Permanent injury or crippling damage are palpable threats that one must learn to avoid or live with when residing in the Shadoweave. The breaking of a wrist, the loss of a leg, or even the failing of an organ are examples of the type of grievous injury that one could face.
Quicklinks: Receiving a Grievous Injury | Delivering the Injury Making Sense of the Injury, Giving a Fair Chance | Ailments | Bone & Limb Injuries Fractures, Detachments | Organ Injuries Chronic, Acute, Failure | Medical-Resistant Illnesses
Bone Fractures: Hand, Wrist or Arm | Foot, Ankle or Leg | Rib Cage or Torso | Teeth | Neck or Spinal Cord
Limb Detachments: Hand & Wrist | Arm | Foot & Ankle | Leg | Teeth | Neck or Spinal Cord
Organ Failure: Brain | Ear | Eye | Heart | Intestines | Kidney | Liver | Lung | Nerves | Skin | Stomach | Tongue
Receiving a Grievous Injury
You can receive a grievous injury in many different ways. A car falling from a parking garage and crushing your legs or becoming impaled by a lance while you lay prone on the ground are examples of a situation that would cause a grievous injury.
You don’t always know when such an injury may happen. When descending a staircase, you don’t consider that you may trip on your shoelace and break your ankle, much like your character doesn’t consider or even see the potential of harm that could befall them from some actions. It is up to the GM of the game if a specific event or action would cause a grievous injury, though your character will always have a chance to prevent such an injury. Your armor class, awareness, saving throws, and skill rolls can all likely prevent a grievous injury at a critical moment of disaster. However, one failure or a chain of failed rolls can lead to certain doom.
For the GM: Delivering the Injury
A grievous injury is not a minor inconvenience or expected result of most actions for a player, or a person living within Shadoweave. When deciding if a player should receive an injury, you should ask yourself two questions before giving the player one.
Does the injury make sense with the trauma?
When a character falls down a staircase it would be odd and out of proportion to sever the characters hands or give them organ failure. However, a broken wrist, finger, or ankle are much more appropriate. You would want to pick an injury that befits the character and helps to drive the story forward.
Did the player have a fair chance to prevent the injury?
A character that failed a Destruction roll to punch down a door could severely damage their hand. You would probably then assume that a grievous injury is appropriate for the failure.
The issue is that the player had only a single dice roll to determine the fate of their character, which, even if logical, is not a fun experience. As an example of why, consider that in a fight a player has many dice rolls that determine if their character will live or die. If an entire combat was boiled down to a single Might roll against a target DC to determine if a character will die or not, no one would like combat, and likely wouldn’t want to play the game. Likewise, if a grievous injury was almost assured and guaranteed regularilly, the same would be true.
You should try to give the character more than a single chance to prevent, or reduce, the injury. In the above case, adding a fortitude saving throw when the door fails to break gives a second point where the character can avoid a damaged hand.
You could go further, and consider that the character is only at risk if the door is especially solid, such as a metal door. You could also consider if the character failed to break the DC by 15 or more, showing a very poor lack of skill. Put this all together and we have a guide that may look like this:
- The metal door has a DC of 25 to break.
- If the character rolls 10 or less, they risk grievous harm if they attempt this without a tool.
- When they roll 10 or less, they must make a Fortitude saving throw against the DC of the door.
- On a saving throw fail, the character breaks their hand
You can adjust and change depending on the situation, and the players at your table. You might find the saving throw isn’t needed, and you just tell the players beforehand about the potential risk. Similarly, you can also let the character investigate the door using a Science roll to see if it would damage their hand. Other environmental factors can also play a role. For example, if the door was not just metal, but also coated in spikes or razor for some reason, you may make it far easier to receive the injury.
Regardless of how you do it, any grievous injury you deliver should be uncommon, impactful, cinematic, and drive the story forward. A grievous injury when used right is not just a punishment or a simple alternative to killing a character, but a storytelling tool that challenges the players and further explores a character.
Ailments are a group of medical symptoms caused from a wide range of sources. Generally, you will encounter ailments from weapons, poisons, malfunctioning devices, or side-effects of medical devices. It is also possible though to receive ailments from environmental sources or as a consequence of a grievous injury. What ailments you may receive and how long they last is up to the GM and injury’s context. You can also receive ailments in addition to other grevious injuries. All ailments can be cured with pharmaceutical devices.
Blurred Vision. Your vision is blurry and distorted. You can still see objects, light, and movement but have trouble distinguishing features or colors. Your Awareness is reduced to 5 and you have disadvantage on Perception rolls using sight.
Drowsiness. You feel excessively tired and your actions feel delayed. Your Initiative is reduced by 10 and you have disadvantage on any skills needed to safely operate a vehicle. When you take a short rest, you unwillingly enter a long rest unless someone else awakens you.
