Suggested medical rework. Organ Regeneratives.

[Kelnor]

What this is intended to solve: Organ regeneratives seem too good, negates the need for a surgeon, but are required if you don't want to scar the crap out of people's organs.

Why it's annoying: Basically, unless the organ is necrotic, you don't need a surgeon. Just inject peri GG. There's the theoretical emergency surgery, but the regeneratives (pneuma-adip) work so fast, as long as they have blood in them by the time the surgeon has them open the organs have healed. Now you could say, "but if there's no pharmacist." Ok yeah, but now everyone's got scarred organs simply because you didn't have a pharmacist, not because the surgery was a pressing issue. Here's how I think we could make it more of a skill based question, instead of a who was on the manifest question.

Which drugs should change: Alkysine, Peridax, Pneumalin, Adipemcina.

How they change:

A decent supply of these drugs should be available in a locker at round start, they should be restockable by a physician some how (either a physician/surgeon accessible dispensor or maybe via Ops)

The main change is that the drug will stop working normally once the organ reaches moderate damage. This should be slightly greater than the cutoff point for organ scarring if repaired.

The main idea is inject the patient, wait till it's moderate and the patient is stable (you'll still likely have to apply EPP, give blood, dex, other drugs etc.) then hand them off to a surgeon.

If the patient isn't stabilizing, it means the organs are taking too much damage for the drugs to compensate, emergency surgery and scar the shit out of one of the organs so the other drugs can catch up. At least now when they wake up you can say you had to scare their organs or they'd have died. Instead of now where it's "sorry I had to scar your organs, we didn't have a pharmacist to make peridax."

If no surgeon, or both ORs are full, then things get fun.

If you can't do surgery, IVing the drugs and keeping a low dose rate (simliar to how saline+ works) will do two things. One it will slightly heal the organ, allowing them to slowly heal out without needing surgery. Two it will restore some of the organ's functionality, potentially helping to cut off the cycle of a cascading organ failure. Note, Pneuma should have to be inhaled to fix severe lungs, and IV'd to go from moderate to full health.

Peridax now only heals liver, kidneys and stomach.

Alkysine still requires 85% BO to heal but will negate some damage at any BO.

We may want to have the metabolism rate double if the organ is at moderate health and their above the "low dose" dose. This is so you can simply inject the IV at the correct rate and wait for the excess drug to metabolize out. We could have this damage the liver and kidneys (or the brain if peridax.)

Tier 3 drugs can be invented to act the way the current organ manipulatives work for off ship roles or to compensate for poor medical skill. They could also be made by a pharmacist but should be a major time/resource investment to accomplish (or maybe require slime research or something.)

We could add additional drug interactions to make it more interesting, like having reduced healing/negation or restoration of functionality dependent on pulse rate, Blood O2, etc. Or having one of the drug's effects not happen if another organ regenerative is present in some kind of rock paper scissors way. But this risks getting over complicated.

Nitty Gritty Code Stuffs:

The main idea can be summed up with the following variables:

organ_damage_negation: this would be how much damage per tick the regenerative will negate. It needs to be tweaked so that it won't always win out. If the Blood O2 is low enough or there's not enough circulation from the heart etc. then all the regenerative will do is buy you time to surgery or maybe fix the other problems some how. We may need to split this into severe level and moderate level negation. Ie. it may negate more damage if the organ is severely damaged vs only moderate/minor.

severe_organ_heal: This would be how much damage per tick the regenerative will heal if the organ is severely damaged. Needs to be tweaked with the negation number to find a happy gameplay medium. Remember we don't want this drug to always just heal an organ to moderate magically. If someone comes in fucked enough, they need to leave with scarred organs.

low_dose_heal: This is how much damage per tick the regenerative will heal if it is in low dose and the organ is not severely damaged. This should be a tiny number to force people waiting for surgery (or if there's no surgerons) to lay on a roller bed hooked up to 4 IVs and think about their bad decisions.

low_dose_restoration: This is how much of the organ's functionality should be restored when on a low dose. This may be percentage based, it'll heavily determine how a patient "claws" their way back out of a cascading MSOF if the physie can manage the dose.

 

Something to keep physicians from just doing heart and lung surgery immediately upon getting the organ to moderate:

Physicians doing surgery on organs should always scar them.

We could do this by coding it for physies, or potentially, creating organ specific surgical tools locked behind a surgeon's access (wall locker in OR probably.) Physies can still do heart and lung repairs with ATKs but the scarring chance is high/100%.

[KingOfThePing]

Organ scarring is 99.9% irrelevant, what problems is this intending to solve?

