This is RPG-ology #49: Stitches, for December 2021.
Our thanks to Regis Pannier and the team at the Places to Go, People to Be French edition for locating copies of many lost Game Ideas Unlimited articles. This was originally published as Game Ideas Unlimited: Stitches, and has been reproduced here with minor editing [bracketed].
I stand in the emergency room of the hospital which we have regarded as local for over twenty years. My almost eighteen year old son is getting stitches and a tetanus booster, for a severe cut in his hand. He was trying to open one of those heat-sealed hard plastic flat bubble packs with his pocket knife, the sort that should have a Consumer Product Safety Commission label that reads Warning: Cannot Be Opened, and slipped. I realize that perhaps a dozen years ago I was here when he was getting stitches for a head wound obtained falling off a bed (jumping, not sleeping). That was not my first time in this room. Since then I have been here repeatedly, for broken bones and organ stones, with each of my five sons, my wife, and myself. The room is very familiar, like an old friend.
And yet like an old friend, it is not so familiar. As I stand within it, I begin to see the changes. The room has grown over those years; it is not the room I entered years ago.
A large computerized rack stands next to the sink; bearing the brand name Pyxis, it contains an amazing variety of medical supplies in plain sight behind locked doors. Here is a rape kit; there is bandage tape. Medicines, splints, nebulizers and catheters—each standard item available with the push of a few buttons, once the computer knows which patient must be billed. This is a long way from the time when there were stickers on each item, and hospital personnel carefully pulled the sticker from the item and pasted it into the patient chart as they worked. I don’t know how long the machine has been there, but I remember when it wasn’t.
Pyxis turns out to be a word. It has several meanings, including a constellation in the southern hemisphere. It was probably chosen for this machine because in ancient Greek it referred to a box in which physicians stored medicines. I didn’t know that; nor did any of the hospital staff whom I questioned.
The wound cart is sitting by my son’s bed. I note that it, too, has changed. Of particular interest to me is that there is no silver sulfadiazine cream on it. I became well acquainted with this topical antibiotic when I managed to pour flaming oil on my own hand (that will be another column) removing quite a bit of flesh. It is still the treatment of choice for the severest wounds, especially burns. But because microorganisms build up resistances to our medicines through exposure, efforts have been made to control the availability and use of this marvelous compound lest we breed a race of superbugs immune to it. There have been other changes, I’m certain—even the layout of the cart has altered—but I never used the cart; I only observed it.
My son is in one of the old beds. The standard rolling stretcher has its station, complete with oxygen, suction, and several other hook-ups in the wall. I wonder which of these are newer, which have always been—but then, my bearings are off. This is now one of the first beds. It must once have been one of the last. A major renovation some time back ripped out several walls and built new ones. There is now a section of four rooms which are more private, closer to the entrance. This main ward-like section stretches deeper into the first floor of the hospital, and has been expanded with a half-dozen beds parallel to it on the other side of the Pyxis and the sink. The nurses station has been enlarged, and patient intake includes a small triage room. This department is probably thrice what it once was.
Even the people here have changed. The nurses, of course, go through turnover and burnout—working every day with lives in your hands is more stress than most people can handle over the long haul, and eventually they look for something with less pressure or more money. But the doctors have also changed, not just who they are, but who they are. Years back I was a local radio station announcer, and co-hosted a medical call-in show. Dozens of doctors shared the mike with me, and I knew and was known to the medical community. Many young doctors trying to establish their practices locally would put in a shift or two a week in the emergency room for a bit of extra money. Only one was actually certified in emergency room medicine; most were just guys who became doctors. One had given driving lessons back in high school to a girl I had dated in college (small world, as none of us were from around here). I knew them; I knew where some of them went to school, and it was always places like Jefferson, or University of Virginia. Today the department is run by emergency room physicians. They have their own practice; this is what they do. Not one of them can claim English as his native tongue. None would know me without a hospital bracelet. I can’t say they didn’t graduate from American medical schools, but would be surprised if any of them grew up here.
