Fair Play has 100 cards. None of them is "manage a seizure action plan."

If you've read Fair Play, or had a friend press it into your hands, you know the idea. Every job it takes to run a household goes on a card, and whoever holds a card owns all of it. Eve Rodsky built the system from interviews with more than 500 couples, and the book comes with 100 cards that "represent the most common tasks in the home ecosystem" (Publishers Weekly).

I think it's a good system. The part that holds up best is that every task has three parts: noticing it needs doing, planning it, and doing it. The person who only does the last part is helping, but they aren't carrying the job. Fair Play's own deck lets you click any card "to learn the conception, planning and execution for each task" (Fair Play Policy Institute). If you've ever been handed a grocery list and thanked for "helping," you know exactly why that matters.

For families like mine, though, there's a gap, and it's worth naming before you sit down with your partner and the box.

The deck has one card for the thing that runs your life

To be fair to Fair Play, it doesn't ignore families like ours. The Caregiving suit has cards for kids' medical care and for health insurance, and it has a card for special needs and mental health (Fair Play Policy Institute).

That's one card. If your child's medical picture is complicated, my honest read is that on some weeks that single card holds more work than most of the rest of the deck — and the game expects one person to hold it, the same way one person holds laundry.

Take one thing that would live under it: a seizure action plan. The American Academy of Pediatrics says the plan should be reviewed and signed by your child's doctor, reviewed and updated regularly — especially when medications change — and given to all administrative staff and teachers at the school, with the information also reaching whoever supervises bus rides, field trips and sporting events (HealthyChildren.org, American Academy of Pediatrics).

That's one document. Here are the jobs I can count hiding in that guidance:

• Noticing the plan is out of date: after a medication change, a new school year, a new aide.
• Getting the appointment or portal message that gets you a fresh signature.
• Making copies, and knowing exactly who still has the old one.
• Getting a copy to the bus, the aftercare program, the PE coach, the field trip chaperone and the grandparent who does Thursdays.
• Following up when the front office says it never got one.
• Checking that whatever supplies the plan names are actually where the plan says, and still in date.
• Walking a new staff member through it in August, and again in January when someone leaves.

Each of those is a full Fair Play card on its own, with its own noticing, planning and doing. And that's one plan for one condition. Plenty of our kids have several documents like it — a feeding plan, a behavior plan, an emergency information form, a health plan at school — each on its own update cycle, each with its own list of people who need the current version.

Why one card can't stretch that far

There's research on how much of this there is. In a national survey of families of more medically complex children with special health care needs, families reported a median of 2 hours a week on care coordination and 11 to 15 hours a week on direct care at home, and 54.1% said a family member had stopped working because of the child's health (Archives of Pediatrics & Adolescent Medicine, 2011). The survey is from 2005–06, and its definition of "more complex" was narrow: among other criteria, the child used medical equipment for daily activities and had seen two or more specialists in the past year.

The study doesn't connect any of this to Fair Play (Archives of Pediatrics & Adolescent Medicine, 2011). That part is mine. The game assumes two partners renegotiating a pile of work that's roughly shareable. In a lot of our homes, one parent already left a job to hold the medical card before anyone opened the box. So the useful question is what the other partner can take from a deck that is mostly one card.

What it looked like in our house

The moment that broke me was realizing how much of this my wife had been carrying without me knowing the details of it. There was no big medical event attached. It was the brand-name lookups, the temperature rules, the which-water-from-which-container rules, the fever logs going back to when he was a baby, and the mental map of his unsafe body movements at meals — what to watch for, when to step in, what kind of crash is the dangerous kind.

None of that would have fit on a single special needs card in a form I could pick up. It was dozens of small jobs, each with its own rules, and she was doing the noticing for every one of them. The only reason I saw the size of it was that every time someone else watched him — a sitter, a grandparent, a substitute teacher — she had to dictate the contents of her head out loud, in real time, and half of it still didn't transfer.

Build the second deck yourself

You can do this tonight with a stack of index cards or a notes app. It works for a seizure action plan, a feeding plan or anything else that lives under that one card.

1. Pull the one card out. Set the special needs card aside. Play the rest of the deck the way the book says.
2. Write one card per document and per recurring job. The seizure action plan above becomes at least four cards: keeping it current, getting it signed, getting copies out, and walking new people through it.
3. Write the trigger on each card. Most of the noticing in this kind of care is set off by a date or an event — a new school year, any medication change, a new staff member, a field trip form. With the trigger written down, the partner who doesn't usually notice has something to watch for.
4. Deal them for real. If your partner takes "copies of the action plan," they own it, including finding out the bus company switched drivers.
5. Give the high-stakes cards a backup holder. This is where I part ways with Fair Play, and it's my own call. Rodsky wants one person per card. For anything that matters when the main holder is sick or away, a second person should know where the current copy lives and who has it. Otherwise one person is holding all of it, which is the same single point of failure you started with.
6. Reshuffle on a schedule. The start of the school year and the week after a specialist visit are natural times to do it.

Here's what one card looks like written out. Copy the shape:

Seizure action plan: copies Trigger: plan re-signed, new school year, new staff member, field trip notice. Plan: a list of everyone who should have the current version, and the date each person got it. Do: deliver it, confirm they received it, collect the old copy. Holder: [name]. Backup: [name].

Ten or twelve of those and you have a real picture of the load. That's useful whether or not you ever play the rest of Fair Play.

Where Fair Play still helps

The best thing the book gives families like ours may be its vocabulary. "I hold the noticing on this, and I need you to take the planning" is a much easier sentence to say across the kitchen table than "you never help with the medical stuff." Fair Play gave a lot of couples that language. We just need more cards than came in the box.

If you want somewhere to start writing down what's in your head, the Handoff Sheet below is a one-page version of exactly what my wife used to have to say out loud.