“Easy. Just use chaffs to scramble their radars, stay in the corners, and wait until their mouths open to attack – that’s their only weak spot, really.”

“Dude, thanks, Man!”

“You’re welcome. Let me know if you have any trouble. Oh, and if you’re struggling with the Rays, you might need some help with Solidus Snake, the final boss.”

“Don’t be trash talking me, Punk!”

We both beamed, having finally actually connected on something other than his inevitable mortality.

The next day I was in early, eager to share my experiences in this game. It occurred to me that our lives, despite being of similar age, were worlds apart. And yet gaming culture had given us a set of common experiences that we could relate with. There had to be something here. Instead of just pontificating about it, I wanted to ask him directly.

“Warren, what is it about gaming that, you know, just does it for you?” We had just finished a discourse about how to complete the rest of Sons of Liberty, and desperately afraid that we had come to the end of a common experience thread, I opted to find out a little more about what his motivations for playing were.

“Well, the easy answer is an escape, I think. But I think its more than that. I think it has to do with losing myself in another world. Being something different. You know, taking a football team to the Superbowl, leading armies to defeat the Goblin King, piloting a star cruiser – silly stuff, I know, but important to me. It also keeps me from being negative.”

“How so?”

“Well, when I’m playing I don’t have time to be worried about what my other friends are worried about – clothes, girls, cars – but mainly girls.”

“I got 99 problems . . .” I chimed in.

“Tell it, Playa.”

We both laughed at the somewhat lewd inside Jay-Z lyric, as both his mother and the nurse were around and we had pulled off some mad poetry.

“What if you could get on Xbox Live? What if you could game with other folks out there going through something similar?”

“That would be freakin’ sweet.”

“Agree . . . damn! Look, I’m late for rounds. By the way, your infection’s better according to the blood tests.”

“Uhh, thanks for all the info, Doctor”

“You’re welcome, Punk.”

The days came and went, and we continued to build upon our relationship as his infection was treated. Ultimately, with the blood cultures having remained negative the entire time he was there, we opted not to remove his dialysis access. During that time I spoke with the facilities director and managed to get permission to install an Xbox in his room, playing off the television. Unfortunately we couldn’t figure out a way to get access to the internet, meaning that XboxLive was out of the question. Still, I made sure that after rounds I would swing by and we’d have a quick race on Project Gotham Racing before I left for the day.

But the infection wasn’t the only issue he was working against. A repeat CT scan of his abdomen showed that his cancer had returned with a vengeance, almost doubling in size since the last round of chemotherapy. We had had to put the chemotherapy on hold because of this infection, and there was very little we could do to reverse its course. Despite being comfortable now, the oncologist downgraded Warren’s prognosis based on the aggressiveness of his disease. Oncologists are some of the most vivacious and optimistic people I know, and when even they can’t offer hope, things can look pretty bleak.

“You never told me what your favorite game was, Warren.”

“That’s easy – Final Fantasy.” Touche. Most hardcore gamers considered this particular series of games one of their favorites. It was known for its complex narrative, multiple branching storylines, and lengthy, lengthy gameplay experiences. The typical single-player experience could last anywhere from 40 to 80 hours. I recalled playing one of the games, Final Fantasy VII, over one of my med-school summers, and I still couldn’t finish it. And what a fusion of culture – the games epitomized J-culture, or Japanese entertainment / pop culture, with manga-inspired character art and mythology – all processed, synthesized, and analyzed by this young African-American man from downtown Baltimore.

“If you could be any character in the Final Fantasy universe, who or what would it be?”

“Bahamut.” The Dragon King – a supremely empathetic being who would from time to time be summoned by the adventuring party to lend assistance when the party was attacked by foes who were simply too big to face alone.

We discharged Warren to hospice care a few days later, and I remember being asked by Facilities to come and retrieve the Xbox that had been in his room. I remember standing in the empty room, thinking about the experiences we had shared over the past few short days. I thought about what he had said to me regarding shared experiences, about living in other worlds, about the benevolence of the Dragon King. It occurred to me that this concept of enabling patients with the chance to discover the same things that Warren had through online interactive worlds was simply too powerful to ignore. Wrapping the cables haphazardly around the gaming console, I noticed something lying on the floor. It was Warren’s discarded patient ID bracelet. Purple magic marker emblazoned his allergies and room number. To this day I still wear a purple gel band to remind me of this powerful young man who inspired me to put forward his legacy of bringing positive community gaming experiences to patients facing chronic illness. HOPEconnectsKIDS.org

This young man had certainly been cast a hard lot, and my walking into his room and actually seeing him for the first time confirmed everything. Sitting back on his bed, he was a small and emaciated-appearing young African-American man, hair cut tight to his head, his face aged beyond its years and set to a slight grimace. It was hard not to feel for this young man’s plight. This particular admission had resulted from an infection that we suspected was from his dialysis access. We had hit him hard with antibiotics and were conferring with the nephrologist and vascular surgeons as to whether the access needed to come out. Our workup had only begun, and the infection could certainly have come from elsewhere, which is what we were hoping, as we really didn’t know how many more surgeries his frail body could handle.

