This is a variant to the standard healing rules for gritty campaigns. As such it will not be suitable for every table. Only use it if you want injury to be much more of a setback. Personally, I think it will make the game more dramatic- you risk something serious every time you get into combat. Let me know what you think. Please correct me if I made a boneheaded math error- I'm not a math guy.

Variant: Immersive Healing

A stable character at 0 hit points no longer regains a hit point after 1d4 hours. They remain unconscious and at 0 HP. They may be moved and tended to without taking damage. They will remain in this state without medical care.

Phase 1: Regaining Consciousness

Phase one is the most difficult phase- battling one's way back from the brink of death. After completing this phase, the character is "out of the woods".
 
In the absence of magical healing, another character may make a Wisdom (Medicine) check against DC 20. If the patient has a positive modifier to Constitution, this check is made with advantage, and if the modifier is negative, the check is made with disadvantage. If it fails, the check can be made again every 3d20 days, except that the DC decreases by 5 each time.

In the absence of Medical attention, the character must make a DC 15 Constitution Save every 3d20 days. If they succeed, they recover 1 hp and move on to phase 2. Otherwise, they may try again every 3d20 days, reducing the DC by 5 each time.

During this time, the character must be cared for, fed small amounts of broth, bathed, etc. Going without food and water follows the normal rules, but going without bathing runs the risk of infection. The neglected character must make a Constitution Save vs. DC 10 (modified by the DM) after the first week of neglected bathing, or take 1 point of damage and begin dying again. If the character makes the Save, but the neglect continues, the Saves increase in frequency to one per day.

When the DC becomes 0, the check succeeds automatically.  If the check succeeds, the injured character regains consciousness and 1 hit point. This means that in the absence of Medicine, the character will eventually wake up as the DC gradually decreases to 0.  He or she now enters phase two.  

Phase 2: Recuperation.

Phase two is where the character heals his or her body- the actual physical damage.

For a week of phase two to count, a character must be able to take at least 5 long rests.

At the end of the first week of phase 2, a character regains 1/2 his or her maximum Hit dice (with a minimum of 1), but not hit points. The character may roll these normally during a short rest. At the beginning of every week thereafter, the character once again recovers 1/2 of his or her hit dice. When a character regains 50% of their maximum HP, they move onto phase three.

Every time a character is brought below 50% of their hit point maximum, they reenter the Recuperation Phase.  

Phase 3: Full Recovery

Phase three is where the character recovers from the emotional and spiritual trauma of nearly dying and gets back into shape.

During phase 3, a character recovers 1/2 of their maximum hit dice (with a minimum of 1) per 1d4 days, but no hit points without expending them. This continues until they are at full hit points and hit dice.

Whenever a character takes damage that doesn't bring them to 50% of their hit point maximum or below, they reenter phase three.  

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 This variant dramatically alters the game's pacing. Without magical healing, it will be very hard to get back into the action after a hard fight. This will make a fight in a low-magic world more of a serious undertaking, and stretches out downtime between fights. This will lead to more cautious characters and a slower sense of progress.

These rules are largely overcome with the application of magical healing and other class abilities that affect hp recovery. This is how it is intended to work. These rules just make it more immersive for low level PCs without healing magic or similar abilities, and for NPCS who lack the same. With this system, healing times in the absence of magic or special circumstances will be more like they are in our own world.

Here's an analysis of the times involved.

All times assume 1st level Medicine, a d8 hit die, and a patient Constitution of 10-11. A month is assumed to be 30 days long.
 

Phase 1 Timescales:

Maximum time: 240 days (8 Months).
Minimum time (with Medicine): 1 round.
Minimum time (without Medicine): 3 days.
Expected time (with Medicine): Roughly 17 days.


Phase 2 Timescales:

Maximum added time with 5 full rests: 3 Weeks
Minimum added time with 5 full rests: 1 week.
Expected added time with 5 full rests: 1 week.

Phase 3 Timescales:

Maximum added time: 16 days.
Minimum added time: 6 days.
Expected added time: 6 days.

Combined Timescales:

Maximum combined time from 0 to full hp and hit dice: 9 months, 1 week.
Minimum combined time from 0 to full hp and hit dice: 1 week, 6 days with Medicine. 2 weeks, 2 days without Medicine.
Expected combined time from 0 to full hp and hit dice: 1 Month with Medicine, 33 days without.

Interesting if a little convoluted. Could be ways to trim this down to something simpler?

Consider posting it over at RPGG?

It may be convoluted. I'll think about what to do about it.

What's RPGG?

I Googled it. Apparently I'm already a member.

I'll see how it changes after this thread before I post it over there. If I recall correctly those guys are very good with mechanics, and I don't want to embarrass myself.

