Holding On: The Troubled Life of Billy Kerr Rulebook

Table of Contents

Table of Contents

• Warning
• Overview
• Components
• Setting Up
• Scenarios
  • Scenario Objectives
  • Successfully Completing a Scenario
  • Losing a Scenario
• The Care Team
• Billy's Condition
• Patient Cards
• A Day at the Hospital
• Handover
• Shift Manager Duties
  • Reveal Patient Card
  • Assigning Staff
  • Providing Cover
• Caring for Billy
  • Medical Care
  • Palliative Care
  • Medical Emergencies
• Care Tokens
  • Gaining Care Tokens
• Partial Memories
  • Gaining Partial Memories
• Events
• Clear Memories
  • Inquiry Action
• Talk About Billy
  • Place Partial Memories
  • Check and Place Clear Memories
• Stress
  • Going On Leave
  • The Price of Stress
  • Becoming Overstressed
• Hospital Warnings
• Rules for Scenario 2 and Beyond
  • Focusing Billy's Attention
    • Steer the Conversation
    • Persist
  • Calling
• Rules Changes for Two or Four Players
  • Two Players
  • Four Players
• Replaying a Completed Scenario
• Resetting the Game
• Icon List
  • Patient Cards
  • Event Cards
  • Events Version
  • Other Icons

Warning

The Partial Memory and Clear Memory Cards are only revealed during the game. While we can't stop you from looking at the cards in advance, it will diminish the sense of discovery that lies at the heart of playing Holding On.

Overview

Holding On: The Troubled Life of Billy Kerr is a co-operative game where players work as Nursing Staff tasked with providing care for the terminally ill. Your latest patient has been rushed in following a massive heart attack on a flight from Sydney to London. When the game begins all you know is this - his name is Billy Kerr, he is 60 years old, and he has been given days to live. Players must work together to provide Billy with appropriate care, responding to medical emergencies while gaining his trust. Over the course of ten linked and fully replayable Scenarios, you will need to piece together a lifetime of memories while being drawn deeper into his troubled past. As you discover more about Billy, can you help him find the courage required to confront the three regrets that keep him holding on?

These rules cover the three-player game. Some minor adjustments are required when playing with two or four players. Those alterations can be found under Rules Changes for Two or Four Players.

Components

• Game Board
• Shift Manager Board
• Billy Pawn
• 4 Nurse Pawns
• 3 Assistant Pawns
• 2 On-Call Assistant Pawns
• Contact Tile
• 39 Patient Cards
• 72 Narrative Cards
• 35 Partial Memory Cards (including 5 Event Cards)
• 35 Clear Memory Cards (including 5 Event Cards)
• 24 Care Tokens
• 12 Stress Tokens
• 2 Warning Tokens
• 10 Tracking Tokens
• This rulebook

Setting Up

1. Place the Game Board, leaving room below it for Billy's Collected Memories which will be added during the game.
2. Take the top three cards for Scenario 1 from the Narrative Deck and place them above the board, ensuring no cards are accidentally revealed. The cards in this deck are in a fixed order, so do not shuffle them.
3. Take the Patient Deck, shuffle it, then place it on the marked space on the board.
4. Separate the Partial Memory Deck and Clear Memory Deck, placing them both near the board.
5. Place the Billy Pawn on space 28 of the Condition Track.
6. Have each player choose a Nurse Pawn to represent them. Place these Pawns along with two Assistant Pawns on the Break Room area. Place the two On-Call Assistant Pawns on their marked positions next to the On Leave space.
7. Place the Care Tokens, Stress Tokens and Warning Tokens in three separate piles near the board. Each player begins the game with one Care Token.
8. Tracking Tokens are not required to play the game. They are provided in case you want to keep track of specific Memory cards in play.
9. Return the Contact Tile to the box. It is not required for the first Scenario.
10. Randomly select a starting player and give them the Shift Manager board. It is the Shift Manager's responsibility to prepare the Scenario.

To prepare the first Scenario, draw the first card titled Personal - Scenario 1 from the Narrative Deck. Flip the card and read aloud Introduction 1 to all players. When finished, place this on the Setup space of the board. Take the next card and continue reading with Introduction 2.

When finished reading, flip the card to the side marked Setup & Rules. This side includes any Scenario specific changes to game setup the Shift Manager must follow and/or any additional rules the players must observe during the game. Place the Setup and Rules card over the Introduction 1 card.

