Guide to Surgery

Direct port from Azure wiki

Medical Diagnostics

Generally before you can administer treatment with confidence, you'll need to figure out what's actually wrong with the patient first. There's a number of ways to do this - most underrated of which being the patient describes to you what's wrong - and they will be covered in detail under the following subheadings. Once you've figured out what needs treatment you can proceed to the next section.

Your Heart

Checking your health is important. Clicking the heart in the top left of your screen will tell you how you're doing at a glance and let you know each limb's status. It's verbose enough to tell you if your limbs are brutalized, burned, bleeding, crippled, if anything is stuck inside (with underlined text), etc. but won't be more specific than generalizations - the bigger and bolder the text, the more severe it should be considered. It will also tell you if you're paralyzed or anemic, among other things. A diminished heart with nothing else out of the ordinary means you are probably poisoned.

Miracle Diagnosis

Medical roles such as the Court Physician and Acolytes of Pestra get access to Diagnose miracle. This miracle is capable of showing you a verbose readout of the patient's status similar to your own health readout. The biggest difference will be that you can see the exact values of damage a limb has suffered (ex. instead of BRUTALIZED you will see 71 BRUTE instead). This miracle has a short cooldown and no cost to cast, so it is very effective for monitoring patients during extended treatments.

Visual Examination

If Diagnose is unavailable to you then you'll just have to do things the old fashioned way. Obviously having a conscious patient would help greatly because they can tell you what's wrong, but if they somehow can't then you'll need to use your eyes.

Examining anyone, no matter what, will give you a general idea of how their health is doing. If you don't see anything in the examine text about how their health is doing then they're either fine or suffering from something that isn't immediately obvious such as paralysis or poisoning. You will otherwise see text such as They are gravely wounded. which will clue you in to their physical trauma. You can prioritize patients this way if need be.

If you're next to someone you can examine them with a limb targeted and be prompted to inspect that limb closer. This method is most effective if the limb is not clothed, but there are some injuries that can be ascertained even while obscured such as fractures. You will otherwise be able to tell how many individual injuries belong to the limb, or an artery was cut, whether or not they've received treatment (in parentheses), if it's dislocated, or if the part is somehow disabled: numbness means it's too damaged, limp means the whole body is paralyzed.

Just like the above section, you can see embedded objects (like leeches) as well that you're allowed to rip out as long as you're targeting the correct limb. Just click the underlined text.

You can also listen to someone's heartbeat if you have the chest targeted to see if it's still beating. If it isn't, they're dead and you should look at how to make them less dead.

Treatments

After diagnosing your patient you can move on to the actual treatment. Hopefully you've studied most of this information already, because you're going to be thrown a lot of curve balls while doctoring. If you're reading this and something is life-threatening, the quick and dirty subheading above is a good list to quickly check since everything underneath this one is suited towards more nuanced, explained medical knowledge.

For the most part, many treatments will involve strips of cloth (obtained either by weaving fiber or ripping clothes), needles (crafted with thorns and fibers, or a better version for 1 iron ingot), or with the tools found in a surgery bag. Buckets of water and leeches (usually cheeles) are also pretty commonly used. If you have all of these then you can fix virtually anyone.

Damage Types

Brute Trauma

Brute damage is perhaps the most common form of injury since everyone loves to beat each other up, usually with weapons! Brute damage is the most varied of all types and will usually pose the most complexity for treatment.

• Plain brute values can be healed by sleeping, drinking red potions, or by using miracles.
• Brute tending surgery can also fix this, which is especially useful if they're extensively injured.
• Brute often introduces the risk of bleeding! Cuts and similar injuries are individualized and will stack to make bleeding worse based on how many there are on a limb. There's four ways to stem this in order of effectiveness, least to most:
  1. Grabbing: Grabbing the limb and reinforcing that grab will slow the bleeding down. This is only relevant if you don't have any other means of stopping the bleeding, or don't have time to.
  2. Cloth: Strips of cloth in particular (bundles of cloth don't work), these can be used to try and keep blood from falling out. It is only effective if there aren't many cuts, or else it will be bled past and be ineffective!
  3. Needle: Crafted thorn needles and dedicated suture needles are the second most effective way of sealing wounds. If a limb has multiple wounds you will be prompted about which one you wish to sew. Succeeding in finishing sewing will use one needle thread.
  4. Cautery: Heating a cautery iron and using it on the affected limb will seal all open wounds almost instantly in one go. Twenty puncture wounds will disappear in a flash this way.
  • There is also arterial bleeding, which will have an obvious red spurting animation on someone when it happens. Cloth is ineffective, you'll have to sew it closed.

