How to Keep Medicine Relevant in a World Where Magic Exists
Jak Charles
Originally published at Apothecary Press
Intro
So unless you’ve been living under a rock you’ve no doubt heard of the Combat Wheelchair homebrew that’s been knocking about. Look, I’m not here to get into a discussion about that, but there was one thing I noticed some detractors saying. Go into any thread about said Wheelchair and you’ll see someone say something to the effect of:
“Just use healing magic to fix your legs.”
I’ll be honest, I don’t entirely disagree with this interpretation, but I can’t help but feel that it lacks imagination, and today I’d like to explain why.
Image: Pauline Voß /Wizards of the Coast
What Does Healing Magic Heal Exactly?
Let’s start here. It’s already well established that in D&D 5e Hit Points are an abstraction of health. It’s not ‘how many times can you be stabbed before you die?’, it’s more ‘how much punishment can your body go through before it gives out?’. This is why things like Psychic damage deal, well, damage. They’re not turning your brain to physical soup, but they are slowly weakening your mental state until your brain is at capacity and shuts down.
Healing spells restore Hit Points. Hit Points are an abstraction of one’s stamina (which is why we add Constitution to our HP when we level up). When we heal up an amount of Hit Points we’re not necessarily knitting flesh back together, we’re refreshing stamina. It’s more like drinking a post-workout protein shake than it is like bandaging a gash.
Now yes I think it’s fair to say that in among this is some form of magical accelerant to natural healing processes. Wounds knit back together over time and the application of magical healing helps those wounds knit faster. Sufficiently powerful healing magic may help these wounds knit almost instantaneously.
But what about more grievous wounds?
Bones Heal Themselves
Bones regrow over time, but have you ever heard of someone breaking a bone and then just leaving it to heal on its own? Hell no! We set bones, we lash splints to them, we put them in plaster casts. If you applied healing magic to an un-set bone then sure the bone will start to regrow faster, but it’s not going to be in the right shape. In fact, you’ll probably just accelerate the emergence of a painful physical deformity. Furthermore, you’ll probably now need to intentionally break the bone just to re-set it properly. I’ve known people who had to have this done and I wouldn’t wish it on anybody.
The same is even true of sufficiently deep cuts. We don’t just let them knit shut on their own over time. We apply antiseptic, we get stitches put in, and we don’t aggravate the wound while it heals. Accelerating the healing process with magic may allow that wound to knit together nice and fast, but it won’t knit together well. It’ll be messy, and rife with scar tissue. The build-up of scar tissue can cause all kinds of ongoing physical problems, so managing how much of it grows when we treat severe lacerations is extremely important.
This concept goes further and further. Healing magic (as in magic that restores Hit Points) doesn’t inherently treat diseases. We have entirely separate spells for that. Yeah you’ve got an immune system, but at best the magic can only augment and accelerate that immune system. It doesn’t bypass it altogether.
What about magical plagues? What good is our healing magic then? The best we can do is use Medicine to treat the symptoms and hope the body fights back on its own.
What then about birth defects? Or genetic disorders? Or un-treatable injuries?
Magic and Medicine
I’m going to lay my opinion out plain and simple here:
I think Magical Healing is way more fun and interesting when it works in tandem with regular medicine, not when it supplants it.
Let’s go back to the example of broken bones. I had a campaign where two characters broke into the barracks of the city garrison. They got what they came for, but in so doing raised the alarm. This led to a tense escape sequence that ended with the two characters, a Bard and Monk, stood atop the high walls of the barracks. Seeing no way out, they jumped.
The Monk used Slow Fall and was fine. The Bard, not having any spells like Feather Fall on his list, did not fare so well. He took fall damage. A lot of fall damage. Not enough to kill him, but very nearly so.
This damage was flavoured as him impacting the ground feet-first and effectively shattering his legs. It made excellent thematic sense given the way he took the damage, and now he was in a serious predicament. He was stuck on the streets during a city-wide lockdown with non-functional legs and in excruciating pain. He threw a couple of healing spells into himself to take the edge off, but this didn’t fix his legs.
Then he had to start making Constitution saves against Shock. If he failed, he would start to fall unconscious. He barely got himself to somewhere the party could safely retrieve him before succumbing to shock and passing out. The whole thing became a really thrilling sequence, but then there was the matter of what to do once the Bard was rescued.
With the earlier healing magic not fixing his legs I had made one thing clear: Healing Magic isn’t some cure-all. The Paladin was all ready to dump their full Lay on Hands pool into the Bard, but first the bones in his legs had to be set or he’d never walk again.
The Crunch
Sorry for the grizzly pun. Before the Healing Magic could be applied the party Ranger had to make a Medicine check to properly set the bones.
Hey presto, the Medicine skill just became meaningful again!
But this isn’t the only way these concepts can be applied. Let’s look again at the bard going into shock. Imagine now we have a Druid on the scene with a ‘Herbalist’ theme going on. They quickly brew up a natural remedy that helps overcome the effects of shock while also being a strong painkiller. Force-feeding it to the Bard will give them a bonus on their Constitution saves against passing out from shock. Now we have provided satisfying mechanical applications to interesting character flavour.