Disoriented. You have become dizzy and are unable to focus on anything at a distance or keep your balance. You have disadvantage on all ranged attack rolls, and automatically fail all saving throws or skill rolls to resist being grappled, restrained, knocked prone, or forcefully moved. Your safe fall is reduced to 0.
Heart Arrhythmia. Your heart beats irregularly, causing you to sweat, have shortness of breath, and chest pains. If you fail to remove this ailment within 24 hours, you experience heart organ failure (as seen on the Grievous Injury page).
Insomnia. You are unable to get a full and complete rest each night. When you take a long rest, you gain 2 levels of exhaustion instead of removing a level, as you are unable to sleep properly.
Irritability. You are unable to concentrate and are quick to anger. You have disadvantage on Endurance rolls.
Malaise. You have a general sense of unwellness that is difficult to pinpoint. You gain a -1 penalty to all d20 rolls.
Nausea. Your appetite is diminished, and your stomach turns constantly, causing you to vomit. You must make a DC 15 Constitution saving throw whenever you eat. On a failed save, you expel your meal and gain 1 level of exhaustion.
Nerve Damage. You lose the ability to feel things through touch. You cannot distinguish between hot and cold temperatures. You also have disadvantage on sleight of hand and assembly rolls.
Skin Damage. Your skin is discolored, swollen, and covered in abscesses. You have disadvantage on all Charisma general skill rolls.
Bone & Limb Injuries
Bone and Limb injuries are injuries that affect either your extremities or your skeletal structure. Although the two types of injuries are different roleplay wise, the effects and mechanics of both types are similar and are grouped together for simplicity.
Bone & Limb Fractures
Bone and limb fractures occur when a particular bone or limb experiences severe enough force or trauma to impair its function and cause pain, but not so severe it becomes detached or removed from the body.
Within this system, breaking a bone or spraining a joint are examples of fracture. A fracture can affect one specific bone or in cases of limbs, a whole group of bones, tendons, and muscles that have become damaged.
For all fractures, you can heal them naturally with minimal assistance (for instance, a brace, cast or splint) or through hospital treatment to rapidly restore function to the body part. A fracture will heal naturally after 8 weeks, assuming you have given it the necessary rest and assistance. You may cause further damage if you ignore the condition and avoid giving the limb or bone rest. Additionally, you may receive permanent disfigurement if you over exert a fractured limb, that can only be cured through forced refracturing or advanced medical treatments such as regeneration or replacement that must be done by a trained physician.
When experiencing any type of fracture, you will suffer aches and pains any time you make a movement or perform a skill roll that involves the fractured bone or limb. This may require you to make Endurance rolls to ignore the pain and perform actions or skills without penalties. You may also be asked to make Fortitude saving throws to avoid causing further trauma to the affected limb or bone when performing certain actions, falling on the fractured body part, or otherwise having the body part agitated.
Common fractures and their effects are listed below.
Hand, Wrist or Arm. You are unable to lift any object that has a weight of 1 pound or more without succeeding on a Endurance roll, with a DC equal to 10 + the weight of the object unless you are unable to feel pain. You can not perform any actions, reactions, or skill rolls with the damaged hand. If an action, reaction, or skill roll would typically use both hands, you are disadvantaged on the roll as you must use only 1 hand. If two hands are required for the action, reaction, or skill, you can not perform it.
Foot, Ankle or Leg. All of your movement speeds are cut in half, or become 0 if both limbs are fractured. If you attempt to move more than 5 feet on your turn, you must succeed a Endurance roll with a DC equal to 5 + the number of feet moved. On a failed roll, you fall prone and the destination and become incapacitated until the start of your next turn. You can not perform any actions, reactions, or skill rolls with the damaged leg. If an action, reaction, or skill roll would typically use both legs, you are disadvantaged on the roll as you must use only 1 leg. If two legs are required for the action, reaction, or skill, you can not perform it.
Rib Cage or Torso. When you have a fracture in your ribcage or torso, you will suffer the following effects:
- You are unable to lift any object that has a weight of 10 pounds or more without succeeding on a Endurance roll, with a DC equal to 5 + the weight of the object unless you are unable to feel pain.
- Your ability to hold your breath is cut in half.
- You have disadvantage on any skill roll or saving throw that is physically taxing.
- Your safe fall is reduced to 0.
Teeth. You experience pain any time you eat solid food (such as rations), requiring you to succeed an Endurance roll with a DC equal to 10 + half the number of teeth fractured (rounded up). Drinking water or eating liquified food can be done without a roll, unless the liquid is notably cold, hot, or acidic. Additionally, fracturing a large amount of your teeth can result in changes in your voice and your ability to pronounce words that is notable to other creatures.