Blood Loss

So your patient's looking pretty pale because all his precious red stuff fell out of his body. First of all, make sure that stops happening by following the bleeding treatment outline above! Here's how you help restore blood:

• The easiest way is to drink water. One full mug of water is, oddly enough, an extremely effective means of restoring a gigantic chunk of blood. The patient must be alive for this to properly process.
• A cheele is a leech capable of sucking blood and infusing blood. Get it fat with blood and squish it to get it to directly infuse blood into someone. You can place it on someone by just clicking them with a cheele. The patient doesn't have to be alive to be infused with blood.
• Miracles (not the lesser variant) is capable of restoring blood each time it's cast.

Dislocation

Sometimes your arms and legs pop out of their socket, which will make using them difficult. The treatment for this is simple:

• While combat intent is inactive, grab the affected limb on weak intent to attempt to relocate the joint. Success depends on medicine skill.

Crippling

Crippling is actually a broad way to describe a limb has been disabled and rendered unusable in some way. It does not always mean it's fractured or dislocated. The most common way a limb will cripple is if it takes too much damage, but this is not always the case. The following are all the ways a limb can be considered crippled:

• Damage: A limb that suffers too much brute (or even burn, actually) damage will be considered crippled. Treat the damage to fix this.
• Fracture: Broken bones will usually disable a limb, hence it will be considered crippled. Repairing the bone through surgery or with miracles will fix this.
• Paralyzed: A broken skull (or neck) will cause whole body paralysis. Fixing them will fix the paralysis.
• Clamping: Forceps or a speculum present inside the limb will technically cripple it.

Dismemberment

Sometimes, if the combatant is especially strong, a victim may find their arms, legs, or even head lopped off by a really big sword! There's two ways to fix this:

• The limb replacement surgery allows you to sew missing bits back onto people.
• Bodypart Miracle can attach limbs to someone as well.

Burns

Another common form of limb damage are burns. Chiefly they'll turn up whenever someone gets set on fire, and the damage will continue to build for as long as they're on fire! The worse the fire (sometimes known as firestacks) the more intense the damage will be per tick. There's a few ways to fix burns:

• Sleeping, drinking red potions, or using miracles are the most common ways of dealing with burns.
• Burn tending surgery can heal extensive burns across the entire body.

Poisoning

The sinister side of bad health is poisoning, something that's pretty difficult to ascertain until it's too late. Poison comes about most commonly from consuming inedible jacksberries, but consuming rotten food will also poison you, as will missing your liver. The usual ways of telling how injured someone is won't work to tell you how poisoned someone is, you'll have to look for other cues. These cues are generally:

• A diminished health heart with no other discernible problem.
• Vomiting blood.

The treatment for poisoning is the following:

• Sleep!
• Leeches (preferably a cheele) will reduce your poison damage for as long as they're attached.

Suffocation

Suffocation (also known as Hypoxia) most often manifests when someone is anemic, is drowning, or is being throttled by someone with their hands on the patient's throat. Both normal ways of checking someone's condition do not tell you if they're hypoxic, but the patient will be gasping involuntarily over a certain threshold. The following will replenish oxygen in someone:

• Lesser Miracle

Organ Trauma

Organ damage is a bit of a loose way to describe certain organs no longer functioning. As of writing, this applies almost exclusively to the eyes as those can be stabbed out and rendered ineffective.

Note that critical hits citing your heart bleeding is not your heart being damaged, but rather an arterial bleed happening in your chest.

Revival

Should the worst come to pass, your patient's time in this realm may suddenly be cut short and they will die! You can tell they're dead either by seeing X gurgles out their last breath. in the chat or by examining their chest to listen to their heart and hearing no heartbeat. For the patient this means they have the option to quit the round as that character to play someone else or spectate the round as a ghost - for you this means getting the patient back into the round is that much harder as revival is at times a difficult hurdle, and one that's a bit time sensitive so that the patient's body doesn't rot and turn into a zombie!

In truth, as long as the torso and head are connected and aren't skeletonized, the patient isn't rotted/a zombie, and has enough blood, revival is possible at any time! There's two ways to yank a patient from Necra's embrace and back towards the realm of the living:

• The lux infusion procedure can revive someone so long as no limb is damaged!
• Anastasis, when performed on someone laying in front of a cross, will quickly bring them back to life.

