Death Penalty & Extended rest

I suggest following the core idea of 4E; Do what will make your game fun.

If its going to mess things up, and you as DM think the game will be more fun if over the next 2 non-encounter sessions the penalty goes do that. Just let the players know you consider that to be sufficient in game time for the penalty to be removed, and that this doesn't mean the penalty will not follow the rules while they are actively adventuring.

Of course its a judgement call, why is the presence of the penalty an issue if it doesn't matter?

Sometimes the real world time it takes to "fix" something is far longer than the game world time.

Say that 2 sessions of talking covers less than a game day, I'd leave the penalty. Say it covers a few weeks or more of game time I would wave then penalty.
 

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Change what a milestone is.

Maybe if he role-plays getting drunk with his buddies that's a milestone. Or whatever you think would be cool, helping him get over his "mostly-dead but partly-alive" state.

It's what I do...not the drunk part, but changing milestones.

In Rackham's world of Confrontation/Ragnarok/Cadwallon/whatever else, they had Immortals that were chosen by the gods, and if they died in a fight and the god brought them back, they had to collect "Elixirs" to restore their full power, and oftentimes these elixirs were guarded by a "Shadow," a guardian specifically bound to try and stop that person from getting the elixir.

I never read too much about it, but I always pictured it as being a very situational thing, as in the Elixirs and Shadows could be just about anything. One person's elixirs might include a magic sword, a phoenix feather, and the title of Lordship over a swath of land. Their shadows would be a Dragon guarding the sword, the monster that killed the phoenix, and a rival Barony that must be appeased through diplomacy. Meanwhile a different person might require saving a Dryad's tree from loggers (elixir and shadow), and whatever else.

Anyway, milestones could be just X Encounters, or they could be something that's meaningful for the story. I opt for the latter.
 

This milestone business is a metagame tool to ensure that there is some penalty for a PC dying, but that the penalty doesn't last forever. It is there to encourage the player to keep pushing forward rather than rest and wait to recover. Feel free to justify it in-world any way you want, or not at all if you don't want to (the characters won't necessarily even be aware of a -1 penalty).

If two sessions go by and no dice are rolled, then the player shouldn't have any reason to care about the penalty. If dice are being rolled, even for purely non-combat encounters, then most likely milestones are being reached.

Pointless fights in a bar should not count as milestones.
 

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