For some adventurers, essential equipment includes rope, iron rations, a ten-foot pole, and lithium carbonate.

For some adventurers, essential equipment includes rope, iron rations, a ten-foot pole, and lithium carbonate.

Here's one of the big things that separates illness in real life from illness in a game setting: chronicity. When your characters are threatened by sickness and plague, its tends to be things that have discreet starting and stopping times, such as infections and wounds. Cure spells are clearly designed to "treat" illnesses like this;, the logic behind them does a very good job of encompassing stab wounds and parasitic worms but starts to break down when "disease" includes heart attacks or mental retardation. In the real world, at least in the developed nations, the sicknesses that feature prominently in D&D are overshadowed by chronic illnesses, such as hypertension, dementia, major depressive disorder, and other things which are a bit harder to fix. How does it affect a character's life when they have an illness that can't be eliminated with a single spell?

Suppose a character has diabetes. Around the age of 10, the character develops a curious wasting illness. Although he has access to competent clerics at his local temple, they can't fix him with basic healing magic, because diabetes is caused by the destruction of an organ, and it's not every cleric who can cast Regenerate to make an organ grow back. Instead, the clerics use much simpler magic to craft a supply of single-use magic tablets which, when swallowed, normalize his blood sugar levels for a few hours. As long as he consumes three of these per day, the boy grows up big and strong, and at the age of 14 he leaves home to become an adventurer. He has to ensure that he always carries a supply of tablets with him; a month's supply of 90 tablets can be created by any cleric for about sixty gold pieces, which is a pittance to even a low-level hero. One day, though, the hero's party chases a squad of drow into some underground tunnels. The hero's companions have to spend the next few weeks keeping careful track of their food and water, but he has the added challenge of knowing that if he runs out of tablets, he has a very big problem. And thus, we have opportunities for roleplaying and the story hopefully becomes cooler for everyone.

This sort of scenario wouldn't work in every group of players, naturally. In most games, the DM doesn't require players to keep track of things like food, water, ammunition, and spell components, so why medication? While it isn't something that I'd force on a player who I know wouldn't enjoy the challenge, this is the sort of complicating character trait that players often enjoy working with, and if and when a player gets tired of it, all they have to do is find a temple with a cleric who can cast seventh level spells and get themselves cured. With a bit of proper back-and-forth between player and storyteller, this sort of thing might add some richness and depth to a character. Alternately, an NPC who needs a regular supply of medicine is perfectly placed to be a blackmail victim, a reluctant villain, or a wealthy patron looking to hire a party of adventurers.

There are, of course, countless other illnesses that might logically be hard to cure magically for which a character might find him or herself requiring treatment over a period of time. Any mental disorder, particularly bipolar disorder or a psychotic disorder, might conceivably need daily alchemical therapy or monthly casting of a spell to prevent symptoms from recurring. An elderly mage with coronary artery disease might require regular treatments to stave off the inevitable heart attack and a powerful king might (rightly or wrongly) believe that eating a rare flower every day will prevent him from becoming demented.  As long as a storyteller has a clear idea of what treatment works, how it can be obtained, and what happens if it's missed, any one of them becomes a simple character motivation, story complication or plot hook to keep a game moving in the right direction. 

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 January 11, 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.