In either case, make sure the patient doesn't accidentally die from the same thing twice by double checking their health and healing any abnormalities!

Surgery

Unless you are equipped with the divine miracles of different patrons, surgery will eventually become relevant for a patient's treatment. Below is a list of surgeries that are possible, as well as the minimum skill level in Medicine required to do those surgeries in the first place.

The minimum skill requirements decide whether the surgery is even available to you at all, but still poses a risk of failure based on your medicine skill level. There is no consequence to failure other than needing to repeat the step. Note that clamping with forceps or the speculum will cripple the limb you're working on, this is normal!

The Instruments

Near everything under this heading is what you can expect to find inside a doctor's bag, which you will spawn with as a relevant surgeon role fastened to your belt, but can also be crafted at a blacksmith's for two bars of steel and one bolt of hide.

• A scalpel for incisions.
• Two forceps for clamping and manipulation.
• A speculum for widening surgical sites.
• A bone speculum for resetting bones.
• A saw for sawing, usually through bones.
• A cautery for sealing all bleeding wounds (including incisions) quickly at the cost of burning, as well as torching rot.
• Perhaps a needle, also for sealing incisions, which can be fed more thread by clicking it with fiber.

They're Dead!

If you're attempting to operate on a corpse but nothing happens except seeing They're dead! in chat, do not fret: all you have to do is take their clothes off, or at least the clothes covering the site you are attempting to perform surgery on.

The Procedures

Trauma Surgery

Requires Apprentice medicine skill. This procedure heals brute and burn damage every time it succeeds, and will restart automatically for as long as there's still brute or burn damage anywhere on the body.

1. Target the chest, since... I dunno actually. Just do it.
2. Scalpel to incise.
3. Forceps to clamp.
4. Speculum to retract.
5. Forceps to select a procedure, select Tend damage or similar.
   • No matter the exact tending procedure, it will be repeated automatically until there are no more relevant injuries on the patient.
6. Retrieve your tools, or do another procedure starting from step 4.
7. Seal the site.

Bone Repair

Requires Journeyman medicine skill. Note that setting a bone with the bone speculum will not instantly fix the bone, only set it. It will heal on it's own with sleep!

1. Target the part of the body you are certain has a broken bone. Note that the throat must be targeted to reach the neck.
2. Scalpel to incise.
3. Forceps to clamp.
4. Speculum to retract.
5. Bone forceps to reset and heal the bone.
6. Retrieve your tools, or do another procedure starting from step 4.
7. Seal the site.

Object Removal

Requires Novice medicine skill. This refers to objects that are embedded inside someone that shouldn't, such as arrows, stuck swords, and other things that got flung into them at high velocity. This also applies to leeches, but it'd be faster to just rip them off normally. Note that surgical procedures involving the forceps or speculum are considered embedded objects and will be removed by this procedure as well!

1. Ensure you are targeting the correct limb that you've diagnosed to have (sometimes strange) objects embedded within, then:
2. Scalpel to incise the surgical site.
3. Forceps to clamp bleeders and embed within.
4. Forceps again, select Remove embedded objects if prompted.
   • You can use an open hand as well, but this has less of a chance to succeed.
   • In either case, this will remove the clamped forceps from earlier, don't forget!
5. Seal the site, or do other surgeries from here starting at step 2.

Burn Rot

Requires Apprentice medicine skill. This will destroy full body necrosis and return zombles back to just being a corpse. You can do this procedure preemptively on normal corpses to extend the time it takes them to rot as well.

1. Target the chest, since that's where the source of the vile infection tends to fester.
2. Scalpel to incise.
3. Burn away the ignoble parasite.
   • You can use either a heated cautery or a psycross/other holy necklace to do this.
4. Seal the site.

Lux Extraction

Requires Journeyman medicine skill. Do note that this will debuff the victim donor with a penalty to Fortune.

1. Target the chest, since that's where you'll find the precious lux has accumulated in living beings.
2. Scalpel to incise.
3. Forceps to clamp.
4. Speculum to retract.
5. Saw through the ribs to reach the heart.
6. Scalpel to scrape off spare lux.
7. Fix their ribs with the bone forceps.
8. Retrieve your tools, or do another procedure starting from step 4.
9. Seal the site.

Lux Infusion

Requires Expert medicine skill. This will revive a dead person. The patient must have no brute or burn damage, or the lux revival won't work. Do note that whatever killed them in the first place should probably be taken care of before you attempt this, or else they might die again and waste your precious lux. If the corpse is clothed, you will probably see They're dead! when attempting to operate, just remove their clothes and you may continue.