Draw the next card from the Narrative Deck. This is the Objective Card. Read out the Objective, ensuring all players understand what is required to successfully complete the Scenario. Place this on the Objective space on the board. Do not read the other side until you complete the Objective.

Later Scenarios will make use of the area marked with the Scenario-specific space on the board.

You are now ready to play.

Billy's Collected Memories: A key aspect of Holding On involves discovering important moments from five significant periods of Billy's life. Each period is called a Timeline. These Timelines are organised into a virtual five-by-six grid of linked Memory Cards, forming Billy's Collected Memories. You will rarely (if ever) complete the entire grid in one game. Instead, players should use it as a rough guide when adding and linking any Partial Memory and Clear Memory Cards they obtain.

Scenarios

Holding On is played out over ten linked Scenarios. The Scenarios are played in order with each one building on the last. To play a new Scenario follow the Setting Up instructions above. Some Scenarios will introduce additional cards or components. Follow the specific instructions as described on the Set Up and Rules Cards, referring to this rulebook for a detailed explanation of any keywords you encounter.

Cards from completed Scenarios can be kept in the extra storage space provided in the box. You may also be asked to set specific cards aside for later use.

Note: Even though Scenario 1 makes no changes to the basic setup and rules found in this rulebook, a Setup & Rules Card is provided for the sake of consistency.

Scenario Objectives

Each Scenario has an Objective that must be met before players can progress further through the game. While each Objective is unique, they will usually require players to have specific Clear Memory Cards present in Billy's Collected Memories. Where required, the Objective Card will depict the Partial Memory Card versions of these memories to aid players in their search. Some Objectives will include additional requirements for players to meet.

Example (Scenario 1): Unearth some basic information about your new patient. Players must have at least 1 Clear Memory in each Timeline (1-5) of Billy's Collected Memories.

Successfully Completing a Scenario

A Scenario is successfully completed when the Scenario Objective is met. After completing an Objective, you will be instructed to flip the Objective Card to reveal the Scenario Outcome.

Players may not progress to the next Scenario until they have achieved the current Scenario's Objective. If players fail a Scenario, they may attempt it again as many times as necessary in order to successfully complete it. Only then may they proceed to the next Scenario.

Losing a Scenario

Players immediately lose the current Scenario if Billy dies or is transferred away from the ward.

Billy dies if:

• The Billy Pawn reaches the final space on the Condition Track.
• The Patient Deck is empty at the start of a new day.

Billy will be transferred if:

• The players do not have enough Nurses, Assistants or On-Call Assistants available to cover a Shift (see Assigning Staff).
• The players receive a second Warning (see Hospital Warnings).

Replaying earlier Scenarios: It is possible to replay previously completed Scenarios. See Replaying a Completed Scenario for instructions on how to do so.

The Care Team

There are three different types of Staff found in Holding On; Nurses, Assistants and On-Call Assistants. Each player controls a Nurse, while Assistants are controlled by the Nurse currently acting as Shift Manager for the day (see Shift Manager Duties). On-Call Assistants are also controlled by the Shift Manager and are there to help out at difficult times. The Shift Manager duty rotates to the next player at the start of each day.

	Nurses	Assistants	On-Call Assistants*
Controlled by	Individual players	Shift Manager	Shift Manager
Provides Medical Care	Yes	Yes	Yes
Provides Palliative Care	Yes	Yes	Yes
Can use Break Room	Yes	Yes	No
Can gain Stress	Yes	Yes	No
Can use Inquire	Yes	No	No
Can use Call Action

*On-Call Assistants can be called in to help for a single day. They leave the hospital and are set aside during End of Day Duties.

Billy's Condition

• Condition Deteriorates (red symbol): Billy's Condition -1.
• Condition Stable (yellow symbol): no change.
• Condition Improves (green symbol): Billy's Condition +1.

In Holding On, Billy's Condition will change throughout the game. All Patient Cards and some Event Cards feature these symbols. How they impact Billy will be based upon which of these icons, and how many, appear on the card.

The Condition Track records Billy's deteriorating condition throughout the game and is divided into four different coloured stages: green (30-14), orange (13-08), red (07-04) and black (03-0). These colours are referred to when resolving Event Cards (see Events).

