[ Sahkil ] [ Impostors | Lurkers | Stalkers | Tormentors ]
[ Caseafula | Chakanaj | Erasak | Esipil | Ganerul | Hemnallid | Ijhyeojin | Jichjik | Maatambil | Yatorak | Yogob ]
Trigger warning — this fiend description contains themes of animal cruelty and fake medical treatment, so if you have concerns about content like that, I suggest you give this creature a miss
Caseafula Sahkil
The Withering Nurse (CR 13); pharmacophobia — fear of medicine
Home Planes: Ethereal / Xibalba; Nether
Alignment: Neutral Evil
The caseafula [ka-SAYA-foola] is a sickly spectre that masquerades as a healer, and preys on the hopes and fears of the sick. They adopt a shape that might pass for a woman in tattered finery—if your eyes could ignore the mass of tumours, ragged stitches holding everything together, and cage full of writing beasties, for just a moment. They have ashen skin riddled with weeping sores, and what passes for their head sprouts twin feathery antennae above a gaping maw, in the centre of which sits a lidless, unblinking eye. Get close enough and you’ll notice they stink of antiseptic gone foul—old pus, bitter herbs, and the cold metallic tang of dirty surgical steel. Their dresses rustle with the frantic scurrying of warped rodents and birds. These creatures have been imprisoned in the caseafula’s lower half—a metallic cage whose bars drip with ichor. They scratch and flutter in desperate attempts to escape and issue pitiful cries of pain and fear. When a caseafula tires of toying with her victims, she will transform them into vermin and add them to the menagerie to prolong their torment.
The caseafula is fear’s midwife for disease and medicine—delighting in the terror of affliction and the dread of “cures” gone wrong. They cloak themselves in the guise of a healer, peddling false remedies to the desperate, and revelling as their touch inflicts a supernaturally virulent form of consumption: the victim’s lungs fill with blood, their bodies ruined from the inside. Caseafula who reveal their truly horrifying visages can panic mortals with visions of agonising infection and despair. They will often sow carnage in the aftermath of plague, visiting sickhouses and slums. There they will attempt to cause survivors to turn on each other, hunting for scapegoats and fighting over miracle cures, sowing distrust of doctors and priests. For the caseafula, fear is sweetest when it festers behind locked doors—private, desperate, and shameful. They plant themselves in the crumbling margins of civilisation—the shadowy tenements of cities that have grown too large and too infested with disease. The caseafula blur the line between leech and healer, priest and parasite. They feed off mortals who dread their own frailty and the uncertain intentions of those meant to save them. Turns out that sometimes the cure is far worse than the sickness, cutter.
Source and Stats: The Creature Codex [PF1e] here
Other Sources: Jon Winter-Holt. Canonwatch: These sahkil are a fabulously horrid type of fiend from Pathfinder lore, who make a great addition to the Ethereal Plane and Planescape lore generally. The Creature Codex has done an awesome job of expanding the number of sahkil massively too, and I’ve included all their creations here. Organising the sahkil into three sub-types based on their hunting style was my idea, because the list was unwieldy and their names are (deliberately) hard to remember, and this splits them up into bite-sized chunks.