Medicine and roleplaying games ... what could they possibly have to do with each other?

As a games-master of fifteen years and a medical doctor of five years, I can tell you that the two subjects intersect more often than you might think. I've lost count of the number of times that something from medicine has proved useful in running or designing a roleplaying game, and of a few occasions when roleplaying has helped my medical practice as well.

Within these articles I intend to share with you the ways that I've found ways to apply medical knowledge and ideas to roleplaying. My goal is to allow you to use medicine to tell better stories, to simulate medical conditions more realistically in your games and to have fun doing so.

The first subject I'd like to approach is the process of injury, and how to use some ideas from Trauma medicine in your games.

Trauma

Isn't it a lovely word?

Trauma has a dual definition, representing both physical injury and the psychological impact of injurious events. The word brings to mind an injured person reeling away from the shock of his wounds, clutching at his broken limb or his spilled-open abdomen.

In short, trauma is traumatic.

I've noticed though, that physical injury in role-playing games very rarely seems traumatic.

Games systems often play down the visceral, messy aspect of wounds and injury. Few games really simulate the sheer physical impact of a blade digging into flesh. Those that do tend to have massive critical hit tables which concentrate on humorous rather than realistic injuries.

While this may be appropriate and satisfying for a certain cinematic style of games, it can be equally satisfying for trauma to be described and simulated accurately, with all the gore, guts and gristle that this entails.

Applying trauma properly is not just for simulationists, either. These days most of us don't want to be able to simulate every type of possible injury through endless hit location tables, blood loss charts and one-hour-per-combat-round slowness. Most of us are interested in the flow of narrative and in evocative imagery.

So, how can we use the ideas from trauma medicine to achieve this goal?

The Meat of the Matter: Slicing and Dicing

Whether it's a WFRP dwarf trollslayer putting his axe-blade into your thigh, or a LO5R Crane Clan Bushi slicing your tendons with a katana, it seems that our favourite genre settings are full of people trying to stick sharp bits of metal into you.

This is easily hand-waved away as the loss of hit points or a wound level, but to do this is to miss out on the chance to evoke interesting descriptions and game consequences.

The first way to approach this is in the type of injury. We’ll look at four types of injury here today: cuts, lacerations, piercing injuries and burns.

Cuts

Cutting is caused by a single edge, which breaks through the skin and often slices through subcutaneous tissue, connective tissue and muscle as well. A cut has to be pretty forceful to reach the bone.

Aesthetic Notes: With a cut, there will be a straight or slightly curved line along the flesh, which most likely will split and stretch open into an ellipse-shaped or crescent wound. Cuts will vary in deepness of course, and because they tend to sever blood vessels can bleed profusely.

Mechanical Considerations: Stitching skin closed is easy. The trick is stopping the bleeding, which is achieved most easily with applying pressure till the body does the job itself, or by sutures and cautery.

During a combat, a bleeding cut will make a mess, much more than movies give credit for. Even if this is not the case well-vascularised tissues (like scalp or hands, for example) tend to bleed continuously and massively.

In the mid-term, infection is an issue, especially if the fight was in an especially dirty environment. A septic wound can kill easily, and those aiming for gritty realism should remember that before the onset of sterile techniques and antibiotics, wound gangrene was a big problem for even the smallest of wounds.

In the long term, a cut will leave a scar, though if sutured up properly this could just be a thin white line. Don't forget also that other things may be cut other than blood vessels. A severed nerve may leave an area numb or a muscle further away non-functioning. Losing a ligament or cutting through a muscle could lead to inability to make certain movements.

It's worth noting that most of the tendons that deal with the fingers are stretched taut running from their insertions in the fingers, down through the hands to high in the forearm. This means that a severed tendon will snap all the way down inside the arm, far from the original cut, and unless you’ve got surgical skill enough to “chase” and reattach the tendon, you can say goodbye to that finger’s function.

Lacerations

Often confused with cuts, lacerations are breaks in the skin caused by blunt or irregular surfaces. A knife cuts, whereas a rock lacerates. This isn't just a case of being pedantic for the sake of it – the implications of a laceration are quite different.

Aesthetic Notes: The laceration has a tattered edge and the exposed will be a mess of mashed and mangled flesh. Often a flap of skin or muscle will hang raggedly off it. These are good injuries to evoke if you are aiming for gross-out horror, especially if applied to the face.

Mechanical Considerations: Lacerations can bleed a lot, though often not as much as a true cut might.

In the long term, whereas a chirugeon of no great skill or technology may be able to stitch together the two edges of a cut with not too much worry, the repair of a laceration is much harder work. With 21st century technology we have options such as skin and muscle grafts from around the body, and careful reconstruction is possible. In a dirtier, grittier setting, a laceration may be hard to close and impossible to rebuild.

Piercing

Piercing is a sort of cut, but runs in along a channel rather than across the surface.

Note that though a bullet is a piercing injury it's a common fallacy to believe that it is the piercing that does the most damage. Bullets essentially work by transfer of kinetic energy from the bullet to living tissues.

A bullet's impact essentially triggers a small internal explosion out from the point of impact.

Aesthetic Notes: A piercing wound bleeds most when the weapon is pulled out again, as till that point the weapon itself plugs the blood flow. If you describe a piercing injuries going through the torso or abdomen, bear in mind that it is very likely to be lethal because of damage to internal organs.

A bullet hit may cause a person to jerk or spasm, but they won’t be thrown backwards three feet as there simply isn't enough kinetic energy to achieve this.

Mechanical Considerations: A piercing injury is far less likely to cause massive bleeding or to sever tendons and nerves than a cut is, but is far more likely to go deep enough to damage vital organs. Simply put, piercing weapons are for killing.

Burns

Burns are caused by heat or chemicals traumatising living tissues. They are messy, nasty injuries and should always be taken seriously.

Aesthetic Notes: A superficial burn is through the top layers of skin only, and looks pink. Superficial burns are extremely painful as all the never endings are exposed.

A deep burn looks white, and because all the subcutaneous nerves are destroyed they don't hurt at all. You can poke a deep burn with a needle, and it'll be completely numb. Of course, deep burns are bad news for the victim.

Mechanical Considerations: In the short term, burns are rapidly dehydrating injuries. You might not bleed through your burns but you still lose moisture through them at a rapid rate, which is one of the reasons that ambulancemen put cling film over burns.

The mid term complication is infection, as burns get infected very easily. Your skin is designed to keep moisture in and bugs out, and having it burnt away is very bad for you.

The long term complication is scarring. A superficial burn may heal with cosmetic scarring only, and may look almost normal later. A deep burn is far more serious, as it will be left numb and the scars will likely be very disfiguring. Even in the modern day and age plastic surgeons find dealing with the cosmetic effect of burns very difficult. Certain positions of burns can be very significant as well – burnt hands and arms (which are very common) can be graded in severity by whether they are circumferential or not. A burn that goes right the way around the wrist may scar into a sheath of hard and leathery tissue that restricts movement completely.

On the next article, we head deeper into the body, and see what happens when your organs get mauled.

Sweet dreams and happy gaming!