How Spiritfarer Helped a Chicago Palliative Care Physician Process the COVID-19 Pandemic

For healthcare professionals on the front lines of the COVID-19 pandemic, finding healthy coping mechanisms became as critical as securing personal protective equipment. Amidst the unprecedented strain of caring for critically ill patients, Dr. Matthew Tyler, a palliative care physician based in Chicago, turned to an unexpected source of solace: Thunder Lotus Games’ indie title, Spiritfarer. Released in the summer of 2020, the critically acclaimed management game about dying provided Tyler with a metaphorical vehicle to process the relentless grief, abrupt losses, and emotional toll experienced within hospital walls during the global health crisis.

Described by its developers as a "cozy management game about dying," Spiritfarer places players in the role of Stella, a young woman tasked with ferrying spirits to the gates of the afterlife. For a physician whose daily routine involved delivering fatal prognoses over hospital telephones to invisible family members, the game’s themes struck a profound, therapeutic chord.

The Intersection of Virtual Mechanics and Real-World Medicine

The structural design of Spiritfarer heavily mirrors elements of palliative care and end-of-life management, albeit wrapped in vibrant hand-drawn animations and a melancholy, nostalgic soundtrack. Players must construct living quarters aboard a sprawling ferry, gather raw materials to navigate uncharted waters, and cook individualized meals tailored to the distinct preferences of each passenger. A core gameplay loop involves comforting spirits through physical gestures—such as hugs—which directly influence their emotional well-being and willingness to share their life stories before crossing over.

For Tyler, these mechanics offered a striking parallel to his professional reality. In traditional palliative medicine, clinicians rely on established frameworks and disease trajectories—such as the predictable decline of advanced metastatic cancer—to guide patients and their families through future planning. This medical knowledge serves as an invisible psychological shield, offering clinicians a mental schema to process inevitable patient loss.

However, the onset of COVID-19 shattered these established paradigms. The virus introduced a frightening, breakneck clinical trajectory where patients deteriorated rapidly, leaving medical staff with no pre-existing narrative to emotionally brace themselves or grieving families for the sudden outcome. Hospital visitor restrictions further compounded this trauma, reducing family interactions to desperate, tortured voices over telephone lines.

An Unexpected Loss Mirroring Reality

The therapeutic parallel within Spiritfarer crystallized during a poignant moment in Tyler’s playthrough. While walking past the quarters of one of his favorite in-game companions, he noticed the exterior adorned with flowers—the definitive visual indicator in the game that a spirit had already passed through the gates of the afterlife.

Because the companion’s storyline remained unfinished and no formal goodbye had been exchanged, Tyler experienced a visceral jolt. The sudden, unannounced departure stripped away any sense of closure, instantly teleporting him back to the harsh reality of his Chicago hospital ward. The abrupt disappearance of the virtual companion mirrored the countless COVID-19 patients who slipped away under strict isolation protocols, leaving families without the opportunity for a proper farewell or emotional closure.

This unexpected trigger highlighted a central tension of the pandemic: the profound resentment healthcare workers felt toward a disease that defied the natural order of aging and chronic illness. None of the COVID-19 patients were supposed to be dying in such a sudden, isolated manner, stripping clinicians of their traditional ability to facilitate peaceful, prepared transitions.

Broader Implications for Healthcare Resilience

The psychological impact of the COVID-19 pandemic on healthcare workers has been a subject of extensive study by organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). Millions of medical professionals worldwide experienced heightened rates of burnout, moral injury, and compassion fatigue due to continuous exposure to mass mortality and systemic limitations.

Experts in medical humanities note that artistic mediums—ranging from literature and film to interactive video games—play an increasingly vital role in helping clinicians process secondary traumatic stress. Unlike passive media, interactive titles like Spiritfarer require active participation, compelling players to engage directly with themes of loss, acceptance, and stewardship.

Through his prolonged engagement with the game, Tyler derived a lasting philosophical shift regarding control and agency in healthcare. Spiritfarer served as a gentle reminder that COVID-19 did not hold a monopoly on unanticipated loss, nor does working adjacent to death afford mortal control over its timing or methods.

Redefining Participation in End-of-Life Care

The ultimate takeaway from Tyler’s experience transcends simple escapism. Spiritfarer reinforces a foundational tenet of palliative medicine: the inability to control a final medical outcome does not negate the value of active participation in the process. Even when a terminal diagnosis is unchangeable, clinicians, caregivers, and community members retain the agency to hold space, listen to personal narratives, and provide comfort during humanity’s most vulnerable moments.

This realization underscores the importance of community care in shaping a resilient post-pandemic future. By charting the best possible course through professional and personal uncertainty, healthcare providers continue to find meaning in their daily labor, accepting that some journeys must ultimately be left to the open water.

Spiritfarer remains accessible to a broad audience across multiple platforms, including PC via Steam, Xbox, PlayStation, and Nintendo Switch. The narrative surrounding its therapeutic impact on healthcare workers has also been featured across medical humanities forums, including Pallimed, and discussed in companion video essays produced in collaboration with the Digital Doc Games channel, emphasizing the growing recognition of video games as legitimate tools for emotional processing and psychological healing.