The Hospital Beneath the Hill

“Patient 34-B presents with fatigue, weight loss, and intermittent visual disturbances. Clinical chart diagnosis: idiopathic chronic fatigue. Actual diagnosis: third-stage fae pollen exposure, with spore colonization of the optic nerve. Treatment: standard antifungal protocol will not work. I am prescribing iron-salt solution administered as eye drops, which I have listed in the clinical chart as a ‘vitamin supplement.’ The patient’s husband asked why her eyes glow green at night. I told him it was a medication side effect.”

• Dr. Sera Kohl, chief physician, St. Wren’s Clinic

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1. Setting Overview & Tone

St. Wren’s has been treating supernatural illness for three generations, passed from one chief physician to the next through a combination of mentorship, locked filing cabinets, and the specific kind of trust that comes from sharing a secret that would destroy your career. The clinic looks like any rural hospital: a stone building with a reception area, examination rooms, a small surgical suite, and patient beds. The basement ward is accessed through a door marked “Storage” and secured with a key that only the senior medical staff carry.

Tone: Medically precise, morally complicated, and infused with the exhaustion of people maintaining a lie for their patients’ benefit. The doctors are not mad scientists. They are competent physicians working with incomplete knowledge, improvised treatments, and the constant fear that their patients will discover the truth and that the truth will be more harmful than the illness.

Sensory Pillars:

1. Sight: The ground floor: clean, well-lit, indistinguishable from any small hospital. The basement ward: older construction, lower ceilings, warmer lighting, and examination rooms equipped with instruments that do not appear in medical supply catalogues. The patients themselves: people with symptoms that look clinical but behave strangely, a woman whose bruises form patterns, a man whose fever spikes at the same time every day regardless of treatment, a child whose blood work returns results that the lab equipment cannot process.
2. Sound: The hum of fluorescent lights on the ground floor. The quieter, warmer acoustics of the basement, where the stone walls absorb sound. The click of a locked filing cabinet, which in this hospital sounds different because the contents are different. The murmur of a patient describing symptoms they cannot explain to a doctor who understands them perfectly and cannot say so.
3. Touch & Smell: The antiseptic smell of the ground floor, which is the same as any hospital. The basement’s smell: older, mineral, and carrying a trace of the herbal preparations the staff mixes in a converted supply closet. The temperature difference between floors: the ground floor is climate-controlled; the basement is naturally cool, regulated by the hill itself, which the founders chose because certain supernatural conditions are temperature-sensitive.

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2. The Clinic

The Ground Floor is a functioning rural hospital: reception, examination rooms, a small lab, and six patient beds. It treats ordinary illness with ordinary competence. The ground floor staff includes nurses and a junior doctor who are not aware of the basement ward. They know the senior staff sometimes treats patients downstairs. They have been told it is a “specialty consultation room.” They have not asked follow-up questions because the senior staff’s manner discourages them.

The Basement Ward contains four treatment rooms, a locked pharmacy, and Dr. Kohl’s office. The treatment rooms are equipped for supernatural diagnosis: iron-lined examination tables, silver instruments, and a collection of remedies sourced from local herbalists, folk practitioners, and one retired professor of mycology who does not ask what the samples are for. The ward is quiet, well-maintained, and completely off the books.

The Pharmacy Cabinet is the locked supply of supernatural treatments. Its contents include iron-salt solutions, cold-forged silver tinctures, distilled sunlight (a preparation that requires a process Dr. Kohl learned from her predecessor), and a collection of dried herbs that the local flora guide does not list because they do not grow in ordinary soil. The cabinet is the clinic’s most valuable and most vulnerable asset: if the contents are discovered by the wrong person, the clinic’s cover fails.

Cairn Hill looms above the clinic. The hill is the source of many of the supernatural conditions the clinic treats: its soil, plants, and water carry trace elements that interact with human biology in ways that conventional medicine cannot explain. The hill is beautiful, wooded, and dangerous to people who wander too deep without protection. Dr. Kohl has a map of the hill’s hazard zones that she does not share with patients.

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3. Factions

The Medical Staff (senior) consists of Dr. Sera Kohl, her colleague Dr. Luca Vane, and nurse practitioner Mira Oakes. They are the only staff who know the full scope of the clinic’s work. Kohl is the chief physician: meticulous, compassionate, and carrying the weight of a deception she considers necessary. Vane is the researcher, developing new treatments and studying the hill’s effects. Oakes manages the basement ward’s day-to-day operations and is the person who most frequently lies to patients about their diagnoses.

The Patients are people suffering from conditions they cannot understand. Most arrive through referral from local doctors who have exhausted conventional diagnosis. They know they are sick. They do not know why. The most challenging patient currently is Elena Marsh, a farmer who has been exposed to Cairn Hill’s deep-soil organisms and whose condition is treatable but requires a regimen that no conventional explanation can justify. Elena is intelligent, observant, and beginning to question why her “vitamin supplements” taste like metal.