The Billy Pawn is used to track Billy's condition and begins each Scenario at 28 on the Condition Track. While he may temporarily improve beyond this, he will inevitably slide towards zero with each passing day. All Patient Cards and some Event Cards will impact Billy's Condition. The effect will be based upon which of these icons, and how many, appear on the card.

If Billy's Condition ever reaches zero on the Condition Track, he dies and players lose that game immediately. The current Scenario must be attempted again in order to progress.

• Billy's Condition will worsen if Medical Care is not provided when a Patient Card shows Deterioration.
• When Billy is Stable, his Condition can be improved with Medical Care (see Medical Care).
• Some Event Cards can result in an immediate improvement or deterioration in Billy's Condition.

Patient Cards

There are three different types of Patient Cards found in Holding On: Deteriorating, Stable and Emergency. A Patient Card will be drawn for each Shift and must be completely dealt with before players can progress.

1. Staff spaces. This shows how many Staff are required to cover the Shift.
2. Medical Care symbol. Players can choose to provide Medical Care to improve Billy's Condition or slow his deterioration.
3. Palliative Care symbol. Players can choose to provide Palliative Care, spending time with Billy to gain Partial Memories and/or Care Tokens.
4. Billy is deteriorating. Billy's Condition will drop by one space for each Deterioration symbol shown if he does not receive Medical Care during this shift.
5. Billy is stable. Providing Medical Care will improve Billy's Condition (+1) on the Condition Track.
6. Care Tokens & Partial Memories. This is the number of Partial Memories and/or Care Tokens players will receive by providing Palliative Care.
7. Players may use the Inquire Action to learn more about the Partial Memories in Billy's Collected Memories.
8. During a Medical Emergency, players can only provide Medical Care as they attempt to prevent a significant decline in Billy's Condition.
9. Staff will receive a single Care Token if they can completely avert the emergency.

A Day at the Hospital

Each round in Holding On represents one day at the hospital. A day is broken down into three separate Shifts - Morning, Day and Night. Beginning with the Morning Shift, the Shift Manager will reveal a Patient Card that indicates what happens to Billy during that Shift. They will then assign Staff to the Shift. When assigned, Staff will be faced with the dilemma of what kind of care to provide at that time. The decision of what to do on a Shift must be weighed against the level of trust players have with Billy, his current Condition and any Stress Staff might be carrying. They must also find time to learn about Billy's past in order to meet the Scenario Objective. This is repeated for the Day and Night Shifts.

Every day at the hospital will play out in the following way:

1. Handover - Pass the Shift Manager Board to the next player who becomes the Shift Manager for that day.
2. Morning Shift - Shift Manager reveals a Patient Card and assigns Staff to deal with the Shift (see Shift Manager Duties). Assigned Staff then decide how best to handle the shift (see Caring for Billy).
3. Send on Leave (optional) - Shift Manager decides whether to send unassigned Staff On Leave (see Stress).
4. Afternoon (Day) Shift - same as Morning Shift.
5. Night Shift - same as Morning Shift.
6. End-of-Day Duties - When all three Shifts are finished:
   • Check for Hospital Warnings.
   • Any Staff in the Break Room at the end of the day were able to spend time with Billy, building trust. They gain two Care Tokens each.
7. Gather Care Team
   • Return Staff Pawns from their Shifts to the Break Room.
   • On-Call Assistants working today are removed and no longer available.
   • Any Staff currently On Leave now return to the Break Room, Stress free.
   • Any Overstressed Staff (see Stress) must go On Leave at this point.
   • Prepare for next day - Discard Patient Cards and return to the pool any Care Tokens placed on the board during the day.

Handover

During game setup, players will have chosen who will be Shift Manager for the first day. On subsequent rounds (during Handover) the responsibility passes to the player on the left of the current Shift Manager. The Shift Manager Board is passed along with any Care Tokens currently held by the Assistants and/or Hospital Warnings players have received.

Shift Manager Duties

Reveal Patient Card

Each Shift begins with the Shift Manager revealing a Patient Card and placing it face up in the next available Shift space on the board.

Assigning Staff

The Shift Manager must now assign Staff. Each Shift will require between one and three members of Staff. Any combination of available Nurses, Assistants and On-Call Assistants can be assigned to a Shift.

To assign a member of Staff to a Shift, move their Pawn from the Break Room and place it on an open Staff space. The first player whose Pawn is placed on a Patient Card is the senior member of Staff for that Shift, and will make the final decision on what action should be taken. If only Assistants are used, the Shift Manager will make the decision.

