You’ve probably never heard of Pathologic 2. It’s even less likely that you’ve actually played it. What follows is a series of articles about why this is one of the greatest games ever made but why it’s not for the faint of heart and maybe isn’t for everyone.
Pathologic has a sort of mystical reputation as being punishingly difficult, extremely ambitious and made on a shoestring budget, so it’s somewhat of a holy grail for people interested in video games that push the medium forwards. Luckily self-isolation and now lockdown, provided not only the perfect excuse but also the perfect backdrop to delve into the world of Pathologic 2 and its strange take on a viral outbreak. I stepped into the shoes of Artemy Burakh, a trainee surgeon and son of a town shaman, returning to his hometown to discover a society collapsing under both the strain of cultural divides and an impending viral outbreak.
Much like the clash between science and shamanism that forms a major part of the games story and gameplay, the articles are going to be broken into two parts. The first will deal with the body of Pathologic 2 – how the game works, why it works as well as it does and all the connective tissue that binds it together. The second, soon to come, article will be about the spirit of the game – How it made me feel, the impact of the story on me and why I think it’s such a special achievement in the medium. Neither one is more important than the other but I think breaking it up like this will help you appreciate what is an incredibly cleverly designed game this really is.
The game takes place over the course of 12 days and consists of a fine balancing act between investigating the murder of your father, a local cultural leader, helping the town deal with the outbreak of a deadly plague and simply surviving, all while time ticks down. Everything you do eats into the 12 days that you have to work with (you are told during the tutorial that the town will be destroyed on the 12 day in a prophetic vision) and needs to be planned in advance. Sleeping takes up time, going to buy food takes time, completing quests takes up time and simply walking between locations takes a really long time meaning everything you do is always against the clock.
The game opens with a short tutorial that plays out more like a Lynchian dreamscape and sets the perfect tone for what is to come. When you finally wake up having arrived in town, the rest of the game opens out into a beautiful mixture of multiple different gameplay mechanics that mix seamlessly with the narrative and make you feel like you are really experiencing the story of Artemy Burakh.
There is a concept in video game analysis called “Ludo narrative dissonance” which describes how often a game’s gameplay and stories can clash. The classic example of this comes from the Tomb Raider remake in 2016 in which Lara Croft is extremely traumatised after she is forced to kill someone to defend herself. She then proceeds to spend the rest of the game mercilessly headshotting people or pick axing them in the head under the player’s control with not so much as a tear shed. It’s a sort of strange clash where the actions a player takes and the narrative the player is told don’t really match up. Pathologic 2 is probably the best example of a game that recognises this concept and manages to make every single element of the game completely cohesive with the story it is trying to tell and the world it is trying to craft.
You spend the majority of the game completing “quests” although this is incredibly far removed from a standard open world RPG checklist. Artemy has a mind map which acts as both a guide for what you need to do but also mental clues to the story. Thought bubbles join various narrative snippets together and lead the player to not only investigate elements further but also think about them as Artemy would. There are minimal map markers telling the player where to go and you’re expected to use your intuition to work things out. A late game section requires you to find a courier who has been injured and thus hasn’t delivered his message. The “quest” simply reads – “where might he have gone?” and the player is expected to work it out.
The answer is of course, that he’s gone to find a doctor and is outside of your house but while that might seem obvious it’s actually fairly lateral for video game design. Most seasoned players might expect to find a blood trail that leads them round the corner to him or a series of small quests that lead to his location. Pathologic is full of these lateral thinking moments that ask the player to think outside of the box, not just when it comes to the story but to the act of merely being able to continue playing. Unlike other open world style games, none of the quests you complete reward you with money – after all why would they? Money is just as hard to come across as in real life and people do not willingly part with it for simply talking with them.
While attempting to complete these quests and unravel the story further, the simple act of staying alive is what will take up the bulk of your time as Artemy. You arrive in the town penniless with no shelter, food or water and are expected to manage a series of meters that manage your actions throughout the day.
