Serious Skills: Heal

Second Wind: DC 10 – Allow an adjacent character to use his or her second wind without the character having to take an action to do so. The character does not gain the normal defense bonuses, however.

Commentary: Turns out there’s a lot of other things that can trigger off a second wind that the DM and players need to consider when using this application of Heal. The character doesn’t get normal defense bonuses but if a Divine ally nearby has the Sure Protection Channel Divinity, can that still be used? What about the new Disciple of Justice feat from Player’s Essentials 1 – can a character receiving a second wind via Heal check then pass those HPs on to yet another adjacent ally? Can a Githzerai Ranger still shift his Beast Companion 3 squares with Githzerai Beast Mastery if given a Heal check? I believe by RAW, all of these options would be acceptable but I’m not entirely sure if I’d allow them at my table. There are in fact 78 feats currently in the Compendium that modify the effects of a second wind; if you have one or more, run them past your DM outside of play to see how (s)he wants to deal with them if the second wind is triggered by a Heal check. That being said, the Second Wind application of Heal can make any character a temporary leader and should be one of your first couple fallback tactics if you’re not in a good position to do damage. Also, Leaders can pull this off in addition to a normal healing encounter power in a single turn so if you have feats that net you get extra goodies from your heal AND extra goodies for an ally using second wind, consider using a full turn of healing to Super-Charge an ally a la Team Fortress.

Saving Throw: DC 15 – An adjacent ally can immediately make a saving throw, or the ally gets a +2 bonus to a saving throw at the end of his or her next turn.

Commentary: It’s pretty common to see the immediate saving throw use of this application but I can’t say I’ve ever seen the +2 to next natural save application. There’s a good reason for it; two saving throws gives you an 80% chance of success with a saving throw value of 10 (55% + (55% * 45%) = 79.75%). A +2 bonus only jumps your odds to 65%, making it less effective. However, this assumes you can fail all you want without additional penalty. Thus if you’re assisting with a death save or some kind of disease (OR the character for some reason needs an 19 or 20 to save* – YIKES!), use the +2 to prevent accumulating failures. For pretty much any other save ends effect, though, just hand them the free roll. This is another good fallback tactic for if you can’t really dish out the damage or somebody’s getting the crap beat out of them in action denial and ongoing damage effects. Note this is only ONE saving throw, applicable to ONE ongoing effect. You can’t give someone a save vs. multiple effects unless the power that conferred the conditions specifically ties them together. DMs should have minions on hand for Solo and Elite monsters specifically to make Heal checks.

*Yes, I’m aware the same phenomena occurs if you only fail the save on a 1 or 2, but if that’s the case you probably aren’t wasting a standard action on this anyway.

Stabilize the Dying: DC 15 – The character can stop making death saving throws until he or she takes damage. The character’s current hit point total doesn’t change as a result of being stabilized.

Commentary: Because this came up on an ENworld thread the other day, let’s go over the ‘stabilized’ status. Stabilized means you are no longer making death saving throws but you still have the ‘Dying’ condition. It does NOT mean you are “taking 10″ on death saving throws (unless you’re a Warforged or something similar) nor are you conscious and thus able to spend healing surges. That means you can’t use Pulse of Life on someone who’s been stabilized or give them bonuses to death saving throws in the hopes of bumping their ‘roll’ up to a 20. There is no roll. The character is simply not going to get any worse unless hit again. You could, however, use a stabilize check and Unnatural Mantle to keep your ally fighting while below 0 HP. Once the encounter is over if a stable creature doesn’t receive any healing, it is restored to 1 hit point and becomes conscious after a short rest. Opinions differ on when best to administer a stabilization check. Most DMs rule that a dying character becomes stable (or someone just stabilizes them) at the end of an encounter to cut down on rolls (because EVERYONE gets a Heal check in-between death saves to get technical about it) and avoid out-of-combat death situations. If this is the case, you’re probably better off letting your ally make a couple checks while everyone else finishes off the bad guys or at least drives them away from the fallen comrade. If it’s really early in the encounter or your DM is a hardliner about death saves, stabilize early, stabilize often. As a personal note, I don’t like being stabilized because it’s very much like being stunned. At least if I’m not stable I get to roll my die once per turn. Maybe it’s just me.

