CAUTION: Explicit content about injuries, death, and dying. Not for the squeamish or easily offended. This is also based on my personal experience and knowledge, some of it formal training, and some self education from miscellaneous things I have read over the years. Like a lot of other RPG players, I am good at Trivial Pursuit due to my eclectic knowledge and dabblings in a lot of different things. That does not mean that all of what I have written is using the correct terminology or explanation, but is an illustration for adding flavor to your game. This is not for everyone, so if this is not your cup of tea, move along.

The following is to give a sense of things and not to be the basis for a special table or more realism in the game engine. Just information to keep in mind, either for descriptive purposes, or for effects on characters and NPCs to add some flavor to the game. Disease and parasites are covered on pages 13 & 14 of the DMG. I have rarely played in games where this was used. My only recollection of something close to this was one player reading a cursed book and getting a psychological disorder, which is not the same thing.

The effects of wounds can be much more devastating than the game might convey. Unless it is a game with magic, like a heal or restoration spell in AD&D or similar, or a high-tech science fiction RPG with technology to put you back together. Side Note: If you think about the Star Trek transporter technology, no injury would be a showstopper and one could merge their memories with a scan of their younger self and maintain perpetual youth.

Major Bones:

I knew an elderly woman who broke her hip. The shock to her system was such that she was confused and didn’t know who or where she was and didn’t know anyone. It was several weeks until suddenly one day she knew what was going on. Major bones breaking can cause people to go into shock and lose consciousness. The breaking can be from a fall, accident, or wounding, like being shot. Surgery to fix a broken hip prevents death. Prior to such surgery, people with a broken hip would die of pneumonia because they couldn’t get upright enough to keep their lungs clear.

Adrenaline:

Once one of my brothers, Robert, and I were coming home from school. I was driving a 1973 Buick LeSabre, a tank of a car. It was wide and long, and low to the ground. I could lay down in the the front seat and not be cramped. Robert and I were trading punches in the arm. We started that just as we turned onto the bottom of our street. By the time we were pulling in the driveway, we had passed the point of fun and were both pissed. I pulled in slammed the car into park and opened the door and started to get out. Robert grabbed my shirt and pulled me close and hit me so hard he knocked my torso out of the car. He had at least 50 pounds on me, maybe more like 75. I jumped out and ran around the back of the car and he met me and we punched and swung and swirled and were engaged in mortal combat, two testosterone crazed teenagers. My dad heard us and came to the front porch and hollered at us and broke it up. Robert’s hand started hurting. He said he hit me in the back. I had no discomfort in my back. I am surprised we didn’t have bruises. Adrenaline can stop you from feeling pain as part of the fight or flight process. This is why bears are known to fight beyond the point where they should be dead as reflected in the AD&D Monster Manual.

Eyes of the Dead:

I once sat with a man with terminal cancer so his wife could get a break and go shopping. While she was out, he died. I combed his long hair, etc. to clean him up. I tried to close his eyes and they opened about half way. I tired several times. This is the origin of coins on the eyes of the dead, to keep them closed. It is why modern undertakers sew shut the eyes of the dead, if there is to be a viewing. When the wife returned she was bothered that he would be embarrassed to have soiled himself. I had to explain that when you are dead you can’t control your bladder or your sphincter. When creatures are killed in game, there will be an odor on top of whatever the thing smells like.

My family has grown weary of my complaining about every movie and TV show where they close the eyes of the dead and they stay closed. I can’t help it, that is totally wrong! In modern American culture, we have distanced ourselves from death. Sanitation, plentiful food, vaccinations, and antibiotics have done so much in the 20th century up to the present to halt huge numbers of people dying from the simplest things. I think it is morbid to have a viewing of the dead, but it is a part of closure and reminds us that we are all mortal. The majority of people who eat meat have never killed any animal for which they eat its meat. We are so distanced from the death and slaughter that leads to our plastic wrapped meat, it is all too easy to forget where it comes from.

The dead also fart and can make sounds like they are exhaling or gasping or moaning. There can also be spontaneous muscle contractions and a dead body can “sit up”. My high school biology teacher said that in college he had a job driving a hearse to transport bodies from the hospital to the funeral home. He quit after he looked in the rear view mirror and saw his passenger “sit up” in the body bag.

As a body decomposes it will swell and eventually burst. I “missed out” on this experience, thankfully.

A body in water swells up like a bloated water balloon and easily comes apart during retrieval from the water. I am very glad, I have never had to be a part of something like that!

