In the Midst of Fertility Challenges, Video Games Offer Me a Sense of Control

I’m in the fourth exam room with one of my last patients of the day, late afternoon light streaming in through the windows behind him. We’re about to go over the results of his scans after several months of therapy for metastatic kidney cancer, and as I turn from the computer screen, squinting against the glare, I clear my throat once again. This is a routine I know well. But as I begin to tell him what we’ve found, I find my train of thought interrupted by the insistent strings of the battle theme from the recently released console role playing game Persona 5 Royal. Outwardly, everything proceeds as normal—the right words still come, and I tell him that the pills seem to be working, that we need to continue them every day. Yet my discordant mental soundtrack continues as a strange counterpoint, testing my waning powers of concentration. 

Later that day, while I’m writing progress notes in my upstairs office, my focus breaks again, the pixels of the computer screen reforming themselves from lines of bland text into the animations that accompany the special combination attacks in the game. Every hour brings more evidence that the boundaries between worlds are not as solid as they once appeared.

I know I’ve been spending too much time in the alternate reality Tokyo of Persona 5—mashing buttons to control my party traveling the in-game Metaverse, plotting my teenage characters’ social lives to gain new abilities. There’s real-world work to be done, after all. Taxes to be finished, messages from my cancer patients to be answered, and, of course, the paperwork for the interminable surrogacy process, which is itself the terrible culmination of the nearly five years of infertility my wife and I continue to  stumble through. Yet, increasingly entranced by the all-consuming world of the game, its reality now bleeding into mine, I have neither the wish nor the will to turn away. 

Persona 5 Royal gives the player control of a group of Japanese teenagers navigating high-school life, fusing this drama with that of their eventual quest to find the cause of a mysterious, high-profile series of psychotic breakdowns across the country. A role-playing game, it invites the player to very literally take on the roles of these characters as the peaks and valleys of their everyday lives are further intensified with the white-knuckle responsibility of saving their world. There’s a similarity between how the “real lives” of the characters in Persona become irrevocably entwined with their alter egos’ quest to save “the world”, and how my day-to-day life is slowly melding with the game. Daily disappointments feel smoothed out by Persona’s narcotic narrative. I fight a growing urge to wrap it totally around myself like a thick woolen blanket, keep warm, keep the darkness out. I want to live in that feeling. 

Some days later, my wife and I are at our long wooden dining table, a laptop open between us. We’re on a video call with a psychologist who will determine our mental fitness to proceed with surrogacy. I think about how we got here, how it began with my wife’s desire to have a child, which became our desire to have a child, which came up against years of failed fertility procedures, false hopes, thousands of dollars paid, and a single, cursed miscarriage. Desire unextinguished, each disappointment is a redirection, not an end. Swept up in this current, lack of control can feel like a failure of will – maybe we just hadn’t wanted it badly enough—and with that thought, desire shrinks into desperation, a hope that a single success could wash away the whole sorry mess. We smile, move through the boilerplate conversation, the theme music again playing in my head, now the constant accompaniment to the ebb and flow of the world around me. “Tell me about your relationship,” the kindly psychologist says. The tune reaches a climax, and I think I know what to say. 

I turn Persona back on that night, tapping buttons to use my items, make connections with characters in the game, move the plot forward. I’ve loved games like these for years. While in elementary school, I was allowed to rent one for my Super Nintendo once every three months. I don’t know how my parents came up with that number, but for all its arbitrariness, the rule remained ironclad. Weeks of research went into each decision—poring over copies of Nintendo Power and Electronic Gaming Monthly, talking to my friends at school about what they were playing. The night before each trip to Video Giant off East Frank Phillips in the middle of Bartlesville, Oklahoma, I couldn’t sleep with excitement, wondering if my first choice would be there on the shelves. When we finally pulled up to the store in our Toyota the next morning, I raced to the far wall, where the game rentals were displayed on long, parallel shelves that, in my childhood, seemed to stretch on forever. 

Each rectangular box was a portal to another world. When I was in elementary school, my favorites were side-scrolling platformers like Super Mario World, but I became drawn to role-playing games the older I got—the wacky alternative reality of Earthbound, the freewheeling time-travel of Chrono Trigger, the steampunk fantasy of FFIII. The finely drawn details of their imaginary worlds were what most captivated me. Though they seemed endless, they also seemed understandable, knowable in a way that what passed for the real world often was not. When my mom went to Wal-Mart on the weekend to get groceries, I begged to go along so I could go to the electronics department and read the guidebooks to whatever RPG I was playing at the time. I liked to know how much damage Mallow’s attacks caused in Super Mario RPG, how many hit points the pizza in Earthbound replenished. I liked to look at the details of all the inventory in the stores I’d find a little further on in Lufia II—what the shields and armor looked like, what they did. When I came home, I’d draw up my own detailed catalogs with pencils and paper, listing the attributes of all the battle gear I dreamed up. 

