SETTLERS | Thomas Robey
We played Catan last night at the cabin. Our version is twenty years old, with settlements and roads perched precariously on seams between tiles that drift apart when not held tight by the interlocking borders found in newer editions. Wheat and brick and sheep traded for favors and small betrayals. For years I gave the kids advantages; longer roads at the start, better settlement spots; a subtle tilt of the board toward their victories. Those days have evaporated. They see angles now. They count victory points and track what I’m holding. They make trades that look like gifts until they aren’t.
There’s also a clause in our house version that never made it into the rulebook.
Trades flow downhill.
If there’s a choice, resources tend to move away from me. Not maliciously; not even consciously most of the time. Just enough redistribution to keep the game alive for everyone else. Dad will figure it out. Dad doesn’t need the help.
And the roads.
On paper, any road can go anywhere. In practice, mine often stall a hex short of someone else’s city. An invisible perimeter forms. Don’t hand him the connection. The board fills with almosts; my network always one segment shy of becoming the longest road.
The rules haven’t changed.
The customs have.
Somewhere in the middle of last night’s game, one of my moves landed like a snow squall. A roll, a placement, a little bit of trash talk. One of the boys pushed his chair back and declared the game over for him, not because it was, but because it felt that way. A few turns later, his brother erased the map entirely; hexes skidding, settlements overturned, wooden infrastructure scattered like startled thoughts.
I wish I could say I handled it with fatherly wisdom. At first, I watched the way frustration ripples through a room. Then I saw something better: they came back. They rebuilt the board into a new game with the same pieces, a similar arrangement, but with fresh permission. No apology or redemption accompanied the return; just a new start at a quieter table.
In the second game, the odds returned to baseline: I had no chance. The board leaned away from me, or so it seemed. With the earlier night’s antics still raw, I felt the urge to stand up, leave the map to them, and declare my own inevitability. For a few breaths I understood the earlier exit. There’s a peculiar solidarity in giving up; a fellowship of people who have decided the dice are loaded against them.
Night shifts in the emergency room can feel like that.
Not every night. Most nights are a steady shuffle of cards, each hand played with the tools we carry. Lately, the table has changed. A few retirements. A reshuffle. With new dealers come new rules that aren’t written anywhere, but are felt in the way cards are traded. I’ve gone years without a complaint; longer, it seems, than my last win at Catan. Recently, a small stack accumulated, neat and official, each in the language of review rather than conversation.
It would be easy to narrate this as a conspiracy, to imagine that others are playing against me. That the trades are traps. That the robber sits on my tile because someone placed it there on purpose. It would be easy, and it would be wrong in the way easy things often are.
I read through the cases and see something more familiar. A patient who wanted buprenorphine without detox. A man with a boxer’s fracture splinted in the hallway. Another who drifted along the edge of our waiting room, sometimes quiet, sometimes not, asking if he could stay until morning.
One night, that last patient sat across from me, wrapped in a blanket folded into something like structure.
“Can I stay here until the buses start?”
Behind him, the waiting room hummed. Security watched from a distance shaped by experience. The charge nurse stood at the desk, already carrying the next several hours.
The question didn’t feel clinical. It felt like placement.
Where does he go?
My instinct was to let him stay. A controlled space. A chance to rest long enough to make a different decision in the morning. It felt pragmatic. Humane.
It did not land that way.
From another angle, the same moment carried different meanings: risk, precedent, fairness, the accumulated weight of prior encounters I had not witnessed. The board looked different depending on where you were sitting.
I wrote back what I could remember, which is always less than the chart suggests and more than it can hold. I wrote about intent, which is a poor currency in a system that prefers receipts. I wrote about gray zones and shared spaces and the way a lobby becomes a ward by gravity when there are no beds left. I wrote about how each of us was responding to the same patient, but to different versions of the situation.
Narrative medicine teaches that stories are not just told; they are held. That perspective is part of care. That listening is not passive. In that frame, the problem was not that someone was wrong. It was that we were not aligned on what story we were in.
If I’m honest, the critiques land because there’s a clear runway. Team nurturing has never been my natural language. I bring donuts and the staff asks if it’s a bribe. Often, while solving the immediate problem, I forget that the game is not only the board in front of me; it is also the players around it.
In Catan, you can play a brilliant solitary game and still lose because you refused to trade. You can hoard ore and wheat and wait for the perfect hand while others build a network you cannot enter. Then someone rolls a seven and half your supply is confiscated. It isn’t personal. It’s structural.
Medicine pretends otherwise. We write as if the right answer will carry the day regardless of how it is delivered or who hears it. But the hospital is not a puzzle box; it is a table full of people who have to keep playing together after this hand is over.
Nothing written has shifted in any meaningful way. Protocols are intact. Policies read the same. But the trades feel different. The informal “sure, go ahead,” the benefit of the doubt that once smoothed things over; those have thinned out. Not vanished, just redirected.
Where I used to feel part of an unspoken exchange economy, I now feel more like an external player at my own table.
And the roads again.
There are moments where I can see exactly where a plan would connect, where a patient-centered decision would link cleanly into flow and safety. And then it stops. Not blocked outright, just not joined. A charge decision here, a security threshold there. The endpoint is visible, but the last segment never gets built.
There’s a version of this where I stand up and leave the game.
There’s another where I stay, but change how I play.
Not by giving things away, but by remembering that every move is also a message. That a hallway splint signals something about flow. That advocating for a patient signals something about thresholds. That if I want the map to hold, I have to understand how others are reading it.
It might also mean offering trades differently, and not assuming they will happen because they used to, or assuming shared understanding where it hasn’t been rebuilt.
The harder work is slower. It sounds like: “Help me understand how you’re seeing this.” It looks like waiting a beat longer before making the move that feels obvious. It feels like staying at the table when the odds don’t feel favorable.
After the board was knocked over, my sons put it back together. Not the same way, but close enough to recognize, different enough to feel new. They didn’t argue about who was right. They just started again.
I keep thinking about that.
The night shift is another board. Each night has the same pieces in slightly different arrangement. I can feel the urge to declare “no chance” when a few moves go against me. I can also stay.
I am not good at this, but I am still here, trying to learn how we play now. Last night ended without a dramatic victory. The roads lay where we left them. The cities stood. No one flipped the board.
This morning, the pieces are back in the box, waiting for the next map.
In a few hours, I’ll be back in the emergency department.
Understanding the board doesn’t quiet the butterflies, but it does make it possible to sit down anyway.
Thomas Robey is a nocturnist emergency physician in Everett, Washington, where he leads a street medicine program focused on low-barrier care for people with substance use and behavioral health needs. His clinical work spans the emergency department and community settings, often in situations where decisions are made without clear alignment across systems. Robey’s writing reflects on these experiences, with an emphasis on setting, perspective, uncertainty, and the practical realities of care.