Medicine
Treatment and Convalescence
Medicine Charms generally supplement or replace the normal dramatic action for medical treatment (see below). Solar physicians use ordinary techniques rather than "healing magic"—herbal remedies, dressing wounds, splinting broken legs, personal inspiration and the like. Medical supplies are necessary unless otherwise stated. Experienced Solar physicians can master Combos that approximate healing with a touch, but the core of their talents is actual medical skill. The effects of Medicine Charms on most poisons, temporary Crippling effects and wound penalties are immediate. At the Storyteller's discretion, patients might need a short convalescence to fully recover from terrible illness, rare poisons, wounds and long-term Crippling effects—one to three days for Exalted, and one to three weeks for mortals.
Trait Description: Medicine is the skill of using herbs, acupuncture, medicines, bone saws, sutures and scalpels to treat illness and repair injuries. Without either the Charms of the Exalted or the talismans and alchemical procedures of mortal thaumaturgy, medicine is difficult, bloody and exceedingly uncertain. While the most skilled physicians can treat almost any illness, many doctors simply hack off badly broken limbs or crudely cauterize bleeding wounds.
Specialties: Infections, Specific Diseases, Broken Bones, Puncture Wounds
Trait Effects: Someone with Medicine 1 can probably stitch up a shallow head wound or set a simple fracture. Someone with Medicine 3 can successfully treat smallpox, set a badly broken compound fracture or perform an appendectomy. Someone with Medicine 5 can remove cataracts, cure cancer or repair a damaged kidney.
Dramatic Rules for Medicine
Academic Knowledge (Craft, Lore, Medicine, Occult, War)
Whenever characters are called upon to know information that they have learned in the course of their experience and education, an (Intelligence + Ability) roll is required. The Ability in question depends on the subject at hand. For most conventional academic subjects, such as mathematics, history, geography and the like, use Lore. Occult governs mystical knowledge, especially pertaining to spirits, Fair Folk, the Exalted and actual Charms and artifacts. To know how something is constructed and understand the arcane trivia of forge temperatures, gem-cutting techniques, or what have you, use Craft. Medicine covers the workings of the body in health, sickness and trauma, as well as the assorted remedies for both disease and injury. War commands the strategies and tools of warfare, from the deployment of siege engines to types of formations to actual training regimens. Other Abilities can come into play for knowledge checks when characters draw upon the formal details of their expertise. For example, identifying a fighter's style from her kata requires a successful (Intelligence + Martial Arts) check.
The difficulty of an academic knowledge check depends on the obscurity of the fact, with difficulty 0 indicating that any character with a dot of this Ability automatically knows the information without a roll and difficulty 1-5 for most checks. Difficulties above 6 are possible, but such esoteric insights are generally beyond mortal understanding. These rolls and difficulties assume the character has several minutes in which to think. Characters who try to recall details and facts on the fly substitute Wits for Intelligence and add two to the difficulty.
Avoiding/Overcoming Disease (Resistance, Medicine)
In the world of Exalted, plague is a horrifying prospect. The Chosen might be virtually immune to sickness, but mortals have no such protection. See Disease and Infected Wounds. In addition, characters can also become diseased from a magical effect with a Sickness effect keyword. These diseases are sometimes conventional and sometimes sorcerous ailments with their own idiosyncratic rules. Characters who are immune to all illness ignore both natural ailments and those caused by Sickness effects, even if the Charm uses its own rules. Characters who are immune to natural ailments ignore only those diseases that use these following rules.
When a character is first exposed to a disease through its usual vector, roll her (Stamina + Resistance) against a base difficulty of the Virulence of that disease. Reduce this difficulty by as much as two if the contact is brief, or increase the difficulty by as much as two if the vector is practically unavoidable (like the stinking miasma of festering rot in a plague-wracked ruin). If the roll succeeds, the character avoids catching the disease. On a failure, she contracts the sickness.
Once a character has caught a disease, she has a period of time equal to its Incubation before it threatens her life. (She may develop symptoms much sooner, putting her at -1 or -2 internal penalty to all actions from discomfort.) Once this period is up, reroll (Stamina + Resistance) every day against a difficulty of the illness's Untreated Morbidity. If the character receives medical attention from a healer before the Incubation period elapses, the difficulty is the disease's Treated Morbidity instead. With a success, the character’s symptoms never worsen. They fade over a day as her immune system overcomes the malady.