Does this only concern those who ever drop to zero or negative HP?
As long as you stay at 1HP or above, you still have the short rest healing surges, long rest full HP recovery etc.?

Quote from: Skyrock;784160Does this only concern those who ever drop to zero or negative HP?
As long as you stay at 1HP or above, you still have the short rest healing surges, long rest full HP recovery etc.?

No. As written, it applies to all healing. In phase 2 it says that if you ever drop below 50% HP, you reenter phase 2. In phase 3, it says that if you lose *any* hp that don't drop you to or below 50%, you reenter phase 3.  

When fully healed with all of your hit dice, however, you do have a buffer that you can apply until those hit dice are gone.

In that case you should rather re-arrange the phases, so that is more intuitive from the perspective of getting a fully healthy character successively wounded.
(IF HP < 100% AND HP => 50% GOSUB Full Recovery
ELSEIF HP < 50% AND HP > 0 GOSUB Recuperation
ELSEIF HP <= 0 GOSUB Regaining Consciousness
ELSEIF BREAK)

Some implications:
1.) In-combat healing to keep party members on their feet will become more desirable. By vanilla rules it usually only gets done if a character is already downed, or would likely be downed by the next attack. Now a stabilized character will become a burden rather than a one-hitpoint-wonder.
2.) Characters that can provide extraordinary healing (Bards, Clerics, Druids, Fighters with Second Wind etc.) will become both more important and weaker. More important as they are the major healing source that greatly overshines natural healing, and weaker in that they will need to put aside more resources for healing that otherwise could have been spent on other things. (e.g., spell slots)
3.) "Easy" encounters will become comparatively more meaningful. While by vanilla 5e rules they are more about HP and resource attrition, scarcer healing means that they will play a bigger role.
"Hard" encounters gain comparatively less meaning from this house rule, as they will probably already require in-combat healing (which's availability isn't reduced).
4.) It will mess a lot with the assumptions about the adventuring day in the DM rules by making rests much less effective. A group will progress much slower per day than assumed by those rules. When a group can't choose the pace at which it progresses (as in most location-based adventures), but gets encounters thrown at them (as in most scripted adventures), the DM will need to take the reduced "adventuring day" into account.

Those aren't necessarily bad implications (they might be exactly what you are after for in a gritty campaign), but things you should be aware of when you employ this rule.

They look fun, and properly scary.

Not getting bathed killing you is going to be a riot at the game table. "I want that Elf hottie of yours bathing me." "I am NOT sponge-bathing your sorry hairy Half-Orc ass!" etc.

I like the direction you're going in, but I doubt this will come up much, unless you have a group / campaign without access to magical healing.

What bugs me most about about the zero HP rule is that the RAW allow magical healing to instantly bring you up to x HP, especially in the midst of combat. If your guy gets put down in this round, the cleric rushes over, casts heal ... and six seconds later, you're up again, swinging your sword as though nothing had happened.

We've put in a houserule that says you take one round to "come to" after being magically healed from zero. You can move, but you cannot take actions. If I were to go for a more gritty campaign, I might even rule that you stay semi-conscious (can take only a move or an action, but not both) until combat ends.

Quote from: Skyrock;784166In that case you should rather re-arrange the phases, so that is more intuitive from the perspective of getting a fully healthy character successively wounded.
(IF HP < 100% AND HP => 50% GOSUB Full Recovery
ELSEIF HP < 50% AND HP > 0 GOSUB Recuperation
ELSEIF HP <= 0 GOSUB Regaining Consciousness
ELSEIF BREAK)

Good idea. When I rewrite it (and possibly simplify the math) I might invert it.

QuoteSome implications:
1.) In-combat healing to keep party members on their feet will become more desirable. By vanilla rules it usually only gets done if a character is already downed, or would likely be downed by the next attack. Now a stabilized character will become a burden rather than a one-hitpoint-wonder.

Which is how I want it in some campaigns. I kind of pictured a scene where a party limps back to town carrying/dragging one or more of their allies while desperately hoping to avoid danger.

In other campaigns, this would be wholly inappropriate, I think. I have an ancient world, age of heroes setting, for example. The character there are supposed to be badasses. In that world, PCs (favored of the gods) might use the standard healing rules while most NPCs used the Immersive rules.

I could also come up with rules for that setting that are something in between Immersive Healing and Standard. This isn't meant to be a one-size-fits-all solution.

Quote2.) Characters that can provide extraordinary healing (Bards, Clerics, Druids, Fighters with Second Wind etc.) will become both more important and weaker. More important as they are the major healing source that greatly overshines natural healing, and weaker in that they will need to put aside more resources for healing that otherwise could have been spent on other things. (e.g., spell slots)

I did realize this. Still, the issue of not being able to do anything but heal is a bit troublesome. I want these characters to have the strong role of healing the party, but I don't want to make playing these classes less fun.

