Stories from the World of Medicine
Season
5
Episode
8
|
Apr 27, 2023
The Resident and the Rogue
Medical student Kaid van Kampen brings us into the magical world of Dungeons & Dragons. The deeper they get into the forest, the more parallels they find between their role as Dungeon Master and their role as physician-in-training.
0:00/1:34
Illustration by Eva Vázquez
Stories from the World of Medicine
Season
5
Episode
8
|
Apr 27, 2023
The Resident and the Rogue
Medical student Kaid van Kampen brings us into the magical world of Dungeons & Dragons. The deeper they get into the forest, the more parallels they find between their role as Dungeon Master and their role as physician-in-training.
0:00/1:34
Illustration by Eva Vázquez
Stories from the World of Medicine
Season
5
Episode
8
|
4/27/23
The Resident and the Rogue
Medical student Kaid van Kampen brings us into the magical world of Dungeons & Dragons. The deeper they get into the forest, the more parallels they find between their role as Dungeon Master and their role as physician-in-training.
0:00/1:34
Illustration by Eva Vázquez
About Our Guest
Kaid van Kampen is an aspiring physician-artist and future orthopedic surgeon exploring the crossroads of medicine, art, and the humanities. They will be graduating from McMaster University, and heading to the University of British Columbia for their orthopedic surgery residency training. They have written for the CBC, Healthy Debate, and The Journal of Bone and Joint Surgery. In their free time, they are an avid theatre goer and dungeon master. Their written work can be found here.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Kaid van Kampen is an aspiring physician-artist and future orthopedic surgeon exploring the crossroads of medicine, art, and the humanities. They will be graduating from McMaster University, and heading to the University of British Columbia for their orthopedic surgery residency training. They have written for the CBC, Healthy Debate, and The Journal of Bone and Joint Surgery. In their free time, they are an avid theatre goer and dungeon master. Their written work can be found here.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Kaid van Kampen is an aspiring physician-artist and future orthopedic surgeon exploring the crossroads of medicine, art, and the humanities. They will be graduating from McMaster University, and heading to the University of British Columbia for their orthopedic surgery residency training. They have written for the CBC, Healthy Debate, and The Journal of Bone and Joint Surgery. In their free time, they are an avid theatre goer and dungeon master. Their written work can be found here.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
This season of The Nocturnists is sponsored by The Physicians Foundation. The Nocturnists is made possible by the California Medical Association, and people like you who have donated through our website and Patreon page.
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman.
In today’s episode, medical student Katie van Kampen brings us into the magical world of Dungeons & Dragons (otherwise known as D&D). When Katie’s not in the hospital, they’re often playing the role of Dungeon Master, guiding their players through different adventures and scenarios and obstacles, and as you’ll hear in the story, the deeper they get into the game, the more parallels they find with their work as a physician-in-training.
Katie is a student at McMaster University in Canada, a writer, an avid theater goer, and will be heading to the University of British Columbia for their residency in orthopedic surgery. Katie initially told their story on stage at the Women in Medicine Summit in Chicago in September of 2022, but this version was actually recorded in the studio, which makes for an extra intimate and immersive listening experience which we hope you’ll enjoy.
After the story, Katie and I chat about the ins and outs of D&D, how to build one’s “character” as a physician, and the perks of seeing the hospital as a magical land of narrative encounters.
But before we get there, here is Katie’s story.
Kaid van Kampen
You're walking through the forest. It's dark. There's a gentle breeze through your hair. You look around at your friends, your companions, the people you trained with to become a knight. Standing at the center of the box formation you have going on, is a princess. Tall, pretty. The only thing she said so far is she doubts whether or not you can protect her, and honestly, she has a point. This is your first mission, and no one knows what happens when you walk through the woods. You keep going though, putting one foot in front of the other; the leaves crunching against your boot. You just need to make it to the other side, and that's it. First mission complete.
My name is Katie van Kampen. I'm a third year medical student at McMaster University in Canada. I'm also a Dungeon Master for a little tabletop role-playing game, known as Dungeons and Dragons, enjoyed by millions of nerds, like myself, worldwide. Dungeons and Dragons is a collaborative story-based game, in which I, the Dungeon Master, create a world of adventure for my players to explore. It's collaborative because sometimes I put beasts in front of my players, and instead of fighting them, they decide to befriend them. Now, when I'm not spending my time thinking of dragons and castles, I like to spend the rest of my time in the hospital, role-playing as a doctor.
I'm dodging nurses pushing the blood pressure machines; moving out of the way of doctors looking down at their notes. I'm heading to the trauma bay. I pull on my yellow gown; put on my N95 that always seems to smell like pickles. We're waiting for a 26-year-old woman, found on the side of the road. No one knows what happened to her. Soon the stretcher is coming down the hall, and enters the bay. Bouncing off the doors, bouncing off the podium, until finally, the patient lands in the center of the room on the stretcher, fluorescent lights beaming down on her. I'm in the corner, holding the warm blankets - my only contribution.
The primary survey team swarms the patient, all trying to do their part. The anesthesiologist goes to place a stethoscope to her chest. She moves away. "I don't understand. Why... Why am I here? What happened?" The team attempts to console her, to calm her down. But she continues to be uncooperative. The Trauma team leader stands at the back of the trauma bay, behind the yellow line, directing the orchestra. They take a step forward, and the rest of the team backs off. They approach the patient, warmth in their eyes, and they place a hand on the patient's shoulder. "It's okay. You're safe. We just want to help you." The patient meets their eyes. "Can you let my team do their tests?" The anesthesiologist places a stethoscope to her chest.
The forest has been uneventful so far. The elf has drank five cans of cider, and continues to be distracted by the colorful mushrooms on the side of the road, being told multiple times that, "No, they can not eat them." You come across the glade on your route. Roll a Perception Check. My players groan and mumble, and begrudgingly pull out their dice. They know that when I ask them to roll a Perception Check, that something is about to happen.
The dice clatters on the table. Ah. So, the Dragonborn has rolled an eighteen. The Gecko's rolled a six, and the Elf has rolled a three. You see, the Wizard is too busy feeding their pet Gecko, and the Elf is too busy sniffing a mushroom, to notice that out of the trees is coming a dark blur heading towards the Princess. The beast's jaws are outstretched; claws are ready to bite into the Princess' shoulder. The Dragonborn steps in front of the beast, holding up their sword, blocking the blow. They roll to attack. A twenty; a critical success. And, with one fluid movement, they lop the head of the beast off, and it rolls to the foot of the Princess, who is looking aghast. A Dragonborn wipes their blade on their leg and leans on their greatsword. So, you doubt her skills now, Princess? And you realize that this trip to the forest might not be that bad after all.
It's late. I'm trying to keep my eyes open, as I finish up notes. A nurse walks into the room. "Doctor, one of the patients isn't getting the tests that they need. Can you please come talk to them?" My attending huffs, and gestures for me to follow them. I find myself back in the trauma bay, seeing the 26-year-old woman found on the side of the road. She's clutching her broken clavicle. The attending stands at the foot of the bed. "So, I hear you don't want to get these tests." "Listen, doctor. I'm really tired. I don't want to have any more tests." "I understand it's been a long day. But these tests are really important for your care." "Sure thing, Doc. But I feel like you can use the tests that I already had." "Listen, we really need you to have these tests." "I just want to go home."
The patient struggles to understand why these tests are important to her care, and the attending is too exhausted to explain clearly. I watch as they both struggle, becoming increasingly frustrated at not being heard, until, finally, the attending snaps. "How are we supposed to help you? You're wasting everybody's time." The emergency room is quiet. The patient is still clutching her broken clavicle, eyes wide at being spoken to like that. And then she leaves, against medical advice. And my attending storms off. I am left standing there, wondering what could have been done differently.
You've now come to the part of the forest where all the trees collapse in on themselves, creating a dark halo of vegetation. The only light is the Elf's torch. Roll a Perception Check. My players roll well, a 12, a 14, a 16. Another 12. You hear rustling off to the side, and the party quickly forms a protective circle around the Princess. You hear footsteps, and the trees begin to shake. You clutch the hilt of your weapon, palms sweaty. An assassin jumps out of the forest, pointing a silver dagger at the Princess' throat. "Step aside. It's her I want."
The Dragonborn looks at me, from across the table. "Dungeon Master, what does the assassin look like?" I look down at my notes. Hmm. I thought they would just kill the assassin, I didn't plan what the assassin looked like in detail. "Um, the assassin is wearing dark clothing, with a cloak slung over one shoulder." "No, Dungeon Master, is the assassin hot?" Um... I look down at my notes again. "No, I do not have notes about that either." "Oh, OK." "The assassin has a strong jawbone, with high cheekbones, and bright blue eyes that reflect the light of the torch." "Alright," I said, "Deuce the assassin." The Dragonborn rolls, a natural 20, a critical success, and the table is going wild.
Standing chest to chest with the assassin, the Dragonborn looks them up and down. "So, you come around here often?" And, the assassin falls head over heels in love with the scaly beast before them. And the party is led safely out of the forest, avoiding all the traps, all the beasts, and all the survival checks I had planned for them. When I look back at my notes, the ones I didn't use, I chuckle to myself. Sometimes, you prepare for things that never happen, and that's just part of playing the game.
I'm back in the trauma bay, on my Surgical rotation. We're waiting for a 56-year-old man, involved in a motor vehicle accident. Soon enough, the stretcher is coming down the hall, and the patient lands in the middle of the trauma bay, fluorescent lights beaming down on him. I cast the Message Spell. My resident will be here soon; they're just finishing something up on the ward. The patient is swarmed by the primary survey team, and I look at the spot where the resident should stand. Now, I've done the primary survey before. I've stood in that spot, but I haven't done it without the resident nearby. I could jump in, but I'm scared. What if I mess up? I step forward. I roll an Investigation Check. "Sir, does anything hurt?" "Everything hurts." The patient clutches their stomach. I feel their abdomen, looking at their legs for any deformities. And, when it's my turn to present in the primary survey, everybody is looking at me. I roll a Charisma Check. I must feel pretty bad, because when I start talking, my voice begins to crack. "The patient's abdomen is soft and non-distended." I struggle through the rest of my lines. Finally, the resident comes. They roll their own Investigation Check. They discover that the patient has some tenderness along their left shin. And, sure enough, after being X-rayed, they find a non-displaced fracture of the tibia. I go home that night, feeling pretty bad about myself for missing that. But then I realize that I'm just a level three Rogue, and my resident is a level ten Dragonborn Paladin. And one day, I'm going to level up, too.
