In this article we’re going to go through the spirit of Pathologic 2 and all of the fantastic writing and world building that gives it such a unique character. You might think it’s strange to do a long write up about a 45 hour long game and leave the story and characters until half way through but it’s important that you understand how it feels to play the game beforehand. Absolutely everything the game wants you to feel about it’s narrative is against the backdrop of it’s brutal cycle of survival. It doesn’t just want you to experience the story from the outside but wants you to feel like you are an active player in the tale – it is a story and experience only possible as a video game.
So just to remind you, you play as Artemy Burakh, son of a local healer and shamanistic cultural leader, who is returning to the town he grew up in after receiving a cryptic message from his father. In a trend that you’ll become increasingly familiar with, things are not what they seem and pretty much as soon as you get to town, you discover that your father has been murdered and the town is currently in the throes of rioting and panic.
In a trend that you’ll become increasingly familiar with, things are not what they seem
The game introduces you to the town through a series of small quests that are framed as Artemy reconnecting with his childhood friends and father’s colleges while also working out where he’s actually going to live. It’s the classic “fish out of water” method of introducing you to a world and it works fantastically here as it’s so naturally presented. Artmey has been away for years so naturally he has some idea of where and who he should speak to but essentially needs to be reminded of how almost everything works in this place.

The character of the town itself forms a massive part of the game’s narrative and working out what exactly this place is and what it should become in the future is a huge element of Artmey’s role as heir to his father. At first it feels like a simple early 20th century industrialised town, most of the architecture, clothing and language feels straight out of Peaky Blinders but there is also an alien underbelly to Pathologic 2.
Living and working amongst the “normal” 20th century world of the town lives a different ethinic group who are referred to as the “Kin ”. They are essentially the town’s natives, having lived here long before the town was industrialised. While most of them look human, they certainly feel extremely alien compared to the townsfolk and have all manner of earthy, shamanistic rituals and language that Artmey becomes more and more exposed to during the game. The sense of alienness goes beyond simple culture however as certain members of the kin even look completely different to normal humans. There are strange dome headed hulks known as “Worms” and near naked “Herb Brides” who tend the earth and seem to live completely out in the wild. Pathologic at no point attempts to explain why or how these people exist – they simply do and are part of the kin. Attempting to discuss their origins simply rewards the player with mythological stories about where they come from, hard facts aren’t available to Artmey and they aren’t available to the player.
This clash between the Townsfolk and the Kin forms one of the foundations of the narrative. The Kin are an oppressed underclass who are coerced into working in the bull meat factory which is the largest employer in the town, it’s grueling work in terrible conditions and the majority of the Kin live in an enormous brutalist apartment block called the Termintary which is said to house over 5000 people. Both the factory and the Termintary look so utterly out of place in the town that it creates this impression that they shouldn’t be there at all and immediately puts you in the same shoes as the Kin, viewing these huge concrete monstrosities as wrong and unnatural.
So far you’re probably feeling a lot of sympathy for the Kin which is only natural. It’s easy to root for the oppressed underclass who just wants to be intune with natural and out of their oppressors yolk. The issue is that Kin are actually pretty horrible and frequently throughout the game they act with cold brutality towards outsiders and people who threaten their culture.
this is a culture that doesn’t just encourage violence but sees it as the moral and correct way to resolve issues
Midway through the game it’s possible for one of your childhood friends, Rubin, to be murdered by them simply because he trespasses on sacred ground looking for ingredients for a potential cure. Later in the game Artmey is straight up told to murder the dissenting elements of the Kin, this is a culture that doesn’t just encourage violence but sees it as the moral and correct way to resolve issues. Strength is all that is recognised and actually forms part of their subservience to the townsfolk as the kin ARE the weaker group. Pathologic constantly asks you to weigh up the question of if inhumane cultural practises should be allowed to continue or if it really is any of your business to tell people how they should live.
After attending your father’s funeral on Day 2, Artmey is given his “inheritance” which consists of a piece of paper with a list of children on it. You quickly discover that Isidor was tutoring a select group of the townsfolk and Kin’s children but to what purpose Artemy has been given this remains completely unclear. Throughout the game you can forge relationships with the children and they can form a structure to the healing gameplay. I focused most of my efforts on protecting the children at all costs but it wasn’t stated anywhere in the game that this was an actual goal to be achieved and there is also absolutely no punishment if you do allow them to die.

