I disagree that you cannot provide any narration. You can provide some narration - but, as Hussar pointed out upthread, you can't provide complete narration. The analogy to the spear strike to Frodo in Moria, which has been made upthread, is apposite here. Some narration is given - the reader knows that Frodo has been knocked unconscious by a spear strike - but all the details are not known. They are revealed later. In the book, it is the author who keeps the reader in suspense. In a game, it is the mechanics that keep the players (including the player of the injured PC) in suspense.Like I said, narration after the fact. You cannot provide any narration of injury until the encounter is resolved and the state becomes known. After all, how deep can the wound be if it is fully healed from a 5 minute rest and the fighter is as fresh as a daisy the next morning? It was but a scratch! Unless it killed him of course then it was a mortal blow that would fell the strongest of men.
As to the wound being fully healed from a 5 minute rest - why assume that that is the case? After a 5 minute rest the wound is no longer impeding the PC's performance. That is not the same as it being healed. And that is consistent with the general tenor of D&D for most of its history.
As to the wound being fully healed and the PC being fresh as a daisy the next morning - as I posted upthread, that is a discrete issue of design - completely separable from the other ways in which 4e healing works - which is obviously a decision taken to facilitate adventure pacing. The houseruling required to make the pacing more gritty - 1 surge per day, or 1 surge per week - is completely trivial. And there are alternative non-mechanical approaches available that likewise are trivial to implement - no houseruling of recovery, but an understanding among the group that much resting time - weeks, months, whatever - will pass between adventures, as the PCs sort out their ordinary lives and recover from the strain of their travails.
As I posted upthread and have reiterated here, the houseruling or playstyle adjustment required to answer that objection is trivial.But if I was reading a novel in which the characters each suddenly made their own wounds disappear once a day, I'd find that stupid and stop reading the book.
To reiterate: The recovery of all surges after an extended rest is a discrete part of the 4e healing mechanics. It's soul function is to facilitate adventure pacing, by making recovery quick and by making sure that all PCs recover at the same rate. Changing it - either mechanically, by houseruling, or narratively, by the table agreeing to extensive downtime between adventures - is trivial and will have no other effect, that I can see, on the play of the game.
It is in the relationship between healing surge expenditure, hit point recovery and healing powers that 4e's healing rules demonstrate a mechanical intricacy, where damage to balance might be done by careless tinkering. The extend rest recovery rules are completely extraneous to this.
This is not true of all characters in 4e. Just PCs. That's more or less what "hit points as plot protection " means!In 4e characters seem to be in only 2 conditions. Dead or just had the wind knocked out of them.
I've often posted that the 4e rulebooks could benefit from more clearly indicating how the designers think the game is to be played. I don't think that healing is a particularly egregious case - it's certainly caused no trouble at my table - but I wouldn't object to it being given a makeover.If a game is to use terms such as these, and then expect players of the game to understand that the words don't mean healing, bloodied, and hit, then there needs to be some serious discussion in the rules books about what these things DO mean and how to narrate them well.
I'm not saying that this can't be done, but I'm saying I don't know how to do it.