Emily Silverman
I am sitting here with medical student Katie van Kampen. So Katie, we met several months ago when I got an email from you out of the blue, and you said, "Hi, my name is Katie, and I love Dungeons and Dragons, and I want to tell a story about it." So, tell me a little bit about your decision to send that email, and how you even found out about The Nocturnists.
Kaid van Kampen
One day I sat down, after a very trying day on Internal Medicine, and I wrote my story, and I sent it to one of my mentors. He really liked it, and we were talking about where we should send it. And one of the things he mentioned was The Nocturnists, so I found the "Contact Us" form on your website, and I wrote my little message. And, what's actually funny is, your response went to my spam mail.
Emily Silverman
So you found my response, and then a few months later, you were standing on a stage in Chicago, telling the story. And, not just telling a story, but I told you to burn up and tear up your written story, and made you start from scratch. So, what was that like?
Kaid van Kampen
Really scary, because I was so focused on writing the words perfectly, and making sure that every sentence fit. So, I found it very stressful to suddenly just have to start talking, and know what I'm going to say, and know where I was going. But, I think that was the best part of the process, and I learned a lot from that. It kind of was interesting looking back on that, because I was really scared about dropping the script. But my entire story is about adapting and improvising. So, even I was struggling with doing what I was saying in my own story. And I don't think it was until I also dropped the script, that I was able to tell the story better. And it really expanded, and it was more flexible and things could change on the spot. I think it was a lot more rewarding, and better at the end because of it.
Emily Silverman
And, just for the audience, I get a lot of messages from people, with essays that they've written. And I often explained to people about the difference between the art of the written word and the art of the spoken word. And Katie, your essay was an example of something that I thought really had a lot of potential to be adapted to the stage. So, I definitely was excited to hear more about Dungeons and Dragons. I think part of the reason why I was so attracted to your story is because, during COVID, my husband, who is one of four siblings, invited all of his siblings, and all of their significant others, to play Dungeons and Dragons virtually on Zoom, as, like, sort of a COVID pandemic activity. And, so I played my first Dungeons and Dragons game. And had I not done that, I don't think I would have known what D & D is. And so, for those in the audience who don't really know what it is or how it works, you get into it a little bit in your story, but maybe you can just lay it out for people. Like, what is D & D? What is it like to play?
Kaid van Kampen
So, Dungeons and Dragons is a tabletop role-playing game, that really popped off in the 80s. There's five editions, and each time they make a new book, there's different rules, and there's different characters or races or classes you can play as. But, essentially, it's a collaborative role-playing game, where there's a Dungeon Master, which is myself, and I create a story for people to play through. And then there's the players, who come with their own characters. So, they make their own characters with their backstory. And then, I like to drop people in a tavern usually, and then they talk to villagers in the town, and eventually get sent on some sort of quest. And then they go off and fulfill their quest, and often, I'll write for how I think they're going to explore the world. And oftentimes, they don't do what I want them to do, which I think is very fun. How they get there is different than how I expected.
Emily Silverman
Yeah, so I remember there was an app or some piece of software that I had to log into before even starting the game, and I had to design my character. And that alone was really fun. And I think I was an lol for a bard or something. And I get to pick all of my strengths and weaknesses. And you know, was I going to be physically strong? Or was I going to have magical powers? Or was I going to be fast? Or was I going to be a mind reader or all of those different choices, and all of that work went in upfront before we even begin the game. And then our dungeon master who is this amazing, very enthusiastic, bearded guy, he also dropped us in a tavern. And I remember it was like a dark, stormy night, and we were all sitting at the bar. And the story began with goblins invading the village. And we all had to figure out what to do about the goblins. So yeah, you mentioned that you have a story in mind, but that are often changes. So as a dungeon master, how do you navigate that tension between scripts, and improv?
Kaid van Kampen
I have a background in theater. So I did improv in, in university. So I don't find it too difficult to make things up when I'm describing new locations, but in the end, a dungeon master just wants their players to have a really good time and to enjoy the game, right. So even if I think that they should go fight a giant, if they don't want to fight the giant, that's okay, if they want to go deal with how for the giant has sibling issues and go find the sibling and decide to convince the sibling to come back to the angry giant. And then the giant stops being angry and trying to terrorize the countryside, they've still resolved the plot, they've just resolved it in a different way than I expected. A lot of the times, I think it's really fun and satisfying when they take a completely different route than what I thought because I have to adapt things on the fly or I have to make things up. But then they feel satisfied because they circumvented what I thought they were going to do or they thought of a creative solution that panned out. And I think, or I hope that players get satisfaction from their ideas actually working in the world.
Emily Silverman
So how does that work that switching off between the Dungeon Master and the players? Like, at what point? Are you just narrating and kind of writing? And at what point are you pausing and taking in input from the players? And how does that all work? And then how does that toggle back and forth?
Kaid van Kampen
Yeah, so usually you start off narrating the location. So you drop your characters into a tavern. It's a dark and stormy night, and you tell the players who the bartender is. And then you say, okay, like do you want to order something to drink. And then they kind of take it from there. A tavern is a good example, because there's a lot of things you can do in the tavern. So players sometimes choose to just go get a drink and sit down. Other players want to look around and see who looks a little suspicious. Other people want to eavesdrop on conversations, often I put in conversations that they will listen to, which usually lead to a quest. For example, in one of my games, they were in a tavern. And they heard of a group of theater actors who are looking for their missing actor, and they don't know where they went. And the players essentially ended up saying that they would find that actor and that led them on their quest for that session. And so when they're in this tavern, and they choose to do things, going up to the bar and asking for a drink that doesn't require a dice roll, they can just say, hey, bartender, I'd like to get your finest mug of ale, and then the bartender will probably give it to them if they're a good bartender. But sometimes they're like, one gold piece for one Ale, that's too much money. So sometimes they'll be like, I want to persuade the bartender to give it to me at a discount. So then they'd roll a dice to determine if they're persuasive enough to do that. Or if they're listening to a conversation, that they would roll a perception check to see how well they can hear those conversations.
Emily Silverman
What's the difference between something like just asking for a drink, and something like wanting to bargain for the drink? Like, what is it exactly that makes your brain know that now it's time to roll the dice?
Kaid van Kampen
Because the dice basically acts as a equalizer between what could happen and what will happen. So if you're trying to persuade the bartender, and I've decided that, you know, this bartenders, pretty nice, dude. They're generous. So I would say, Okay, in order to persuade this bartender, that your character can have a drink at a discounted price, I'd ask them to roll a persuasion check. And if it is above, for example, a 10, you have successfully convinced the bartender to have a cheaper drink. But if they rolled a 20, which is quite high, or something around there, I say, not only is this bartender going to give you a free drink, they're also going to buy around for your entire table, because they liked you so much. So that's kind of how the dice changes how the game pans out.
Emily Silverman
As we were preparing for you to tell your story in Chicago, you and me and Molly, Molly for the audience is our amazing Head of Story Development. We were planning to toggle between the gameplay, so the knight in the forest protecting the princess, and then in the hospital. So we have the medical student and the attending, and the young, woman patient. And we were trying to draw parallels between the two environments. And so I'm wondering, as you're moving through the hospital as a medical student, with this background, and being a dungeon master, what do you see? Do you look around and you're like, those are the surgeons and those are the ID Docs. Those are the psychiatrists. And they're, sort of like, those are the elves. Those are the goblins. Those are the you know, do you think about it like that? And how do you map the D&D universe onto the hospital because I feel like the hospital is kind of a magical place.
Kaid van Kampen
I actually was recently on my psychiatry rotation, which is kind of closed off from like the rest of the wards like where I was, and it felt like a completely different place than the rest of the hospital. And I was like, Oh, my goodness, I'm just visiting this town for a few weeks,” because everyone has their established routines, and everyone has their established roles. And it was whoa, like, these are all completely different people who I have not begun to get to know because it was like the beginning of my psychiatry rotation. And they all have these well documented stories, they're all here. And I get assigned to X number of patients, and I get to know those people. But there's also these other people who they interact with from day-to-day. So it was very interesting. I think, specifically on the psychiatry ward because patients interact with each other, I would say more on the psychiatry ward than other wards because people are encouraged to walk around. So we were walking around and some of our rounds were with other patients, like it was in the hallway, like we were having conversations in the hallway, which felt very different from where you like, go around to each room, and everyone's asleep. Because it's 5am in the morning, that felt a little less magical to be honest. I was trying to figure out what their deal was when I met them as in how they got there, how they're feeling like how their progress has been going, and then what my role was in their care team.
Emily Silverman
And so how do you think about this idea of role playing in the hospital?
Kaid van Kampen
I think there's multiple facets to this. One facet I think as a medical student, as I said in my story, I feel like I'm roleplaying as a doctor a lot of the time because I'm stuck in this world where I have responsibility, but I'm also still learning. So there's one facet of like, what am I allowed to do? What should I be doing to impress my attendings? So there's the tension, I think about not really sure where I lie in terms of medical professionals in the hospital. But then there's also role playing in terms of the fact that every encounter is a narrative encounter in medicine. So the idea that when you talk to a patient, you have to investigate why they're there. So their differential diagnosis, like that's my investigation check. But then there's also the perception check of how mentally able are they able to tell me a good story, or to have factual information that will help me? We're both rolling checks on each other because the patient also is rolling perception on me. Is this a trustworthy person? Should I open up to them, which I think is another part of why Dungeons and Dragons is collaborative, but medicine is also collaborative, because your patient perceives you as much as you perceive them. And then there's the idea of role playing, as in everything's always changing. Well, I think it depends on your specialty. But in the emergency room, and in my story, I talk about how things are changing, and you suddenly have to adapt on the spot. Or, eventually, I want to be a surgeon, you have to adapt on the spot and surgeries when there's intraoperative complications or things and the cases aren't going as you want, or you don't have the tools that you want. So you have to figure out how do I get around this and what's the solution to the problem? Simply being at the hospital, doing your job often takes a lot of improvisation, and figuring things out as you go.