We can also look at things like what the healing process might mean more long-term. For one thing the Bard was always more careful and swapped out a spell for Feather Fall as soon as they could. They also walked with a cane now to help support their weight. The injury may have healed, but the trauma remains.
Lingering Injuries
On page 272 of the Dungeon Master’s Guide we get some light rules for Lingering Injuries. They give examples of when a character might receive a lingering injury, such as by receiving a critical hit, dropping to 0 hit points, or failing a death saving throw by a wide margin.
These are great ideas, but more important is the actual narrative beat of the injury. When someone receives a critical hit we might flavour it as ‘Their sword drags across your face, blinding you in your left eye, you now have a Lingering Injury’. Once we’re doing things that way though we can actually start going flavour-first. We can start describing action based on the effects it would be having on a body. Flavour a hit as ‘His sword thrusts right at your abdomen. You twist so that it misses your vital organs, but you can’t avoid it leaving a gash down your side’. If that attack had been a crit then it becomes ‘He’s too fast, you can’t avoid his sword piercing through your chest just below your heart’.
Obviously this starts to lean more into the territory of engagingly narrating combat, which is something many great DMs have covered over the years so I won’t go into more detail about it here.
But think now about how that engaging narration ties back into the actual meat-and-potatoes of needing to use the Medicine skill to set bones and dress wounds, or the Nature skill to make healing balms and herbal painkillers. Now when you say ‘His sword barely misses your abdomen’ the player has a real sense of how important that is. If that blow had successfully landed it would have meant a battery of skill checks after the combat (assuming the party survives), whereas now they’ll only need some light patching up and a bit of Healing Magic.
Doubly Satisfying
In this way we’ve made something that is doubly-satisfying. When the attack misses, we’re satisfied that we have avoided the extra complication of needing to properly treat wounds before applying Healing Magic. When the attack hits, we’re satisfied at the end of combat because we have a party member who took the Medicine skill and now they get to shine because of that.
With very little effort we’ve now got a simple application of existing mechanics and concepts that has deepened the use of both magical and non-magical healing.
On Trauma
This isn’t to trivialise very serious issues, but in the context of D&D trauma is interesting. The lingering effects of years of adventuring and witnessing comrades die in front of you make for really compelling narrative. They also allow for us to explore serious topics in a safe, controlled, simulated environment. Much smarter people than me have talked about this at length, and I really would implore you to seek out such works if you’re a sceptic.
There’s an old saying in response to the whole ‘Why do adventurers always have edgy backstories about being an orphan?’ Because mentally sound people from stable upbringings don’t go out and become adventurers. Now yeah that’s an oversimplification, but I daresay D&D actually lends itself really well to dealing with the emotional concept of damage (if that’s what we choose to do with our games).
Carrying on from this baseline, a character receiving a serious injury can create a significant narrative beat that influences the player’s roleplay as well as the character’s overall arc.
To provide another example, I had a Diviner Wizard in a campaign who unwittingly destroyed a Hag Eye. When it came time to confront the Hag coven, the first thing they did was cast Hold Person on him and rip his left eye out of its socket.
First of all this was an intense character moment and the character underwent a permanent physical change. From that point on they always wore an eyepatch.
When they reached a high enough level to cast powerful Divination spells like Scrying, they removed their eyepatch to reveal that in its place had grown an artificial eye of pure arcane energy. This was the eye through which they saw what their Divination spells could perceive. This reveal was a surprise even to me, and is genuinely one of the coolest things a player has ever done at my table. All of it was made possible by the permanent alteration that came from losing their eye.
So the advice here is to look for the narrative opportunities that come from altering the application of healing magic such that injuries are not so easily mitigated.
About The Wheelchair Thing
Regenerate is a fucking 7th level spell! Be honest, how many of your campaigns have routinely made it to 13th level? How many 13th-level NPCs are there in your world that can do this magic at a price the average low-level schmuck can afford?
Now look, yeah Regenerate exists and that means these sorts of disabilities can be mitigated. I’m not going to get into the whole can of worms that is the wider discussion here because that’s beside the point. What I hope I’ve illustrated is that debilitating injuries will still exist in a world that has Healing Magic. If we require the Medicine skill to be able to properly set bones in preparation for magical mending, what do we do when an injury is too severe to mend even with the magical accelerant of healing spells?
And let me be clear about one thing, if that Wizard character had just waited to cast Regenerate on their eye then the character would have been less interesting than what we got instead.
Conclusion
Really this piece isn’t about Combat Wheelchairs, it’s about meaningfully tying together the separate disciplines of Medicine and Magical Healing in a way that allows both to shine. I hope if nothing else I’ve made that abundantly clear. I feel this is a topic that has become pertinent lately because of the whole ‘Combat Wheelchair’ debacle.
My aim here hasn’t been to defeat a strawman. In fact I’ve very intentionally omitted my own thoughts on the homebrew content in question. My goal has simply been to provide you with tools for your games, and hey they may even be tools that can marry with your application of homebrew like the Combat Wheelchair in your games.
Thanks for reading.
This piece comes from one of our talented storytellers Matt. You can find more of Matt’s writing at Apothecary Press. Republished with permission of Matt.
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