Neck or Spinal Cord. You are paralyzed and fall prone (see the conditions) until the fracture is cured. However, you retain the ability to speak.
Limb detachment is when the limb and its corresponding bones and muscles become separated from your body. Detachment occurs when a limb experiences tremendous pressure, force, or trauma that it is severed (either partially or completely) from the rest of your body.
Additionally, if a limb becomes completely crushed from pressure or a significant weight rather than removed, such as a car falling on your arm, the limb is still considered detached mechanically.
You can heal a detachment through three methods: reattachment, regeneration, or replacement.
Reattachment. To reattach a limb you must go to a properly equipped hospital and have the limb preserved and intact. A limb that has been detached for too long, was not cleanly severed, or has experienced significant deterioration cannot be reattached. At a hospital, a trained physician can perform a long surgical operation to reattach a limb’s nerves, muscles, and bone.
Replacement or Regeneration. You can replace your original limb through several different medical procedures. Replacing or regenerating a limb can be performed regardless of the original limb’s condition and the nature of its detachment. Either procedure is performed at a sufficiently equipped hospital and by a trained physician. To replace a limb, you must purchase either a prosthetic limb (found under prosthetics in the general item list) or an organic or synthetic one (found under organs in the general items list). A regenerated limb is purchased in a similar way to an organic or synthetic one, except the limb is indistinguishable from your original one.
If you experience limb detachment, you will feel an extreme pain at the time of detachment and will likely require a Fortitude saving throw to avoid becoming stunned or falling unconscious. After recovering from this initial pain, you may still suffer pain if the limb’s stump is irritated but, in most situations, the absence of the limb is generally painless. However, going without a limb for a long time may cause you to experience strange phantom sensations or pains as if the limb was still attached. An Intelligence saving throw may be needed if these phantom sensations become too distracting or troubling.
Common limb detachment and their effects are listed below.
Hand & Wrist. You lose the ability to use the severed hand for anything, and if two hands are required for any actions, you gain disadvantage on any associated rolls. Assuming you do not receive a prosthetic or other replacement, you are still able to perform very basic functions with the stump of your arm, as long as those functions were not reliant on having fingers.
Arm. You lose the ability to use the severed arm for anything, and if two arms are required for any actions, you gain disadvantage on any associated rolls. Unlike losing a hand, you can not even perform basic actions, as the arm has been completely severed. You additionally lose 5% of your body weight if you do not replace the lost arm.
Foot & Ankle. You lose the ability to use the severed foot for anything, and if two feet are required for any actions, you gain disadvantage on any associated rolls. Assuming you do not receive a prosthetic or other replacement, you are still able to perform very basic functions with the stump of your leg, such as moving or pushing an object. You are unable to balance without some sort of prosthetic, and all your movement speeds are reduced in half without one. If you use a makeshift prosthetic (such as a peg leg) your movement speeds are reduced by 5 feet instead (or half, whichever is less).
Leg. You lose the ability to use the severed leg for anything, and if two legs are required for any actions, you gain disadvantage on any associated rolls. Unlike losing a foot, you can not even perform basic actions, as the leg has been completely severed. You additionally lose 17.5% of your body weight if you do not replace the lost leg. Your run speed is reduced to 5 feet, and all other speeds are halved if you have only lost one leg. Your speeds are reduced to 0 if both legs are detached. Unlike losing a foot, you can not adequately make up for the loss of a full leg with a makeshift prosthetic.
Teeth. If you lose a significant number of teeth, you will lose the ability to chew and eat solid food, such as rations. You will be required to eat liquified food or receive nutrients intravenously to stay alive. Assuming you do not receive a prosthetic or other replacement for your teeth, your voice will become different and your speaking will be harder to understand. You have disadvantage on all skill rolls that require verbal communications.
Neck or Spinal Cord. You die and can not be resuscitated.
Organs are parts of your body that perform specific and necessary functions. When organs are grievously injured, they can cease functioning properly causing you to suffer from long-term symptoms or outright organ failure.
While you likely know that your heart, lungs, stomach and liver are all important organs, other parts of your body such as your tongue, skins, eyes, nerves, and eardrums are all considered organs that when damaged can hinder your ability to accomplish tasks.
An organ injury falls into one of two categories of failure: chronic (slow) and acute (immediate)..
Chronic Organ Injuries
Chronic organ injuries is when a specific organ in your body is heading down the road to a complete malfunction. The process may take anywhere from days to months before your organ finally gives out. A trained physician with adequate supplies (typically in a hospital) can repair the damage, preventing the inevitable failure and saving the organ. If the damage is not repaired however, the organ failure will occur (see below).