These consist of your health, which is not only affected by taking damage in fights but by the degradation of your other meters. Exhaustion, which is replenished by sleeping and governs how much activity you can do at any one time. Hunger and Thirst, which also doubles as your stamina, and are replenished by eating and drinking. Finally your immunity represents your resistance to the plague and becomes an incurable infection meter if you do contract it, killing you if it fills up. Taken out of context these don’t seem like anything particularly interesting but it’s how these interweave with the game world and each other to create gameplay that makes it so thrilling.
At the start of the game both water and food are pretty abundant. The town has wells and barrelled drinking water set up at various points for people to take as they want (the town is in the remote Russian steppe with poor access to clean water) and shops sell food cheaply as a lone cargo train delivers new supplies daily. The issue is that as the plague progresses and more and more people become infected, resources become scarce for everyone in the town. On the third day news comes that a new cargo train won’t be coming because of the risk of spreading the disease which causes panic buying of food, leading to a massive scarcity and huge price hikes. Affordable food suddenly quadruples in price, sending it wildly beyond your ability to buy it.
A few days later a rumour circulates that the plague stems from contaminated water, leading to groups of people destroying the wells and emptying barrels of drinking water. Where you would previously sprint around town drinking as you went, trading bottles of water to drunks in exchange for money, now you have to horde and conserve water. Doesn’t sound too hard until you’re faced with needing to race across town and back in order to prevent someone from dying and thus driving your thirst to perilous levels and massively increasing your exhaustion. Later in the game as resources become even more scarce you’ll have to weigh up if you even can do certain tasks as you might not have the energy or resources to maintain the exertion. Unlike other survival games, Pathologic keeps throwing these curveballs at you which never allow you to reach a point where you have enough and can go at your own pace. You will have to choose quests to miss and people to let die simply because you don’t have the tools to keep yourself alive while doing it.
The final building block of the game is Artmey’s skills as a healer and surgeon. As the story progresses, you are asked to help operate the town’s makeshift hospital and while this is completely optional, you’ll be rewarded with food and money by the town’s council and thus the incentive to do so is pretty massive. Along with this, you’ll also be trying to keep the huge cast of characters you meet throughout the game healthy and free of infection by identifying their ailments and treating them with various tonics you can now give them.
Artmey’s family forms a sort of hybrid made up of the town’s two opposing cultures, the industrialised townspeople and the more shamanistic people of the steppe, and due to this his abilities as a healer reflect both worlds. While you’re able to perform surgery and autopsies on people, which results in a small minigame where you have to balance the condition of your scalpel against the organ you are removing or treating, the process is often treated like butchery by the people of the steppe and you’re frequently required to use these skills on animals in rituals for the steppe people. That being said, you’re given the option to completely reject this and plant your feet firmly in the world of science but it’s this clash of cultures that is one of the game’s key themes and is so well reflected in this element of the gameplay.
Along with surgery you also are required to treat the townsfolk and your patients with various tonics and medicine you can craft from herbs native to the steppe. While this is a huge element of the game, you are never outright instructed to do this and although Artemy remembers snippets of information from his father about the tonics, it’s up to the player to make time to hunt the herbs down and work out the different mixtures through experimentation. It’s easy to totally ignore this element in the early days of the game but as more and more people become infected it’s absolutely critical to make time for this. It’s particularly interesting as it mirrors the player’s reaction to giving sick people mushed up herbs – at first you’re completely dismissive (why on earth would that work) but as the game progresses and the situation becomes more frantic you simply just have to embrace it and survive by whatever means you have available.
The concept of risk also extends into how combat works and how the economy of the town is formed. While working at the hospital can provide a steady stream of income, the tasks you have to perform there are usually pretty damn difficult and sometimes it’s not even possible to get to get there meaning other, riskier, forms of income need to be considered.
You can delve into plague ridden districts in order to loot houses which usually contain a pretty massive amount of spoils but then you’re risking infection and let me tell you, it is very easy to become infected. If that’s too risky you can go into districts that have just had the plague and are in a burnt out state but then you risk running into other looters who will have no hesitation about murdering you and taking everything you have.
