Casey Valentine and Dr. Ethan Ramsey
(Not to be confused with the TV series of the same name.)
Open Heart is one of the many Visual Novels from Pixelberry's Choices: Stories You Play collection. A Medical Drama, this story stars you, a new intern at Boston's Edenbrook Hospital, serving under the renowned and demanding Dr. Ethan Ramsey. Can you save your patients' lives?
Contains examples of:
- Actually, I Am Him: Book 1, Chapter 9 has Nigel Platt demand to see Dr. Ramsey’s manager when he tells him to stop being a rude jerk. That’s when Ramsey tells him he is the manager.
- And Now for Someone Completely Different: In Book 2, Chapter 11, you get to play as Bryce and Ethan for the first time, since Casey has become infected and been put under quarantine.
- Anti-Climax: Unlike the major legal conflicts from Book 1 note and Book 3 note , the major legal crisis in Book 2 note has enormous build up with a very quiet resolution. The commentary in the story will remind the player that their choices will affect their relationship with Esme going forward—but Esme will only reappear a few more times at most with a handful of lines before the end of the series, and the hospital closes regardless of how the player chooses.
- At the Opera Tonight: A premium date with Ethan in Book 1, Chapter 12 has him take Casey out to the opera for them to get over Mrs. Martinez's death.
- Bait-and-Switch: One of the secondary plots of Book 3 is the core group studying for their certifications. Sienna feeling particularly anxious about the board exam. In chapter 16, when everyone gets their results back, she will burst into tears upon seeing her result. Oh no! She must have failed! … she passed handily, but she’s crying because she has actually just realized that she no longer wants to practice internal medicine.
- Baseball Episode:
- Book 1, Chapter 5 has Casey and the interns go out to a baseball game where Casey can end up on the kiss cam.
- In Book 2, Chapter 8, Edenbrook will play Mass Kenmore in a game of baseball.
- Book 3, Chapter 5 has a diamond outing with Rafael that lets you go on a date with him to the VIP box of a baseball game.
- Beach Episode: Book 3, Chapter 11 features the gang visiting Hawaii to celebrate Dr. Ines Delarosa’s elopement.
- Bedsheet Ladder: A premium scene in Book 1, Chapter 1 with Dr. Ramsey has his patient, Barbara, threatening to do this.
- Betty and Veronica: The love interests are divided this way. The Bettys are Bryce (charming and easy-going) and Rafael (courageous and selfless). The Veronicas are Ethan (aloof and strict) and Jackie (blunt and competitive).
- Big Disaster Plot: Book 1, Chapter 14 involves a subway derailment.
- Big "NO!": Declan Nash in Book 2, Chapter 15 after Jackie sends proof of his company’s widespread Medicare fraud to the New York Times.
- Big, Stupid Doodoo-Head: During the premium scene to help Sienna dump Wayne in Book 1, Chapter 14, one of the options is to call Wayne a "moldy bowl of mayonnaise". If Casey can't think of anything to say, Sienna calls Wayne a buttface instead.
- Birth-Death Juxtaposition: Book 1, Chapter 4 has this with Dolores dying and her son being born.
- Book Ends: Both Casey's first day on the job and first day back in Book 1 has a patient collapsing in the reception lobby.
- Book 2 begins and ends with the roommates celebrating their close of their working year at Donahue’s.
- Break the Haughty: So, so many characters go through this. Most get back up and get better (Jackie, Bryce, Dr. Ramsey), but more than one (Landry, Declan Nash) doesn’t.
- Busman's Holiday: Book 1, Chapter 5 has this with the interns responding to an emergency when the pitcher for the Boston Nighthawks collapses on the mound.
- Cliffhanger: Book 1, Chapter 15 ends with Casey realizing what's wrong with Dr. Banerji.
- Color-Coded for Your Convenience: Book 1, Chapter 14 involves this for triage victims. Green for minor injuries, yellow for injuries that are serious but not life-threatening, red for major life-threatening injuries, and black for patients who are dead or too far gone to save.
- Content Warnings:
- Book 1, Chapter 4 opens up with a warning that it covers childbirth and trauma.