Assigned Staff must deal with the Patient Card for the current Shift before the Shift Manager can reveal a Patient Card for the next Shift.

Example: The Shift Manager moves the Assistant Pawn from the Break Room to the second Staff space. With two Staff now assigned, this Shift is covered. The Nurse (Yellow Pawn) is the senior member of Staff and will decide what kind of Care to provide.

Providing Cover

If there are not enough Staff available to fill all spaces on a Shift, the Shift Manager has three choices:

• Bring in one or both of the On-Call Assistants, if available.
• Re-assign a Nurse, Assistant or On-Call Assistant from the previous Shift to cover the current shift. After moving, Nurses and Assistants will gain Stress. On-Call Assistants will not gain Stress.
• Have any Nurse or Assistant assigned to the current Shift provide additional cover for up to two other members of Staff, gaining Stress for each unoccupied space. On-Call Assistants cannot be used in this way.

See Stress for more information about its impact on the Care Team.

Example: The Assistant assigned to the Morning Shift cannot be re-assigned to the Night Shift, as it was not the previous Shift. The Nurse on the Day Shift is re-assigned to cover the Night Shift, gaining Stress. They gain another Stress for providing additional cover. The On-Call Assistant covers the third Staff space.

If the Shift Manager still cannot assign enough Staff to cover a Shift fully, then the players receive a Hospital Warning (see Hospital Warnings).

The Night Shift: Once all Staff spaces on the Night Shift have been filled and the Shift is covered, one Care Token is immediately gained. This is given to a single member of the assigned Staff and can be used during this Shift. This bonus is only received during Night Shifts.

Caring for Billy

After Staff have been assigned to a Shift, they must decide which kind of care they will provide for Billy. Maintaining a good balance of care is vital if Staff are to support Billy both physically and mentally.

During a Shift, assigned Staff must provide either Medical Care OR Palliative Care, never both.

Players should discuss their preferred approach and come to a collective decision. If they fail to do this, the final decision is left to the most senior member of Staff.

Players must provide Billy with Medical Care at least once per day. Failure to do so will result in a Hospital Warning.

A Shift ends after players have provided either Medical or Palliative Care. On a day where Billy is Stable, the players also have the opportunity to Inquire (see Inquiry Action) before finishing the Shift.

Medical Care

Providing Medical Care will help keep Billy alive longer, but in doing so you miss the opportunity to build trust or learn about Billy's past. Assigned Staff may spend Care Tokens they have previously gained to provide Medical Care. Nurses may choose to use Care Tokens belonging to Assistants also assigned to the current Shift.

Medical Care works in the following two ways:

• For each Deterioration symbol on the Patient Card, assigned Staff may use a Care Token to cover it, cancelling the negative impact on Billy's Condition. While you do not have to fill all spaces on a Patient Card with Care Tokens, doing so keeps Billy alive for longer. Once Medical Care is given, move the Billy Pawn one space down the Condition Track for each Deterioration symbol left uncovered.
  • Example: By using two Care Tokens to cover the symbols on the Patient Card, Billy's Condition will only drop by one.
• When Billy's Condition is Stable, a single Care Token may be used to cover the Stable symbol. This improves Billy's Condition. Move the Billy Pawn one space up the Condition Track.
  • Example: By using a Care Token to cover the symbol on the Patient Card, Billy's Condition will improve by one.

Palliative Care

Providing Palliative Care allows you to gain Billy's trust and/or learn about his past. In doing so you forego providing Medical Care. As a result, if his condition is deteriorating, it will immediately drop by the number of Deterioration symbols shown on the Patient Card. If Billy's condition is Stable, there is no change in his state.

By choosing to provide Palliative Care, the assigned Staff gain Care Tokens from the supply and/or a number of cards from the Partial Memory Deck (see Partial Memories) equal to the amount depicted on the Patient Card. If there is an option, the senior member of Staff makes the final decision. The Patient Card shows one of three options: gain 1 Care Token; draw 1 Partial Memory Card; or gain 1 Care Token OR draw 1 Partial Memory Card.