Persona 5 Royal takes the average gamer over one hundred hours to complete. That’s time right after work, stolen hours later in the night. I recently talked to a good friend of mine, a busy neurologist, a father of three kids, who told me how the similarly all-consuming Elden Ring was ruining his life, its allure driving him to stay up far past midnight for weeks in a row. I dallied with pen and paper RPGs, but the console experience is what I’ve always loved most. Those hours on my own long after everyone else has gone to sleep, just me and the game, night after night, week after week, drawing deeper into a narrative that seems under my control.  

The illusion of control is especially seductive, distinguishing video games from the escape of a good book or television series. Control over not only my character’s actions, but over their long term strengthening, their accrual of new powers and abilities. The Japanese RPGs I loved best followed a particular arc – you’d start off as a spiky haired young kid in some corner of a weirdly named empire, and you’d soon get sucked into a conflict regarding the renewal of a long forgotten magical power or something. As you passed through dungeons, towns, and the open land between, you’d be assaulted with random enemies. They’d start off slightly stronger than you, but as you battled them and gained experience, you’d soon become slightly stronger than them. Then you’d go on to the area’s boss, who maybe you’d beat the first time through. If you didn’t, you could retreat and battle some more underlings until you’d become strong enough to beat the boss and go on. It was a game mechanic derisively called “grinding”, a cheap way to side-step difficulty. Yet I still loved that if I put in enough time, any in-game challenge was surmountable. The story inevitably moved forward. 

A few weeks after our interview, we receive an approval from the psychologist over email. There is no celebration. Wearily anticipating the next steps, I boot up Persona, taking Yusuke, Ryuji, and Ann with me into the tortured psyche of an evil fast food magnate. As I battle sentient robots with deftly timed special attacks, I think about what’s next, all the medical testing and legal discussions. What awaits afterwards looms even larger. There is no guarantee, after all, that even with an apparently healthy embryo, a surrogate lined up, and the papers signed that what comes next will progress the way in which we dream. There is no guarantee. I move my left thumb and the characters on the screen move along with it; I tap my right index finger and they loot a treasure chest. 

But what does this control mean, really, in a totally determined world, one planned out by programmers at a game company? Skill matters some, the hours I put in, but in the end the outcomes are finite—either a “good” ending or a “bad” one. Perhaps what I really want isn’t control after all, but some assurance that the arc will all make sense, that I’ll fight longer and longer and get stronger and stronger and then there’ll be an end, for good or for bad, and then it’ll all be over. 

That’s the thing about infertility: there are no assurances of a compelling narrative, no promises of a dramatic ending. The only guarantee is that it’ll go on until you have a child or until your emotional endurance or your savings run out. Some of our good friends entered the world of infertility alongside us for a while and succeeded with their first or second round of IVF. The experience for them will be a footnote to a story they’ll one day tell their wide-eyed children. What story will we one day tell? And to whom? Someday at brunch—we tried for a long time and then we didn’t anymore. 

I’ve lived through so many narratives that were true for a while and now are not—I’m an Indian kid living in Oklahoma; I’m an assassin in Elder Scrolls IV: Oblivion; I’m a medical student; I’m a survivor of nuclear annihilation in Fallout III. All have passed from present to past tense, the stories about what I could once say about myself as real or unreal as anything on my Xbox. Now, I advance through the labyrinths of Persona 5, destroying the perverted desires of the corrupt authority figures that populate the game world, still hoping that the story of our infertility can reach its own narrative climax, whatever that is. Drifting through time, moving from story to story, hoping that ours is interesting, or at least makes sense before receding irrevocably into the past.    Plot has become the enemy of presence. The way I make sense of my past shifts constantly, my thoughts consumed with events that can’t be changed. The desires for what I wish I had now and in the future have become ways to be dissatisfied with all that the present gives me. If happiness exists, it can only be here, it can only be now. But I don’t know how to do anything but keep looking ahead: towards the next boss fight, towards a future I hope will finally bring my wife and I what we think we need. Just for tonight, I want to stay in the world of Persona 5 Royal, pushing aside questions of deeper meaning—if only for the length of the next turn-based battle, one step closer to leveling up.