- Book 2, Chapter 7 opens with another content warning, this time related to prescription drug abuse, specifically an anxiety sufferer who tried to commit suicide by deliberately overdosing on their anxiety medication.
- Book 2, Chapter 15 starts with the warning that the chapter contains disscussions regarding medically-assisted suicide.
- Book 3, Chapter 5 contains the warning that the chapter dealing with end-of-life planning— essentially, a living will for someone who has a terminal diagnosis.
- Death by Childbirth: Dolores Hudson, Dr. Ramsey's first patent when he was an intern, dies giving birth to a son in Book 1, Chapter 4.
- Down to the Last Play: The cross-town baseball game between Edenbrook and Mass Kenmore will come to this point if Casey didn’t take the diamond option to practice beforehand. Choosing to play dirty will get Edenbrook the win, but a massive brawl will ensue and Dr. Banerji will be livid. Not surprisingly, Bryce and Jackie will think the whole thing is hilarious.
- Dr. Jerk:
- Dr. Ethan Ramsey presents himself as a cold and stern mentor figure, but Casey can make him open up with Premium choices.
- Dr. Aurora Emery treats all her fellow interns with disdain, only displaying an affable front to her patients and superiors.
- Landry is completely uninterested in his patients on a personal level and tries his best to avoid interacting with them socially.
- Dr. Garrett Thorne is so unpleasant to interact with that he managed to make an enemy of Harper Emery herself.
- Subverted with Dr. Zaid Mirani, who makes it a point to act like a bigger jerk than he really is to prove that he is different from his extremely friendly and outgoing twin, Dr. Baz Mirani.
- Easily Forgiven: Casey can take the jerk option to interact with roommates, coworkers, and patients, and at most, people are briefly annoyed, with Nigel Platt and Dr. Esme Ortega being some of the (very few) people who continue to hold a grudge. Averted with Dr. Landry Olsen and Dr. June Hirata. None of the other roommates forgives Landry (not even Sienna!), and no one from the diagnostics team ever mentions June again after she jumps ship and goes to Kenmore—not even her former lover, Dr. Carrick.
- Fictional Counterpart: The baseball game in Book 1, Chapter 5 features the Boston Nighthawks facing their hated rival, the Manhattan Stingrays, clear stand-ins for the Boston Red Sox and New York Yankees.
- Foregone Conclusion: The diagnostic team position is presented as an opportunity that any intern could win, but the events of Book 1 will quickly reveal that only Casey, Aurora, and Landry actually stood any chance of getting it.
- Forgiven, but Not Forgotten: Casey is brought before an ethics panel at the end of Book 1 due to giving an elderly patient experimental medication that directly results in her death.. In Book 3, it is discovered that a patient has been maneuvered into the test group from the control group of a clinical trial for medication that can treat an otherwise incurable condition. Even though this is not a true FDA trial and the patient desperately needs help, the manipulation could potentially taint the test data. Multiple people publicly blame Casey, stating Casey has already displayed little regard for proper hospital procedure. Ethan Ramsey eventually confesses to it.
- "Friends" Rent Control: A premium choice apartment in Book 1, Chapter 3 is this, especially with the rent being $10,000 a month. Casey, Elijah, and Sienna do this by either offering their landlord free cookies from Sienna or pointing out the fact that the tech bros would have enough money for the first month and that venture capitalism is another word for communism.
- Fun with Acronyms: Nigel Platt, the patient of Book 1, Chapter 9, is called a PITA, aka pain in the ass.
- Gargle Blaster: Jackie will try to talk Aurora into trying a “cement mixer“ shot in book 3. Casey is able to take the shot along with Aurora, although they will be very unhappy if they do so.
- For the uninitiated: A cement mixer consists of taking a shot of Bailey’s Irish cream, then following it with a shot of lime juice. The taste is not particularly offensive—think citrusy chocolate—but the texture is reminiscent of slimy, under-done scrambled eggs. It is very much a prank to be offered one, especially if the offer is being made to someone who is already tipsy.
