Nebula Dragons are nocturnal creatures. With the best eyesight to be found, they are often seen staring into space. Each dragon tends to observe a particular nebula and will eventually change their colors and patterns to match it. As the nebula changes over time, the dragon changes with it. The more intricate the design of the nebula, the better chance an individual has of attracting a mate. It is said that the markings on no two Nebula Dragons will be exactly the same.

Dragons are highly-intelligent reptilian creatures that—from a human perspective, at least—appear to live forever. Many different varieties of dragon exist, each with their own unique qualities, habitats, and behavior. Adolescence in dragons is usually marked by the growth of a hatchling’s wings, although not all breeds of dragons grow wings and some breeds have other traits that indicate the beginning of maturation. In Galsreim, dragons and humans coexist peacefully.

The Manual of Efficacious Surgery, like all her siblings, derives her name from an object she guards. Frightening of aspect, with many-scarred hide and hooked steel claws, she is not easy to approach. Her icy calm makes her unpleasant to talk to, as it seems she's always sizing up her conversational partners for one procedure or another, and not many dragons have spoken with her and returned unchanged in some way.

She trades her specialty, magic that changes the body, for any number of things—some say she lets her secrets go too easily, but she's always happy to 'help' in her own way. It's said that those who go under her claws never forget her razor-edged grin.