Rabbits:

I hunted rabbits and squirrels in high school. I did not know that rabbits made noise until I wounded one. A wounded rabbit makes a sound like a baby crying. It is heart wrenching. I still finished it off, dressed it and cooked and ate it. Rabbit and squirrel have a consistency similar to chicken and a somewhat similar taste. Wild rabbit and squirrel have a “gamey” taste to them, that is common of wild animals. It is not a bad taste, just one most are not used to living with farm raised meat.

My parents taught me how to cut up a store bought chicken to make fried chicken. Where I live, near Kalamazoo, MI, I haven’t found a fryer in the store. The only whole chickens are for baking or roasting. Part of that is frying isn’t the healthiest option, and most people don’t fry their own chicken anymore. This will be much different in a wild west or D&D setting where every housewife knows how to kill, clean, and prepare fowl, small game, and farm animals. Lots of blood and gore and refuse pits if they farmers don’t have hogs. I have been told that hogs eat anything, even the bones. Someone told me that if you want to kill someone and get away with it, take the body to a hog farm. While that may be true, 80+% of modern hog farms are indoors and are factory farms, so they would have cameras to keep an eye on things. It isn’t that easy anymore. But in a rustic game setting, it would be possible. How do you solve the murder without a body and forensics to identify trace remains. CSI and Columbo can’t make it in those settings.

My mother told me that she asked her mom what food she most missed from the farm, and my grandmother replied, “Fried blood.” I don’t know how it was prepared or if flour or starch or anything was added. It is not something I would try, short of starvation.

Cremation:

My parents were cremated and my siblings and I scattered their ashes. These ashes are a fine grey powder and remind me of cement in color and the consistency is much like ashes from a fireplace or campfire. If you don’t buy a fancy urn, the cremains (technical term for the remains of those cremated) are placed in a plastic zip lock bag (about the gallon size, if memory serves) inside a two part cardboard box that is about 8 to 10 inches cubed. This fine stuff will get into crevasses and some inevitably sticks to the plastic bag and in the corners of the box. I would guess that the weight was no more than ten pounds.

One Armed People:

I was an EMT way back when. One call we had to go get a one armed woman who fell between her toilet and tub and was slightly overweight. She was a cancer patient and was in a lot of pain. Without two armpits, it is very hard to pick up a a person in a tight spot, especially if they can’t help.

Great Toes and Thumbs:

In the Old Testament, the Children of Israel would cut off the thumbs and great toes (fancy terminology for the big toe) of the captured enemy kings. This was so that these kings could no longer lead men into battle. Back then, most kings were also the military leaders of their people. Without thumbs you can’t hold most weapons. I would think you would be limited to some sort of thrusting weapon that goes over what is left of the hand(s). The great toe is a major part of the ability to stand and balance as well as to walk and run. If you ever saw “Roots”, you may recall that Kunta Kinte had part of one foot cut off so he could not run away.

Warm and Dead:

In my EMT class, we learned that you aren’t dead, until you are warm and dead. This is because people that fall through ice, etc. can go into a sort of hibernation, and one should not declare them dead until they warm up.

Sucking Chest Wounds:

This occurs when the chest wall is punctured due to stabbing, gunshot, or other piecing injury. When a person exhales, the hole in the chest allows air into the chest cavity so that the lungs can’t expand when the person attempts to inhale. The EMT method for this is to put your hand over the hole when they exhale and remove it when they breathe in to help get the air out and then to seal it with plastic and tape until reaching the ER. If you ever saw ER or other medical dramas, they might open the chest between the ribs to drain blood which filled the chest cavity, or used a syringe to let the air out of the chest cavity so the patient can breathe. In addition to compressing the lungs, air or blood in the chest cavity can also compress the heart to the point it can’t beat or can’t beat correctly or enough to maintain life.

Evulsed Eye:

The eye can be knocked from the socket and dangle by the optic nerve and the patient can still see. The EMT treatment is to put a sterile cup over the eye and socket to keep it clean. I have no idea how the ER deals with it.

Exploding Cars:

In addition to once being an EMT, I was an Volunteer Firefighter/EMT. I attended multiple car fires and even had one of my cars have a fire. None of those 20+ cars ever exploded. While in the right conditions, gasoline vapor, gasoline is very explosive, those conditions are usually not present very often. From TV and the movies, every car crash seem to result in an explosion.

House Fires:

The average house fire burns at about 3,000 degree F. This is hot enough that the steel I-beam most modern houses use for support will twist. For this reason, I have no problem believing that a high speed jumbo jet loaded with jet fuel would burn hot enough to weaken the steel holding up the World Trade Center buildings. 20 or 30 floors of falling debris would be enough to collapse one floor, which adds to the weight on the next floor, until each floor has collapsed like dominoes.