- Hollywood New England: The story takes place in Boston, Massachusetts. A premium choice date with Bryce in Book 1, Chapter 4 is in Somerville. A premium choice date with Rafael has him fly you to Cape Cod.
- Hospital Hottie: Casey’s first meeting with Jackie and Bryce happens in the lockers, while both of them are still in their underwear.
- Hotter and Sexier: Although the story does not shy away from describing sexual encounters with the various love interests, there is a very noticeable upward trend from Book 1 to Book 3. Book 2 has a premium opportunity for a threesome, and Book 3 has an available premium encounter with Dr. Ramsey with full-on BDSM. The love scenes with the other love interests can potentially become aggressive if the player chooses for them to be so.
- The Intern: The story’s focus is around Casey Valentine (the main character), a medical intern, during their three year residency at Edenbrook Hospital.
- Ironic Echo: Book 2, chapter 15: When Jackie posts the evidence of Declan's dirty business to the internet, she smugly states "payback's a bitch, ain't it?" to his face. Later on, it's revealed that the partnership between Mass Kenmore and Edenbrook is off. Sure enough, when the doctors go to check Declan's old hospital office, it's empty except for a post it note containing Jackie's words from earlier.
- It's All My Fault: Casey can feel this way about giving Annie antibiotics that she's deathly allergic to.
- Labcoat of Science and Medicine: The Premium outfit for Casey is a white doctor coat while the standard option is a plain scrub uniform.
- Local Hangout: Donahue’s is the bar where the residents from Edenbrook go after work; even Dr. Ramsey drinks there frequently.
- Magical Defibrillator: Subverted as it's played out like a proper one does to get a proper heart rate going instead of just outright reviving Annie. She still needs to be intubated and given epinephrine.
- Master-Apprentice Chain: Naveen was Head of Diagnostics before he became Chief of Medicine and gave the position to Ethan, his protégé and Casey's mentor. In Book 3, Chapter 16, when Ethan succeeds Naveen as Chief of Medicine, Casey can choose to succeed Ethan as Head of Diagnostics.
- Medical Drama: The story as a whole.
- Mentor in Sour Armor: in book 2, all of your roommates except Aurora because she is transferring to Kenmore will be given a brand new intern to mentor. Jackie gets an intern literally described in the narration as “one clueless looking young man,” and she is excited about the opportunity to mess with him. Despite this, Jackie is the only one of your group whose mentorship is unambiguously successful. Sienna‘s intern washes out before the year is up, Elijah‘s intern will not pass qualifications if the reader doesn’t make the premium choice to get involved, and Casey can completely ruin their relationship with their intern by accusing her of very serious medical malpractice.
- My God, What Have I Done?: Happens to more than one character over the three-book series, as part-and-parcel of making major medical decisions.
- Nerves of Steel: Casey has choices to have these. In a premium choice with Bryce in Book 1, Chapter 2, he shows his by nailing the bullseye on the dartboard if Casey chooses to sing an annoying song.
- Nice Job Fixing It, Villain: Declan invites Mrs. Martinez's son, Luis, to Casey's hearing in hopes of getting them fired. However, Dr. Ramsey had showed Luis the photo of his mother in Paris and he realized how much Casey made her happy. This made Luis announce to the panel that's he dropping the lawsuit entirely, improving Casey's chances of a fair hearing greatly.
- Leland Bloom falls into this trope at the climax of Book 3 as he attempts to force Ethan Ramsey out of the hospital with a malpractice suit stemming from a patient injury that happened under Dr. Ramsey when he was still a resident physician. The injury is actually Naveen Banerji’s fault, as Casey will quickly discover. Not only does the power play fail, Leland finds himself forced to accept a significantly less influential role within the hospital and Ethan will ultimately become Edenbrook’s new Chief of Medicine.
- Parlor Games: Book 1, Chapter 13 has the group play Charades with Casey pairing up with Jackie, Sienna or Landry. A premium choice can allow Elijah and Phoebe to get closer.
- Parents as People: A great deal of book 2 is devoted to exploring this on behalf of Dr. Ramsey. His good relationship with his father will remain intact, but the player will be responsible for how he resolves his painful past with his mother.
