Citadel Notes Pt. 1 - Premise (Patreon)

So, I was organizing documents on my laptop and I came across this little gem...my first outline for Citadel, dated January 2019. 

It's interesting to see what made it into the actual product...and what got left on the cutting room floor. No spoilers found here, since a lot has changed - especially the driving conflict in the game. 

Enjoy!

"It’s probably a decade or more in the future. Universal healthcare is now a thing—for those with documents, anyway. One thing isn’t completely covered by insurance, however. Neuro-Interfaced Nanite Operations (NINO). This is the final frontier of biotech: how to solve unsolvable diseases. Cancers. Degenerative disorders. With NINO, these can be cured or kept under control.

Enter Citadel Health. The pioneer of NINO. Originally based in Palo Alto, they moved to Hudson, Wisconsin and quickly established a sprawling “vacation medicine” destination in what once was a failing, post-industrial city. 90% of the buildings in Hudson are owned by Citadel Health. People from all over the world fly there for treatment.

You are a newly minted physician at Citadel Health, having just graduated from medical school. This is your dream job—residency at Citadel is almost impossible to obtain. You can pick from two choices of residency:

Primary care at Citadel Health is in charge of intake. Any patient who wants to undergo the NINO procedure must first make an appointment with a primary care physician at Citadel Health. Because NINO must be constantly performed in order to treat targeted illnesses, it’s important for patients to have a consistent contact within the Citadel Health system. Primary care physicians at Citadel Health evaluate the suitability of patients for NINO, prepare patients for NINO, and track patients over time. Primary care physicians are also responsible for admitting patients who can’t pay into the fee waiver program.

Chronic disease management at Citadel Health is one of the largest departments. Surgeons in this department are responsible for performing the NINO procedure on patients suffering from chronic diseases, including cancer and degenerative disorders. With the invention of NINO, things previously considered untreatable are now completely manageable. Patients, however, must receive NINO for the rest of their life in order to keep their disease under control. The chronic disease management department at Citadel Health receives the most attention from the press and is the most well-known by the public.

How does NINO work? Surgeons who perform NINO plug into a program that allows them to control of various types of nanites. The patient is put under anesthesia, and nanites are pumped into the body area of interest. Surgeon then use the nanites to destroy/repair tissue as needed.

Some brief history on Citadel Health. Citadel Health was founded in Palo Alto and quickly became a darling of the Bay Area. Nanites had already been engineered before the founding of Citadel Health, but Citadel Health was the first to bring nanites into healthcare. By developing nanites that could work within organic material as well as a unique interfacing system that allowed users to control different kinds of nanites, Citadel Health quickly moved from animal models to human patients when the FDA realized just how effective NINO was. However, there have been rumors that Citadel Health has unpublished data of early clinical trials that ended disastrously. Even more distressing are the patient populations involved.

How is Citadel Health viewed by the public? Equal parts respect and resentment. Citadel Health can work miracles—you just have to have the money to pay for it. Even with the fee waiver program, there are always some patients who have to stop NINO treatment or who are turned away outright. Some don’t even make it to Hudson, since you have to be referred by a physician approved by Citadel Health. This, of course, has made a number of people angry.

Let’s say there’s three factions that dislike Citadel.

First are the very public group of people upset that Citadel Health’s services are not fully covered by insurance. Protests abound Hudson, although Citadel Health has a good security system to disperse crowds. Physicians not affiliated with Citadel often join in these protests.

Second are a smaller group of people who believe that Citadel Health has unpublished data of early clinical trials that ended in failure. These are mainly family members of patients who initially enrolled in these trials.

Third are a private group of physicians who believe that what Citadel Health does is abominable. They believe that Citadel Health’s NINO procedure is a perversion of medicine (to be explored)."