Surgery is one of the uses of the Physician skill, and provides opportunities for tense medical roleplay.
Physicians can perform surgery to treat some Conditions - broken bones, some infections, infestation by horrible alien parasites, etc. Surgery does carry some risk, however, and may fail or even have negative consequences. The Condition lammie or sheet will indicate the type of surgery required, and whether any additional resources like Medicaments or other requirements are needed.
Having more ranks in Physician makes a surgery more likely to succeed, as does working with a team of other Physicians or on a patient with the Steel Viscera skill. Some Conditions might be more challenging or risky to try and remove, particularly complex or life-threatening ones. As a surgery progresses, unless the Condition is repaired quickly, the risks increase more and more, and an unlucky surgeon must eventually choose to stop working or continue and potentially risk a patient's life.
To perform Surgery, a Physician spends time (at least 6 minutes) roleplaying surgical actions - they must use appropriate physrepped tools to do so. They can begin immediately, but require the presence of a Referee in order to get any results.
A Physician character can only try to cure a specific Condition on a given patient as the Lead Physician once per day. This means that if they choose to stop treatment (usually because of repeated failures increasing the risk of the surgery), they cannot try to treat that Condition again as the Lead Physician (they have exhausted their personal knowledge or techniques trying to cure it). They can, however, assist another character to treat that Condition as Lead Physician later on in the same day.
Any given session of surgery is divided into three phases - Starting, Treatment, and Finishing. This is to make the roleplay make sense, reduce the time that the surgery requires a dedicated Referee, and provide a good tension curve.
During the Start Phase, the Physician gathers their team and begins the surgery. Any character with one or more ranks of the Physician skill may join during the Start Phase, and decide on a Lead Physician. You do not need a Referee to begin surgery, but you do need one to continue past the Start Phase. The Start Phase takes at least 3 minutes of roleplay - this time is a good time to send or radio for a Referee. Once at least 3 minutes have passed and the Referee is present, the surgery proceeds to the Treatment Phase. The Lead Physician should identify themselves to the Referee and provide the following information:
During the Treatment Phase, the Physician or team of Physicians does the surgery needed to remove the Condition, but this can be a risky process. The risk in this case is represented by drawing a card from the Treatment Deck held by the Referee. At the beginning of the Treatment Phase, and every minute thereafter, the Lead Physician must draw a card from a prepared Treatment Deck.
After drawing a card, the Lead Physician may choose to keep going, roleplaying another minute of surgery and drawing a card, or stop and proceed to the Finishing Phase. The cards drawn are returned to the Treatment Deck after each draw. The assisting Physicians must continue to be involved, or the benefits of their help (increasing the odds of success) will be removed for the next card draw.
The Lead Physician may ask how many of each card are in the Treatment Deck prior to drawing a card, and may choose to stop and proceed to the Finishing Phase before drawing. If they draw a card, then they must accept the result of that card.
The Finishing Phase represents the time taken to tie up the loose ends (or organs) and close up the wound. During the Finishing Phase, the risky part of the surgery is over, and the participating Physicians can relax a bit. At least one Physician who was participating must spend an additional 3 minutes of roleplay to complete the surgery - at the end of this time, the patient regains 1 lost hit to each of their locations (or 3 Global body hits). Failing to complete the Finishing Phase may also result in the patient acquiring an Infection Condition.
When the Referee arrives at the surgery, they will gather some basic information from the players present and build a Treatment Deck. The basic Treatment Deck consists of 2 Green, 2 Yellow & 1 Red card. Other factors will affect what cards go into the initial Treatment Deck;
After every card draw, the Referee may add or remove cards from the Treatment Deck to denote the increasing risk of prolonged surgery.
If a Green card is drawn, that indicates a success. The surgeon may continue the surgery to attempt to remove another Condition affecting the patient - if that other Condition has additional cards that need to be added to the deck, then those will be added for the next Card Draw.
If a Yellow Card is drawn, that indicates a setback. There is no direct negative consequence to the patient, but the risk of the surgery failing increases. If a Yellow card is drawn, then the Referee adds another Yellow card to the Treatment Deck.
If a Red card is drawn, that indicates that something has gone wrong in the surgery - one of the Physicians may have clipped a blood vessel, the Condition may have worsened, or similar. The negative consequence might be another Condition given to the patient, or the Referee may afflict the patient with a LETHAL wound, beginning their Death Count (note that Physicians who are workign to stop someone's Death Count do not contribute their Green card to the surgery while they are doing so). If a Red card is drawn, the Referee also adds another Yellow card to the Treatment Deck.
If a Black card is drawn, that indicates that something has gone very wrong. Either the patient will die during the surgery, or has acquired a severe, long lasting and possibly incurable Condition. The Referee may confer briefly with the patient's player, and will decide on the most dramatically appropriate and fitting course of action - the Referee's decision is final. No additional cards are added to the Treatment Deck.
The longer the surgery goes on without success, the more likely it becomes that a negative consequence will occur. If at any point the Treatment Deck has 4 Yellow or Red cards, some of them are swapped for a card of the next level of severity.