And the hospital environment and procedures have changed drastically. I can remember when Computer Axial Tomography was done in Delaware, and if it was necessary patients were sent there; the hospital argued long and hard for the State of New Jersey to approve the cost of installing a used CAT scanner in the building. Today Computer Tomography is routine, and Magnetic Resonance Imaging is also done in-house, right around the corner from here, in Radiology. They still send people to other hospitals from time to time—there’s no neonatal intensive care unit here, pediatrics is not well supported, and we’re within half an hour of some of the best hospitals in the world in several fields (including the Crozer-Chester Burn Center)—but quite a few of them leave from the helipad that was added on the other side of the parking lot.
So the difference between entering this room in 1987 and entering it today is one of uncounted details. And, as they say, the devil is in the details.
So, is this going to be another one of my long walks down memory lane? No, the walk is over. There is a different lesson in this one.
I use to watch all those courtroom drama mysteries. My mother was a fan of Perry Mason, and it rubbed off on me. Have a lawyer questioning witnesses to try to get to the truth of the murder, and I was hooked. Then I went to law school. After that, I couldn’t watch Matlock without wanting to jump up and shout, “Objection, your honor!” Being so familiar with the real rules of that corner of the universe, it was difficult to watch them being so abused.
My wife, a critical care certified registered nurse (in the intensive care unit of this same hospital), is the same way with medical shows. It was one of the first episodes of one, maybe Diagnosis: Murder, maybe E.R., when during the opening credits she suddenly lost it. Someone was walking down the hall with a roll of bandage tape hanging on the ear piece of the stethoscope draped over his shoulders. What’s wrong with that, I asked. I often saw nurses carry tape on their stethoscopes. Not that way—it would fall right off. You have to disconnect the tubing from the ear piece and stick the tape in the middle.
Let’s go back in time again. I can remember fragments of the sixties. They say that if you can remember the sixties, you weren’t really there—but I was younger than that. In those days, there were few places that sold gasoline that didn’t have a mechanic on duty when they were open. It was quite ordinary to pull into a gas station and ask for someone to take a look at something while you were getting gas, to tell you if it was serious. Conversely, there were very few mechanics who didn’t work in gas stations. There were body shops and tire stores, Sears installed batteries, Midas did mufflers, and Aamco transmissions, but generally those who did car repairs also sold gas. Then the oil crisis of the seventies put a lot of gas stations out of business; many places that had been gas stations were now just repair shops. And on the rebound the oil companies started setting up the superstations, places that just sold gas, many of them inviting you to save money by pumping it yourself. Today there are few places that both sell gas and fix cars; even those which do are extremely limited in what they will fix. One down the street here will change your oil and do minor repairs, but won’t do tune-ups because they don’t have the computers. Yet there are still times when I feel like if I pull into a gas station there should be someone there who knows more about my car than I. And if I were pulling into a gas station in the nineteen sixties, I’d be right.
People get details wrong all the time; and people who know what they should be notice immediately. Mercifully, in role playing games you can gloss over many of the details. Your players are going to fill in the gaps with what they think they should see, whether or not that’s what you see. As long as there aren’t any glaring discrepancies, the game can continue quite comfortably. But don’t, don’t, DON’T try to run a game in a setting that your players know better than you do. They will eat you alive. And if you’re going to use a real setting, or even a well-known fictional setting, in your game, make sure you have it right. Known settings can be very useful, because if all the players have been there before (or read about it or seen it) each will already have a good idea about their surroundings. But check the details. If you’re bringing them into the local hospital today, make sure you know what it’s like to be there now. But if your adventure is set there ten years ago, try to have some idea what was different. One of your players just might remember when he broke his arm or his appendix was inflamed, and be put off by the differences between his memories and expectations compared to your reconstruction.
Of course you can’t get it perfect; at one level you don’t want to get it perfect, because you’re more interested in getting something playable. But you can’t make mistakes that are going to shock your players into seeing the unreality of it all. If they are in a familiar place, it has to be right. If it isn’t, they are either going to wonder why and attach undue importance to your mistakes, or they are going to lose their connection to the setting as it fails to jibe with their expectations.