Cheiron

By any reasonable standard of craft, Cheiron is a very poorly-made piece. It was not originally designed for general consumption, and only marginally as a game. Rather, it was designed by med students as a study tool. It's technically fiction, but it's the fiction of training scenarios, intentionally avoiding literary qualities.

The game contains four patients. You need to diagnose them using the standard methods available to a doctor: part of this lies in asking them about a fixed set of topics, and part of it involves a physical examination using a lot of specialist verbs (AUSCULTATE) and an immense list of anatomical nouns (FIFTH CRANIAL NERVE, STANDING BLOOD PRESSURE). Some of this is accompanied by stock medical photographs. The overwhelming majority of details are default responses, some of them totally inappropriate. All the patients are built from the same template and imperfectly customised, so you can (for instance) receive assurances from male patients that they are menstruating normally.

Given the game's intent as a revision tool and its sandboxy implementation, it's easy to assume that the patients will have a different condition each time. This was, I think, the original design intent, but it was never accomplished. Worse, once you've reached a diagnosis there's no way to tell the game this; the answers are included, and you have to be satisfied with that.

All this said, I had a hugely entertaining time with Cheiron. I played together with an EMT and anatomy student, and we made heavy use of internet resources. Divorced from its usual context -- the anxiety that you or someone you care about might have some horrible condition -- amateur diagnosis becomes a fascinating mystery, a complicated puzzle striking a balance between research, deduction and informed guesswork that I haven't seen equaled in any IF mystery. Most IF is designed to be self-contained, requiring as little external knowledge as possible; Cheiron demonstrates that taking the opposite approach can be compelling, although it doesn't suggest that it could be done in a stable and easily-played way.

The answers are telegraphed slightly -- you can't send off for lab tests, but you can see the results of the tests that a qualified doctor sent off for. The choice of tests alone is often a strong clue, but it still requires some interpretation.

Cheiron could, with a vast investment of work, have been turned into an excellent game. As it stands, its half-baked implementation will probably make it a frustrating experience for most players, its heavy requirement of specialist knowledge is likely to seem unfair, and some will find its focus on disease and infirmity off-putting.

(This is a repost of a review posted on the IF newsgroups right after the 2005 IF Comp)

The dual nature of IF—works generally are both stories and games - is one of those things which authors need to grapple with. Regardless of where the balance point winds up being, the best IF manages to weave the two strands together so that they're complementary rather than antagonistic. The authors of Cheiron aren't particularly interested in that task, however, and the result isn't so much antagonism as it is an all-out rout. The game is a medical-care simulator, with deep implementation of the process of diagnosis; gameplay consists of poking and prodding at patients until you discover what's wrong with them. Concerns of story are chucked out the window to an almost unprecedented degree—as far as I can tell, there's no way to even get the game to acknowledge that you've "solved" one of the "puzzles" and identified a patient's malady, which means Chieiron provides even less narrative closure than a hand of Freecell.

Which isn't necessarily a bad thing, don't get me wrong. To borrow a paradigm from Will Wright, Cheiron is more of a software toy than interactive fiction as such, but (see above) I'm hardly a purist in such matters. However, the reason that I'm harping on the lack of narrative context is that Cheiron's approach to its subject matter is pointillistically detailed, and makes no concessions to the nonspecialist. The overall effect is austere and forbidding, and a more robust frame, more deeply-drawn characters, more story, might have rounded off some of its sharper edges, making for a more satisfying and more approachable experience for those who don't happen to be in the rather narrow core audience. There's definitely something to be said for sticking to one's guns and refusing to compromise a vision in favor of accessibility—hell, if you can't get away with it in IF, you can't get away with it anywhere—but here, while the end result is certainly impressive, it doesn't have much to offer to anyone who isn't a doctor or medical student.

The implementation, as mentioned, is very deep—you can PERCUSS all sorts of nouns, and ask the various patients about a wide variety of subjects. There are occasional bouts of awkwardness, however: I encountered a number of annoying disambiguation issues (many revolving around nipple-lumps and discharge, unpleasantly enough), which isn't helped by the parser often presenting degenerate possibilities. AUSCULTATE CHEST, for example, presents a host of available targets, one of which is the torso. But AUSCULTATE TORSO requires you to specify heart or lungs, and AUSCULTATE HEART is similarly not specific enough, prompting another deluge of Latinate nouns. Listing only the possibilities which would actually lead to a result would have been far more convenient. Some dialogue responses are shared across patients - diet in this part of the world seems remarkably uniform—but given the wide variety of conversational topics, this is understandable.

There are long help files provided, but they're fairly contextless - that is, they just give you a long list of things to try, without any guidance provided for individual patients. The help file points out that you can call the lab for test results, but I found the feedback to be meaningless. Again, there's no context or baseline given: if a patient has a peak flow of 418, is that high or low? Who knows? It seems like it would be possible to incorporate some cues of this kind into the game itself, and even if that would interfere with the pedagogic purpose, the authors could still have provided a reference manual or something similar, to allow the non-expert some recourse. Diagnosing an illness could be a rewarding puzzle, albeit one involving many highly-complex steps, but where a normal work of IF would provide clues at each step and attempt to guide the player through the process of deduction, Cheiron just leaves the player to flail around helplessly. There's no sense of progression, of working towards an understanding of a complicated problem by examining each part of the whole—rather, you're just left with a sea of atomized data. And the patients don't have much in the way of personality, which keeps the whole exercise feeling abstract.

So does Cheiron work on its own terms? Probably. I'm not aware of what training tools medical students generally use these days, and I'm certainly not qualified to judge whether the detail provided is medically accurate and sufficient to help students learn how to diagnose patients, but from my layperson's perspective, it seems like it would get the job done. Still, I feel like the authors missed an opportunity here. I enjoy playing around with complex systems, and going in, I was excited to play around and maybe even learn something about medicine, but there just weren't enough concessions on hand to allow me to do that. I have to respect what the authors have accomplished, here, but Cheiron unfortunately didn't have anything to offer me.

This game summarizes itself pretty well with this disambiguation text:

"Which do you mean, lymph nodes generally, the inguinal lymph nodes, the supraclavicular lymph nodes or the cervical lymph nodes?"

This is a game written by two medical students for the 2005 IFComp. They wanted to show exactly what it was like being a medical student, and they succeeded (as far as I know!) The game comes with both images and sound.

It's polished and descriptive, but there's no emotion and it's too confusing to be as interactive as I'd like. I played it quite some time ago, but for some reason I never reviewed it.