Medical Emergencies

During the game, Billy will experience Medical Emergencies where his Condition is failing dramatically. Players can only provide Medical Care during an emergency. If all symbols are covered, then the emergency is averted. If an emergency is successfully averted, assigned Staff earn Billy's trust and may claim one single Care Token. This is immediately given to a Nurse or Assistant who was assigned to the Shift. If players do not cover all symbols, they have failed to avert the emergency. Move the Billy Pawn down the Condition Track a number of spaces equal to the symbols left uncovered. No Care Token is gained.

Example: By using four Care Tokens to cover all the Deterioration symbols on the Patient Card, the emergency is averted, and the players earn Billy's trust, gaining one Care Token.

Care Tokens

Care Tokens gained throughout the game represent the level of trust Billy has in the hospital Staff. Care Tokens are primarily used to provide Medical Care and to Inquire about Clear Memories (see Inquiry Action). They may also be used to deal with certain Event Cards. Finally, Care Tokens may be used to Focus Billy's Attention as a way of finding specific Partial Memories (see Rules for Scenario 2 and Beyond).

Care Tokens in the Assistants pool can only be used to provide Medical Care when an Assistant or On-Call Assistant is assigned to a Shift. Nurses may not use Care Tokens from the Assistant pool when Inquiring.

Gaining Care Tokens

Care Tokens can be gained by all Staff and come primarily from providing Palliative Care. A single additional Care Token is always earned during the Night Shift. Any unassigned Staff remaining in the Break Room at the end of the day also gain Care Tokens.

Any Care Tokens gained by Assistants go to a collective pool on the Shift Manager Board. Nurses are responsible for their own Care Tokens and may hold a maximum of six at any given time.

Partial Memories

Billy will initially be reluctant to talk about his past. By providing Palliative Care, players will gain Billy's trust. As a result, Billy will share Partial Memories from his life.

The back of the Partial Memory Card shows which of the five Timelines in which it appears. It also contains a quote from Billy that conveys his thoughts about the event depicted on the card. The front of the card shows a blurred scene featuring Billy. This visually represents his reluctance to reveal all at this time. The edges of each card have 'stitches' to help with placing the card in Billy's Collected Memory (see Talk About Billy).

Gaining Partial Memories

Whenever assigned Staff decide to gain Partial Memories as a result of providing Palliative Care, they must first agree who will be talking to Billy. Hand the Partial Memory Deck to a different player and have them shuffle it. This person will act on behalf of Billy, sharing his memories.

For each Partial Memory that Billy shares:

• The player acting on behalf of Billy draws a card face down from the BOTTOM of the deck.
• If an Event is drawn, reveal and resolve it immediately (see Events). Event Cards still count towards the number of cards drawn, unless an Ignore Event is triggered.
• If a Memory is drawn, keep it FACE DOWN while reading out Billy's recollection on the back of the card.
• Then, still keeping it face down, pass the Partial Memory to the assigned member of Staff who spoke with Billy. Cards received by Assistants are placed on the Shift Manager Board.
• Once a card has been drawn for each Partial Memory symbol on the Patient Card, Billy stops talking. Return any Event Cards you may have drawn back to the Partial Memory Deck.

Remember, any Memory Cards drawn MUST REMAIN FACE DOWN UNTIL THE END OF THE ROUND.

Drawing cards: At various times during the game you will be asked to draw cards on behalf of Billy from the Partial Memory or Clear Memory Decks. Remember to ALWAYS draw from the BOTTOM of these decks. This will ensure that cards drawn remain a surprise.

Events

Event Cards can be found in both Partial Memory and Clear Memory Decks, and have a different effect depending on Billy's Condition at the time.

When an Event Card is drawn:

• Reveal the card immediately.
• Check Billy's position on the Condition Track. It will determine the severity of the Event.
• Resolve the Event (see Icon List).

Remember, Event Cards still count towards the number of cards drawn unless the Ignore symbol is triggered.

Note: Some events will be represented by multiple symbols.

Example 1: This Event Card appears in the Partial Memory Deck. If Billy's Condition is in the green or orange stages of the Condition Track, the event is a Quiet Moment and Billy does not share a memory. If Billy's Condition is in the red, you may still encourage Billy to talk by using one Care Token to draw a Partial Memory ignoring Events. If Billy's Condition is in the Black, he refuses to talk any further; stop drawing cards immediately.

Example 2: This Event Card appears in the Clear Memory Deck. If Billy's Condition is in the green stage of the Condition Track, the event is ignored and the next Clear Memory Card is drawn instead. If Billy's Condition is orange, he changes the subject (see Icon List). If Billy's Condition is in the red, he changes the subject and the card is removed from the game. If Billy's Condition is in the Black, he refuses to talk any further; stop drawing cards immediately.