- This happens again at the end of Book 3, during the malpractice suit. Ethan is blindly determined to maintain a spotless legacy for his figurative father, Naveen Banerji, to the point that he is willing to take the blame for one of Naveen’s errors and lose his career in the process. It is a genuine shock to him when Naveen accepts responsibility, very publicly.
- Plot Allergy: Book 1, Chapter 2 reveals that Annie is allergic to the antibiotics used to treat her.
- Book 2 ends with Caroline Bloom, the wife of multi-billionaire Leland Bloom, discovering that thanks to her husband’s new kidneys, she is literally allergic to him. Skin-to-skin contact between them gives her a severe anaphylactic reaction, which means that Bloom can no longer have physical contact or intimacy with his beloved wife, and despite his habit of buying solutions to problems, no amount of money that he throws at the problem can resolve it. They are not amused.
- Reassigned to Antarctica: Zaid threatens to do this to anyone who misbehaves during the governor's visit in Book 2, Chapter 2. Elijah thinks it sounds like fun.
- The Reveal: Book 1, Chapter 14 reveals Landry was the one who tipped off the Martinez family and was the one sabotaging Casey.
- Rewatch Bonus: Landry's scenes are seen in new light before he's revealed to have sabotaged Casey.
- All of the scenes with Rafael in Book 2 show him slowly cutting ties with his local community. Initially it appears to be leading up to his departure for Brazil. It was originally leading up to his tragic demise.
- Schmuck Bait: More than one person will hint to Casey that sacrificing Esme to a civil liability suit will be key to saving the hospital. Dr. Naveen Banerji is notably NOT one of those people. If Casey gives in, Esme will resolve it on her own, but she will be rightfully resentful. Because it takes multiple chapters for all of this to play out fully, the player will not be able to change course afterwards. And in this game, only the immediate chapter can be replayed. Have fun starting over!
- Shout-Out:
- Book 1, Chapter 16 is titled The Curious Case of Dr. Banerji.
- In the same chapter, Rafael texts Casey about watching the Korean drama You Are Beautiful online.
- Slap-Slap-Kiss: A very mild version between Casey and Dr. Ramsey in Book 1, Chapter 15. Casey will poke Ethan in the chest while they argue over why Ethan isn’t openly defending Casey at the upcoming ethics hearing, and Ethan will shout back, “I’m not your boss anymore and that means …” leading them both to realize that they can kiss freely now … or go further.
- Sleep Cute: Book 1, Chapter 6 has this with Sienna and a nurse, Danny, having fell asleep next to each other after the party.
- Stag Party: A premium date with Bryce in Book 1, Chapter 8 has Casey and Bryce joining one in an act of spontaneity.
- Stern Teacher: Dr. Ramsey mixes this with Secret Test. He gives Casey plenty of time to figure out what happened to Annie on their own, instead of just giving the solution. Casey can reprimand him for this or thank him for giving them the chance to learn.
- Successful Sibling Syndrome: Aurora feels this way about her aunt Dr. Harper Emery, a doctor with almost the same level of renown as Dr. Ethan Ramsey.
- Zaid Mirani feels like this about his twin brother Baz, who is a brilliant diagnostician and a stellar researcher. This feeling is exacerbated by the realization that Baz deliberately followed him to Edenbrook and impersonated him in an interview with administration in order to be hired. By Book 3, the brothers have successfully reconciled and work together in Bloom’s research laboratory.
- Symbol Swearing: A premium choice allows Sienna to break up with Wayne in Book 1, Chapter 14. One of Casey’s options is just a long string of these.
- Team Pet: Book 1, Chapter 12 allows you to buy either a pet turtle named Mitch, a chinchilla named Andi, a fennec fox named Furball, or buy all of them.
- Tempting Fate: Dr. Bryce Lahela is renowned (and reviled) for his track record with risky surgeries. His main boast throughout Books 1 and 2 is that his hands never shake, thanks to his unflappable confidence. Then comes Book 3 … note
- Dr. Ramsey will repeatedly butt heads with Leland Bloom in Book 3, and at the first opportunity, Bloom will remove Ethan as the Lead Diagnostician. Ethan will return, gloating that Bloom is no longer a threat to him … only to reveal at the end of Chapter 12 that he is party to a career-ending malpractice suit.