Quote3.) "Easy" encounters will become comparatively more meaningful. While by vanilla 5e rules they are more about HP and resource attrition, scarcer healing means that they will play a bigger role.
"Hard" encounters gain comparatively less meaning from this house rule, as they will probably already require in-combat healing (which's availability isn't reduced).

I don't know if I agree that hard encounters gain less meaning; I just think they're much more likely to injure you, and so you be less likely to take them on without amazing planning or sheer numbers. A fight versus a (sufficiently powerful) dragon might be an undertaking for an army, hopefully led by the PCs, not an adventuring party alone. Even with in-party healing, the game assumes that these kinds of fights will take a lot out of the party, it just gives it all back the next day*. My rules wouldn't do that.

*Referring to the intangible resources of the party, not things like potions, wands, or what have you.

Quote4.) It will mess a lot with the assumptions about the adventuring day in the DM rules by making rests much less effective. A group will progress much slower per day than assumed by those rules. When a group can't choose the pace at which it progresses (as in most location-based adventures), but gets encounters thrown at them (as in most scripted adventures), the DM will need to take the reduced "adventuring day" into account.

Yes. The setting itself would probably have to be a lot less action-oriented, and a random encounter might pause an adventure for months. I think that could be cool as well.

"We began the expedition to the Necrodium in distant Atronicus. At the end of the third week, we were beset by Curseborn cultists. Our guide Geirog and the mage Arthon were injured gravely, and rather than leave them behind we decided to spend the rest of the season in the wretched city of Jeradon. There we gained a few new allies, but found trouble as well. Geirog recovered well, but Arthon was not fully healed when were were forced to leave under the cover of night."

QuoteThose aren't necessarily bad implications (they might be exactly what you are after for in a gritty campaign), but things you should be aware of when you employ this rule.

Thanks for your input.

Quote from: The Butcher;784186They look fun, and properly scary.

Not getting bathed killing you is going to be a riot at the game table. "I want that Elf hottie of yours bathing me." "I am NOT sponge-bathing your sorry hairy Half-Orc ass!" etc.

That is funny.

Quote from: Jorunkun;784188I like the direction you're going in, but I doubt this will come up much, unless you have a group / campaign without access to magical healing.

I expect it to come up at low levels, and in later situations where the cleric/other healer is dead or incapacitated. It could be very interesting even at higher levels to run a survival adventure where the party is down for the count, and the cowardly rogue (or wizard) has to get them out of it.  

Mostly, though, it would affect NPCs. I know I could hand wave this, but I prefer to make PCs and NPCs use the same basic rules unless there's a good in-world justification.

QuoteWhat bugs me most about about the zero HP rule is that the RAW allow magical healing to instantly bring you up to x HP, especially in the midst of combat. If your guy gets put down in this round, the cleric rushes over, casts heal ... and six seconds later, you're up again, swinging your sword as though nothing had happened.

We've put in a houserule that says you take one round to "come to" after being magically healed from zero. You can move, but you cannot take actions. If I were to go for a more gritty campaign, I might even rule that you stay semi-conscious (can take only a move or an action, but not both) until combat ends.

I like that.

Are there any specific changes you guys would make to this? I'm certain there are.

Without trying them yet these look like they'd push the sort of game I prefer... where combat is SCARY and to be avoided if at all possible.

They seem like they might encourage having a stable of secondary PCs as well... something to play while primary is in hospital.

Quote from: Monster Manuel;784242I don't know if I agree that hard encounters gain less meaning; I just think they're much more likely to injure you, and so you be less likely to take them on without amazing planning or sheer numbers.

Less meaning in comparison to easy encounters.

Under standard healing rules, easy encounters are just a minor attrition thing that can get undone with a Short Rest. Now they will eat up more limited resources to be undone (spell slots, healing potions).
Hard encounters gain relatively little, as in-combat healing options aren't really different. They will only be affected as far as the group is more likely to suffer from more attrition from previous encounters.

QuoteYes. The setting itself would probably have to be a lot less action-oriented, and a random encounter might pause an adventure for months. I think that could be cool as well.

Addendum: Slower Adventuring days will also result in slower XP gain and progression. If that is an undesired side effect, you should increase with XP per creature, or lower the level thresholds.
(Under the eye-balled assumption that short rests become mostly worthless and long rests becoming mostly good for regaining slots for healing spells, double XP per monster or halved XP tresholds should result in roughly the same progression rate per adventuring day as far as gaining levels is concerned.)

I think I'd prefer to use IQ rather than WI for that initial check by a player administering medical aide... because I picture them stopping the bleeding, removing arrows, quick sewing up open wounds... rather than just praying over the body. More mechanical repair than spiritual.