Example Draw - The Deck of Many Pains

Setup

Your party is in the middle of a fight with a giant hell-gorilla. Your character has a 25 hit point maximum, and the big ape just bashed you for 15 points of damage. Since that's over half of your maximum hit points, it's time for you to draw from the Deck of Many Pains.

In Good Times

If you were at full health, you would still have 10 hit points remaining and be conscious. You immediately draw three cards, choose one, and discard the rest.

Here we have a Head of Blood, Elemental Gore, and an upside-down Eye of Pain. With no Relief cards available, Pain is the next best bet. Unless you really need to see well in the next minute, you'll probably choose the Eye of Pain.

Side note, but it's hard to tell with the Eye cards which side is "up." For reference, if the little light reflection in the pupil is on top, it's right-side up. Since it's on the bottom, this card is upside-down, and effects the left eye.

With your card chosen, you discard the other two and immediately suffer the effects of an Eye of Pain. The GM tells you that you're blinded until the end of your next turn, and you're gonna have trouble seeing for up to a minute after that, although you'll get a Constitution saving throw at the end of each of your turns to end it early.

The GM describes how the giant hell-gorilla's cracked nails scratch into your eyes as it slaps you across the cheek. Gross.

Keep this card with your character sheet even after the injury is done, so that sessions later when you're relaxing in town, you can tell the story of how you got that scar across your left eye.

In Bad Times

If you instead had 15 hit points or less, this would knock you unconscious and you'd start dying. You immediately draw three cards, but leave them face down in front of you.

At the end of the giant hell gorilla's turn, molten lava pours off it's body onto anyone within 5 feet of it, including you. You take 8 points of fire damage, which causes you to fail one death saving throw. As you mark that off, discard one of the cards without looking at it.

At the start of your next turn, your allies still haven't gotten a chance to heal you, so you roll a death saving throw. You roll a 7, which causes you to fail another death saving throw, and discard another card.

Things are looking grim when you ally finally gets a chance to heal you. Now that you're no longer dying, you flip over your remaining card and choose which injury to suffer. Not that there's much of a choice though...

Oof. Gore cards deal serious effects that last for days and might become permanent. Elemental cards deal damage based on the damage type that injured you, which in this case is bludgeoning. You could maybe argue that it was fire since that injured you most recently, but I would go with bludgeoning since bludgeoning damage is what took you down first and you took more bludgeoning damage than fire damage.

The first effect of Bludgeoning Gore is that you're knocked prone, and can only use your movement to crawl or stand up from prone until the end of your next turn. The second effect requires that you draw cards from the bottom of the deck until you draw a "hit location," which is to say any card except for faces cards and Jokers. You do that and draw a Leg card, which the GM tells you is connected to your Dexterity. They then tell you to reduce your Dexterity score and Dexterity score maximum by 5 each, to a minimum of 1. You had a Dexterity score of 14 (+2), so it's now 9 (-1).

The GM describes a loud crack as the giant hell gorilla smashes into your right hip, shattering bone, and the pain you feel as you try to stand up again. Hopefully you'll be able to heal this before it's too late. As before, keep the card to remember the grisly scene.

In Ugly Times

If you instead took enough damage to kill you instantly, immediately draw one card and play it.

You can ignore the movement effect, because you can't move when you're dead. But if you are later revived, this injury will apply to your body then.