Combat is particularly difficult in Pathologic 2 and it’s the most frequent way that I died throughout my playthrough. It’s so easy to become overwhelmed or run out of stamina which can leave you open to attacks. Healing items are rare and aren’t really meant to be used in combat and weapons, while powerful, degrade really quickly meaning you have to really weigh up the fights you take. You are after all playing as a normal man and not some fantastical killing machine.
If you do get lucky and manage to make it out of a district with some items a fair few of them will likely be useless and need to be either sold at shops or traded with the townsfolk. On top of the normal shop system you’d expect from a game like this there is also a fairly comprehensive trading economy which you’ll need to take advantage of, with certain items only really available through trading. Drunks will trade water for bandages, children will trade marbles and trinkets for medicine they find and the steppe people will trade tonics for food.
All of this is based off of your reputation which is another smaller meter you need to be conscious of. Kill any innocent people or be caught stealing and your reputation will drop and make the townsfolk shun trading with you which again sets up a difficult decision about if it’s worth ruining your reputation simply to stay alive when you are desperate. That being said there is a certain shop in the town which will happily trade human organs for money so again it creates further horrible decisions, it’s actually incredibly profitable to sell organs to this vendor but you need a steady stream of non-infected bodies to do this…
The marriage of all of these gameplay elements mean the pace of the game is actually pretty intensely frenetic. You’ll constantly need more food and water, you’ll need more money to buy medicine not only for yourself but for townspeople and most importantly you’ll need to be managing your time to make sure you can do all this while also progressing the story and somehow not dying of exhaustion. The first few days act as a complete misdirection, even allowing for some “time to yourself” at the end of the day but the intensity quickly builds once the plague breaks out and you’ll generally find yourself within a hair’s breadth of dying at almost every single point in the game.
What’s particularly amazing is that absolutely none of this gameplay is scripted and is all generated naturally by the player trying to balance their attention on the story, on keeping people healthy and on stopping your meters from falling. The most minor of oversight can lead to a frantic race against time to a bed in order to rest or a mad scramble to try and find some food which easily beats any scripted set piece in an FPS or action game in terms of sheer adrenaline pumping desperation.
What drives a huge amount of this fear is the death system which is where the game gets a lot of it’s punishing reputation from (not that the above is a walk in the park). Saving is done manually at various save points dotted around the town and when you die you are sent back to your last manual save with a permanent penalty to your meters. This could be a smaller health pool, exhaustion that rises faster or less immunity to the plague and it feels absolutely dreadful to get hit with one of these. When you couple this with the game’s lack of save states or multiple save files (which is on purpose as Pathologic HD actually had these and the developer removed them on purpose) we are left with a game where the player genuinely fears death in a way I’ve never seen in other games even come close to creating.
The level of immersion this creates is absolutely ridiculous. I have genuinely never been as scared to see a group of looters come around the corner whilst I was low on health or to open my inventory and see I’d forgotten to bring my last bit of food with me. This is what I mean when I refer to this game being the opposite of ludo-narrative dissonance. Just like the panic and despair that Artmey would feel scrambling to survive during a plague, the game successfully manages to use it’s gameplay to generate this in the player without using a single line of text or conversation. We haven’t even touched on that side of the game and yet I am sure you can already appreciate just how stressful, intense and punishing this game is to play. It’s the perfect video game representation of the struggle to survive by any means necessary.
This is the body of the game – it’s not just the frame that the rest of the game sits on but it’s actually the connective tissue that makes the narrative and gameplay blend into a single seamless experience. Unlike the style that the majority of AAA games use, where narrative and gameplay are clearly divided, the Pathologic experience is just as much about the things that happen in between the narrative as during the big story reveal. Whilst we haven’t touched on it here, the narrative and characters also develop in a beautifully organic way that isn’t possible without the atmosphere and emotion that the gameplay creates. Even if Ice Pick Lodge had left Pathologic 2 as just the above, lacking any kind of compelling narrative, we would be talking about a fantastic achievement but lucky for all of us – we still have strange and twisted spirit of the game to explore…