[Kelnor]

9 minutes ago, KingOfThePing said:

Organ scarring is 99.9% irrelevant, what problems is this intending to solve?

Scarring reduces the max health of the organ. Not sure what that does outside of making it easier to damage in the future.

But I would say:

If scarring truly is irrelevant then remove scarring.

If we want scarring to be relevant, then implementing this could allow us to make scarring more harmful since scarring would only occur in emergency surgeries. Like have it reduce the functionality of the organ, scarred lungs make your BO drop if you move too much.

There is also the issue that healing an organ with a regenerative is way faster and easier than surgery and still makes surgeons kind of useless with or without scarring.

Edited November 10, 2022 by Kelnor

[Gem]

i think it's fine as-is.

[Fluffy]

I support the organ scarring being more relevant and the nerfing of some drugs such that surgery would be the best option to fix organ damage, the rest IMHO isn't as good as it sounds on paper fun-wise, perhaps locking the nice chems behind a device placed in the ICU that only the surgeon can activate after hooking up the patient, and only then they will work?

That would both give additional things to do to the surgeon, and make the ICU an actually used area

[Kelnor]

25 minutes ago, Fluffy said:

I support the organ scarring being more relevant and the nerfing of some drugs such that surgery would be the best option to fix organ damage, the rest IMHO isn't as good as it sounds on paper fun-wise, perhaps locking the nice chems behind a device placed in the ICU that only the surgeon can activate after hooking up the patient, and only then they will work?

That would both give additional things to do to the surgeon, and make the ICU an actually used area

Not sure what you mean by "nice drugs" but drugs are physician things, so locking them to surgeons makes no sense to me. The drugs are also there to compensate for not having a surgeon so locking them behind surgeons seems like a bad idea. Surgeons have the ability to fix organs with surgery so giving them the drugs too is just loading everything on to them.

[kermit]

Scars were added as a consequence for repeatedly getting severely injured, so officers getting hospitalised by antags can't just return at full-power again so I disagree with what this suggestion aims to resolve. Personally, I'd like it if even chemically-healed organs resulted in scarring, it would level the playing field between surgery and pharmacy and make the consequences of being grievously injured more common, instead of isolated to post-surgery. I'm also opposed to organ regeneratives being available in a cabinet at roundstart, when those drugs make up a third of the workload of a typical pharmacist. The rest of the proposed flow, if I've understood it right, rests on those regeneratives though, so without a pharmacist you're now unable to heal the damage up to the point it then requires surgery - not great.

I personally think scars are a good thing for gameplay, and that they shouldn't be a treatable thing as they are a consequence for receiving treatment.

[Kelnor]

25 minutes ago, kermit said:

Scars were added as a consequence for repeatedly getting severely injured, so officers getting hospitalised by antags can't just return at full-power again so I disagree with what this suggestion aims to resolve. Personally, I'd like it if even chemically-healed organs resulted in scarring, it would level the playing field between surgery and pharmacy and make the consequences of being grievously injured more common, instead of isolated to post-surgery. I'm also opposed to organ regeneratives being available in a cabinet at roundstart, when those drugs make up a third of the workload of a typical pharmacist. The rest of the proposed flow, if I've understood it right, rests on those regeneratives though, so without a pharmacist you're now unable to heal the damage up to the point it then requires surgery - not great.

I personally think scars are a good thing for gameplay, and that they shouldn't be a treatable thing as they are a consequence for receiving treatment.

Scarring would still occur for severe injuries, though it would most likely require more than just one damaged organ. I would balance the numbers such that say severe heart and lungs will likely require scarring one of them with surgery, or requiring them to be on the drugs for a long ass time with replacement drugs from the pharmacy to get up to moderate first.

I'd also be ok with causing scarring from these drugs, perhaps a function of how long the drug was in the system with a severely damaged organ. Short amounts of use shouldn't scar but if it took 5 minutes to get them out of the severe damage zone then yeah, scarring. This could be done with or without the rework.

Would also be fun if we added a drug that does nothing mechanically but RP fixes scarring over the course of days. Add significant penalties for a scarred organ, like running putting you in Low O2, toxins building in system requiring dialysis, etc and have people come in off duty while recovering from canon injuires. Brain scarring reduces maximum brain activity.

One last point, without the drugs, you can still do the surgery to fix, this doesn't remove doing surgery on severe organs, it just gives you options that don't also fully heal the organ in seconds, it would be no different than the current situation without pharmacists if you just don't make the drugs available at round start.

Edited November 10, 2022 by Kelnor

[Kelnor]

Also, could tweak it so that long term use of the drugs to heal all the way will scar, surgery on severe organs without using the drugs first will scar, a non surgeon doing the surgery will scar, severe enough injury will require emergency surgery since the damage the organs are taking is greater than the drugs can keep up with, and thus the drugs just buy you time to surgery instead of stopping scarring.