In later Scenarios certain Event Cards may be removed or new ones introduced. This will be indicated on the Setup and Rules Card for that Scenario.

Clear Memories

At the end of a Shift where Billy is Stable, AFTER providing either Medical OR Palliative Care, assigned Nurses may Inquire about Billy's past in an attempt to gain greater understanding of the Partial Memories in Billy's Collected Memories. These take the form of Clear Memory Cards. The back of each Clear Memory Card shows the Timeline in which it appears. The front of the card shows the unobscured version of a corresponding Partial Memory. Billy's surroundings are now clear as he reveals more about this specific time from his past. The edges of each card have the same 'stitches' as the associated Partial Memory to help with placing the card in Billy's Collected Memories (see Talk About Billy).

Inquiry Action

Inquiring is a free action which any assigned Nurses may take multiple times. Assistants may not perform this action. Begin by deciding who will be talking to Billy. Hand the Clear Memory Deck to a different player and have them shuffle it. This person will act on behalf of Billy, sharing memories in greater detail than before.

For each Inquiry Action taken:

• The Inquiring Nurse places one Care Token on the Inquiry action space of the current Patient Card.
• They then nominate a Timeline (1-5) that already has a Partial Memory in play.
• The player acting on behalf of Billy then draws cards face down, one by one, from the bottom of the deck. Keep drawing until an Event or Memory from the nominated Timeline is drawn. Ignore any Memory Cards from other Timelines that are drawn.
• If an Event is drawn, reveal and resolve it immediately (see Events). Event Cards still count towards the number of cards drawn, unless an Ignore Event is triggered.
• If a Memory from the nominated Timeline is drawn, keep it FACE DOWN and pass it to the inquiring Nurse.

The assigned Nurse now has three options. They may keep Inquiring about the same timeline, change subject and Inquire about a different timeline, or stop Inquiring.

• To Inquire about the same timeline, perform the Inquiry Action above nominating the same timeline. The player acting on Billy's behalf must not shuffle the deck or return any previously drawn cards to the deck before they start drawing cards.
• To Inquire about a different timeline, the player acting on Billy's behalf must return all discarded cards to the Clear Memory Deck and shuffle it before proceeding. Then the assigned Nurse performs the Inquiry Action again, using a Care Token and choosing a new Timeline.
• When the assigned Nurse either chooses to stop (or has no more Care Tokens), any discarded cards are returned to the deck ready for the next time an assigned Nurse wishes to use the Inquire Action.

There is no limit to the number of times an assigned Nurse can Inquire, as long as they have the Care Tokens to do so.

Remember, any Memory Cards drawn MUST REMAIN FACE DOWN UNTIL THE END OF THE ROUND.

Talk About Billy

After work, the Care Team come together to share what they have learned about Billy. Partial Memories and Clear Memories will be played to Billy's Collected Memories, revealing key moments from his past. Players always place Partial Memory Cards in Billy's Collected Memories first, before checking and placing Clear Memory Cards.

Place Partial Memories

Just like a jigsaw, every Partial Memory has one correct position in Billy's Collected Memories. Use the stitch symbols on all four edges of each card to help you link them with adjacent memories. The stitches will also tell you in which Timeline the card appears. Don't be surprised if you find you have to reorganise the cards in a Timeline when new Memories are revealed.

Check and Place Clear Memories

After placing Partial Memories, players then secretly check the Clear Memories they have obtained this round, comparing them against the Partial Memory Cards already in play. When looking for a match, use the figure of Billy, as well as the stitches, as a guide. Billy will appear exactly the same on both versions of the memory.

If a Clear Memory matches a Partial Memory in play, place it on top of the corresponding card. The Partial Memory is not removed. Any Clear Memories that do not match are returned to the Clear Memory Deck without revealing them to other players. This occurs even if the card is required to complete the current Scenario.

Note: Players may choose to place a Marker Token on Clear Memories as a reminder of which cards have been discovered.

Stress

Working in a hospital is stressful. Gaining Stress limits the flexibility of the Shift Manager when assigning Staff. It also restricts a Nurse's ability to talk to Billy. Nurses and Assistants gain Stress if they are ever required to cover more than one Shift during a day (see Providing Cover). When a Nurse or Assistant gains Stress, place a Stress Token on that Pawn.

