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 LIFE & DEATH

 If you would be repulsed by a program that graphically depicts surgery in a
clinical, vivid, and lifelike fashion, don't read this review. Don't pick up the
box, and don't look at the screen shots on the back. But _especially_ don't buy
it, take it home, and boot it up. Because if you have even the slightest bit of
morbid curiosity (the kind that compels you to thumb through a book on medical
rarities, or drive by an accident slowly), you, too, may become hooked on LIFE &
DEATH. I played this game on an IBM-compatible; IBM-specific information will be
found later in this review.

 LIFE & DEATH comes from The Software Toolworks, publishers of CHESSMASTER 2000,
MAVIS BEACON TEACHES TYPING, and SOFTWARE GOLDEN OLDIES. Strikingly packaged,
L&D is a medical simulation with an emphasis on abdominal surgery. The game is
divided into two segments; you must complete the first before proceeding to the
second. In the first, your examination of the patients will reveal one of four
conditions: intestinal gas, bacterial infection, kidney stones, or appendicitis.
If it's gas, you observe; if it's bacterial infection, you medicate; if it's
kidney stones, you refer the patient to a urologist; but if it's appendicitis,
you operate!

 In the second segment, you might diagnose an arthritic condition or you might
reveal an aortal aneurysm. The arthritis requires exercise and medication, but
the aneurysm calls for surgery...most of the time. Sometimes an ultra-sound test
will reveal an immature aneurysm, which calls for observation and nothing more.
The operation, if needed, is much more complex than the appendectomy, involving
grafting a man-made dacron aorta in place of the aorta with the defect.

 First things first. In your package you'll find a few things every good doctor
requires: a beeper, a rubber glove, and a surgical mask. You put aside the glove
and mask until surgery. The beeper is actually a cute, fancy code wheel that
serves as copy protection. Early in each game session, you'll be given a phone
message to return; say Dr. Schwartz called from his car phone on line 4. Line up
Schwartz with the Car Phone and look in the Line 4 window; there's your code
number. Call him back at that number and he'll remind you not to forget that
staff meeting, or tell you that he'll meet you on the links later...whatever.
Neglect to return the call, and you'll be pulled out of surgery.

 Search through the box a bit more. Here's your "History of Surgery" booklet: a
brief, humorous retrospective of the barber's art. Here's an "Operating
Procedures Manual" (actually the computer-specific instructions, including
installation, keystrokes, and game directions). There's a memo to "All
First-Year Residents" outlining some of the game's features. And there's a
packet of photocopies of the relevant pages in ANATOMY AND THE SURGICAL
TECHNIQUE. These pages include sections on diagnosis, surgery, and an appendix
(which I deftly removed) -- a glossary and description of the tools of the
trade.

 You boot up the game and appear at the nurses' station on the floor to which
you're newly assigned. The nurse will greet you and ask you to sign in. Here's
where you can type your professional name, and the game will remember where you
are in your residency (how many patients you've seen, and how many of those
you've correctly treated). Up to ten people can be registered to practice at
Toolworks General. Once you've successfully completed both kinds of operations,
you're given a diploma, removed from the active list, and placed on the Honor
Roll. A notation is made regarding the skill level at which you've succeeded.

 You can also customize some parameters here: difficulty level (at higher
levels, the action speeds up, assistants are less helpful, and things begin to
go wrong during operations); sound; and your handwritten initials, so that
whenever you sign a patient's chart, a facsimile of your real signature will
appear there. After attending medical class (where you may be shown videotapes
of proper procedures), your first patient will be assigned to you. The
examination requires reading the chart to hear about the symptoms; you then
palpate the abdomen. To do that, you click the cursor on the patient's stomach,
and you see a close-up. Move the cursor around the stomach, clicking as you go.
A visual "dialogue balloon" (as well as accompanying digitized speech) lets you
know where the pain is and isn't. Based on that information and details you
glean from the documents and the classroom lessons, you decide whether you'll
observe, medicate, or X-ray. The X-ray will reveal kidney stones if there are
any; if not, you operate.

 Great surgical teams are made, not born. Entering the personnel office, you'll
find descriptions of six co-workers who can assist you in the Operating Room
(OR). You may only choose two at a time, and they'd better be compatible; make
sure to read their files completely before selecting them. An expert on arterial
grafts who doesn't work well with the nurse you've chosen won't be much help
during an appendectomy.

