Tuesday, January 24, 2006

Playing Doctor

When I bought Bruno Latour and Peter Weibel's lavishly illustrated tome on Making Things Public: Atmospheres of Democracy (Cambridge, MA: MIT Press, 2005), I was initially surprised at the number of pages devoted to medical simulators as manifestations of public rhetoric. Now that I have returned from Stanford's SimWorkshop on Creating Games & Simulations for Learning in Long Beach, I can better see the civic function of the graphic displays of medical knowledge that represent the most intimate architectures of our private bodies. Furthermore, as part of the larger genre of "risk communication," many medical virtual reality environments are being funded by taxpayer initiatives to train first responders for combat casualties or terrorist attacks.

I'll start with Joseph V. Henderson's talk about "Narratives, Emotions, and Media for Simulated Learning" and the work being done at the Interactive Media Laboratory at Dartmouth.

The first demo Henderson showed was from a Clinton-era project, Regimental Surgeon: Preventative Medicine in the Combat Theatre, in which the Soviet Union has re-formed after a right-wing coup. A new doctor, the hero in this first-person game, arrives at the base and must solve the mystery of a "fever of unknown origin." Shot at Camp Pendleton and a soundstage at Norton Air Force Pace, the user's point of view shuttles between a number of separate characters (presented as either poker-faced or wise-cracking agents) who introduce themselves and then almost immediately manifest their stock attitude about physicians. The player can look at documents, which provide the opportunity to develop certain subplots, and concoct plausible reasons to leave the base for further investigation.

As a writing instructor, my favorite part of the program was when the base commander sternly informed our protagonist that he would have to "support findings with facts" and write up a report that followed a proscribed outline and emphasized to him the importance of "logic" and "facts." (I use the word "he," because the program explicitly genders the user.)

The next project that Henderson demonstrated was Primary Care of the AIDS/HIV Patient: A Virtual Clinic. What I found interesting about this simulation was that it emphasized representing the clinic in the virtual reality environment rather than representing the actual body of the patient. As Michel Foucault writes in the opening of The Birth of the Clinic, "This book is about space, about language, and about death; it is about the act of seeing, the gaze." Although Foucault rehashes the general assumption that "the human body defines, by natural right, the space of origin and the distribution of disease: a space whose lines, volumes, surfaces, and routes are laid down in accordance with a now familiar geometry," he challenges this commonsense spatializing of disease in the body as "neither the first, nor the most fundamental."

In Henderson's Virtual Clinic, which is demarcated by floor plans, cutaways, and confrontations with closed doors, the learner occupies the POV of an infectious diseases physician. As this physician, the learner follows the case of Laurie Matthews, a female HIV positive patient who is joyful about having settled down into a safe-sex relationship but has some catching up to do after missing an appointment. During this first meeting, Laurie also reports some alarming symptoms that indicate that her anti-viral regime may have begun to fail. In this introductory appointment, the user must probe into Laurie's mouth, which is covered with yeasty deposits. Appointments continue as Laurie's condition deteriorates. Her psychic pain is dramatized along with her physical decay. For example, she wants to have a child and must be gently dissuaded from this reproductive plan for the sake of public health. (Luckily, an updated release of the game will soon allow this wish to be granted, because prenatal drug therapy has minimized transmission risk.) Matthews is played by an actress, but there are also videos of real AIDS patients who tell of their harrowing experiences with disease, social ostracism, and mortal fear.

Later projects like the The Virtual Terrorism Response Academy use less video and more CGI. They also take advantage of a combination of open source tools and off-the-shelf products ( the Quake 2 game engine, ws-widgets, Python, and Tamale, according to Henderson). The Terrorism Academy story begins cinematically with swelling music in pitch blackness. Then titles announce the facts: "Capitol Region" and "September 11, 2001." Soon the player hears the recognizable sounds of transmissions from the first responders and becomes aware that he or she is being situated in the story by a historical document. The scene shifts to where the "game" itself opens, upon the closed door of the academy, which can only open after the player enters the prescribed data into a virtual computer terminal. Much like the Clinic, which is similarly public yet private space, the cutaway plan of the Academy's shared built environment is used to situate the story. With funding from the Bush administration, the form of contamination in this scenario is radiation not disease.

The path of the training narrative depends on the user's occupation. Firemen, EMT's, and law enforcement officers all have different professional trainers/magical helpers and move through different story arcs with different social roles. In the story I saw, an unfortunate landlord, Mr. Gupta places a 911 call about some suspicious characters transporting and storing what looks like bags of fertilizer, but -- rather than wait for help to arrive -- Mr. Gupta decides to use his key to investigate. The player must decide how to react after the resulting explosion. Rush in to rescue Mr. Gupta or focus on the larger public health risk. The dilemma has "no right or wrong answer," but the player has a radiation meter to assist with this decision making.

What is strange about all this noisy, violent, urban action, is that it all takes place in the clinical environment of the Academy with an instructor available for "breaking it down" at all times. In the words of Noah Falstein, it is "a simulation of a simulation" in which the narrative is constantly being interrupted.

We didn't hear about the newest "virtual clinic" from Henderson on using DNA evidence in sexual assault cases, which is apparently still early in development. Like the HIV/AIDS module, the DNA program also emphasizes the importance of a psycho-social approach and is being funded by a number of federal agencies from public health services to the Department of Justice.

Labels: ,


Post a Comment

<< Home