Wednesday, November 2, 2016

Amputation

A procedure in which a part of the body is removed, possibly resulting in death. Amputation is sometimes used to control the spread of disease or necrosis moving outward from an affected limb, such as malignancy or gangrene. It may also be necessary to separate a creature from a limb if the creature is trapped and cannot otherwise be freed.

When performed by any person without sufficient medical knowledge, the chances of a creature surviving the loss of a limb is extremely low. To determine if a creature survives an amputation, the creature will need to roll on the amputation shock survival chart (see below). If survival occurs, the creature will also suffer a severe injury.

Shock

The amount of shock a creature suffers from an amputation depends upon the limb that is severed. For the purpose of this system, amputations have been broken down into five categories, from the least invasive to the most extreme, from the least likely to result in death to the most likely:
  • Incidental: fingers and toes, ears, nose and teeth. 
  • Minor: partial hand or foot, tongue or eyes. 
  • Major: wrist or ankle, through the forearm, at the elbow, below the knee, at the knee. 
  • Radical: above the elbow, at the shoulder, above the knee, at the hip, removing the genitals or the breasts. 
  • Drastic: cutting through the torso or decapitation (remembering that many creatures have more than one head). 

It must be noted that the success or failure of the procedure is not always one that can be determined in a matter of minutes. For that reason, there are two stages in determining the survival of the patient. The first is where the chance of surviving the initial surgery is checked on the amputation shock table below:


This indicates the patient's chance to survive the procedure. Note that these numbers are unchanged even if the amputation is performed by an ordinary person - so long as every possible measure (with or without the use of magic) is made to reduce the bleeding and care for the patient's welfare. If the roll is made under the percentile shown, the patient has not died on the table and is very likely to survive (see post-surgery infection, below).

If the patient has failed the amputation shock roll, however, and the operation was performed by an unskilled surgeon, then the patient will be dead in just a few minutes. Note that nothing can be done to save the patient short of a heal spell. Because the amputation was bungled by a physician with less than an authority medical knowledge, the patient will bleed out or die from shock no matter what other cure spells or procedures are employed.

However, if the amputation was performed by a character with a medical knowledge of at least 30 points (amputation is a medical sage ability for authorities), then there is still a chance of saving the patient. If this is the case, the patient is assumed not to die immediately, unless the amount of knowledge needed is greater than the medical skill of the physician. To determine this, the DM rolls a d100 in secret. If this number is greater than the number of knowledge points possessed by the physician, the patient will still die - but they will linger for a time before death occurs.

For example, a character with a 15 constitution, Bertrand, has a hand removed at the wrist by a physician with 46 points of medical knowledge. With a 71% chance of surviving outright, Bertrand rolls a 74. The DM then rolls a d100, with the result of 37 - meaning that Bertrand will survive, as long as he continues to receive care from a physician with at least 37 points of knowledge. At this point, we consult the Survival Time table to see how long Bertrand's life remains in jeopardy:


Bertrand's amputation was major, so he will need 2-5 weeks of recovery. If it proves that no physician of sufficient knowledge can look after him, he will die at the end of the period rolled - it is simply a matter of course that his body fails in some manner to adjust to the damage done. On the other hand, if he gets sufficient care, he will absolutely survive once the time period has passed.

Note that if the original roll of d100 resulted in a number that an amateur (or even less than an amateur) had enough knowledge points to look after Bertrand, he would not actually need an authority physician to ensure his good health.

Infections

Regardless of who performs the amputation, all patients must make a constitution check against acquiring a disease of some kind. This is a random roll, determining the area of infection, nature and degree of the ailment; the amount of time necessary to survive this disease is then added to total recovery time for both disease and amputation survival. If a disease is contracted and the patient failed their initial amputation shock roll, they will need the care of a physician, with the necessary knowledge, for the combined recovery time. And, of course, there is always a chance that the disease might end in death.

Injury

Naturally, the amputation is in itself an injury, meaning that hit points are lost and the amount of time to heal is greatly increase (see Injury rules). For the amount of damage suffered, consult this table:


Returning to Bertrand, imagine that he has a maximum total of 36 hit points at the time of the amputation (always use the character's full health as the guideline when determining the amount of damage). We'll remember that Bertrand had his hand removed at the wrist. Because the amputation was major, he suffers a total of 32 damage from the removal of his hand. Of this, 18 of this damage will be injury damage, meaning that he will need to regain a total of 196 hit points before he is at full (180 from the injury and the additional 16 ordinary damage he suffered. This damage can be healed by any form of spell, magic item, healing practice or rest to which the character has access.

Note that where 105% of total hit points is indicated, this will mean that the character is reduced to negative hit points (Bertrand would take his full 36 hit points plus 1.8 more - rounded down to 1 additional hit point, putting him at -1 total).

If the number of hit points caused by the amputation is sufficient to kill the patient, then no amount of medical care can help the patient survive the procedure. Somehow, the patient's hit points must be raised sufficiently to allow the patient to survive the amputation.

See Medicine

12 comments:

Maxwell Joslyn said...

Sometimes one writes rules to expand on a quick ruling made during the game, and sometimes one does it because it's pleasing to flesh out part of the game-world.

Did you have an amputation go down in a recent session?

Alexis Smolensk said...

Nope.

I have two characters who have recently upgraded their clerical sage abilities; both made authority medicine level at the same time, so I'm upgrading medicine to fit their present knowledge. Amputation is the first of the new skills alphabetically.

