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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:

• How many ranks of Physician they have
• How many other Physicians are participating
• What are the Conditions they are treating
• Anything else that is relevant

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.

• If they draw a Green, they succeed in treating one Condition (assuming it only requires a single success).
• If they draw a Red, they suffer a setback, and can continue the treatment, but at increased risk.
• If they draw a Black, the patient deteriorates, and may suffer a LETHAL wound or some other negative consequence.
• If they draw a Grey, the patient suffers a severe negative consequence and may die.

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 Red & 1 Black card. Other factors will affect what cards go into the initial Treatment Deck;

• Every Rank of the Physician skill that the Lead Physician has adds another Green card.
• Every additional Physician assisting adds another Green card, up to the number of ranks of the Physician skill possessed by the Lead Physician.
• Every rank of the Steel Viscera skill that the Patient has adds another Green card.
• The Condition being treated may add more cards of any of the 4 types based on how easy or difficult it is to treat.

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 Red 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 Red Card is drawn, then the Referee adds another Red card to the Treatment Deck.

Performing surgery requires a referee and at least 5 minutes of roleplayed surgery, using appropriate tools. After the surgeons have completed their roleplaying, the lead physician will be asked to draw a bead from a bag containing black, red and other coloured beads. Drawing a black bead means that the character undergoing surgery suffers a negative consequence - this is usually a LETHAL wound that immediately begins their Death Count, but may be a Condition. Drawing a red bead means that the surgery has failed and has no effect. Drawing any other colour of bead means that the surgery has succeeded. By default, the bag will contain 1 black, 3 red and 3 other beads. Each rank of this skill that the lead physician has above the first adds one other coloured bead to the bag. Other characters with the Physician skill can assist in a surgery, adding an extra positive bead to the bag. The number of extra characters who can assist is limited by the number of Physician ranks that the lead surgeon possesses. There may be other difficulties in surgery, which can create complications and extra requirements - exotic Conditions or very alien physiologies may complicate matters.