Emily Silverman
So what kind of checks are there? There's an investigation check, which it sounds like is about collecting data and that very concrete type of knowledge. There's a perception check where you're trying to ascertain the environment. There's a charisma check. How many are there and how do you think about these different checks?
Kaid van Kampen
There's a lot of them. They all map to one of the five core skills so there's intelligence, strength, courage as well. Wisdom, dexterity, some of the specific skills are less relevant in the hospitals, so acrobatics, I don't know how often you would say You're doing acrobatics in the hospital, but acrobatics max to dexterity, which is something that's key for surgeons, for example. So I guess surgeons would have a high dexterity, whereas psychiatry, from my understanding, they're all about trying to figure out what's the patient's motives? Like, what do they want? Who is this person and like really like getting a in depth picture of the person? So I would say there are people who have high perception, or at least they tried to have high perception, and that maps to wisdom, I'm pretty sure. So they'd probably like be high hiring wisdom in relative to the other statistics. Yeah, I think you can map the skills to different types of specialties. And you need a different set of skills for every different type of specialty. But then there's also variation. Within each class. People have people who are good at D&D max out the stats that their class is good at. But people who like me, like when I first started, I just picked my Rogue based on what I wanted. And he wasn't really the greatest rogue, but he was still a rogue. So it doesn't necessarily mean that you have to be good at your skill sets to be your class if you're still that class.
Emily Silverman
So how do you think about yourself, Katie, like in the hospital? You've chosen to go into orthopedic surgery? What kind of orthopedic surgeon are you? You know, like, what kind of rogue are you? Why did you choose that category? And how do you think about your character?
Kaid van Kampen
I was drawn to surgery to begin with, because I really liked technical skills. So I played piano, I did martial arts, I really enjoy the process of actually learning a skill and becoming good at it. And the process from like, seeing yourself go from, I can't even punch to being able to have a black belt, I really enjoy the process of learning those skills and getting better. And there's usually always someone who's better than you that you can learn from. And there's always another step that you can get better at. Once I figured out that I wanted to do surgery and not medicine, which is like the greatest rift in medical specialties. Apparently, even though lots of people parallel plan with a non surgical specialty and a surgical specialty, it was all about trying to figure out what type of surgery I wanted to do. I was pretty convinced I wanted to do general surgery for a solid four months. And then I was pretty convinced I wanted to do urology for two months. But I ended up choosing orthopedic surgery, because I found it really interesting. Like I just genuinely found all the steps for making decisions in orthopedic surgery, really interesting. And I personally really like learning about the different tools that you can use and the different sets. And one thing that stood out to me about orthopedic surgery, and how it kind of relates to my character and like my other my Non Medical Life is it's actually very creative. Because every fracture breaks differently. And so you have like your basic trauma principles, and oftentimes you follow it, but sometimes you don't follow it. And sometimes you need to have a plan A, B, or C. So I was recently in a surgery, and it was a posterior hip dislocation and the acetabulum was fractured. So it's a pretty complex pelvic case. And we were trying to reduce the hip back into place. And it was taking a very long time. And the surgeon was like, Okay, if this doesn't work, we're gonna have to go to plan C, I guess. And the resident was like, oh, what's, what's Plan C? And the surgeon said, I don't know, I'm just gonna make it up as we go. So I really like orthopedic surgery, because it's very creative. I think specifically trauma, surgery, and orthopedic surgery. So breaking bones, which is their bread and butter. I think that's super cool. Because cases have patterns. And there's patterns enough that we could classify things. But then there's also surgeon preference. And there's also the ability to break principles sometimes if you think that's the right choice.
Emily Silverman
I want to go back to this idea of the dice roll real quick. In the dungeons and dragons portion of your story, you are the Dungeon Master, so you're not the player, and you're not the princess or the knight. You're the one behind the scenes, kind of like writing the story or pulling the strings. And yes, it's collaborative, and yes, your players can surprise you, but you're the one kind of driving the narrative. We talked a little bit about this leading up to your story, like can that situation be mapped perfectly onto the hospital scenario? Let's say you do have a surgeon-patient interaction. Is the surgeon the Dungeon Master? Is the patient the player who is rolling the dice? Isn't God-like, you know, can you map that onto the hospital perfectly? Or is it more just a general sense of that tension between predictable and unpredictable?
Kaid van Kampen
I don't think it perfectly maps. I don't know who would be a dungeon master in the hospital. I mean, they call it the dungeon master God in D&D. So I guess if you believe in some type of higher power, then that's the closest analogy you can get. It's like some type of higher power ruling some form of dice, which begs the question of freewill and randomness, a philosophical conversation. But I don't think it can be mapped perfectly. I think it's just that the skill sets of a dungeon master translate quite well to medicine because you have to adapt to new situations. It's difficult to fit people nicely into a role-playing template.
Emily Silverman
When you told the story on stage in Chicago, there was this one sentence that kind of tumbled out, and I don't think you've ever said it before in any of our rehearsals: “Sometimes you prepare for things that never happen.” That line felt significant for you. Why?
Kaid van Kampen
I think it was significant because I told you, "Oh, that's what I've been trying to say this entire story." And I think that just goes to show that you can plan as much as you want, but things are going to go differently than how you planned. And the key to being good, in my opinion, at life or Dungeons and Dragons in the hospital is being adaptable and being able to pivot. Knowing that even if plans change, you can be flexible and make up a new plan. And if that plan changes, that's okay. I think being comfortable in that uncertainty is important to me.
Emily Silverman
A lot of people take themselves really seriously, and they take life really seriously. And I'm probably guilty of taking myself and my life too seriously at times. There's something about walking into the hospital and looking around, where it feels like a magical land with different villages and towns. You have the psych ward, the AOR, and the radiology area, all with their unique characters and roles. And then you have all these encounters, where some go well and some are a miss. There's a playfulness to that perspective, a lightness, and almost a gamification of it. I feel like this perspective makes the hospital more fun and less scary and intimidating. Seeing the hospital or life through the eyes of a dungeon master, somebody who's just kind of writing the story on the fly, does something for me.
Kaid van Kampen
I think it adds a sense of depth to everything. There's this word in German, and I can't remember the word. It basically is defined as the sense that everyone's story is just as complex as your own. And I feel that when I walk into the hospital with this lens of a dungeon master, because every encounter is a part of someone's story, and how my encounter impacts them is important. It just allows you to grasp a sense of empathy, humanity, and collaborative narration in a way that viewing things as patient encounters and thinking 'Oh, you have x, now I need to do XYZ' does not. Viewing it as more algorithmic takes away the empathy and the privilege it is to be a doctor and see these people and get to impact their stories or try to guide them towards what I think would be a good resolution of their problem or that narrative arc. But then remembering that these people come with their entire world, stepping out of it to come into mine, it's very narrative, which is something that I've always been interested in with Narrative Medicine. But just journaling about medicine didn't really resonate with me. For me, it took on more of a viewing everything as a narrative and seeing medicine as an opportunity to be part of these narratives, which I think is a privilege. I really like being a dungeon master, because it reminds me that being a medical professional is a privilege, and I get to be part of people's narratives in some form, hopefully in a positive way.
Emily Silverman
Yeah, I think you just put it so beautifully. If you look at it as algorithmic, there's a deadness to that. It reduces everything to almost like a metal mechanical interaction. But the way that you frame it, not as an algorithm, but as a collaborative story that's actively unfolding, there's an aliveness to that that I think is so missing in medicine right now, like this sense of magic and enchantment. And I think that's one of the reasons why I responded to your email right away. It just really struck a chord in me. I was really hungering for your story. So I'm so glad that we were able to develop it a little bit together, both for the stage and in the studio. And in this interview, is there anything that you would like to leave our audience with, maybe some advice?
Kaid van Kampen
No, I don't think I've run out of my wisdom points for the day. Definitely play Dungeons and Dragons at least once in your life if you haven't already.
Emily Silverman
Perfect. Thank you, Katie.
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman.
In today’s episode, medical student Katie van Kampen brings us into the magical world of Dungeons & Dragons (otherwise known as D&D). When Katie’s not in the hospital, they’re often playing the role of Dungeon Master, guiding their players through different adventures and scenarios and obstacles, and as you’ll hear in the story, the deeper they get into the game, the more parallels they find with their work as a physician-in-training.
Katie is a student at McMaster University in Canada, a writer, an avid theater goer, and will be heading to the University of British Columbia for their residency in orthopedic surgery. Katie initially told their story on stage at the Women in Medicine Summit in Chicago in September of 2022, but this version was actually recorded in the studio, which makes for an extra intimate and immersive listening experience which we hope you’ll enjoy.
After the story, Katie and I chat about the ins and outs of D&D, how to build one’s “character” as a physician, and the perks of seeing the hospital as a magical land of narrative encounters.
But before we get there, here is Katie’s story.
Kaid van Kampen
You're walking through the forest. It's dark. There's a gentle breeze through your hair. You look around at your friends, your companions, the people you trained with to become a knight. Standing at the center of the box formation you have going on, is a princess. Tall, pretty. The only thing she said so far is she doubts whether or not you can protect her, and honestly, she has a point. This is your first mission, and no one knows what happens when you walk through the woods. You keep going though, putting one foot in front of the other; the leaves crunching against your boot. You just need to make it to the other side, and that's it. First mission complete.
My name is Katie van Kampen. I'm a third year medical student at McMaster University in Canada. I'm also a Dungeon Master for a little tabletop role-playing game, known as Dungeons and Dragons, enjoyed by millions of nerds, like myself, worldwide. Dungeons and Dragons is a collaborative story-based game, in which I, the Dungeon Master, create a world of adventure for my players to explore. It's collaborative because sometimes I put beasts in front of my players, and instead of fighting them, they decide to befriend them. Now, when I'm not spending my time thinking of dragons and castles, I like to spend the rest of my time in the hospital, role-playing as a doctor.