Jonathon said...

How does this rule (if at all) interact with the high-level cleric spell Regenerate (or it's reversal, Wither?)

I know that this is for non-magical amputations and healing, but if a cleric had Withered Bertrand's hand instead, would that still require a system shock roll and/or do damage, or would you handle that differently? Would a person who failed their recovery roll (and who had no sufficient-skilled physician on hand) but had the limb Regenerated recover, or would they need additional treatment?

Jonathon said...

(I wish I could edit my comments, because the "it's" where an "its" should be is going to drive me crazy and it is all my own fault because I did not proofread for autocorrect-introduced errors.)

Alexis Smolensk said...

In fact, there's nothing in the spell description of regenerate/wither that states that a system shock survival roll is needed. That said, however.

It is fairly clear from the manner of the spell's wording that the stump is meant to remain behind as if given time to heal. I say this because no time is taken to describe the physical/emotional effect on the actual victim. It is annoying that there are no rules for how many hit points are lost due to the withering - and admittedly, I did not think to include those rules when I rewrote the spell for my wiki. I've added a few notes to the wiki now to address the issues you raise, Jonathon.

I do not think a physician would be needed; while the withering would be a shock, it would not be accompanied by the blood loss, the exposure of the body to the air nor the concomitant need to further suture the skin. The shock would be primarily emotional - and I'm not ready to introduce PTSD as a character metric.

Good question. Anything that makes me rewrite the wiki is a good thing.

Alexis Smolensk said...

Hah!

People who make a big deal of "its" vs "it's" fail to recognize that the primary purpose of writing is to communicate, not to bow down to the great god grammar. I understood you perfectly, Jonathon - and after 20 years of reading the internet, my brain auto-corrects such incredibly minor errors without the change consciously registering. Until you added your second comment (which I did not see until after I had answered your first), I did not even know you'd done it.

You know, the little horde that correct such errors for a newspaper are considered among the lowest of the low in journalism - basically, it is work for monkeys. Don't worry about it. Writing that makes small mistakes like these is fine. Not until the whole sentence is a collection of creative grammar do we start to judge the writer's intelligence.

Jonathon said...

I appreciate the responses. I've drifted more and more into the descriptivist language camp over the years for exactly the reason you describe - the point is to be understood, not to score points for technical merit - but some of the rules drilled into me during childhood seem awfully resistant to being dislodged and I notice them first and worst in my own writing.

Perhaps 'annoyingly pedantic' should be somewhere in the negative CHA or WIS traits in the background generator.

Robin Irwin said...

Magic amputation spell?

Alexis Smolensk said...

Robin,

I would leave it to the players to build a laboratory and invent the spell if they wanted ~ but since two of the characters in my world are already competent surgeons, there's not much need for it. Remember that a spell that was able to "safely" produce the amputation without the shock causing death would effectively be as difficult as the 7th level Regeneration spell. The only other useful purpose of the spell would be to make a cut as clean as a surgeon would - and it is EASIER, the way I've designed my system, to gain 30 knowledge points as a physician than it would be to obtain what would probably be a 4th level spell.

Baron Opal said...

Based on the traumas I've been involved with I would consider:

Major: wrist or ankle, anywhere on the arm, below the knee, face or jaw, removing foreign objects in limbs. (Genitals / breasts- not a lot of blood loss, but highly innervated. Perhaps major.)

Radical: at or above the knee, at the hip, removing foreign objects from the abdomen or head, removing the genitals or the breasts.

Drastic: Removing foreign objects from the chest.

I'm basing this on vessel size and controllability of blood loss. Cutting into the chest without some form of mechanical ventilation is usually fatal. Exceptions I can think of would be pushing an arrow through the chest, and then sealing the holes to prevent a pneumothorax.

Tim said...

Jonathon, "annoyingly pedantic" would be a great malus for the background generator: perhaps a charisma penalty when speaking to characters of higher level/higher knowledge authority?


Alexis, I was wondering about the "secret roll" the DM performs to see if the character dies (where the necessary knowledge points exceed the character's actual knowledge). What's the purpose of making the roll secret? It seems out of place compared to your usual recommendation to let the players see the rolls. From what I would expect, couldn't it be the case that the physician knows that they cannot "fully" save the patient, but perhaps perform a risky operation that increases the chance of infection while still giving the patient a few more days to reach a better doctor or relay information?

Alexis Smolensk said...

Tim,

I am not opposed to keeping some details about what is happening secret from the players. The dividing line is simple: WHAT CAN THE PLAYERS KNOW vs. WHAT THEY CAN'T. When I roll a die from an enemy attacking a character, that is happening in front of the character and should be openly rolled.

But pray tell, how do the characters know how skilled the physician has to be?

As regards to the physician performing a risky operation in a desperate attempt to save the patient, THAT is exactly what I propose is happening. Given that the patient is going to secretly die in three weeks, towards the end of that time there's no sign that the patient is getting better; the physician without the necessary knowledge automatically becomes more desperate - in the end, they try the best thing they know how to do (the risk you describe) and the patient dies.

I don't intend to increase the metrics here by giving further chances to the die roll. The physician with 36 knowledge points CANNOT save a patient needing 37 knowledge points, period. Them's the breaks. But I also want the actual result - save or fail - to be unknown. As a physician, do you trust your skill to save the patient or do you admit your doubt and try to find a better physician? Do you do both? It is up to you. Take your time deciding.