Cause Personalized Wounds

Eric Lis

Different animals in nature have very different types of bites, causing different injuries and predisposing to different medical complications. Why, therefore, shouldn’t their bites have a bit more individuality in our games? Let’s give our sharks a bit more character.

Shark bites aren’t generally considered a major health problem in most of the world. As has been repeated many, many times by many, many conservationists, biologists, and documentaries, shark bites are actually very rare occurrences and can generally be attributed to only a handful of the many hundreds of shark species in the world. Even taking into account that all animals tend to be more dangerous in games than in real life, a human living in a coastal city in most campaign settings probably has at least 20 times higher risk of being struck by lightning than bitten by a shark. Living near a grove of evil druids might conceivably increase the risk, but it probably also increases the danger of being struck by lightning, so I would wager that the relative risk remains similar. There’s actually a lot that we don’t know about how many shark bites happen worldwide each year, because most official statistics record only shark bites that happen near the shore and we think that a considerable number of shark-related injuries and deaths happen at sea when boats sink or plans go down. We do know that many recorded shark attacks – of which there’s probably less than 100 per year all over the world, representing an unknown percentage of the real number of attacks -- seem to be “accidental,” meaning that they happen because a shark is curious rather than aggressive, or mistakes a human for a prey animal; sharks, like human children, lack the ability to use limbs as a means of exploring the world and therefore have to explore objects by putting them in their mouths. Unfortunately, as every scientist knows, the act of studying an object has an unfortunate tendency to break it, and even when the shark’s intention isn’t to kill, the result of its investigation can be dramatic and require extensive surgical repair.

In studies of shark attack victims, cause of death tends not to be the shark actually eating a creature, but the tissue damage from a single severe bite. Most deadly shark attacks on a human-sized target consist of a single bite that tends to be large enough and deep enough that the creature subsequently bleeds to death or suffocates due to damage to the chest wall. Unlike many animal attacks, shark bites commonly damage the bone, leaving “spindle-shaped” incisions which are useful to identify the bite even in severely decomposed bodies. When sharks bite, the lower jaw is believed to grab the prey and hold it still while the upper jaw saws and tears the flesh; this leaves a wound with a classic serrated edge and triangular skin flaps around it. Except in the case of extremely large sharks, the force of the bite tends not to be strong enough to break bone, only to scratch it. Because of the structure of their jaws, teeth commonly break off during the bite and can be found in the victim afterwards, which also helps in later identification. Shark survivors are rarely victims of only a single type of damage, however. They may be suffering from exhaustion from swimming, and by the time they’re found they’re often suffering from hypothermia or exposure from being in the water for hours. Wounds are usually contaminated by sand, debris, or tooth fragments, and sharks’ mouths are rich in a number of bacteria which can cause life-threatening infections, sometimes within hours of the attack. Although shark bite is a supremely rare form of injury, its severity has been compared to military injuries or high-speed motor vehicle accidents. A “Shark-Induced Trauma Scale” has even been created to allow physicians to classify the severity of the attack; scores range from 0 to 10 and anything above a 4 predicts, at best, major long-term complications and a need for multiple surgical repairs over time. Of course, about 80% of shark bites are thought to be extremely mild and might not even be noticed until the person gets out of the water, but when a bite is bad, it’s frequently very bad.

Even in a fantasy setting, shark attacks are likely complicated to treat. At first glance, it may seem like a simple cure spell would do it, and indeed, this ought to be enough to close most wounds and heal the hit point damage. This should be only the beginning, however. Shark bite victims may have injuries to major arteries, which would manifest as either ongoing bleeding damage or progressive Constitution loss in the rounds following the attack. Shark bites typically remove large chunks of flesh which require extensive plastic surgery to repair; in a fantasy setting, this likely requires restoration or even regeneration magic to repair without, at the very least, Charisma damage, and if muscles or tendons have been severed, quite possibly Strength or Dexterity drain. If a wound is simply closed with cure spells, then not only has there been no prevention of disease, but in fact, any bacterial or dirt has arguably locked inside and infection ought to be nearly inevitable. Within hours to days, the wound site likely becomes inflamed and painful and the creature should begin showing signs of severe infection, such as malaise and drops in blood pressure leading to fainting or delirium (or, in game terms, Intelligence, Wisdom and Constitution damage). Storytellers are justified in getting as creative as they like with something like shark bites, which should have all sorts of complicated sequelae that might not be seen after a simple bite by a wolf or bear. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on December 20, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system