Forever Thursday

[[Credits|fin]] [[About|about]]

!Forever Thursday<<set $experience to 0>> //A game about medical education// [[Click the links to progress.|real-start]]

Thursdays are the days you learn clinical skills, and it is on a Thursday you do [[your first chest exam|first tutorial]].

You stepped into the room with all your classmates (well, now they're 'colleagues') and after all the preamble, the first thing the tutor taught you was the acronym WIPER. That stands for: <<if $wiper is 1>>Wash your hands, [[introduce yourself|first tutorial][$wiper += 1]] <<elseif $wiper is 2>>Wash your hands, introduce yourself, [[ask for permission|first tutorial][$wiper += 1]] <<elseif $wiper is 3>>Wash your hands, introduce yourself, ask for permission, [[expose the appropriate area|first tutorial][$wiper += 1]] <<elseif $wiper is 4>>Wash your hands, introduce yourself, ask for permission, expose the appropriate area, and [[reposition the patient|chest exam]]. <<else>>[[Wash your hands|first tutorial][$wiper to 1]]<</if>>

Then there's actual medical stuff: palpation, auscultation, all that. But the first time you stand [[in front of a 'patient'|chest exam patient]] your voice simply up and disappears. <<set $wiper to 0>>

She's been helping to train medical students as a volunteer patient for years. Don't worry, she says, she knows the routine. [[And so do you|chest exam patient start]].

First you [[wash your hands|chest exam patient introduce]] //Seven steps. Hand sanitiser.//

and [[introduce yourself|chest exam patient permission]] //"Hello, my name is... I'm a first year medical student at..."//

then you [[ask for permission|chest exam patient exposure]] //"Would it be okay if I did a chest exam on you?"// //"Yeah, yeah."//

then you [[expose the area|chest exam patient reposition]] //"Could I get you to- oh, you've already taken it off."//

and [[reposition the patient|chest exam done]]. //"And could you sit up for me, please? Perfect." //

That leaves you ready to get on with it. You look at your 'patient' from the end of the tiny gurney. You check that her chest expands symmetrically (of course it does, she's perfectly healthy) and that her chest is equally resonant on both sides (it is) and lung sounds are clear on both sides (they are) and are we actually done? You [[thank her|chest exam ending]].

//"Thank you, er-"// //"No problem, love."// That was... fast. <<set $reason to "">> <<timed 1s t8n>>That was your [[first tutorial|memory-2]].<</timed>>

<<script>>$('body').removeClass().addClass('memory')<</script>>When you were choosing a uni to apply to, you looked at their prospectus. They told you that, at this medical school, you will have "early patient contact". They tell you that there's "vertical integration" and learn to "function in the ward environment". What they don't tell you is that you will learn how people [[look like]]<<if $experience == 0>>.<<elseif $experience == 1>>, and what they [[feel like]].<<else>>. Despite yourself, it [[surprises]] you.<</if>>

<<script>>$('body').removeClass().addClass('memory')<</script>> You've done your fair share of attachments. You even got to sit in at a surgery once (your classmate's mom is an anesthetist). It was cool! You saw a heart beating in the chest, like in that video you found on Facebook, but for //real//. But of course now you do have [[attachments|second tutorial]] for real.

<<script>>$('body').removeClass().addClass('memory')<</script>>They look like the youngest patient in the hospice, who was just a few years older than you. They look like the man with the bright orange cap who told your tutorial group about who he thinks he got HIV from. They look like the cadavers in the anatomy lab. All you really knew about them was their cause of death, yet you held their hands as you dissected the arms. <<set $experience += 1>>\ [[Back|memory-2]]

The big stuff: you learned to perform physical exams, what doctors do to get an idea of patients' health. The small stuff: you learned to occasionally touch people on the shoulder. You sometimes forget to ask if people are in pain, though. It's not that you don't care, it's just... not a habit. <<set $experience += 1>>\ [[Back|memory-2]]

It's a Thursday again, and you're on the wards on attachment. This was achieved by bugging your aunt, a senior consultant, until she relented and let you shadow her for two weeks. Consultants buzz around at the helm of their [[little ragtag group|second-tutorial-1]], lanyards swinging.

You, the first-year exchange student, follow the third year students around the wards. One of them, Nicole, was from the same school as you were, so you stick mostly with her. She goes around clerking patients, mostly, and sometimes practicing procedures. (She has a quota to fill.) One of the patients she's clerking today is an elderly man who's here for shortness of breath. She turns to you. "You know the respiratory system, right?" she asks.