The Medical Board is the regional oversight body that licenses rural clinics. Inspector David Hale has noticed that St. Wren’s recovery rates for certain conditions are statistically anomalous: the clinic cures patients that larger hospitals cannot diagnose. Hale is not suspicious of wrongdoing. He is curious about method, and his curiosity is the most dangerous thing the clinic faces, because a thorough inspection would reveal the basement ward.

The Hill Folk are the local community that lives on and around Cairn Hill. They know the hill is unusual. They have folk practices, passed through generations, for dealing with its effects: iron in the doorframe, certain herbs in the garden, and the rule that you do not walk the hill’s deep paths after dark. The Hill Folk’s elder, Granny Birch, has been the clinic’s informal consultant for twenty years. She considers Dr. Kohl a competent apprentice who relies too much on science and not enough on the hill’s own logic.

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4. Unique Mechanic: Diagnostic Integrity

Track a shared Diagnostic Integrity from 0 to 6, starting at 4.

Raising Integrity (+1 each):

• Successfully treat a basement patient without revealing the true diagnosis
• Develop a new treatment that can be disguised as conventional medicine
• Deflect an external inquiry (Medical Board, curious colleague) without raising further suspicion
• Receive guidance from Granny Birch or the Hill Folk that improves treatment protocols

Lowering Integrity (-1 each):

• A patient discovers their true diagnosis through their own investigation
• A treatment fails publicly (symptoms worsen in a way that conventional medicine cannot explain)
• Inspector Hale or another outsider accesses the basement or the Pharmacy Cabinet
• A staff member breaks protocol (tells a patient the truth, discusses cases outside the clinic)

Thresholds:

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5. Character Archetypes

The Chief Physician

You run the clinic. You treat diseases that your medical degree does not cover, using remedies that your training does not explain, for patients who trust you enough not to ask why their eye drops taste like iron. You carry the secret because someone has to, and because the alternative is patients dying of conditions that conventional hospitals cannot diagnose, let alone treat.

• Drive: “Keep the clinic running, the patients alive, and the secret intact long enough to find a way to make this work without the lying.”
• Approach Distribution: Force 1 | Finesse 2 | Mind 3 | Presence 2

The Observant Patient

You came to St. Wren’s because your doctor could not explain your symptoms. The clinic has been treating you for three weeks. You feel better. You also notice things: the locked door marked “Storage” that staff enter with keys they carry on a separate ring, the taste of your medication, and the way the nurses change the subject when you ask specific questions. You are grateful for the treatment. You are increasingly certain that the treatment is not what they say it is.

• Drive: “Find out what is actually wrong with me, even if the answer is something my understanding of medicine cannot contain.”
• Approach Distribution: Force 1 | Finesse 2 | Mind 2 | Presence 3

The Hill Folk Herbalist

You have been supplying the clinic with remedies for ten years. You know the hill’s dangers better than any doctor because you grew up walking its paths. You consider the clinic’s approach, treating supernatural illness with medical methods, to be effective but incomplete. The hill’s conditions are not diseases. They are relationships, and the clinic is treating the symptoms without addressing the connection.

• Drive: “Help the doctors understand that the hill is not a hazard to be managed but a neighbor to be negotiated with.”
• Approach Distribution: Force 1 | Finesse 3 | Mind 2 | Presence 2

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6. Starter Scenario & Why It Matters

Patient Zero Returns: A former patient, cured five years ago of a Cairn Hill exposure, has returned with a recurrence that does not match any previous case. The original condition has mutated. The treatment that worked before is ineffective. Dr. Vane believes the mutation originated in the hill itself, which means the hill’s ecology is changing and the clinic’s existing pharmacopoeia may be obsolete. Elena Marsh has found the locked pharmacy cabinet and is asking questions that Nurse Oakes cannot deflect. Inspector Hale has scheduled a site visit for next week. Granny Birch says the hill is “unhappy” and refuses to supply herbs until the clinic “pays its respects,” which she will not explain further. The characters must develop a new treatment, manage the exposure risk, and decide whether to bring Elena into the secret or find a more convincing lie, all before Hale arrives and starts opening doors.

Why It Matters: The Hospital Beneath the Hill asks whether concealment can be compassionate. The doctors lie to their patients because the truth, that their illnesses are caused by supernatural organisms, that the hill they live near is not entirely natural, that the medicine keeping them alive is folk remedy dressed in clinical language, would be more damaging than the disease. The setting is about the ethics of protective deception, the limits of medical authority, and the specific exhaustion of people who heal in secret because the world they work in does not have a category for what they do.