Meaning in order to not scar, you need a physician (or surgeon with physician knowledge,) and a surgeon, and possibly a pharmacist. Missing any piece of this equation results in scarring one way or another.

We could also limit the amount of drugs available at round start so that saving more than one or two people requires a pharmacist.

This also affects mass casualties giving the physician options to keep someone alive while waiting for an OR to free up, without it also straight magic healing the guy's organs all the way.

Though considering how rare pharmacists are, it feels bad pinning so much on them existing. Maybe have a step by step worksheet for these drugs that physicians can follow to restock if needed?

Edited November 10, 2022 by Kelnor

[Fluffy]

1 hour ago, Kelnor said:

Not sure what you mean by "nice drugs" but drugs are physician things, so locking them to surgeons makes no sense to me. The drugs are also there to compensate for not having a surgeon so locking them behind surgeons seems like a bad idea. Surgeons have the ability to fix organs with surgery so giving them the drugs too is just loading everything on to them.

I mean something like, you have peridax currently, let's say it regenerates 100 per tick of organ health

 

Now, with what I was suggesting integrating what you was saying, you'd have:

- peridax, regenerates 1 per tick
- peridax with a surgeon, the physician takes the drug out of the cabinet, loads it in said machine, the surgeon connects the patient to the machine and let it run, regenerates 25 per tick, no scarring
- peridax plus, the pharmacist have to make it, regenerates 50 per tick
- peridax plus with a surgeon, same as above, regenerates 100 per tick

 

That would encourage:

• To involve both a surgeon and a physician to treat organ damages without scarring
• To try to have also a pharmacist if possible, to heal people faster and reduce the mortality rate
• To actually use the ICU and/or long term ward
• To give the lonely physician a way to treat someone with a fucked up organ, over a long period of time, even if he's alone in the round and no pharmacist or CMO ever showed up
• To hand the patient back to a physican after a surgery that gave scarring, place it in the long term ward with the drug that will sooner or later heal the scarring

[Kelnor]

1 hour ago, Fluffy said:

I mean something like, you have peridax currently, let's say it regenerates 100 per tick of organ health

 

Now, with what I was suggesting integrating what you was saying, you'd have:

- peridax, regenerates 1 per tick
- peridax with a surgeon, the physician takes the drug out of the cabinet, loads it in said machine, the surgeon connects the patient to the machine and let it run, regenerates 25 per tick, no scarring
- peridax plus, the pharmacist have to make it, regenerates 50 per tick
- peridax plus with a surgeon, same as above, regenerates 100 per tick

 

That would encourage:

• To involve both a surgeon and a physician to treat organ damages without scarring
• To try to have also a pharmacist if possible, to heal people faster and reduce the mortality rate
• To actually use the ICU and/or long term ward
• To give the lonely physician a way to treat someone with a fucked up organ, over a long period of time, even if he's alone in the round and no pharmacist or CMO ever showed up
• To hand the patient back to a physican after a surgery that gave scarring, place it in the long term ward with the drug that will sooner or later heal the scarring

I think it'd be too hard to code tieing the surgery and the drug together using a machine. Makes more sense just to IV it or inject it. The ICU should be the physician's wheelhouse (or a surgeon with physician skills and no physicians on shift.) so I'm not for locking drugs or a drug delivery system behind a surgeon's access.

Though a special unmovable ICU IV and bed that can deliver multiple drugs at varying transfer rates might be worth it when waiting for an OR to free up or if there's no surgeon.

I'd also like to create mechanical issues from scarring, which would make the ICU more viable by itself. Like if your lungs get scarred bad enough you're stuck on EPP, your heart scarring would require an ICU machine that helps pump blood, for liver and kidneys, the ICU machine will auto handle dialysis. This would last the rest of the round (and maybe a few days or weeks or months after that if it's a canon injury.)

[Omicega]

I think this all sounds like a lot of effort and extra complication for no real actual benefit. I don't think medical complications arising from scarring really adds anything to the medical 'experience', and I think the way things are currently works well enough for all parties.

[Carver]

I'd be happy simply seeing the chemical leave scarring as well. Leaves both solutions viable (the chemical healing organs by itself is needed for occasions where medical has no surgeons, unless that lovely poll to merge Surgeon and Physician ends well) while not making one quite objectively superior as a choice - unless people opt for more intensive organ transplantation from a proto-donor, or a mechanical organ from the machinist's workshop; both of which leave the Surgeon with work that the Chemist cannot replace.