I'm dodging nurses pushing the blood pressure machines; moving out of the way of doctors looking down at their notes. I'm heading to the trauma bay. I pull on my yellow gown; put on my N95 that always seems to smell like pickles. We're waiting for a 26-year-old woman, found on the side of the road. No one knows what happened to her. Soon the stretcher is coming down the hall, and enters the bay. Bouncing off the doors, bouncing off the podium, until finally, the patient lands in the center of the room on the stretcher, fluorescent lights beaming down on her. I'm in the corner, holding the warm blankets - my only contribution.
The primary survey team swarms the patient, all trying to do their part. The anesthesiologist goes to place a stethoscope to her chest. She moves away. "I don't understand. Why... Why am I here? What happened?" The team attempts to console her, to calm her down. But she continues to be uncooperative. The Trauma team leader stands at the back of the trauma bay, behind the yellow line, directing the orchestra. They take a step forward, and the rest of the team backs off. They approach the patient, warmth in their eyes, and they place a hand on the patient's shoulder. "It's okay. You're safe. We just want to help you." The patient meets their eyes. "Can you let my team do their tests?" The anesthesiologist places a stethoscope to her chest.
The forest has been uneventful so far. The elf has drank five cans of cider, and continues to be distracted by the colorful mushrooms on the side of the road, being told multiple times that, "No, they can not eat them." You come across the glade on your route. Roll a Perception Check. My players groan and mumble, and begrudgingly pull out their dice. They know that when I ask them to roll a Perception Check, that something is about to happen.
The dice clatters on the table. Ah. So, the Dragonborn has rolled an eighteen. The Gecko's rolled a six, and the Elf has rolled a three. You see, the Wizard is too busy feeding their pet Gecko, and the Elf is too busy sniffing a mushroom, to notice that out of the trees is coming a dark blur heading towards the Princess. The beast's jaws are outstretched; claws are ready to bite into the Princess' shoulder. The Dragonborn steps in front of the beast, holding up their sword, blocking the blow. They roll to attack. A twenty; a critical success. And, with one fluid movement, they lop the head of the beast off, and it rolls to the foot of the Princess, who is looking aghast. A Dragonborn wipes their blade on their leg and leans on their greatsword. So, you doubt her skills now, Princess? And you realize that this trip to the forest might not be that bad after all.
It's late. I'm trying to keep my eyes open, as I finish up notes. A nurse walks into the room. "Doctor, one of the patients isn't getting the tests that they need. Can you please come talk to them?" My attending huffs, and gestures for me to follow them. I find myself back in the trauma bay, seeing the 26-year-old woman found on the side of the road. She's clutching her broken clavicle. The attending stands at the foot of the bed. "So, I hear you don't want to get these tests." "Listen, doctor. I'm really tired. I don't want to have any more tests." "I understand it's been a long day. But these tests are really important for your care." "Sure thing, Doc. But I feel like you can use the tests that I already had." "Listen, we really need you to have these tests." "I just want to go home."
The patient struggles to understand why these tests are important to her care, and the attending is too exhausted to explain clearly. I watch as they both struggle, becoming increasingly frustrated at not being heard, until, finally, the attending snaps. "How are we supposed to help you? You're wasting everybody's time." The emergency room is quiet. The patient is still clutching her broken clavicle, eyes wide at being spoken to like that. And then she leaves, against medical advice. And my attending storms off. I am left standing there, wondering what could have been done differently.
You've now come to the part of the forest where all the trees collapse in on themselves, creating a dark halo of vegetation. The only light is the Elf's torch. Roll a Perception Check. My players roll well, a 12, a 14, a 16. Another 12. You hear rustling off to the side, and the party quickly forms a protective circle around the Princess. You hear footsteps, and the trees begin to shake. You clutch the hilt of your weapon, palms sweaty. An assassin jumps out of the forest, pointing a silver dagger at the Princess' throat. "Step aside. It's her I want."
The Dragonborn looks at me, from across the table. "Dungeon Master, what does the assassin look like?" I look down at my notes. Hmm. I thought they would just kill the assassin, I didn't plan what the assassin looked like in detail. "Um, the assassin is wearing dark clothing, with a cloak slung over one shoulder." "No, Dungeon Master, is the assassin hot?" Um... I look down at my notes again. "No, I do not have notes about that either." "Oh, OK." "The assassin has a strong jawbone, with high cheekbones, and bright blue eyes that reflect the light of the torch." "Alright," I said, "Deuce the assassin." The Dragonborn rolls, a natural 20, a critical success, and the table is going wild.
Standing chest to chest with the assassin, the Dragonborn looks them up and down. "So, you come around here often?" And, the assassin falls head over heels in love with the scaly beast before them. And the party is led safely out of the forest, avoiding all the traps, all the beasts, and all the survival checks I had planned for them. When I look back at my notes, the ones I didn't use, I chuckle to myself. Sometimes, you prepare for things that never happen, and that's just part of playing the game.
I'm back in the trauma bay, on my Surgical rotation. We're waiting for a 56-year-old man, involved in a motor vehicle accident. Soon enough, the stretcher is coming down the hall, and the patient lands in the middle of the trauma bay, fluorescent lights beaming down on him. I cast the Message Spell. My resident will be here soon; they're just finishing something up on the ward. The patient is swarmed by the primary survey team, and I look at the spot where the resident should stand. Now, I've done the primary survey before. I've stood in that spot, but I haven't done it without the resident nearby. I could jump in, but I'm scared. What if I mess up? I step forward. I roll an Investigation Check. "Sir, does anything hurt?" "Everything hurts." The patient clutches their stomach. I feel their abdomen, looking at their legs for any deformities. And, when it's my turn to present in the primary survey, everybody is looking at me. I roll a Charisma Check. I must feel pretty bad, because when I start talking, my voice begins to crack. "The patient's abdomen is soft and non-distended." I struggle through the rest of my lines. Finally, the resident comes. They roll their own Investigation Check. They discover that the patient has some tenderness along their left shin. And, sure enough, after being X-rayed, they find a non-displaced fracture of the tibia. I go home that night, feeling pretty bad about myself for missing that. But then I realize that I'm just a level three Rogue, and my resident is a level ten Dragonborn Paladin. And one day, I'm going to level up, too.
Emily Silverman
I am sitting here with medical student Katie van Kampen. So Katie, we met several months ago when I got an email from you out of the blue, and you said, "Hi, my name is Katie, and I love Dungeons and Dragons, and I want to tell a story about it." So, tell me a little bit about your decision to send that email, and how you even found out about The Nocturnists.
Kaid van Kampen
One day I sat down, after a very trying day on Internal Medicine, and I wrote my story, and I sent it to one of my mentors. He really liked it, and we were talking about where we should send it. And one of the things he mentioned was The Nocturnists, so I found the "Contact Us" form on your website, and I wrote my little message. And, what's actually funny is, your response went to my spam mail.
Emily Silverman
So you found my response, and then a few months later, you were standing on a stage in Chicago, telling the story. And, not just telling a story, but I told you to burn up and tear up your written story, and made you start from scratch. So, what was that like?
Kaid van Kampen
Really scary, because I was so focused on writing the words perfectly, and making sure that every sentence fit. So, I found it very stressful to suddenly just have to start talking, and know what I'm going to say, and know where I was going. But, I think that was the best part of the process, and I learned a lot from that. It kind of was interesting looking back on that, because I was really scared about dropping the script. But my entire story is about adapting and improvising. So, even I was struggling with doing what I was saying in my own story. And I don't think it was until I also dropped the script, that I was able to tell the story better. And it really expanded, and it was more flexible and things could change on the spot. I think it was a lot more rewarding, and better at the end because of it.
Emily Silverman
And, just for the audience, I get a lot of messages from people, with essays that they've written. And I often explained to people about the difference between the art of the written word and the art of the spoken word. And Katie, your essay was an example of something that I thought really had a lot of potential to be adapted to the stage. So, I definitely was excited to hear more about Dungeons and Dragons. I think part of the reason why I was so attracted to your story is because, during COVID, my husband, who is one of four siblings, invited all of his siblings, and all of their significant others, to play Dungeons and Dragons virtually on Zoom, as, like, sort of a COVID pandemic activity. And, so I played my first Dungeons and Dragons game. And had I not done that, I don't think I would have known what D & D is. And so, for those in the audience who don't really know what it is or how it works, you get into it a little bit in your story, but maybe you can just lay it out for people. Like, what is D & D? What is it like to play?
Kaid van Kampen
So, Dungeons and Dragons is a tabletop role-playing game, that really popped off in the 80s. There's five editions, and each time they make a new book, there's different rules, and there's different characters or races or classes you can play as. But, essentially, it's a collaborative role-playing game, where there's a Dungeon Master, which is myself, and I create a story for people to play through. And then there's the players, who come with their own characters. So, they make their own characters with their backstory. And then, I like to drop people in a tavern usually, and then they talk to villagers in the town, and eventually get sent on some sort of quest. And then they go off and fulfill their quest, and often, I'll write for how I think they're going to explore the world. And oftentimes, they don't do what I want them to do, which I think is very fun. How they get there is different than how I expected.
Emily Silverman
Yeah, so I remember there was an app or some piece of software that I had to log into before even starting the game, and I had to design my character. And that alone was really fun. And I think I was an lol for a bard or something. And I get to pick all of my strengths and weaknesses. And you know, was I going to be physically strong? Or was I going to have magical powers? Or was I going to be fast? Or was I going to be a mind reader or all of those different choices, and all of that work went in upfront before we even begin the game. And then our dungeon master who is this amazing, very enthusiastic, bearded guy, he also dropped us in a tavern. And I remember it was like a dark, stormy night, and we were all sitting at the bar. And the story began with goblins invading the village. And we all had to figure out what to do about the goblins. So yeah, you mentioned that you have a story in mind, but that are often changes. So as a dungeon master, how do you navigate that tension between scripts, and improv?
