The mechanics of each diagnosis & complication are related to their real-life origins, and this leads to an understanding of the inter-relatedness of medical problems; the organ systems are all connected and impact each other.

This is abstracted into a simple system with injury represented to various organs: Brain, Heart, Lungs, Blood, and Inflammation, which comprises a combination of toxins, metabolic, chemical and inflammatory injury to the body. Diagnoses and Complications cause patients to accrue injury to these organs in the form of representative tokens; when the organ injury reaches capacity, it “spills over” into other organs, exposing the patient to further complications.

In this way, what starts as a single problem such as Status Epilepticus- a seizure disorder which only adds Brain injury - can be Complicated by Hypertensive Crisis, which activates off of Brain but adds Heart and Blood injury, which then exposes the patient to complications like Pulmonary Edema, which activates off of Heart and adds Lung injury… and so on. The inter-relatedness of these real-life problems is experienced directly through the game play.

These work off of a similar system as above, except instead of adding injury, they remove it. The systems are, of course, abstracted - but they get the general picture across. More importantly, Therapy cards have nuances baked into the mechanics that reflect real life.

Use a procedure card and it has a risk of Complications, but using an appropriate imaging modality before the procedure might help mitigate that risk. Medications and diagnostic studies all represent real things we do as well, and they carry that flavor; a CT scan gives you answers, but it won’t happen right away - unless you use your “experience” and order it STAT.

"Critical Care" empowers players with knowledge that can help translate the jargon utilized by doctors and demonstrate the breadth of expertise needed to care for the sick. The ICU can be an intimidating environment for everyone. "Critical Care" allows them to navigate complex medical situations in a psychologically safe, risk-free setting, building their confidence and familiarizing them with this new world. Everyone who plays learns about the people who work in critical care as well as common medical problems and the therapies used to treat them.

Anyone who plays will feel like they’re living out an episode of a medical drama on TV. “OK, I’ve got 12 hrs on my shift, I’ll come over and get you an arterial line and an X-ray for Ramzi and I’ll have enough time left to call the Wound Nurse for Marley!”

Use a Staff card and you’ll get a flavor of what they do in real life - the Wound Nurse removes complications related to bleeding; the Intern uses your entire shift when you first play them (you have to teach them, after all!) but then, attached to a single patient, they extend your bandwidth on every future turn.

One of the most powerful examples of the way the theme drives the mechanisms is through the Goals of Care track. Cards that advance a patient towards hospice scale proportionally with how sick the patient is, just like our bedside conversations change as someone’s illness progresses. If you play some of those cards on a patient that isn’t that sick, you’ll get a limited benefit - but if you play them strategically as a team when the patient is in true crisis, the impact is potent. Not only do you get the weight of those conversations in these tense moments, but you may literally win the game because of it. That moment when you work together to turn the game from impending doom to a graceful victory is a little bit like what it feels like when we work with families to recognize the end is near and to guide them through that most intense time in their life.

These topics and more come up through the Pager cards. We abstracted this a bit - in real life, you don’t get paged about structural racism. But paging has a mechanistic effect that ties closely to the real life experience - it happens unpredictably and is usually bad news, but not always.

In the game, you find out you get paged just before you start your turn, and you have to resolve the pages before you can start playing cards. The pages often throw a major wrench in your plans; perhaps it is a national holiday and players have to discard any invasive procedures and diagnostic cards from their hands – always hard to get that stuff done on a holiday with a skeleton crew in the hospital! The Pager cards all have similar thematically linked effects; Implicit Bias impacts the staff cards in play on a patient, whereas Untreated Pain destroys the Rapport bonus you’ve built up with a patient and increases their risk and suffering, represented by Crisis tokens.