Designer Diary: Trepanation, or Really, Don’t Try That at Home!

by Robin David

Trepanation is a strange design for me because it’s one that was completely designed theme-first. Usually, I design games by asking questions about mechanical hooks, then later try to find themes that fit those hooks. And maybe because I designed the game with the theme first, Trepanation took me AAAAAGES to make!

At the time — I think around 2016 — I was a big fan of the Sawbones podcast. In this show, which is full of pretty dark humor, the hosts talk about medical history and some of the various horrible things we’ve done in the name of medicine. They had a particular interest in the era of medical shows around the 18th century.

At the time we had people like Franz Mesmer conducting work on “animal magnetism” and curing the terrible malady of “female hysteria” — that is, having too much emotion. Alessandro Volta was popularizing galvanism, which was often displayed by electrocuting frog legs and human corpses. And there were magnets. People love magnets. The public was obsessed and would flock to medical shows to see these kinds of performances, along with minor surgeries like tooth-pulling, transplants, lots of drugs, and the titular act of trepanation — that is, the drilling of a hole in the human head in order to release pressure on the brain, or sometimes just to release evil spirits. Medical science was moving quickly, and among all that wonder and horror, Mary Shelly wrote Frankenstein, summing up the fears of a generation.

“Now, if your patient drinks this ether-arsenic mix, they’ll forget all about those warts!”

After a few dozen podcast episodes, I knew I wanted to make a game about this. I just needed…well…a game!

The first forays in the Trepanation design involved deck-building games (each card being a new procedure you’ve learned), a press-your-luck game (performing shows in towns, but trying to avoid too much outrage), and a rummy game (still, in my opinion, an underutilized mechanism). But I was having trouble finding a set of mechanisms that would reflect the reality of the theme. What does it MEAN for the player to cycle through a deck, for instance?

I shelved the game for a little while and worked on other projects. I later came up with a twist on a worker placement mechanism: What if a worker placement game had an element in which your actions would be limited by the time of day? As in, each action spot has a bunch of times attached to it and while you can schedule yourself to be in two places at the same time, when it comes to resolving actions, you have to decide which thing you’re going to do — and then I realized I already had the perfect theme in my pocket!

The first version of Trepanation did well with my playtesting group. I think they were relieved to see one of my weird medicine games that kind of worked!

Players were crooked medical performers who would gather medicine (like swamp roots or uranium!), hire stooges from the local pub, bribe the police to turn a blind eye, exhume cadavers to sell to medical students, and put on shows to a gathered crowd. The ultimate objective was to gain fame, and to this end, I also had the makings of a mechanism that would let players write articles for the local press, providing another route to victory.

After very rapid iteration, I had something that worked well. An interesting early lesson was in the power of the game interface. Players were struggling to visualize the time-slots attached to each location and would keep double-booking themselves. You see, the game works in two phases: players first put their “workers” on the various time slots, then we go through the day. At 9 a.m., everyone can resolve one worker in a 9 a.m. slot; you can’t be two places at once, after all. At noon, the same thing, and so on.

I redesigned the spaces to more closely resemble a clock, but in my infinite wisdom, didn’t put the numbers in the right places…

Confusion reigned supreme. If I recall correctly, the only differences between version 4 and version 5 were in the presentation — but the difference between playtest responses was like night and day.

Very soon I was able to start adding layers of interaction to make player choices more interesting and meaningful. The medical shows were displayed on cards, and these became more interesting. There were also temporary locations, such as shady equipment dealers down alleyways who’ll give you a deal on scalpels during very limited times. The newspaper publications became more interesting, with players being able to choose between writing scholarly articles or just getting featured in the local gossip magazines. Fame is fame, right?

By the 14th version, Trepanation was becoming a favorite at my local playtest meet-up, and I decided to submit it to the 2018 Hippodice contest. Hippodice is an event where representatives from a wide variety of European publishers get together to play prototype games. At the end of the weekend, they name the winners, and usually a bunch get snapped up for publication. The first place winner that year was the excellent Belratti, with Trepanation coming in second. It was quite a thrill to get a call from a room full of prominent publishers telling me how I did and asking, “So who do you want to take the prototype home?”

Games4Gamers in Spain took the game and signed a publishing deal for it. According to the publisher:

Games4Gamers started bringing it to conventions and playtest sessions, conducting their own development work. I think we had one call where we talked about maybe changing the theme, then decided no, this is too fun to lose. Natàlia Romero started work on some outstanding art. And then…COVID-19 happened, so nothing happened to Trepanation for a long time!

While this was a massive delay in the game’s production, this did let Games4Gamers take their time in testing the game with different people and making sure it was the best product possible.

But now here we are in 2023, and Trepanation looks absolutely gorgeous, with production values through the roof. Games4Gamers did a lot of work to streamline the design, making sure that it would be accessible to as many people as possible, while still retaining space for the tough decisions and strategic play.

The theme has remained the same throughout. While it’s dark, the game isn’t gory; the cover is the scariest element…and of course, the things you’ll conjure in your imagination. But also, this is all real history. Every procedure was a real thing that was really done for real audiences. Every medicine card is based on real products that unscrupulous con-men tried to flog to the gullible public. And, err, while we might not see tooth-pulling in public any more, the industry of miraculous cure-alls is alive and well, just with less mercury poisoning and cocaine-wine.

I’m proud that my weird game finally exists and would like to thank the darkly comic podcasts that inspired it, testers at Playtest Dublin (who put up with my terrible early ideas), the judges at Hippodice (who clearly have excellent taste in games!), and the team at Games4Gamers.

The German/English edition of Trepanation is available from dlp games, and the Spanish version will follow soon in 2023.

Robin David