Kaid van Kampen
I have a background in theater. So I did improv in, in university. So I don't find it too difficult to make things up when I'm describing new locations, but in the end, a dungeon master just wants their players to have a really good time and to enjoy the game, right. So even if I think that they should go fight a giant, if they don't want to fight the giant, that's okay, if they want to go deal with how for the giant has sibling issues and go find the sibling and decide to convince the sibling to come back to the angry giant. And then the giant stops being angry and trying to terrorize the countryside, they've still resolved the plot, they've just resolved it in a different way than I expected. A lot of the times, I think it's really fun and satisfying when they take a completely different route than what I thought because I have to adapt things on the fly or I have to make things up. But then they feel satisfied because they circumvented what I thought they were going to do or they thought of a creative solution that panned out. And I think, or I hope that players get satisfaction from their ideas actually working in the world.
Emily Silverman
So how does that work that switching off between the Dungeon Master and the players? Like, at what point? Are you just narrating and kind of writing? And at what point are you pausing and taking in input from the players? And how does that all work? And then how does that toggle back and forth?
Kaid van Kampen
Yeah, so usually you start off narrating the location. So you drop your characters into a tavern. It's a dark and stormy night, and you tell the players who the bartender is. And then you say, okay, like do you want to order something to drink. And then they kind of take it from there. A tavern is a good example, because there's a lot of things you can do in the tavern. So players sometimes choose to just go get a drink and sit down. Other players want to look around and see who looks a little suspicious. Other people want to eavesdrop on conversations, often I put in conversations that they will listen to, which usually lead to a quest. For example, in one of my games, they were in a tavern. And they heard of a group of theater actors who are looking for their missing actor, and they don't know where they went. And the players essentially ended up saying that they would find that actor and that led them on their quest for that session. And so when they're in this tavern, and they choose to do things, going up to the bar and asking for a drink that doesn't require a dice roll, they can just say, hey, bartender, I'd like to get your finest mug of ale, and then the bartender will probably give it to them if they're a good bartender. But sometimes they're like, one gold piece for one Ale, that's too much money. So sometimes they'll be like, I want to persuade the bartender to give it to me at a discount. So then they'd roll a dice to determine if they're persuasive enough to do that. Or if they're listening to a conversation, that they would roll a perception check to see how well they can hear those conversations.
Emily Silverman
What's the difference between something like just asking for a drink, and something like wanting to bargain for the drink? Like, what is it exactly that makes your brain know that now it's time to roll the dice?
Kaid van Kampen
Because the dice basically acts as a equalizer between what could happen and what will happen. So if you're trying to persuade the bartender, and I've decided that, you know, this bartenders, pretty nice, dude. They're generous. So I would say, Okay, in order to persuade this bartender, that your character can have a drink at a discounted price, I'd ask them to roll a persuasion check. And if it is above, for example, a 10, you have successfully convinced the bartender to have a cheaper drink. But if they rolled a 20, which is quite high, or something around there, I say, not only is this bartender going to give you a free drink, they're also going to buy around for your entire table, because they liked you so much. So that's kind of how the dice changes how the game pans out.
Emily Silverman
As we were preparing for you to tell your story in Chicago, you and me and Molly, Molly for the audience is our amazing Head of Story Development. We were planning to toggle between the gameplay, so the knight in the forest protecting the princess, and then in the hospital. So we have the medical student and the attending, and the young, woman patient. And we were trying to draw parallels between the two environments. And so I'm wondering, as you're moving through the hospital as a medical student, with this background, and being a dungeon master, what do you see? Do you look around and you're like, those are the surgeons and those are the ID Docs. Those are the psychiatrists. And they're, sort of like, those are the elves. Those are the goblins. Those are the you know, do you think about it like that? And how do you map the D&D universe onto the hospital because I feel like the hospital is kind of a magical place.
Kaid van Kampen
I actually was recently on my psychiatry rotation, which is kind of closed off from like the rest of the wards like where I was, and it felt like a completely different place than the rest of the hospital. And I was like, Oh, my goodness, I'm just visiting this town for a few weeks,” because everyone has their established routines, and everyone has their established roles. And it was whoa, like, these are all completely different people who I have not begun to get to know because it was like the beginning of my psychiatry rotation. And they all have these well documented stories, they're all here. And I get assigned to X number of patients, and I get to know those people. But there's also these other people who they interact with from day-to-day. So it was very interesting. I think, specifically on the psychiatry ward because patients interact with each other, I would say more on the psychiatry ward than other wards because people are encouraged to walk around. So we were walking around and some of our rounds were with other patients, like it was in the hallway, like we were having conversations in the hallway, which felt very different from where you like, go around to each room, and everyone's asleep. Because it's 5am in the morning, that felt a little less magical to be honest. I was trying to figure out what their deal was when I met them as in how they got there, how they're feeling like how their progress has been going, and then what my role was in their care team.
Emily Silverman
And so how do you think about this idea of role playing in the hospital?
Kaid van Kampen
I think there's multiple facets to this. One facet I think as a medical student, as I said in my story, I feel like I'm roleplaying as a doctor a lot of the time because I'm stuck in this world where I have responsibility, but I'm also still learning. So there's one facet of like, what am I allowed to do? What should I be doing to impress my attendings? So there's the tension, I think about not really sure where I lie in terms of medical professionals in the hospital. But then there's also role playing in terms of the fact that every encounter is a narrative encounter in medicine. So the idea that when you talk to a patient, you have to investigate why they're there. So their differential diagnosis, like that's my investigation check. But then there's also the perception check of how mentally able are they able to tell me a good story, or to have factual information that will help me? We're both rolling checks on each other because the patient also is rolling perception on me. Is this a trustworthy person? Should I open up to them, which I think is another part of why Dungeons and Dragons is collaborative, but medicine is also collaborative, because your patient perceives you as much as you perceive them. And then there's the idea of role playing, as in everything's always changing. Well, I think it depends on your specialty. But in the emergency room, and in my story, I talk about how things are changing, and you suddenly have to adapt on the spot. Or, eventually, I want to be a surgeon, you have to adapt on the spot and surgeries when there's intraoperative complications or things and the cases aren't going as you want, or you don't have the tools that you want. So you have to figure out how do I get around this and what's the solution to the problem? Simply being at the hospital, doing your job often takes a lot of improvisation, and figuring things out as you go.
Emily Silverman
So what kind of checks are there? There's an investigation check, which it sounds like is about collecting data and that very concrete type of knowledge. There's a perception check where you're trying to ascertain the environment. There's a charisma check. How many are there and how do you think about these different checks?
Kaid van Kampen
There's a lot of them. They all map to one of the five core skills so there's intelligence, strength, courage as well. Wisdom, dexterity, some of the specific skills are less relevant in the hospitals, so acrobatics, I don't know how often you would say You're doing acrobatics in the hospital, but acrobatics max to dexterity, which is something that's key for surgeons, for example. So I guess surgeons would have a high dexterity, whereas psychiatry, from my understanding, they're all about trying to figure out what's the patient's motives? Like, what do they want? Who is this person and like really like getting a in depth picture of the person? So I would say there are people who have high perception, or at least they tried to have high perception, and that maps to wisdom, I'm pretty sure. So they'd probably like be high hiring wisdom in relative to the other statistics. Yeah, I think you can map the skills to different types of specialties. And you need a different set of skills for every different type of specialty. But then there's also variation. Within each class. People have people who are good at D&D max out the stats that their class is good at. But people who like me, like when I first started, I just picked my Rogue based on what I wanted. And he wasn't really the greatest rogue, but he was still a rogue. So it doesn't necessarily mean that you have to be good at your skill sets to be your class if you're still that class.
Emily Silverman
So how do you think about yourself, Katie, like in the hospital? You've chosen to go into orthopedic surgery? What kind of orthopedic surgeon are you? You know, like, what kind of rogue are you? Why did you choose that category? And how do you think about your character?
Kaid van Kampen
I was drawn to surgery to begin with, because I really liked technical skills. So I played piano, I did martial arts, I really enjoy the process of actually learning a skill and becoming good at it. And the process from like, seeing yourself go from, I can't even punch to being able to have a black belt, I really enjoy the process of learning those skills and getting better. And there's usually always someone who's better than you that you can learn from. And there's always another step that you can get better at. Once I figured out that I wanted to do surgery and not medicine, which is like the greatest rift in medical specialties. Apparently, even though lots of people parallel plan with a non surgical specialty and a surgical specialty, it was all about trying to figure out what type of surgery I wanted to do. I was pretty convinced I wanted to do general surgery for a solid four months. And then I was pretty convinced I wanted to do urology for two months. But I ended up choosing orthopedic surgery, because I found it really interesting. Like I just genuinely found all the steps for making decisions in orthopedic surgery, really interesting. And I personally really like learning about the different tools that you can use and the different sets. And one thing that stood out to me about orthopedic surgery, and how it kind of relates to my character and like my other my Non Medical Life is it's actually very creative. Because every fracture breaks differently. And so you have like your basic trauma principles, and oftentimes you follow it, but sometimes you don't follow it. And sometimes you need to have a plan A, B, or C. So I was recently in a surgery, and it was a posterior hip dislocation and the acetabulum was fractured. So it's a pretty complex pelvic case. And we were trying to reduce the hip back into place. And it was taking a very long time. And the surgeon was like, Okay, if this doesn't work, we're gonna have to go to plan C, I guess. And the resident was like, oh, what's, what's Plan C? And the surgeon said, I don't know, I'm just gonna make it up as we go. So I really like orthopedic surgery, because it's very creative. I think specifically trauma, surgery, and orthopedic surgery. So breaking bones, which is their bread and butter. I think that's super cool. Because cases have patterns. And there's patterns enough that we could classify things. But then there's also surgeon preference. And there's also the ability to break principles sometimes if you think that's the right choice.