Examples of chronic organ injuries would be damage to just a part of the organ, like a chamber of your heart, or a chronic medical issue, like heart disease or organ rot, that will eventually deteriorate your heart over the course of months.
When one of your organs is experiencing slow organ failure, you will likely experience symptoms that inconvenience your life. These can include a variety of symptoms some of which are ailments that can be treatable by pharmaceuticals and medical devices, others which require good rolls to overcome. Some examples include gaining the nausea ailment from a stomach injury, being unable to run from a lung injury, or requiring Endurance rolls to overcome the pain associated with a liver injury.
Symptoms will likely get worse over time, but the increase in severity can vary depending on your course of treatment or lack thereof.
Acute Organ Injuries
Acute organ injuries is when a specific organ in your body malfunctions severely and immediately. There is no time to seek help or treatment, as you experience organ failure instantly (see below).
Some examples of acute organ injuries would be your heart being punctured by a metal rod, poisonous gas causing your lungs to fail, shockwaves bursting your ear drums, or your body being dropped in a vat of acid that melts away your skin and muscles.
If you are unfortunate enough to experience an acute organ injury, you will likely be in tremendous pain, possibly going into shock. You may have to roll a Fortitude saving throw to avoid becoming stunned or falling unconscious. However, depending on the organ in question, you may be able to recover from this initial pain and shock and live without the organ.
When an organ fails, the organ has ceased functioning and cannot be repaired. Instead, your only option is to have the organ replaced but purchasing a new one, and having a trained physician make the switch. A hospital will always treat a patient that is unable to give consent to the best of their ability, though their services are not free and will be charged post-surgery.
When acting as the GM and deciding appropriate organ injuries, it’s important to consult the purchasable Organ list. Obviously, not all organs in the human body are listed and the list contains the most major organs. Sticking to this list will make it easy for you to determine how much an organ replacement or other medical treatment will cost.
Not all organ failure is equal, some are life-threatening while others are minor inconveniences that a person can learn to live without. Below you can find a list of organs and the effects of it’s failure on a character. If an organ not listed here fails, it is up to the GM to determine the effects that will have on a character.
Brain. You die.
Ear. When your ear fails, you become deafened in the failed ear. Naturally when both fail you become completely deafened (see the condition).
Eye. You become blinded in the failed eye. Naturally when both eyes fail, you become completely blinded (see the condition).
Heart. You become stunned and fall prone. You must be placed on life support by an ambulance or hospital within 3 minutes or you die. This duration starts over if you become disconnected from life support while still experiencing heart failure.
Intestines. You become incapaciated, however you can still perform light activity. You must have the intestines replaced at a hospital, or recieve a colostomy surgery within a week. If neither are done, you will die.
Kidney. If only one kidney has failed, you are able to continue functioning normally, however if both kidneys fail, you become incapaciated, however you can still perform light activity. You must get a replacement kidney within 2 weeks, or you will die.
Liver. You become incapaciated, however you can still perform light activity. You must replace your liver within 48 hours or you will die.
Lung. If a lung has failed, you have disadvantage on all physically taxing skill rolls, since your breathing has become impaired. If both lungs fail, you immediately start suffocating. You must be placed on life support by an ambulance or hospital before you suffocate. Your suffocation starts over if you become disconnected from life support while still double lung failure.
Nerves. You are unable to feel any pain or sensations. You automatically succeed any saving throw or skill roll to resist pain. In addition, you cause yourself 1d4 physical damage when you fail any skill roll that is physically taxing. Lastly, you never know if you are hit or take any damage until you see the damage.
Skin. You suffer the following effects:
- You have disadvantage on all Charisma skill rolls made to interact socially with another creature, if the area of skin that failed is visible.
- You have disadvantage on all Endurance rolls made to endure pain or suffering applied to the area of skin that failed.
- You have disadvantage to resist any contact poison that makes contact with the area of skin that failed.
Stomach. You are unable to benefit from eating food or drinking water to avoid exhaustion. In addition, eating or drinking anything causes you to gain 1 level of exhaustion. You must receive invasive medical treatment at a hospital that will allow nutrients to be given to you intravenously or receive a replacement stomach, else you will die from exhaustion caused by starvation and/or dehydration.
Tongue. You are unable to perform any skill rolls that involve speech, and you are unable to taste, making it impossible to know if food is spoiled or poisoned.
Although most diseases and illnesses can be cured with pharmaceuticals and medical treatments found at hospitals for those willing and able to pay, there are rare maladies that cannot be cured. Not all medical-resistant illnesses cannot be contracted and require you to be born with them. However, there are several that you can receive due to exposure to environmental factors or coming into contact with an infected person. To read more about medical-resistant illnesses, you can go to the Medical-Resistant Illnesses page.