The protective gear a firefighter uses can make it bearable to stand relatively close to a fully engulfed house. However, they are hot enough that standing across a two lane highway from a large burning building is unbearably hot if you open or remove your coat.

Kidney Removal:

My father had a form of kidney cancer that if caught before it grows outside the kidney, they can remove the kidney with nearly 100% chance of getting it all. He had a scar that went from near his spine to his abdomen. The kidney is deep enough that they literally cut you in half. This is what a kidney donor goes through. They do not put the kidney in a recipient as deeply as it is naturally, so it is not as traumatic for them.

Compound Fractures and Infection:

In the age before antiseptics, a compound fracture meant near certain death due to infection, or amputation in an effort to avoid or fight off infection. In D&D such injuries are not part of the rules, unless house ruled. A Paladin in good standing will automatically not have to fear infection, since they are immune to disease. Others will require healing, is cure light wounds or cure serious wounds enough to avoid infection? Do orcs sterilize their weapons between uses? There  are rules for diseases in the DMG to cover this, if you want that as part of your game.

I knew a man who had a quadruple bypass and then had a staff infection. It took nearly six months for him to get over the infection with modern antibiotics.

My ex injured her knee in a car accident and needed surgery. They had to re-schedule the surgery because the air conditioning went out in the surgery room. They don’t operate it the temperature is over 70 degrees to help minimize infection. Even in so called sterile environments in hospitals, it is easy to spread infections.

In a pre-modern D&D setting, will the characters know germ theory? Will the culture have baths and aspire to cleanliness like the ancient Greeks, Romans, and Japanese? (Yes, I know there are other cultures who used baths, etc.). Will they have practices that have the same practical effect as observing germ control in the modern era? Will their be plants or animal substances that are known to fight infection, besides whiskey? Honey is a known antibiotic and was used by ancient peoples in their wound dressings. Some even use raw honey today. Because of it’s antibiotic properties, honey does not spoil. If it dries up, just heat it and it is as good as new. Maybe the honey from giant bees? In MMII, giant bees have a 20% chance to have royal jelly that both cures damage and disease. Would the players encounter someone who knows that?

There is a famous example in The Lord of the Rings where Aragorn knows that Kings Foil isn’t a weed, but a powerful medicine. Will their be similar “weeds” due to “lost” or limited knowledge? The level of verisimilitude is up to the DM and what the players enjoy. If it isn’t fun, you’re doing it wrong.

Car Accident, multiple injuries:

I was in a bad car accident 20+ years ago and broke my back (T-12), left collarbone, had a big gash on the back of my left hand that required 7 stitches, smaller cuts on my forehead, some of which required stitches, loss of an estimated 3-4 pints of blood, and a concussion. I don’t recommend sleeping and driving at the same time. Once was more than enough to know it’s not a good idea. It was very cold and 3 hours before I was found and had minor hypothermia until I was cut out.

My oldest son was almost a year old and we had done Lamaze class so I knew how to breathe. This was important because a broken back was the worst pain I have ever had and would have spasms of pain. The Lamaze style hee-hee-hoo breathing helped with the spasms. Due to my concussion, I had to rely on that to deal with the pain for my first 24 hours in the hospital because they didn’t want to give me pain medication to make sure I didn’t go into a coma. I was blessed and no spinal cord damage, and things were lined up. The treatment was a back brace that I had to wear 24×7 for a few weeks, then I had to wear it except when I was in bed for a few weeks. In such a short time, my back muscles got weak and I had to do exercises and wean myself off of the brace so I could hold myself upright for very long.

When I could finally got something for the pain, they gave me intravenous morphine. My eyes rolled back in my head and I was out, just like in the movies. After I was on morphine, I knew who came to see me, but the order is jumbled in my mind.

While trapped, I KNEW I had a broken collar bone because I could not lift my arm without putting my right hand on my collar bone to compensate for the break. Your arm works like a crane. If your collar bone is broken, it is like a crane with a broken arm, it can’t lift itself, let alone anything else. They also don’t do any surgery to fix a broken collar bone unless is a complication. The female doctor in the family practice we used stopped in to check on me and told me that I could never wear a strapless gown because my lines were now off. Darn, I missed the opportunity. The treatment is a figure eight type wrap to pull your shoulders back straight. For several years after it healed, I had sharp points under the skin that were sensitive to pressure.