Mortals and animals whose players fail this roll spend a number of days equal to their Stamina rating dying (during which they are at -4 to all actions from pain and exhaustion rather than the usual -2). Exalted and other similarly hardy magical beings are at -2 to all actions as a result of failure, but their players may recheck each day until the characters throw off the disease and have their full health restored. As long as the Chosen carry a sickness, they could be contagious, so they must be careful when they encounter a serious malady that they do not accidentally spread it to others. Spirits and Fair Folk are completely immune to normal disease—they resist magical diseases as Exalted. Only the Great Contagion has ever proved an exception, slaying 90 percent of the world's population regardless of Exaltation, leaving only spirits and the Fair Folk untouched.
Treating a sick character requires an (Intelligence + Medicine) roll with a difficulty rather unsurprisingly based on the disease's Difficulty to Treat. If the disease's difficulty to treat is unknown, it equals the (Essence of the character who caused the Sickness effect + 1). Physicians cannot treat a disease until they have diagnosed it (see Diagnose Patient).
Treating illness is a dramatic action, requiring a minimum of a full hour to administer poultices, herbs and/or other curative regimens (the necessary ingredients of which normally have a materials cost of Resources 1, but may be higher for rare diseases). Village healers and witches often gather their herbs and drugs rather than purchase them, requiring a successful (Perception + Survival) roll (difficulty 2-3) assuming proper ingredients can be found in the area.
For dramatic purposes, Storytellers should allow ingredient substitution so this roll has a chance unless finding a rare and exotic ingredient is a plot point. In such a case, characters might be forced to journey to strange lands or to seek magical assistance from spirits, the Exalted or even stranger beings in order to administer a cure.
If a physician actually spends a full day regularly checking in on a patient, the healer's player gains an additional die on the roll. This bonus increases to two dice if the healer does virtually nothing else but administer treatment throughout the day. Giving treatment to a character who is dying from disease after receiving no aid allows the victim's player a reroll at the disease’s Untreated Morbidity. If successful, the character recovers. On a failure, the character continues dying and without magical assistance will expire. Characters suffering from Sickness effects with no stated Untreated Morbidity automatically shake them off, without a roll, when they successfully receive treatment.
Diagnose Patient (Medicine)
When a physician examines a patient to detect and/or gauge the seriousness of wounds or illnesses, roll the physician's (Perception + Medicine). This is a dramatic action requiring five minutes of poking, prodding and taking note of symptoms. In the case of injuries, the difficulty is only 1 for external wounds and 2 for internal injuries (such as broken bones or internal bleeding). Success allows the healer's player to know how many levels of each type of injury the patient currently suffers, which the character interprets in an appropriate in-game context. For example, a patient suffering three levels of bashing damage and a single level of lethal damage might prompt the physician to say, "It looks worse than it really is. Mostly, you're just banged up. Get some rest, and stay off that leg for a few days, and you'll be fine."
Illnesses are more variable, with a diagnosis difficulty based on the distinctiveness of the symptoms rather than the severity of the disease. For instance, the common cold, infected wounds and bubonic plague are all difficulty 1. Other examples include cholera and smallpox (difficulty 2) and yellow fever (difficulty 3). Only extremely rare and/or magical illnesses should have a diagnosis difficulty greater than 3. If it is a Sickness effect without a stated difficulty to diagnose, the difficulty is the Essence of the character who caused the effect.
Without knowing what ails a patient, physicians cannot administer treatment, so quick and accurate diagnosis is critical. Players should keep in mind that physicians risk contracting communicable diseases they encounter. Taking precautions, such as maintaining strict hygiene, can provide bonuses to avoid catching illnesses, but these might not be sufficient, particularly where such horrific maladies as plague are concerned. For all their compassion, doctors often impose quarantine where they suspect a possibility of severe contagious disease rather than get close enough to risk personal exposure.
Treat Wounds (Medicine)
Without powerful magical drugs, mortal physicians can do relatively little to speed the healing of wounds besides convincing overenthusiastic heroes to take their injuries seriously and rest. However, healers can help prevent or treat complications associated with injuries, including bleeding, infection and disabling wounds. The rules for helping with each condition may be found in the respective write-up for those states.
Actual internal surgery (such as to remove tumors or growing parasites) is beyond the skill and resources of all but the most skilled physicians. The difficulty of such feats is at least 5 and climbs rapidly with increasing procedural complexity. Moreover, such surgery takes at least three hours per point of difficulty to perform and inflicts a number of unsoakable dice of lethal damage on the patient equal to the procedure's difficulty. Only the Exalted can reliably perform such wondrous feats of medicine.
Crippling injuries, meaning those inflicted by a Charm with the Crippling descriptor, must first be diagnosed to be treated. If not stated in the Charm, the difficulty to diagnose is the Essence of the character who used the Charm. The difficulty to treat it is the (Essence + governing Ability of the Charm that caused it).