• Nurses can carry a maximum of three Stress.
• Assistants can carry a maximum of two Stress.
• On-Call Assistants never gain Stress.

Going On Leave

Between the Morning and Day Shift of each round the Shift Manager can choose to manage Staff Stress levels by sending one or more of the team On Leave. A Staff member still in the Break Room following the Morning Shift can be sent On Leave that day. Move the Pawn representing the member of Staff to the On Leave space. The member of Staff is not available to work the rest of the day, but will return Stress free at the start of the next day. The Shift Manager may not go On Leave - they have a job to do!

Example: Before revealing the Patient Card for the Day Shift, the Shift Manager (after discussing it with the player) decides to send the Stressed Nurse (Yellow Pawn) home On Leave. Their Pawn is moved to the On Leave space and remains there for the rest of the day. They will return to work the next day, Stress free.

The Price of Stress

The impact of Stress is felt in the following ways:

• If a Nurse gains Stress: they must immediately select either a Care Token, a random Partial Memory or a random Clear Memory. This is returned to the supply or appropriate deck.
• If an Assistant gains Stress: the Shift Manager must immediately select either a Care Token or a random Partial Memory for them to lose. This is returned to the supply or its deck.

If the member of Staff holds no Care Tokens or Memory Cards at the time of gaining Stress, nothing is lost.

Gaining Stress also impairs a Nurse's abilities. If a Nurse ever holds two or three Stress, they are no longer able to perform the Inquire or Call Action (see Calling). A Nurse will regain the ability to perform these actions only after going On Leave, which removes all Stress.

Becoming Overstressed

When a Nurse or Assistant reaches their maximum Stress, they immediately become Overstressed. If this occurs, they complete the Shift as normal but cannot be assigned to a later Shift during the current day. At the end of the day, they are forced to go On Leave and are unavailable for work the next day. They will return the following day, Stress free.

If the Nurse scheduled to be Shift Manager the next day is Overstressed and forced to go On Leave instead, the Care Team will receive a Hospital Warning (see Hospital Warnings).

Hospital Warnings

There are three circumstances under which Staff can receive a Hospital Warning:

• If Staff fail to provide Billy with Medical Care at least once per day.
• If the Nurse scheduled to be Shift Manager the next day is Overstressed and forced to go On Leave instead.
• If the Shift Manager cannot assign enough Staff to fully cover a Shift.

Should players ever receive a Warning, take a Warning Token and place it on the Shift Manager Board. If a second Warning is received during the game, players immediately lose the Scenario.

The above rules cover everything you need to play Scenario 1 of Holding On: The Troubled Life of Billy Kerr.

For true investigators: While the character of Billy is fictional, the events he lived through are very real. Dotted throughout the Memory Cards and Narrative Deck are references to real-life locations and historical events. With a little investigation you can uncover a wealth of information about Billy's turbulent past. When pieced together, it will provide a more detailed timeline of his life. While this additional knowledge is not required to enjoy the game, we believe it will enhance your experience, deepening your connection with Billy.

Rules for Scenario 2 and Beyond

Focusing Billy's Attention

In later Scenarios, you will want to ask Billy about Memories from specific Timelines. When assigned Nurses gain Partial Memories as a result of providing Palliative Care they may, instead of drawing random Partial Memory Cards, choose to Steer the Conversation OR Persist in an effort to gain specific cards. The two options may not be combined.

Steer the Conversation

To Steer the Conversation, use one Care Token and nominate a Timeline. The Timeline must already have a Partial Memory in play. Then, for each card gained from talking to Billy:

• The player acting on behalf of Billy draws cards face down, one by one, from the bottom of the deck. Keep drawing until an Event or Partial Memory from the nominated Timeline is drawn. Ignore any Partial Memory Cards from other Timelines that are drawn.
• If an Event is drawn, reveal and resolve it immediately (see Events). Event Cards still count towards the number of cards drawn, unless an Ignore Event is triggered.
• If a Partial Memory from the nominated Timeline is drawn, keep it face down. Pass the card to the Inquiring Nurse.

Persist

When a Partial Memory Card is drawn, the assigned Nurse talking to Billy may spend one Care Token to ignore the drawn card. They must accept the next Partial Memory Card drawn, unless they use another Care Token to Persist further. When Billy has finished talking, the ignored cards are returned to the Partial Memory Deck.

