’ is pretty much driven by the idea that when a patient presents with a whole bunch of symptoms, those symptoms could be explained by various combinations of diseases. The trick, then is to figure out which disease explains all the symptoms.

In this game of PTA, I threw the responsibility for that onto the players. In brief, all I did was create a list of symptoms and present one to the players. While they were testing their theories about what could be causing that symptom, I kept making the patient’s condition worse.

Here's what I did, in more detail.

1. List out a whole bunch of symptoms to draw on and throw in.

This is what I wrote down before I started the episode:

- glows in the dark
- light sensitive
- starting to turn invisible
- can’t see / optic nerves are disappearing
- internal organs are shrinking
- acute hearing
- hacking cough
- levitation
- curved spine

This list gives you both a place to choose a starting symptom from, and other symptoms to complicate things with once the show gets moving.

2. Empower the players

Tell them it’s their responsibility to suggest what could be causing the symptoms. And that because they are smart doctors, they will be clinically right - their suggestions will match the symptoms.

However, because there are multiple conditions that could explain the symptoms, it’s through playing the game that we’ll determine the correct answer.

3. Don’t worry about plausibility too much.

Okay, playing in a supernatural world is helpful for that. You can’t really say “That’s not how it works”, when the symptom is an optic nerve that’s vanished.

But I think, unless you’re being paid to write an episode of House, you can probably afford to play loose with plausibility.

One of our players (Helen) worked in a medical-related field. She was able to provide us with a veneer of authenticity that was pretty satisfying. The rest of us just drew on general knowledge and stuff we’d watched on TV.

4. Choose a starting symptom

Just one. And generate a patient out of that.

I did a total rip-off of the start of House. There was a family reunion BBQ. A man with a hacking cough rescues a kid who falls into the swimming pool. When he emerges, he finds a woman screaming that she’s gone blind.

5. Describe the patient in clinical terms.

“Judy, female, 39. Mother of 2. Medical history reveals no relevant conditions that would explain her blindness.”

Okay, this wasn’t essential, but it was a nice bit of colour.

6. Have a whiteboard

This isn’t absolutely necessary either, but since we were playing the game in a classroom, we used their whiteboard, which (again) helped the House feel.

Also, big whiteboards are fantastic for PTA pitch sessions.

7. Force the players to generate possibilities for what could be wrong.

After they come up with possibilities, it’s up to them to rule out these possibilities or not. These are Plot scenes, and what’s at stake in them was whether their theory was right or not.

This seems like it might get mechanical and ignore the PCs’ Issues. It didn’t work that way in practice. All the characters got nice Issue-related conflicts in other scenes, and there was a nice cut-to-the-chase feel to these Plot scenes.

So you have multiple theories, each of which can be right or wrong. What happens then?

If all the theories are wrong, great! Now they need to search for more evidence and a new hypothesis.

If only one theory is right, great! Now they have to figure out how to treat it & whether that treatment works.

If more than one theory is right, great! Two or more competing conditions mean that
- mutually exclusive treatments might be required
- one condition might be the true source of the problem while all the others are interfering with it.
- things have become so complicated that a new, untested treatment is required.

8. Don’t be afraid to worsen the condition of the patient

Throw in a new symptom. Make their treatment send the patient into a life-threatening seizure or lycanthropic transformation.

The patient should be in jeopardy until the budget runs out.

Hi Steve!  It sounds like you've really got the plot of House, and other medical dramas, perfectly.  But I'm wondering: how did the characters' issues or connections come into play?  House really isn't about the patient at all, except to the extent that the patient forces the doctors to strain their relationships and make risky, possibly unethical decisions.  It seems to me that Primetime Adventures could do this very well.  Did this come up in play?

Somewhat off topic: the thing that I think makes House unique among medical dramas is the patient is always to blame.  There's always this scene where House confronts the patient and is like, "You can stop bullshitting us now.  You know I know you know what's really wrong with you.  The reason your eyeballs are falling out of your head, and your stomach is turning to stone, and your testicles are full of bees, is because you're (choose one: lazy, lonely, scaredy-cat, ugly, too sexy, nerdy, well-meaning, religious, want to embarrass me).  You're pathetic!  I'm going to make you feel horrible, because the audience loves it when I cut loose, but then I'll have the decency to feel guilty about it in secret."

Issues and Connections came into play most strongly in the conflicts that followed the plot conflicts.

For instance, the epidemiologist who’s Issue was “Obsessive Curiosity” lost a Plot conflict to identify the source of the blindness. In the process, she drew on her Connection, “My Lab Team”, and described working them to exhaustion in an all-nighter (her obsession in action).

In the next conflict, which she won, the epidemiologist had to convince her team to come back in to work, and help her figure out how to reverse a curse. However, the person who won narration rights for that conflict described her lying to her team in order to get them to come back in – which alienated them further, and would definitely have paid off in episodes later down the line.

The character conflict we liked the most was set up by two players winning their plot conflicts to figure out the source of the blindness. To set the scene, it turned out that a ghostly parasite had been growing behind the patient’s eye and was about to start breeding. Just after the parasite had been surgically removed, we decided it was time to reveal some previously known information that the patient had also been cursed by a family member.

In order to reverse the curse, the patient would have to be in their original condition. Which meant there’d have to be a second round of surgery to put the rapidly-swelling parasite back in.

This lead to a conflict between the New Doctor (a PC), and her Connection, the Neuro-Surgeon. This Neuro-Surgeon is the most damaged Connection I’ve ever seen – a successful old-time friend of the New Doctor who thinks she’s wasting her life specialising in the supernatural. In the words of the New Doctor’s player, “I want to come away from every scene he’s in feeling worse about myself.”

Oh, and the New Doctor’s Issue is Self-Worth.

The New Doctor had to convince the Neuro-Surgeon to perform the second round of surgery. If I remember, we sorted out who won the conflict pretty early on (the New Doctor won), and then role-played out the Neuro-Surgeon’s disbelief at what he was being asked to do, then his disgust at her incompetence in not sorting out the situation earlier. Finally he challenged her sense of ethics at having to put the patient at risk of more harm.

The whole scene forced the New Doctor’s player to really stand up for herself, while still defining her character as withering under the attack.

This episode had the most plot scenes and scenes without conflicts of any PTA game I’ve played or produced. The mix felt good, though.

I’m pretty sure that, in later episodes, the diagnosis scenes where the doctors speculate about what could be wrong with the patient would start to have personal conflicts in them – but that’d be a result of getting to know the characters better, and of them getting involved in sub-plots with each other.

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I think the ‘patient is guilty’ thing stems from the show’s philosophy/catch-phrase that everybody lies. The disease is a case to be cracked through testing theories and figuring out the significance of clues, but also through persistent interrogation. The producers probably love that because it stops the disease from getting too abstract and clinical – instead you have these meaty dramatic scenes with life and death on the line, and House forcing people to admit they’re wrong.

Great stuff.

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Also, I realised after my initial post that I was unconsciously inspired by Clehrich's post on abductive reasoning and how to solve mysteries.