1. Do everything in Lux Extraction up to step 5.
2. Ensure the patient has no brute or burn damage, or else the procedure will fail.
   • If they do, you can use forceps on the same surgical site to fix it.
3. Click their chest with lux in hand to begin reviving.
4. Fix their ribs with the bone forceps.
5. Retrieve your tools, or do another procedure starting from step 4.
6. Seal the site.

Limb Replacement

Requires Journeyman medicine skill. This procedure applies to reattaching heads, limbs, and prosthetics.

1. Target the area that is missing the limb.
2. Click the patient with the correct limb in your hand. Obviously you cannot attach a leg to the patient's arm stump.
   • If it was a prosthetic limb then this procedure is finished.
3. Suture the new limb immediately lest the patient bleed out quickly!

Amputation

Requires Apprentice medicine skill, unless you have high strength, then you might be able to just chop their limbs off with a big sword!

1. Target the head if you wish to decapitate the patient, or any limb you wish to dismember.
2. Scalpel to incise.
3. Forceps to clamp.
4. Speculum to retract.
5. Saw through the bone.
6. Scalpel to separate the limb from the body.
   • This does not cause any further bleeding or damage, note. There is nothing to sew or bandage hereafter.

Organ Manipulation

Requires Journeyman medicine skill. This procedure pertains to inserting organs or removing them from a patient/body. This is mostly relevant to people missing their eyes but some people might wind up disemboweled as well and need their guts put back in them.

1. Target the areas of the head, chest, abdomen, or groin.
   • The head contains several individual areas to target:
     • The top of the head contains the brain.
     • The two individual eyes contain the eyes.
     • The mouth contains the tongue.
   • The chest contains the heart, lungs, and liver.
   • The abdomen contains the stomach.
   • The groin contains the appendix.
2. Scalpel to incise.
3. Forceps to clamp.
4. Speculum to retract.
5. Saw through the bone if you targeted the head or chest, otherwise continue to the next step.
   • Sawing the skull will paralyze the patient, but repairing the skull will fix it rest assured!
6. Decide whether you want to insert an organ or extract one.
   • To insert an organ, click the patient with a valid organ in hand to insert it. You don't need to do anything else to make the organ work.
   • To extract an organ, use forceps and select the organ you want to remove when prompted.
7. Bone forceps to reset the skull or ribs if applicable.
8. Retrieve your tools, or do another procedure starting from step 4.
9. Seal the site.

Face Restoration

Requires Journeyman medicine skill. This procedure is for people with disfigured faces or who don't have an apparent identity when unmasked. This also works on people who do have an identity if you wish to rename them. Note that sometimes having a broken skull results in disfiguring, but fixing the skull can undo this.

1. Target the face since this is, after all, a face restoration procedure.
2. Scalpel to incise.
3. Forceps to clamp.
4. Speculum to retract.
5. Scalpel to begin reshaping their face:
   • If they do not have an identity or are otherwise disfigured (appears as Unknown), this will restore their original identity.
   • If they do have an identity (hovering over them shows their name), you'll be able to change their name to something else.
     • If you cancel this prompt, you'll disfigure them. Whoops!
6. Retrieve your tools, or do another procedure starting from step 4.
7. Seal the site.

Additional Tips

Additional information regarding healing.

• Sleeping in a bed takes care of most ailments from bruising, burns, and even poison, the more serious the injury, the longer it will take.
  • You may sleep anywhere you want, but beds increase the healing speed.
• Red potions are uncommon but will heal you without the need for sleep.
• Palness is a sign of blood loss, drinking water helps.
• Bleeding can be stitched up with needles or bandaged with cloth.
  • Arterial bleeding requires stitching, or bloodloss may end in death.
• If someone says a limb is crippled, but not explicitly fractured, then it just needs to be healed.
  • If the limb is fractured then proceed surgery is required.
  • If it's dislocated, grabbing their limb on weak intent will attempt to relocate!
• If someone is rotted (zombie moaning, green skin, producing miasma), they can be cured of their rot through Curing Rot spells or through surgery.
• If someone is otherwise dead, you can revive them with Miracles or through Lux infusion surgery.
• You can carry people by grabbing them and clickdragging them onto you. As long as the grab wasn't reinforced, you'll be able to move them pretty quickly!
  • You can also stuff them inside a handcart if they're resting on the ground.