Emily Silverman
I want to go back to this idea of the dice roll real quick. In the dungeons and dragons portion of your story, you are the Dungeon Master, so you're not the player, and you're not the princess or the knight. You're the one behind the scenes, kind of like writing the story or pulling the strings. And yes, it's collaborative, and yes, your players can surprise you, but you're the one kind of driving the narrative. We talked a little bit about this leading up to your story, like can that situation be mapped perfectly onto the hospital scenario? Let's say you do have a surgeon-patient interaction. Is the surgeon the Dungeon Master? Is the patient the player who is rolling the dice? Isn't God-like, you know, can you map that onto the hospital perfectly? Or is it more just a general sense of that tension between predictable and unpredictable?
Kaid van Kampen
I don't think it perfectly maps. I don't know who would be a dungeon master in the hospital. I mean, they call it the dungeon master God in D&D. So I guess if you believe in some type of higher power, then that's the closest analogy you can get. It's like some type of higher power ruling some form of dice, which begs the question of freewill and randomness, a philosophical conversation. But I don't think it can be mapped perfectly. I think it's just that the skill sets of a dungeon master translate quite well to medicine because you have to adapt to new situations. It's difficult to fit people nicely into a role-playing template.
Emily Silverman
When you told the story on stage in Chicago, there was this one sentence that kind of tumbled out, and I don't think you've ever said it before in any of our rehearsals: “Sometimes you prepare for things that never happen.” That line felt significant for you. Why?
Kaid van Kampen
I think it was significant because I told you, "Oh, that's what I've been trying to say this entire story." And I think that just goes to show that you can plan as much as you want, but things are going to go differently than how you planned. And the key to being good, in my opinion, at life or Dungeons and Dragons in the hospital is being adaptable and being able to pivot. Knowing that even if plans change, you can be flexible and make up a new plan. And if that plan changes, that's okay. I think being comfortable in that uncertainty is important to me.
Emily Silverman
A lot of people take themselves really seriously, and they take life really seriously. And I'm probably guilty of taking myself and my life too seriously at times. There's something about walking into the hospital and looking around, where it feels like a magical land with different villages and towns. You have the psych ward, the AOR, and the radiology area, all with their unique characters and roles. And then you have all these encounters, where some go well and some are a miss. There's a playfulness to that perspective, a lightness, and almost a gamification of it. I feel like this perspective makes the hospital more fun and less scary and intimidating. Seeing the hospital or life through the eyes of a dungeon master, somebody who's just kind of writing the story on the fly, does something for me.
Kaid van Kampen
I think it adds a sense of depth to everything. There's this word in German, and I can't remember the word. It basically is defined as the sense that everyone's story is just as complex as your own. And I feel that when I walk into the hospital with this lens of a dungeon master, because every encounter is a part of someone's story, and how my encounter impacts them is important. It just allows you to grasp a sense of empathy, humanity, and collaborative narration in a way that viewing things as patient encounters and thinking 'Oh, you have x, now I need to do XYZ' does not. Viewing it as more algorithmic takes away the empathy and the privilege it is to be a doctor and see these people and get to impact their stories or try to guide them towards what I think would be a good resolution of their problem or that narrative arc. But then remembering that these people come with their entire world, stepping out of it to come into mine, it's very narrative, which is something that I've always been interested in with Narrative Medicine. But just journaling about medicine didn't really resonate with me. For me, it took on more of a viewing everything as a narrative and seeing medicine as an opportunity to be part of these narratives, which I think is a privilege. I really like being a dungeon master, because it reminds me that being a medical professional is a privilege, and I get to be part of people's narratives in some form, hopefully in a positive way.
Emily Silverman
Yeah, I think you just put it so beautifully. If you look at it as algorithmic, there's a deadness to that. It reduces everything to almost like a metal mechanical interaction. But the way that you frame it, not as an algorithm, but as a collaborative story that's actively unfolding, there's an aliveness to that that I think is so missing in medicine right now, like this sense of magic and enchantment. And I think that's one of the reasons why I responded to your email right away. It just really struck a chord in me. I was really hungering for your story. So I'm so glad that we were able to develop it a little bit together, both for the stage and in the studio. And in this interview, is there anything that you would like to leave our audience with, maybe some advice?
Kaid van Kampen
No, I don't think I've run out of my wisdom points for the day. Definitely play Dungeons and Dragons at least once in your life if you haven't already.
Emily Silverman
Perfect. Thank you, Katie.
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman.
In today’s episode, medical student Katie van Kampen brings us into the magical world of Dungeons & Dragons (otherwise known as D&D). When Katie’s not in the hospital, they’re often playing the role of Dungeon Master, guiding their players through different adventures and scenarios and obstacles, and as you’ll hear in the story, the deeper they get into the game, the more parallels they find with their work as a physician-in-training.
Katie is a student at McMaster University in Canada, a writer, an avid theater goer, and will be heading to the University of British Columbia for their residency in orthopedic surgery. Katie initially told their story on stage at the Women in Medicine Summit in Chicago in September of 2022, but this version was actually recorded in the studio, which makes for an extra intimate and immersive listening experience which we hope you’ll enjoy.
After the story, Katie and I chat about the ins and outs of D&D, how to build one’s “character” as a physician, and the perks of seeing the hospital as a magical land of narrative encounters.
But before we get there, here is Katie’s story.
Kaid van Kampen
You're walking through the forest. It's dark. There's a gentle breeze through your hair. You look around at your friends, your companions, the people you trained with to become a knight. Standing at the center of the box formation you have going on, is a princess. Tall, pretty. The only thing she said so far is she doubts whether or not you can protect her, and honestly, she has a point. This is your first mission, and no one knows what happens when you walk through the woods. You keep going though, putting one foot in front of the other; the leaves crunching against your boot. You just need to make it to the other side, and that's it. First mission complete.
My name is Katie van Kampen. I'm a third year medical student at McMaster University in Canada. I'm also a Dungeon Master for a little tabletop role-playing game, known as Dungeons and Dragons, enjoyed by millions of nerds, like myself, worldwide. Dungeons and Dragons is a collaborative story-based game, in which I, the Dungeon Master, create a world of adventure for my players to explore. It's collaborative because sometimes I put beasts in front of my players, and instead of fighting them, they decide to befriend them. Now, when I'm not spending my time thinking of dragons and castles, I like to spend the rest of my time in the hospital, role-playing as a doctor.
I'm dodging nurses pushing the blood pressure machines; moving out of the way of doctors looking down at their notes. I'm heading to the trauma bay. I pull on my yellow gown; put on my N95 that always seems to smell like pickles. We're waiting for a 26-year-old woman, found on the side of the road. No one knows what happened to her. Soon the stretcher is coming down the hall, and enters the bay. Bouncing off the doors, bouncing off the podium, until finally, the patient lands in the center of the room on the stretcher, fluorescent lights beaming down on her. I'm in the corner, holding the warm blankets - my only contribution.
The primary survey team swarms the patient, all trying to do their part. The anesthesiologist goes to place a stethoscope to her chest. She moves away. "I don't understand. Why... Why am I here? What happened?" The team attempts to console her, to calm her down. But she continues to be uncooperative. The Trauma team leader stands at the back of the trauma bay, behind the yellow line, directing the orchestra. They take a step forward, and the rest of the team backs off. They approach the patient, warmth in their eyes, and they place a hand on the patient's shoulder. "It's okay. You're safe. We just want to help you." The patient meets their eyes. "Can you let my team do their tests?" The anesthesiologist places a stethoscope to her chest.
The forest has been uneventful so far. The elf has drank five cans of cider, and continues to be distracted by the colorful mushrooms on the side of the road, being told multiple times that, "No, they can not eat them." You come across the glade on your route. Roll a Perception Check. My players groan and mumble, and begrudgingly pull out their dice. They know that when I ask them to roll a Perception Check, that something is about to happen.
The dice clatters on the table. Ah. So, the Dragonborn has rolled an eighteen. The Gecko's rolled a six, and the Elf has rolled a three. You see, the Wizard is too busy feeding their pet Gecko, and the Elf is too busy sniffing a mushroom, to notice that out of the trees is coming a dark blur heading towards the Princess. The beast's jaws are outstretched; claws are ready to bite into the Princess' shoulder. The Dragonborn steps in front of the beast, holding up their sword, blocking the blow. They roll to attack. A twenty; a critical success. And, with one fluid movement, they lop the head of the beast off, and it rolls to the foot of the Princess, who is looking aghast. A Dragonborn wipes their blade on their leg and leans on their greatsword. So, you doubt her skills now, Princess? And you realize that this trip to the forest might not be that bad after all.
It's late. I'm trying to keep my eyes open, as I finish up notes. A nurse walks into the room. "Doctor, one of the patients isn't getting the tests that they need. Can you please come talk to them?" My attending huffs, and gestures for me to follow them. I find myself back in the trauma bay, seeing the 26-year-old woman found on the side of the road. She's clutching her broken clavicle. The attending stands at the foot of the bed. "So, I hear you don't want to get these tests." "Listen, doctor. I'm really tired. I don't want to have any more tests." "I understand it's been a long day. But these tests are really important for your care." "Sure thing, Doc. But I feel like you can use the tests that I already had." "Listen, we really need you to have these tests." "I just want to go home."
The patient struggles to understand why these tests are important to her care, and the attending is too exhausted to explain clearly. I watch as they both struggle, becoming increasingly frustrated at not being heard, until, finally, the attending snaps. "How are we supposed to help you? You're wasting everybody's time." The emergency room is quiet. The patient is still clutching her broken clavicle, eyes wide at being spoken to like that. And then she leaves, against medical advice. And my attending storms off. I am left standing there, wondering what could have been done differently.
You've now come to the part of the forest where all the trees collapse in on themselves, creating a dark halo of vegetation. The only light is the Elf's torch. Roll a Perception Check. My players roll well, a 12, a 14, a 16. Another 12. You hear rustling off to the side, and the party quickly forms a protective circle around the Princess. You hear footsteps, and the trees begin to shake. You clutch the hilt of your weapon, palms sweaty. An assassin jumps out of the forest, pointing a silver dagger at the Princess' throat. "Step aside. It's her I want."