<<script>>$('body').removeClass().addClass('memory')<</script>> When you were preparing your personal statement, you looked at what other people wrote. There were several popular reasons for doing medicine that people wrote in their personal statements: <<radiobutton "$reason" "sickness" checked>> Major illness in a close relative and seeing how competent doctors and nurses made a difference <<radiobutton "$reason" "science">> Being good at science and interested in the human body <<radiobutton "$reason" "altruistic">> Making a difference in the world <<radiobutton "$reason" "noneoftheabove">>None of these really fit you. <<button "OK" memory-1b>><</button>>

<<script>>$('body').removeClass().addClass('memory')<</script>> <<if $reason eq "sickness">>No matter who the relative was, it was the <<elseif $reason eq "science">>You were always in biology olympiads, even from primary school.<<elseif $reason eq "altruistic">>Cheesy as it was, you had this vague idea of... changing the world. It was, and is, so easy to see where people had done things wrong. You were in the right place to start a fundraiser, an awareness drive, organise a charity run: your CV, such as it was, was full of references to these.<<else>>None of these really fit, and it was sometimes embarrassing, because people expect a self-contained answer for this deceptively simple question and you would have none.<</if>> (Of course, the reason why you did it is less important than the fact that you're here now.) [[third tutorial]]

It's your final year, and you have been tasked to take blood from a patient. Don't worry, your consultant says, she's got nice veins. You look down at the tray of [[equipment]] in your hands. What now? <<textbox "$wiper" "" autofocus>> <<nobr>> <<repeat 1s>> <<if $wiper is "">> <<else>> <<display "third-tutorial-button-1">><<stop>> <</if>> <</repeat>> <</nobr>>

A plastic kidney-shaped tray, holding a tourniquet, alcohol swabs, cotton swabs, a plaster, the needle itself and a purple-topped tube. [[Back|third tutorial]]

<<button "Okay" third-tutorial-1>><</button>>

<<if $wiper is "wash your hands" or $wiper is "wash my hands" or $wiper is "wash hands" or $wiper is "wash">>You wash your hands. One of the first things you were taught in first year. By now it is ingrained into muscle memory... even if you condense the seven steps into four. Next? <<textbox "$wiper" "" autofocus>><<nobr>> <<repeat 1s>> <<if $wiper is "">> <<else>> <<display "third-tutorial-button-2">><<stop>> <</if>> <</repeat>> <</nobr>> <<>><<else>>You can't afford to be waffling around like that! [[Let's have another go.|third tutorial]]<</if>>

<<button "Okay" third-tutorial-2>><</button>>

<<if $wiper is "introduce yourself" or $wiper is "introduce self" or $wiper is "introduce" or $wiper is "self-introduction">>You introduce yourself, and by this time your name and your 'rank' flows smoothly. //"Hello... my name is... and I'm a sixth year medical student..."// Next? <<textbox "$wiper" "" autofocus>><<nobr>> <<repeat 1s>> <<if $wiper is "">> <<else>> <<display "third-tutorial-button-3">><<stop>> <</if>> <</repeat>> <</nobr>> <<else>>You can't afford to be waffling around like that! <<back "Let's have another go.">><</if>>

<<button "Okay" third-tutorial-3>><</button>>

<<if $wiper is "permission" or $wiper is "ask for consent" or $wiper is "ask for permission" or $wiper is "ask permission">>You ask for permission to perform the examination, and you explain what you're going to do. //"Is it alright if I take some blood? This will involve..."// You try not to wave the needle around. People don't take kindly to that. Next? <<textbox "$wiper" "" autofocus>><<nobr>> <<repeat 1s>> <<if $wiper is "">> <<else>> <<display "third-tutorial-button-4">><<stop>> <</if>> <</repeat>> <</nobr>> <<else>>You can't afford to be waffling around like that! <<back "Let's have another go.">><</if>>

<<button "Okay" third-tutorial-4>><</button>>

<<if $wiper is "exposure" or $wiper is "expose patient" or $wiper is "expose part" or $wiper is "expose">>You gently push up the patient's sleeve to expose the bare arm. Next? <<textbox "$wiper" "" autofocus>><<nobr>> <<repeat 1s>> <<if $wiper is "">> <<else>> <<display "third-tutorial-button-5">><<stop>> <</if>> <</repeat>> <</nobr>> <<else>>You can't afford to be waffling around like that! <<back "Let's have another go.">><</if>>

<<button "Okay" third-tutorial-5>><</button>>

<<if $wiper is "reposition" or $wiper is "reposition patient's arm" or $wiper is "reposition arm" or $wiper is "reposition patient">>You wedge a pillow under her arm. //"Is that comfortable for you? Yeah?"// [[Now for the needles...|third-tutorial-6]]<<else>>You're very near the end! <<back "Let's have another go.">><</if>>

It's like you watch your hands putting the bits together: the needle into the barrel, the vacutainer tube (as it's properly called) into the barrel. You feel for the vein, angle the needle bevel upwards and... [[It's easier than you think.|fin]]

This game was originally inspired by Cheiron, which may be described as a diagnostic puzzle game but which I pegged in my head as the ultimate "OSCE simulator". OSCEs stand for Objective Structured Clinical Examinations, and are a crucial part of medical education. Apart from personal experience, I also referred to <a href="http://geekymedics.com">Geeky Medics</a> for references for OSCEs. <<back "Go back">>

This game was made in <a href="http://twinery.org">Twine 2</a>, a free tool that makes it easy to create your own interactive stories! I used the Twine format Sugarcube and wrote this on <a href="twee2.danq.me">Twee 2</a>. <<back "Go back">>

It's not like you go around touching people - and not like you're //allowed// to touch them without consent. And suddenly the nurses at the hospice heard tell you were a medical student ("But I'm just in first year!" you told everyone), so they asked if you could help change patients' diapers. How could you say no? Enthusiastic medical students don't say no. You don't have siblings, let alone baby siblings: you only see diapers on other people's babies, and only the outsides, at that.