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Characters are often brought to 0 hit points, by mundane attacks or magic (with some effects specifically reducing the target to 0 hit points). In following rounds, the character must make death saves, unless stabilized. A character could die of massive damage (exceeds hit point maximum + current hit points) suffered during a single effect, but in my games that is rare (would only happen in a poorly planned encounter with a low-level party).

The Periapt of Wound Closure stabilizes you "whenever you are dying at the start of your turn." Once stabilized, you begin dying again (and get a death save failure) if you take any damage, but unless you take damage equal to or greater than your hit point maximum, the periapt will stabilize you again at the beginning of your next turn, and the death saves reset to zero. So it seems the only way to kill a character wearing the periapt is:

  1. Do massive damage.
  2. Damage the 0 hp character with two or three[1] separate attacks/effects in one round.
  3. Remove the periapt.

As I mentioned above, 1 will be rare in my campaigns. 2 and 3 seem unlikely during combat, and I would only have it happen if the party was facing a long-time adversary who was aware of the periapt. "You again! Minions, attack Fred, and don't stop until there's no pulse!"

Having a party member exit the combat due to unconciousness can be a big problem, but of course one of the biggest problems of 0 hp is that it puts a timer on the party to try to stabilize/revive the character before death. At first I thought the periapt was a neat magic item, now it seems much more powerful than I realized. Am I presenting its function correctly, or is there something in the rules that I am missing?

[1] As pointed out in a comment below, a successful attack from within five feet against an Unconscious character is automatically a critical hit, causing two death save failures. So three death saves in one round could come from three damage sources that don't meet this criteria (ranged, AoE spells, reach weapons, etc.), or one that does combined with additional damage from any source.

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up vote 33 down vote accepted

Yes

(But it turns out that's not so great.)

As far as I can tell, your reading of the rules is correct: yes, a Periapt of Wound Closure does render you pretty much immune to bleeding out and dying of slowly failed Death Saves. That's kind of the point.

While that's a useful and valuable ability, worth spending money on, it's not actually all that useful. The main thing to consider is that it doesn't actually help you win a fight, it just helps you not die. Once you're down, even with the periapt, you still need healing magic to make it back up again and start usefully contributing to the combat (or a natural 20, which the periapt actually makes impossible as you don't get to roll death saves at all). In pretty much any situation in which healing is available, the #1 priority is getting downed people back on their feet anyway, optimally before their turns so they can do something rather than miss their turn. Yes, there are exceptions, but they're rare enough that it seems reasonable an expensive (in terms of attunement slots if nothing else) specialty magic item should be able to save you in such a circumstance.

If there's no healing magic available - well, the periapt is a bit more useful. But monsters are rarely going to waste time taking swings at downed foes - it's a waste of time when there are more dangerous threats, and intelligent enemies (who could use tactics and try to swiftly eliminate an opponent) would likely understand that without a healer on the field, they're already eliminated. So yes, the periapt does keep you safe in such a situation. But it's already not a very common situation, and again all it does is keep you alive, not let you contribute. If the rest of your party drops, you're dead periapt or no periapt.

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Nice answer. One thing I would ask you to clarify is what you mean by saying it is an "expensive specialty item". If you count attunement, it can be expensive in that it is taking up a slot that you might want for another item. But its rarity is uncommon, meaning that it is not expensive in gold value, item creation time, or, presumably, in terms of DM willingness to hand them out. – Lee Hachadoorian Jan 4 at 17:15
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Honestly, I meant it in the imprecise and potentially-wrong sense of "well, it's a magical necklace, it costs a bunch of money - maybe small change for adventurers but it's still a lot of money in absolute terms". But I forgot about attunement slots! Let's pretend I meant expensive in terms of those too. – a computing pun Jan 4 at 17:28
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The impression I've gotten - though I don't strictly run my campaign this way - is that 5e intends magical items in general to be significantly more rare, and specifically that the idea of just popping over to the store and buying a magic item is not intended to be possible. But yes, the fact that this particular item has no effect on combat balance does make it easier for the DM to hand them out without too much concern. – Amadeus9 Jan 4 at 18:00
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You might add a section that any hit while you're down is an automatic critical, so it would only take 2 hits, not 3. – Kyle W Jan 4 at 18:15
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The item protects you from dying as long as your side wins the field. If they die or are forced to retreat, you'd better hope you have an enemy who doesn't loot or eat their kills, or your "immortality necklace" is either going on your enemy's neck or coming out their backside :D – gatherer818 Jan 5 at 4:42

No, it doesn't make you almost unkillable.

Yes, you are presenting it correctly.

(I hate it when the question in the title and the one in the text have opposite answers!)

As you say: The Periapt of Wound Closure stabilizes you "whenever you are dying at the start of your turn." If you are dead at the start of your turn then its just a pretty ornament.

It is actually quite easy to kill a downed opponent (PHB p.197):

Damage at 0 Hit Points. If you take any damage while you have 0 hit points, you suffer a death saving throw failure. If the damage is from a critical hit, you suffer two failures instead. If the damage equals or exceeds your hit point maximum, you suffer instant death.

Remember, a creature on 0hp is Unconscious, a state which, among other things includes (PHB p.290):

  • The creature automatically fails Strength and Dexterity saving throws.
  • Attack rolls against the creature have advantage.
  • Any attack that hits the creature is a critical hit if the attacker is within 5 feet of the creature.

So the victim is really easy to damage and, if you are within 5 feet, only needs 2 hits to kill.

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