Note: Events cannot be ignored. They are immediately revealed and resolved as normal.

Calling

Some Scenarios will require players to make contact with people from Billy's past. The Setup & Rules Card for the Scenario will tell you that the Contact Tile will be used. It will also provide the rules for Calling. When setting up, place the Contact Tile near the board, below the Patient Deck.

When assigning Staff to a Shift, the Shift Manager may also assign a Nurse to make a Call. Move the Contact Tile below the current Shift space and place the Pawn on the open Staff space on the tile. With some judicious planning, it is possible to make a Call more than once during a day.

After the Patient Card for the Shift has been completely resolved, follow the instructions for Calling outlined on the Scenario card.

A Nurse may be assigned to make a Call as long as:

• The criteria outlined in the Scenario Rules are met.
• The Staff space on the Contact Tile is unoccupied.

A Nurse carrying two or more Stress may not be assigned to make a Call. A Nurse assigned to make a Call is still subject to normal rules regarding Stress and providing cover.

Rules Changes for Two or Four Players

Two Players

In a two player game, the Care Team will be smaller, so the Shift Manager may cover one additional Shift without gaining Stress. When providing cover, they are not restricted to covering consecutive Shifts. They may move from the Morning Shift to the Night Shift if required. If they have only been assigned to one Shift during the day, the Shift Manager may use this flexibility to return to the Break Room area at the end of a day, gaining two Care Tokens.

Four Players

In a four player game, the Care Team is larger. As a result, the Shift Manager is not needed on the ward. At the start of the day during Handover, the new Shift Manager takes their Pawn and places it on the Shift Manager board. They may not be assigned to any Shifts during the day, including Calling. At the end of the day, after resetting the board, move the Shift Manager's Pawn to the Break Room area. They do not receive Care Tokens and will return to the ward at the beginning of the next day.

Replaying a Completed Scenario

It is possible to replay a Scenario in Holding On. To do this, retrieve all Narrative Cards from the box marked with the Scenario number you wish to play. Sort the cards into numerical order with the card titled Personal on top of the pile. Play the game as normal.

Resetting the Game

Holding On has been designed to be replayed as many times as you wish. If for any reason you need to rebuild the Narrative Deck, sort the cards into numerical order with the (A) side facing up. You will find the reference number in the bottom right corner of each card.

Note: Some cards are intentionally numbered on one side only for gameplay purposes. In such cases use the (B) side as a guide when sorting cards.

Icon List

Patient Cards

• Condition Deteriorates: Billy's Condition -1.
• Condition Stable: No change in Billy's Condition.
• Draw Partial Memory Card: Draw one card from the Partial Memory Deck.
• Care Token: Gain one Care Token from the supply.
• Draw Partial Memory Card / Gain Care Token: Gain 1 Care Token OR draw 1 Partial Memory Card.
• Inquiry: An assigned Nurse may use the Inquire Action. Can be performed multiple times by different Nurses.

Event Cards

• Ignore Event: Continue drawing cards as normal. Does not count as a drawn card.
• Quiet Moment: Billy has nothing to say. It still counts as a drawn card.
• Draw Memory Card: Draw one card from this Memory Deck.
• Draw Memory Card, Ignoring Events: Draw one card from this Memory Deck, ignoring any Event Cards drawn.
• Change of Subject: Take next card from nominated Timeline, ignoring any others.
• No More Talking: Billy refuses to talk any further. Stop drawing cards immediately.
• Remove: Once the event is resolved, remove this card from the game.

Events Version

• Use trust to Improve Billy's Condition: Use one Care Token to improve Billy's Condition +1.
• Use trust to gain a Memory Card: Use one Care Token to draw one card from this Memory Deck.
• Condition Improves: Billy's Condition +1.

Other Icons

Rules version:

• Positive Symbol: A positive Memory for Billy.
• Negative Symbol: A negative Memory for Billy.
• Send On Leave: The point in the day when the current Shift Manager has the option to send unassigned members of Staff On Leave.
• Warning Check: The point in the day when the current Shift Manager must check to see if Hospital Warnings are received.
• Morning Shift / Day Shift / Night Shift: The three Shifts that make up a day at the hospital.
• Calling: An assigned Nurse may use the Call Action. Can only be performed once per Shift.