 Once you're in the operating room, the tension mounts. The EKG beeps softly and
steadily as you begin. The documents again tell you the order in which to
proceed; you have a message box, a close-up of the patient's abdomen, and three
trays of instruments to monitor. Smooth cutting takes a definite knack, as does
dealing with a continuous variety of emergencies (loss of blood, erratic heart
rhythms, and the inevitable slip of the scalpel). You may quickly be pulled off
the case for a wrong move, or you may respond to an emergency incorrectly and
wind up killing the patient.

 (Incidentally, just for fun, try making an incision with the scalpel _without_
having anesthetized the patient. Be prepared for an effective, humorous jolt.)

 Overall, the game is terrific. It requires thorough reading and re-reading of
the documents the first few times you undertake a new element of the game. The
interface is smooth and predictable, although there are some quirks to be
considered regarding the positioning of the cursor during surgery. The game is
suitably complex for weeks of playability; I've been playing for three weeks and
have only recently completed both operations (at the novice level). This is
partially because of the documentation -- my one major complaint.

 In at least one instance, the documents are downright wrong about a very
important surgical technique; in several others, the are indadequate. The
incorrect detail has to do with the procedure for cutting the peritoneums (thin
membranes separating the organs from the muscle tissue): They must first be
scraped with a scalpel, elevated with hemostats, nicked again in the same spot
with the scalpel, then carefully cut with the scissors across the area. (See how
much fun it is to throw around this terminology? Playing this game with friends
is a gas!) The manual describes a somewhat different procedure, which never
works; a call to Software Toolworks was required in order to learn the correct
technique.

 There are other sticking points, mainly because the manual includes no
illustrations. You're dealing with some very realistic graphics, and you must
make a lot of precise cuts, nicks, sutures, and so on. But the exact locatio are
difficult to describe in words. For example, it's tough to tell where the
appendix ends and the cecum begins when it all looks like one large lump of
tissue to us laypersons. Fortunately, the medical class you're sent to after a
failed operation or incorrect diagnosis will usually clarify the points that
aren't sufficiently addressed in the documents.

 The graphics are generally very good. The surgical screens are absolutely
fascinating. For the first time, I feel like I have at least a modicum of
understanding of what goes on in an operating room. I also experienced a curious
sensation when making my rounds. I ceased to become involved in the patients'
personal stories and, instead of dealing with a person, I dealt with a
clipboard, an abdomen, and a list of symptoms. In the operating room, I wasn't
trying to save a life; I was trying to take apart a puzzle and put it back
together in the most efficient way possible. I wonder if that's akin to the
separation physicians feel -- a dehumanization that we, as patients, are
becoming accustomed to.

 The IBM PC version of the LIFE & DEATH package includes both diskette format
5-1/4" and 3-1/2". The only copy protection is the aforementioned code wheel.
Thus, the game can -- and should -- be played either from working copies or from
a hard drive. There's an installation program that will create a subdirectory
called L&D and deposit the game files there. You can move them to another
subdirectory if you like.

 Mouse, keyboard, and joystick are all supported; I recommend using a mouse. The
keyboard works adequately, but requires two hands to efficiently operate the
cursor. Virtually the entire game can be played from the mouse or joystick,
except for signing in and recording your initials the very first time you play.
You can pause with the "P" key, and quit with the "ESC" key, but all other
parameters can be modified via menus.

 You'll need some sort of color graphics adapter: CGA, EGA, or VGA. The game
only displays CGA graphics, which was a big disappointment. Given the static
nature of the screens, EGA graphics wouldn't have required that much more
programming. But even the CGA screens (particularly those presented during
surgery) are delightful, and better than CGA graphics in most other games. T
resolution is 640x200, and the colors used are black, white, light blue, and
red.

 Your PC, XT, AT, or compatible will require DOS 2.0 or greater, and a full 512K
of memory to run. If you have less than 512K available, the game won't load.

 All in all, I loved LIFE & DEATH. It's a tense game, and a fun one; it's also a
thoughtful simulation of a real-life topic, the object of which is not typically
destructive. I could have hoped for greater support for better graphic modes,
but other than that, it's well-executed and intelligently programmed. As much
for the educational value as the entertainment value, I'm hooked on it...which
is the greatest and most honest recommendation I can give.

 LIFE & DEATH is published by The Software Toolworks and distributed by
Electronic Arts.

*****DOWNLOADED FROM P-80 SYSTEMS (304) 744-2253