My point was that all players have their peeves, their points of disconnect from the cooperative illusion that is role playing, and that what doesn't work for one person works just fine for other people.
This is the key right here. The perception of the games events through the gloss of rules is just as much in the hands of the players as the rules themselves. There are many cases in the game where you just have to accept that things are the way they are for purposes of playability. Hit points as a measure of staying power is an adequate. Beyond that you are just asking to much of a rule that was never meant to simulate reality.
Consider the RAW regarding hit points. There are three states of hit point health. You are either fully capable (1+ hit points), disabled (0 hit points), or dying (-1 or lower hit points). Other than the closing potential of death with the dying condition and the possibility of slipping into dying from the disabled condition there are no effects of taking damage and specifically no lasting effects.
There are a few reasons for the rules being this way and having been this way for a long time. D&D promotes heroic action. That is the central theme and the seed of the fun of the game in this regard. It may not be realistic or promote versimilitude but it is the standard of this game. Players generally want to be in the action giving there all rather than crippled by debilitating injury. Realism and grittiness are not watchwords of D&D. So in that regard there are stumbling blocks that you just have to turn a blind eye to if you want the game to operate with the fluidity it was intended to.
If a person wanted to have effects that felt more
real then it's a matter of adding layers of rules. Adding layers inevitably creates more complexity. I think that the Reserve Point rule allows for the game to function as intended, without too much additonal complexity, in a low magic setting where magical healing is rare. If you want grittiness and realism regarding injury you have to step outside the rule-set.
So all that being said here's another rule-set that I have used.
Massive Damage and Reserve points are in effect as per standard rules. A character's disable condition is set at 0 to -X with X equaling their Constitution bonus. Any amount of damage taken beyond the disabled condition reduces the character to dying. Each round the character is affected by the dying condition they take 1 point of Constitution damage. No hit points can be restored until the dying condition is removed whether by means of spell, potion, fast healing or Healing check. Upon reaching 0 Constitution they are dead. In this manner there is lasting effect to the dying condition.
Even in settings with ready healing magic Restoration is not always a plentiful spell. The character slowly regains their Constitution which slowly returns the top end of their hit points. Occasionally I'd turn the Constitution damage into a lasting injury (DMG pg. 27) but that was always a case for case situation.
The OP may decide that Reserve Points perfectly represent what he wants to do. He may not. He may decide that toughness saves in
one form, or
another are the way to go.
The point is to give advice and options so that shadow can play exactly the game he wants to play.
What he said.