For me the estimated 3-4 pints of blood loss was not enough to merit a transfusion. IV’s were used to increase blood volume. It was 3 days before they put me in the back brace and tried to sit me up. I immediately grayed out and had to lay down. The levels of blood loss some heroes have in the movies would render them incapable of standing.

There was also concern that my spleen had ruptured because I didn’t have bowel sounds. Your insides make a lot of noise in healthy individuals due to peristalsis, the movement of food from one end to the other. A broken back hampers your ability to move waste, and was the reason for my quiet abdomen. They told me that if I didn’t burp soon, I would have surgery. To avoid surgery, they did a nasal cannula. A plastic tube inserted into my my nose and threaded down to my stomach. I had to continuously swallow to get the tube down. They then drained the contents of my stomach looking for blood. Finding none, I avoided a spleenectomy. After they withdrew the cannula, it felt like it was still there for about a week, yuck!

Both morphine and back injuries make it difficult for the body to pass solid waste. My first BM after the accident was very painful. You don’t realize how many muscles in your back are used for pooping until you have a back problem. OUCH!

When I finally could stay conscious while upright, they walked me around the hospital floor to help me build up my strength. I was still very wobbly and week. Because our son was almost one year old and able to crawl all over the house, I stayed in the hospital nine days, until I could sit up on the bed by myself and walk to the chair so that my then wife wouldn’t have to do so much for me and chase David.

One day, while in the hospital, the fire alarm went off and they had to evacuate. I did not have my back brace on, so I was at the mercy of someone else to wheel my bed out. Thankfully, it was a false alarm, but it had me very concerned for a few moments, because I was helpless.

Another problem I developed was pleurisy. It is a condition where the lubricating fluids between the lungs and the chest cavity are absent due to long term shallow breathing. It can also be caused by pneumonia and other illnesses. It makes deep breathing very painful. The “cure” is to force yourself to breathe deeply to get your body to lubricate the lungs as they inflate and rub against the interior of the chest cavity. The best I can describe it is sandpaper rubbing against the inside of your chest.

My concussion was mild, but any head injury has lasting issues as the NFL has finally acknowledged. My ex had to do all the driving for a few weeks. We lived in south central Missouri and had to take state Highway 68, which is like a roller coaster. Even sitting in the front passenger seat I got carsick and had to have her pull over so I could puke. Later when I was finally able to drive, I had to drive that stretch of road and I got carsick while driving. Thankfully, that was only really bad nausea. I used to spin David around, I could not spin even once without getting dizzy. I can now spin around a few times before it gets annoying. I can no longer handle spinning amusement park rides. I am hoping that spinning is the only thing I have issues with and it doesn’t have major repercussions as I age.

The big gash on my left hand was so deep that the ER doctor who stitched me up said he could see the tendons. My hand was swollen to about three times normal size. For about 7 or 8 years the area of the gash was numb. I could feel pressure on the subcutaneous tissue, but the back of my hand was like it had Novocaine. Nerves grow about 1/4 per year. The worst part of my hand injury was a small “knot” on the inside edge of the knuckle of my index finger. When my boys would hold my left hand, their little finger would naturally rest on that and it felt like a nail going through my hand. One doctor dismissed it as a mere adhesion. 7 or 8 years ago, about 13 years after my accident the skin over this small “knot” split and when I touched it to clean it a small piece of safety glass about the size of four grains of salt square came out. My sons were amazed that my hand didn’t hurt and I told them to squeeze all their wanted.

I’m about a half inch shorter than I used to be. My T-12 vertebrae is shaped like a triangle that slopes towards my front, so my back can get out of place easily. I usually bend over just right and it goes back into place. This was a great frustration to my sons when they thought they were taller than I, and I would put my back in place, and then they were shorter than I. Now they are really taller than me, so that doesn’t work anymore.

Prior to my car accident, the only thing I had broken was my little toe. That pain is immense, due to all the nerves in it. My foot swelled so much I could not wear dress shoes. I had to loosen my sneakers, and driving a manual transmission (stick shift) was painful, because it was my right foot.

I also did something to my neck in the crash. I used to be able to pop my neck with no problem. Now it sometimes feels like it needs to pop and it won’t.

I can still do hard manual labor, but it isn’t easy. It isn’t easy because I have a desk job and don’t do that stuff on a regular basis. It’s definitely not because I’m “old”. 😉

So there is my take on a lot of things that can enlighten things of a “flavor” for your game, not necessarily something requiring a rule, mechanic, or table to handle. As I have said above and elsewhere, if you are not having fun, you are doing it wrong!