The Dragonborn looks at me, from across the table. "Dungeon Master, what does the assassin look like?" I look down at my notes. Hmm. I thought they would just kill the assassin, I didn't plan what the assassin looked like in detail. "Um, the assassin is wearing dark clothing, with a cloak slung over one shoulder." "No, Dungeon Master, is the assassin hot?" Um... I look down at my notes again. "No, I do not have notes about that either." "Oh, OK." "The assassin has a strong jawbone, with high cheekbones, and bright blue eyes that reflect the light of the torch." "Alright," I said, "Deuce the assassin." The Dragonborn rolls, a natural 20, a critical success, and the table is going wild.
Standing chest to chest with the assassin, the Dragonborn looks them up and down. "So, you come around here often?" And, the assassin falls head over heels in love with the scaly beast before them. And the party is led safely out of the forest, avoiding all the traps, all the beasts, and all the survival checks I had planned for them. When I look back at my notes, the ones I didn't use, I chuckle to myself. Sometimes, you prepare for things that never happen, and that's just part of playing the game.
I'm back in the trauma bay, on my Surgical rotation. We're waiting for a 56-year-old man, involved in a motor vehicle accident. Soon enough, the stretcher is coming down the hall, and the patient lands in the middle of the trauma bay, fluorescent lights beaming down on him. I cast the Message Spell. My resident will be here soon; they're just finishing something up on the ward. The patient is swarmed by the primary survey team, and I look at the spot where the resident should stand. Now, I've done the primary survey before. I've stood in that spot, but I haven't done it without the resident nearby. I could jump in, but I'm scared. What if I mess up? I step forward. I roll an Investigation Check. "Sir, does anything hurt?" "Everything hurts." The patient clutches their stomach. I feel their abdomen, looking at their legs for any deformities. And, when it's my turn to present in the primary survey, everybody is looking at me. I roll a Charisma Check. I must feel pretty bad, because when I start talking, my voice begins to crack. "The patient's abdomen is soft and non-distended." I struggle through the rest of my lines. Finally, the resident comes. They roll their own Investigation Check. They discover that the patient has some tenderness along their left shin. And, sure enough, after being X-rayed, they find a non-displaced fracture of the tibia. I go home that night, feeling pretty bad about myself for missing that. But then I realize that I'm just a level three Rogue, and my resident is a level ten Dragonborn Paladin. And one day, I'm going to level up, too.
Emily Silverman
I am sitting here with medical student Katie van Kampen. So Katie, we met several months ago when I got an email from you out of the blue, and you said, "Hi, my name is Katie, and I love Dungeons and Dragons, and I want to tell a story about it." So, tell me a little bit about your decision to send that email, and how you even found out about The Nocturnists.
Kaid van Kampen
One day I sat down, after a very trying day on Internal Medicine, and I wrote my story, and I sent it to one of my mentors. He really liked it, and we were talking about where we should send it. And one of the things he mentioned was The Nocturnists, so I found the "Contact Us" form on your website, and I wrote my little message. And, what's actually funny is, your response went to my spam mail.
Emily Silverman
So you found my response, and then a few months later, you were standing on a stage in Chicago, telling the story. And, not just telling a story, but I told you to burn up and tear up your written story, and made you start from scratch. So, what was that like?
Kaid van Kampen
Really scary, because I was so focused on writing the words perfectly, and making sure that every sentence fit. So, I found it very stressful to suddenly just have to start talking, and know what I'm going to say, and know where I was going. But, I think that was the best part of the process, and I learned a lot from that. It kind of was interesting looking back on that, because I was really scared about dropping the script. But my entire story is about adapting and improvising. So, even I was struggling with doing what I was saying in my own story. And I don't think it was until I also dropped the script, that I was able to tell the story better. And it really expanded, and it was more flexible and things could change on the spot. I think it was a lot more rewarding, and better at the end because of it.
Emily Silverman
And, just for the audience, I get a lot of messages from people, with essays that they've written. And I often explained to people about the difference between the art of the written word and the art of the spoken word. And Katie, your essay was an example of something that I thought really had a lot of potential to be adapted to the stage. So, I definitely was excited to hear more about Dungeons and Dragons. I think part of the reason why I was so attracted to your story is because, during COVID, my husband, who is one of four siblings, invited all of his siblings, and all of their significant others, to play Dungeons and Dragons virtually on Zoom, as, like, sort of a COVID pandemic activity. And, so I played my first Dungeons and Dragons game. And had I not done that, I don't think I would have known what D & D is. And so, for those in the audience who don't really know what it is or how it works, you get into it a little bit in your story, but maybe you can just lay it out for people. Like, what is D & D? What is it like to play?
Kaid van Kampen
So, Dungeons and Dragons is a tabletop role-playing game, that really popped off in the 80s. There's five editions, and each time they make a new book, there's different rules, and there's different characters or races or classes you can play as. But, essentially, it's a collaborative role-playing game, where there's a Dungeon Master, which is myself, and I create a story for people to play through. And then there's the players, who come with their own characters. So, they make their own characters with their backstory. And then, I like to drop people in a tavern usually, and then they talk to villagers in the town, and eventually get sent on some sort of quest. And then they go off and fulfill their quest, and often, I'll write for how I think they're going to explore the world. And oftentimes, they don't do what I want them to do, which I think is very fun. How they get there is different than how I expected.
Emily Silverman
Yeah, so I remember there was an app or some piece of software that I had to log into before even starting the game, and I had to design my character. And that alone was really fun. And I think I was an lol for a bard or something. And I get to pick all of my strengths and weaknesses. And you know, was I going to be physically strong? Or was I going to have magical powers? Or was I going to be fast? Or was I going to be a mind reader or all of those different choices, and all of that work went in upfront before we even begin the game. And then our dungeon master who is this amazing, very enthusiastic, bearded guy, he also dropped us in a tavern. And I remember it was like a dark, stormy night, and we were all sitting at the bar. And the story began with goblins invading the village. And we all had to figure out what to do about the goblins. So yeah, you mentioned that you have a story in mind, but that are often changes. So as a dungeon master, how do you navigate that tension between scripts, and improv?
Kaid van Kampen
I have a background in theater. So I did improv in, in university. So I don't find it too difficult to make things up when I'm describing new locations, but in the end, a dungeon master just wants their players to have a really good time and to enjoy the game, right. So even if I think that they should go fight a giant, if they don't want to fight the giant, that's okay, if they want to go deal with how for the giant has sibling issues and go find the sibling and decide to convince the sibling to come back to the angry giant. And then the giant stops being angry and trying to terrorize the countryside, they've still resolved the plot, they've just resolved it in a different way than I expected. A lot of the times, I think it's really fun and satisfying when they take a completely different route than what I thought because I have to adapt things on the fly or I have to make things up. But then they feel satisfied because they circumvented what I thought they were going to do or they thought of a creative solution that panned out. And I think, or I hope that players get satisfaction from their ideas actually working in the world.
Emily Silverman
So how does that work that switching off between the Dungeon Master and the players? Like, at what point? Are you just narrating and kind of writing? And at what point are you pausing and taking in input from the players? And how does that all work? And then how does that toggle back and forth?
Kaid van Kampen
Yeah, so usually you start off narrating the location. So you drop your characters into a tavern. It's a dark and stormy night, and you tell the players who the bartender is. And then you say, okay, like do you want to order something to drink. And then they kind of take it from there. A tavern is a good example, because there's a lot of things you can do in the tavern. So players sometimes choose to just go get a drink and sit down. Other players want to look around and see who looks a little suspicious. Other people want to eavesdrop on conversations, often I put in conversations that they will listen to, which usually lead to a quest. For example, in one of my games, they were in a tavern. And they heard of a group of theater actors who are looking for their missing actor, and they don't know where they went. And the players essentially ended up saying that they would find that actor and that led them on their quest for that session. And so when they're in this tavern, and they choose to do things, going up to the bar and asking for a drink that doesn't require a dice roll, they can just say, hey, bartender, I'd like to get your finest mug of ale, and then the bartender will probably give it to them if they're a good bartender. But sometimes they're like, one gold piece for one Ale, that's too much money. So sometimes they'll be like, I want to persuade the bartender to give it to me at a discount. So then they'd roll a dice to determine if they're persuasive enough to do that. Or if they're listening to a conversation, that they would roll a perception check to see how well they can hear those conversations.
Emily Silverman
What's the difference between something like just asking for a drink, and something like wanting to bargain for the drink? Like, what is it exactly that makes your brain know that now it's time to roll the dice?
Kaid van Kampen
Because the dice basically acts as a equalizer between what could happen and what will happen. So if you're trying to persuade the bartender, and I've decided that, you know, this bartenders, pretty nice, dude. They're generous. So I would say, Okay, in order to persuade this bartender, that your character can have a drink at a discounted price, I'd ask them to roll a persuasion check. And if it is above, for example, a 10, you have successfully convinced the bartender to have a cheaper drink. But if they rolled a 20, which is quite high, or something around there, I say, not only is this bartender going to give you a free drink, they're also going to buy around for your entire table, because they liked you so much. So that's kind of how the dice changes how the game pans out.
Emily Silverman
As we were preparing for you to tell your story in Chicago, you and me and Molly, Molly for the audience is our amazing Head of Story Development. We were planning to toggle between the gameplay, so the knight in the forest protecting the princess, and then in the hospital. So we have the medical student and the attending, and the young, woman patient. And we were trying to draw parallels between the two environments. And so I'm wondering, as you're moving through the hospital as a medical student, with this background, and being a dungeon master, what do you see? Do you look around and you're like, those are the surgeons and those are the ID Docs. Those are the psychiatrists. And they're, sort of like, those are the elves. Those are the goblins. Those are the you know, do you think about it like that? And how do you map the D&D universe onto the hospital because I feel like the hospital is kind of a magical place.