Your other option with a Heal check is to use it to Treat Disease. If you attend to a creature “periodically” during an extended rest, you may make a Heal check at the end of the rest and the stricken character may replace his or her Endurance check with your Heal check instead. As I said for the Endurance installment of this series, DMs need to be using diseases or at least disease-like afflictions in their campaigns to make maximum mechanical use of certain skills. In fact, Ari Marmell’s Advanced Player’s Guide has a really solid Lingering Injury chart that works using disease mechanics if you’re the type of DM who doesn’t want your players to just walk away unscathed from everything. Though I don’t use it myself (yet), I highly recommend the full injury mechanic set as well as the book as a whole. But I digress…

Who are the folks trained in Heal and why?

Heal, huh? This seems too easy. Medical personnel, of course. You could be a military field medic, a small-town doctor, a cleric with both divine and mundane knowledge of the human body. Then again, there are a lot of folks trained in first aid who enter in as well. Military basic training probably includes rudimentary field medicine as would membership in adventurers’ guilds like the Fall of Stars (Faerun) or Pathfinder Society (Golarian). Your character may also be trained in Heal if (s)he was raised far from civilization, maybe on a farm somewhere in the boonies. If you can’t get to help quickly, it’s good to be your own help. The same could be said for people living in a war zone.

If the Heal skill only covers what we’ve discussed so far, we’re kind of out of options. On the other hand, if we’re willing to expand the definition of Heal a little bit (c’mon, like you didn’t see THAT coming), we get some more options. First off, you can use Heal on a human, an orc, an eladrin, a wilden and – Pelor helps us all – a warforged, but not on a horse? Really? You need Nature for that? I tend to fudge the rules a little here, treating Heal more like Biology or Anatomy, thus including most wildlife as well. That opens up Heal to Farmers petty nicely. Furthermore if you’re willing to extrapolate that theory out to its most extreme, a knowledge of animal anatomy is useful for Butchers, Hunters, and Chefs who will use those parts in various stages of the food preparation process. (Extra bonus for Cooking since it includes knowledge of basic nutrition to whatever extent it’s been studied in your world!) I suppose that also opens up Heal to Cannibals as well, ironically enough.

Sill with me? Good, because I’m going to ask you to make one more mental leap before concluding this section. As I mentioned in a previous post, Heal is a top-tier skill. Many classes with access to lots of skills get Heal, making it a very common trained skill among a random sampling of characters. Yet out of combat it seems to be almost completely useless. Now I understand that in a game primarily about combat not getting killed is a pretty handy trick to have just on its own. Still, the narrowness of it bothers me. So, though I’ve tried to avoid obvious houseruling in this series so far, I’m going to break form for a moment and throw one in here. Since Heal represents (probably) formalized education, it’s a commonly trained skill and is based on Wisdom which is itself a common stat among MANY classes in which to have a decent score, I roll the 3rd edition Profession skills into Heal making it similar to Crafting and Dungeoneering. The decision is probably more gamist than simulationist, but if you consider the Chef example above, there is some basis in in-game logic and you could probably come up with additional justifications yourself. On top of that, it’s a nice way to get a “free” pure roleplaying skill without giving up a needed combat skill. When making a Profession check, call it Profession but use your Heal bonus if it makes you feel better. I won’t reference this platform very often in the rest of the article since it doesn’t really obey 4E RAW but if you decide to implement the change into your game, you open up Heal justifications for a much wider range of characters that have very unique knowledge sets, like Scribes, Courtesans, Brewers and so on.

The real question to ask here is “what does the world look like to someone trained in Heal?” Stop and think for a moment about your Heal-trained character. (S)He may very well have seen the most extreme things people can do to and for one another in the course of work. The miraculous recovery of the sick, the joy of a new life being born, the growth and development of the young and fragile to strength… or because this is D&D, disease, the ravages of old age, crippling injury and grisly painful violent death. There may be very little your character hasn’t been around for and that kind of experience makes you think really hard about the world. You just can’t see what you’ve seen without deciding clearly whether life is primarily beautiful or ugly. That is to say the medical profession has a lot of caring, nurturing folks like Florence Nightingale and just as many cynical, miserable jackwagons like House. Sure, your character may physically notice things about people different than the rest of the party. You might remember “the guy with the bad knee” or “the anemic little girl” instead of their actual names. What will really influence your character’s perceptions more than anything else, as it pertains to Heal, though, is the persistent optimism or pessimism that comes from seeing the workings of life at their deepest levels.

Heal as Social Skill

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