- Teeth-Clenched Teamwork: The underlying conflict of Book 3 once Edenbrook has been purchased by Leland Bloom and he wants to call the shots. Dr. Ramsey is forced to confront his fear of dishonoring Naveen’s legacy and his own stubborn behaviors, and the situation only grows more unstable once Bloom deliberately undermines him by hiring Dr. Tobias Carrick.
- Tonight, Someone Dies: The start of Book 2 has a Flash Forward, showing Casey attending a funeral of someone close to them, It's not stated who it will be, all we know is that someone will kick the bucket before the end of the book. It's revealed to be Nurse Danny Cardinal and a security guard, Bob Gunderson, who were caught in an assassination plot against Senator Ed Farrugia.
- Too Good to Be True: After all the trauma of Book 2 and it appears that Edenbrook will close down for good, a tech multibillionaire will acquire the hospital and make a very public show of building it into a world-class research facility. He seems to have made good on his word at the outset of Book 3. Most of the speaking characters are happy to finally get top-tier equipment (and better paychecks) but naturally Ethan Ramsey objects heavily. And as the book shows rather early on, he’s completely right to be concerned.
- Urgent Medical Alert: The very first case for Casey is a woman who suffers a hemothorax in the reception lobby. Some other patients offscreen get this as well. When Annie gets an allergic reaction to the antibiotics, the only doctor around to help is Jackie.
- Wham Episode:
- Book 1 Chapter 7. Casey discovers that Patient X is Dr. Banerji and that he's dying.
- Book 1 Chapter 12. Mrs. Martinez is cured of her Rhodes disease with an experimental serum that has a 40% chance to kill her, a chance she'll gladly take than stay cooped up in the hospital. A few days later, she dies in Buenos Aires. Ethan finds out that Dr. Banerji only has a month to live, and Casey is brought before Harper to learn that Mrs. Martinez's family is demanding an autopsy of her and if they discover anything went wrong, they will sue.
- Book 2, Chapter 11 is a real Drama Bomb. An attempted assassination on the senator via biological warfare leads to multiple characters being Killed Off for Real, the hospital being quarantined, Casey and Rafael almost dying and Rafael's partner breaking up with him after realizing that he will never stop sacrificing himself without hesitation, meaning that Casey is finally free to rekindle their relationship with him (if they had one in Book 1). This chapter also marks the first time in the series where you get to play as someone other than Casey.
- Book 2, Chapter 13. At the end of the chapter, Esme makes a Tragic Mistake that kills one of her patients (one that she had Ship Tease with, at that). Because of this, the patient's family are suing the hospital, echoing what happened in the last book.
- Book 2, Chapter 15 suggests that Esme intentionally put her patient out of his misery, despite medically-assisted suicide being illegal in Boston. While this is neither confirmed, nor denied, it does mean that if this was true, only Esme would be in legal trouble and the hospital would be safe. Also, Declan Nash's crimes are revealed and Mass Kenmore pulls out of a potential partnership with Edenbrook, leaving them in serious financial trouble.
- Book 2, Chapter 17. Despite everything, Edenbrook only has a month left before it closes its doors, due to lack of funding. This is also the chapter where Casey has to make a decision on what to tell the administration board; did Esme really Mercy Kill her patient, or did she make an honest mistake? What Casey tells them will affect their relationship with Esme for the rest of the series.
- Withholding the Cure: The first of several medical dilemmas that Casey will encounter across the series, and arguably the most shocking. Although the treatment works to cure the patient’s ailment initially, it also directly kills her shortly afterwards.
- Irate patient Mike Knoblauch will accuse the hospital of this practice of this when Casey struggles to diagnose the cause of his mysterious migraines, claiming that they are keeping him there longer without curing him for monetary gain.
- Writing Around Trademarks: A premium date with Bryce in Book 1, Chapter 14 has him and Casey playing Barrio Kart. Bryce actually name drops Donkey Kong before the proprietor asks if they want the company to get sued.