Kaid van Kampen
I actually was recently on my psychiatry rotation, which is kind of closed off from like the rest of the wards like where I was, and it felt like a completely different place than the rest of the hospital. And I was like, Oh, my goodness, I'm just visiting this town for a few weeks,” because everyone has their established routines, and everyone has their established roles. And it was whoa, like, these are all completely different people who I have not begun to get to know because it was like the beginning of my psychiatry rotation. And they all have these well documented stories, they're all here. And I get assigned to X number of patients, and I get to know those people. But there's also these other people who they interact with from day-to-day. So it was very interesting. I think, specifically on the psychiatry ward because patients interact with each other, I would say more on the psychiatry ward than other wards because people are encouraged to walk around. So we were walking around and some of our rounds were with other patients, like it was in the hallway, like we were having conversations in the hallway, which felt very different from where you like, go around to each room, and everyone's asleep. Because it's 5am in the morning, that felt a little less magical to be honest. I was trying to figure out what their deal was when I met them as in how they got there, how they're feeling like how their progress has been going, and then what my role was in their care team.
Emily Silverman
And so how do you think about this idea of role playing in the hospital?
Kaid van Kampen
I think there's multiple facets to this. One facet I think as a medical student, as I said in my story, I feel like I'm roleplaying as a doctor a lot of the time because I'm stuck in this world where I have responsibility, but I'm also still learning. So there's one facet of like, what am I allowed to do? What should I be doing to impress my attendings? So there's the tension, I think about not really sure where I lie in terms of medical professionals in the hospital. But then there's also role playing in terms of the fact that every encounter is a narrative encounter in medicine. So the idea that when you talk to a patient, you have to investigate why they're there. So their differential diagnosis, like that's my investigation check. But then there's also the perception check of how mentally able are they able to tell me a good story, or to have factual information that will help me? We're both rolling checks on each other because the patient also is rolling perception on me. Is this a trustworthy person? Should I open up to them, which I think is another part of why Dungeons and Dragons is collaborative, but medicine is also collaborative, because your patient perceives you as much as you perceive them. And then there's the idea of role playing, as in everything's always changing. Well, I think it depends on your specialty. But in the emergency room, and in my story, I talk about how things are changing, and you suddenly have to adapt on the spot. Or, eventually, I want to be a surgeon, you have to adapt on the spot and surgeries when there's intraoperative complications or things and the cases aren't going as you want, or you don't have the tools that you want. So you have to figure out how do I get around this and what's the solution to the problem? Simply being at the hospital, doing your job often takes a lot of improvisation, and figuring things out as you go.
Emily Silverman
So what kind of checks are there? There's an investigation check, which it sounds like is about collecting data and that very concrete type of knowledge. There's a perception check where you're trying to ascertain the environment. There's a charisma check. How many are there and how do you think about these different checks?
Kaid van Kampen
There's a lot of them. They all map to one of the five core skills so there's intelligence, strength, courage as well. Wisdom, dexterity, some of the specific skills are less relevant in the hospitals, so acrobatics, I don't know how often you would say You're doing acrobatics in the hospital, but acrobatics max to dexterity, which is something that's key for surgeons, for example. So I guess surgeons would have a high dexterity, whereas psychiatry, from my understanding, they're all about trying to figure out what's the patient's motives? Like, what do they want? Who is this person and like really like getting a in depth picture of the person? So I would say there are people who have high perception, or at least they tried to have high perception, and that maps to wisdom, I'm pretty sure. So they'd probably like be high hiring wisdom in relative to the other statistics. Yeah, I think you can map the skills to different types of specialties. And you need a different set of skills for every different type of specialty. But then there's also variation. Within each class. People have people who are good at D&D max out the stats that their class is good at. But people who like me, like when I first started, I just picked my Rogue based on what I wanted. And he wasn't really the greatest rogue, but he was still a rogue. So it doesn't necessarily mean that you have to be good at your skill sets to be your class if you're still that class.
Emily Silverman
So how do you think about yourself, Katie, like in the hospital? You've chosen to go into orthopedic surgery? What kind of orthopedic surgeon are you? You know, like, what kind of rogue are you? Why did you choose that category? And how do you think about your character?
Kaid van Kampen
I was drawn to surgery to begin with, because I really liked technical skills. So I played piano, I did martial arts, I really enjoy the process of actually learning a skill and becoming good at it. And the process from like, seeing yourself go from, I can't even punch to being able to have a black belt, I really enjoy the process of learning those skills and getting better. And there's usually always someone who's better than you that you can learn from. And there's always another step that you can get better at. Once I figured out that I wanted to do surgery and not medicine, which is like the greatest rift in medical specialties. Apparently, even though lots of people parallel plan with a non surgical specialty and a surgical specialty, it was all about trying to figure out what type of surgery I wanted to do. I was pretty convinced I wanted to do general surgery for a solid four months. And then I was pretty convinced I wanted to do urology for two months. But I ended up choosing orthopedic surgery, because I found it really interesting. Like I just genuinely found all the steps for making decisions in orthopedic surgery, really interesting. And I personally really like learning about the different tools that you can use and the different sets. And one thing that stood out to me about orthopedic surgery, and how it kind of relates to my character and like my other my Non Medical Life is it's actually very creative. Because every fracture breaks differently. And so you have like your basic trauma principles, and oftentimes you follow it, but sometimes you don't follow it. And sometimes you need to have a plan A, B, or C. So I was recently in a surgery, and it was a posterior hip dislocation and the acetabulum was fractured. So it's a pretty complex pelvic case. And we were trying to reduce the hip back into place. And it was taking a very long time. And the surgeon was like, Okay, if this doesn't work, we're gonna have to go to plan C, I guess. And the resident was like, oh, what's, what's Plan C? And the surgeon said, I don't know, I'm just gonna make it up as we go. So I really like orthopedic surgery, because it's very creative. I think specifically trauma, surgery, and orthopedic surgery. So breaking bones, which is their bread and butter. I think that's super cool. Because cases have patterns. And there's patterns enough that we could classify things. But then there's also surgeon preference. And there's also the ability to break principles sometimes if you think that's the right choice.
Emily Silverman
I want to go back to this idea of the dice roll real quick. In the dungeons and dragons portion of your story, you are the Dungeon Master, so you're not the player, and you're not the princess or the knight. You're the one behind the scenes, kind of like writing the story or pulling the strings. And yes, it's collaborative, and yes, your players can surprise you, but you're the one kind of driving the narrative. We talked a little bit about this leading up to your story, like can that situation be mapped perfectly onto the hospital scenario? Let's say you do have a surgeon-patient interaction. Is the surgeon the Dungeon Master? Is the patient the player who is rolling the dice? Isn't God-like, you know, can you map that onto the hospital perfectly? Or is it more just a general sense of that tension between predictable and unpredictable?
Kaid van Kampen
I don't think it perfectly maps. I don't know who would be a dungeon master in the hospital. I mean, they call it the dungeon master God in D&D. So I guess if you believe in some type of higher power, then that's the closest analogy you can get. It's like some type of higher power ruling some form of dice, which begs the question of freewill and randomness, a philosophical conversation. But I don't think it can be mapped perfectly. I think it's just that the skill sets of a dungeon master translate quite well to medicine because you have to adapt to new situations. It's difficult to fit people nicely into a role-playing template.
Emily Silverman
When you told the story on stage in Chicago, there was this one sentence that kind of tumbled out, and I don't think you've ever said it before in any of our rehearsals: “Sometimes you prepare for things that never happen.” That line felt significant for you. Why?
Kaid van Kampen
I think it was significant because I told you, "Oh, that's what I've been trying to say this entire story." And I think that just goes to show that you can plan as much as you want, but things are going to go differently than how you planned. And the key to being good, in my opinion, at life or Dungeons and Dragons in the hospital is being adaptable and being able to pivot. Knowing that even if plans change, you can be flexible and make up a new plan. And if that plan changes, that's okay. I think being comfortable in that uncertainty is important to me.
Emily Silverman
A lot of people take themselves really seriously, and they take life really seriously. And I'm probably guilty of taking myself and my life too seriously at times. There's something about walking into the hospital and looking around, where it feels like a magical land with different villages and towns. You have the psych ward, the AOR, and the radiology area, all with their unique characters and roles. And then you have all these encounters, where some go well and some are a miss. There's a playfulness to that perspective, a lightness, and almost a gamification of it. I feel like this perspective makes the hospital more fun and less scary and intimidating. Seeing the hospital or life through the eyes of a dungeon master, somebody who's just kind of writing the story on the fly, does something for me.
Kaid van Kampen
I think it adds a sense of depth to everything. There's this word in German, and I can't remember the word. It basically is defined as the sense that everyone's story is just as complex as your own. And I feel that when I walk into the hospital with this lens of a dungeon master, because every encounter is a part of someone's story, and how my encounter impacts them is important. It just allows you to grasp a sense of empathy, humanity, and collaborative narration in a way that viewing things as patient encounters and thinking 'Oh, you have x, now I need to do XYZ' does not. Viewing it as more algorithmic takes away the empathy and the privilege it is to be a doctor and see these people and get to impact their stories or try to guide them towards what I think would be a good resolution of their problem or that narrative arc. But then remembering that these people come with their entire world, stepping out of it to come into mine, it's very narrative, which is something that I've always been interested in with Narrative Medicine. But just journaling about medicine didn't really resonate with me. For me, it took on more of a viewing everything as a narrative and seeing medicine as an opportunity to be part of these narratives, which I think is a privilege. I really like being a dungeon master, because it reminds me that being a medical professional is a privilege, and I get to be part of people's narratives in some form, hopefully in a positive way.
Emily Silverman
Yeah, I think you just put it so beautifully. If you look at it as algorithmic, there's a deadness to that. It reduces everything to almost like a metal mechanical interaction. But the way that you frame it, not as an algorithm, but as a collaborative story that's actively unfolding, there's an aliveness to that that I think is so missing in medicine right now, like this sense of magic and enchantment. And I think that's one of the reasons why I responded to your email right away. It just really struck a chord in me. I was really hungering for your story. So I'm so glad that we were able to develop it a little bit together, both for the stage and in the studio. And in this interview, is there anything that you would like to leave our audience with, maybe some advice?
Kaid van Kampen
No, I don't think I've run out of my wisdom points for the day. Definitely play Dungeons and Dragons at least once in your life if you haven't already.
Emily Silverman
Perfect. Thank you, Katie.
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