It is so very easy to be caught up in the throes of management. I recall walking into the room and going about my usual assessment – greeting family members, talking to the patient, reviewing vitals, doing a brief physical exam, and discussing management options in that non-conclusive way that interns seem to be excellent at doing. The patient, probably weary of seeing yet another new face in the endless saga of his care, did not offer much. Everything seemed to be going well, and I had a number of patients ahead of me during rounds, so I excused myself politely the moment that I felt the internal gyroscopes within my head say, “OK, time to move on.” Just as I was leaving, I noticed a Nintendo Gameboy by his bed. Inside was a game called Metal Gear Solid: Ghost Babel. Having been brought up through med-school on a steady diet of video games, I simply remarked, “Hideo Kojima is a genius.”

Hideo Kojima is the name of the man who designed the Metal Gear Solid series of games, regarded by many as some of the best gaming experiences out there. I don’t really know why I said it. Perhaps on some level, I did want to connect with this young man who was only a few years younger than myself, but I truly can’t say. It was as if a dampened fuse had finally lit, as he took my final communique and ran with it.

“Damn straight. Tactical espionage action, Bro.” There. Finally. A smile.

(To be continued 12/21)

We were basically mesmerized by the premise of social entrepreneurship – the concept of building a business that invested a portion of its profits into a particular cause. The ceo’s of ethos water and pura-vida coffee spoke of the transformative power of business when applied to problems of poverty, sanitation, establishment and protection of human rights and education. At the time, I was struggling with obtaining funding for our little research entity, the HOPEresearch initiative, and had recently developed the idea for a calendar that would be sold in support of the initiative. Suddenly the somewhat unidirectional and occasionally thankless task of fundraising seemed infused with purpose, and well, hope. I bounced the idea off of Zab (currently working with the UN, and no stranger to novel funding mechanisms for social projects) and he approved. I then approached my longtime friend, Francis and we began setting forth the goals of our little company.

Simply put, we would enmesh our passions of medicine, learning, information technology, and geek culture. Our love of John Nash’s game theory and the promise it holds in terms of helping people learning large amounts of complex information would provide the foundation for our work. But lastly, we would promise ourselves from the very outset and via the bylaws that we would apply a portion of our profits towards social projects that continue to inspire us. Building the world’s first inter-hospital gaming community? Check. Supporting amazing front-line organizations such as the International Red Cross and Doctors Without Borders? Check.

So, echoing Conan O’Brien’s graceful exit from ‘The Tonight Show’, I would say that the best part of what we do entails never being cynical. If you remain intellectually curious, and convey a sense of passion and wonderment to those around you – be it your friends, relatives, teachers or even patients – rest assured you will be nerdcore. Mathews out.

Incidentally, the translation for have no fear my warriors is ‘Tsam siyu, doku re atse’. No fear, indeed.

365 Days of High Yield Mnemonics. Yum!

Order now to secure 365 days worth of high-yield medical mnemonics and clinical pearls, conveniently divided into twelve sub-specialties by calendar month. It makes the perfect new years gift! The best part? A portion of the proceeds go to support the HOPEresearch Initiative at Johns Hopkins! (Pre-orders will be shipped by final week of December). Alternatively, you can order from Amazon, here.

I could not have asked for a more receptive and intelligent audience, having referenced in my status update shortly thereafter that everyone just seemed to ‘get it’. Read on to find out about my new favorite gaming webcast and views on the indie gaming scene and its potential for collaboration with the world of recreational therapeutics.

On the flight back I watched an episode of my new favorite web show, ‘Co-Op’ that had to do with independent game developers that really struck a chord with me regarding gaming initiatives within healthcare. I still believe that game-developers should be allowed to do what they do best. That is, build beautiful gameplay experiences. I believe that we as member of the healthcare community should be charged with the task of evaluating these experiences on their individual merits and exploring the complex psychosocial implications of how the process of healing is affected by these digital landscapes. And yet, with the indie gaming movement gathering steam, one can’t but help wonder if bringing a game developer into a multidisciplinary team, there might be a way to make it work. I realize that an entire conference has been devoted to this concept (Games for Health) however, the various games that I’ve seen seem to focus primarily on function over form. The problem is this – if you take an individual that has been raised on a steady diet of triple A rated entertainment, from such minds as Myamoto, Levine, Kojima and Wright, they become accustomed to a certain quality of experience that simply cannot be replicated realistically, despite the best of intentions.

What struck me about the Coop segment on indie gaming was the beauty and singular focus that these developers bring to the table. Judge for yourself – also, check out the sublime intro credit sequence and docu-style approach. Like I said, my new favorite gaming web show.

Check out the HOPEConnects site for more details on our little charity that could. Proceeds from Nerdcore Learning go to benefit the charity, as if you didn’t already know. In terms of NCL product updates, I’m pleased to announce that one of our newest team members, med student and programming prodigy Hon Wen Chong, has been putting the finishing touches on our very first iPhone app! I’ll just leave it at that.