As you get to know each of the nine children on the list you begin to realise that they form a potential future ruling class for the town and kin. Capella, Khan and Taya are all children of the current leaders and will surely inherit their parents leadership roles. Notkin leads a criminal gang which is gaining considerable power already and Sticky is your father’s apprentice who is learning the same healing ways as Artemy. Two more girls, Murky and Grace round out the list and they both appear to have strange supernatural abilities. Finally the list contains a cryptic symbol from the kin language but frustratingly nobody is able to give you a clear translation of it’s meaning.
Through speaking with the children and further investigating your father’s intentions it becomes evident that he was sculpting the next generation of leaders for the town and kin. While another more traditional game might have you completing quests to continue the education of the children and taking your father’s mantle, Pathologic is no traditional game. Some of the children, Sticky, Murky, Grace and Notkin, are all very open to Artemy and act as allies throughout the story but others simply do not like or warm to you. Capella, Khan and Taya all have their own goals to achieve and frankly couldn’t be less interested in speaking with an outsider who they have never met before. If protecting the children from the list does become an objective for you it is not simple and trying to form good relationships with them can make the difference between some of them dying in non-plague related events.
During day three Artmey is asked by Gregory Kain, one of the town’s elders, to check on Peter Samatin, an architect who has not been seen for a few days. Peter and his brother are responsible for the design of some of the more fantastical buildings in the town with their magnum opus being the Polyhedron, a gravity defying tower that looms over the town serving seemingly no purpose. You’re assured that he’s very important to the town and it’s during this search for him that you discover that the plague has broken out in the town and is spreading quickly.
The plague, or sand pest as it becomes known later in the game, is a completely lethal airborne disease with unknown origins. While the game never explicitly states the symptoms, each character that contracts it changes appearance to be covered in dirty rags from head to toe which implies a sort of leperous element to it. You regularly see infected citizens reaching out, begging for help or attempting to break quarantine only to be beaten down by town guards or later shot by the military. Beyond being an illness, the plague takes a literal physical form and can be seen in floating black clouds that make an absolutely horrible whispery scream when you are near them. Generally these act as blockers in doors or roads, throwing you off your planned route, which can be lethal given the labyrinthine nature of the town’s streets. Along with gating you, there are also clouds of the plague that literally move around and can hit you out of nowhere. Running blindly through an infected district will get you hit and will get you infected so you really need to treat the plague like an NPC to be avoided.

Becoming infected with the plague isn’t just horrible from a gameplay perspective but is actually genuinely disturbing to experience as a player. Once you become infected you begin to hear whispers, a maddening mixture of a male and female voice, that speak to you in cryptic riddles. I’ve frankly never been more terrified than when sneaking around an infected district at 2am in the morning only to have a horrible voice whisper into my headphones.
Your initial reaction is that this must be a feverish madness brought by sickness but there is an interesting event where Murky, one of the more supernatural characters, invites you to meet her secret friend out in the depths of the steppe. She has been hearing these voices throughout the game and at first it seems like a simple imaginary friend but when you go out with her it takes a really dark turn. You discover through a strange conversation with the changeling, another one of the towns healers, that Murky’s imaginary friend has taken a dislike to you and you can make a choice between protecting Murky or allowing her friend to punish her. This leads to either yourself or Murky becoming infected with the plague, a huge price to pay and a potentially game ending moment if you are unprepared.
It brings up the question of sentience. Are the whispers real or madness? It can certainly feel like the plague clouds are targeting you when you enter a house only to find one rushing towards you around a corner. The game is once again asking you to balance if you believe in the supernatural/magical elements of the town or if they are explainable through other means. There is no clear cut answer and it’s left up to you how you interpret this world.

One of your main goals throughout the 12 days you have is to try and create a cure for the plague. You discover that this is actually the second time that the plague has broken out and while your father was able to prevent it wiping out the town, it wasn’t through creating a cure. On the outskirts of the town is a region called The Sprawl which was the epicentre of the last outbreak which mostly houses the destitute kin. Your father managed to detect the plague early and ordered a complete quarantine of the district, leading to the deaths of all 500 citizens but preventing the plague from spreading further. Unfortunately detection has come too late and the plague has already spread into multiple districts leaving the town completely lost for how to prevent total wipeout.
The situation eventually becomes so dire that the “powers that be” (left intentionally ambiguous as to who this actually is, government? Church? Who knows) send an Inquisitor to the town to take over management of the town and prevent the plague from spreading into the rest of the country. Along with his potential work at the hospital, Artemy can report to her each day to update her on his progress in developing a cure and discuss her own plans to resolve the crisis.

The Inquisitor is a strange character who you have a series of odd conversations with but her most important contribution to the world of Pathologic is two major changes she implements in the town.
The first is that soon after she arrives, she writes a decree which makes food no longer purchasable with money. All food can now only be exchanged for food tickets which are handed out from the town hall everyday, in equal amounts to all of the surviving members of the townsfolk.
From a narrative perspective it makes complete sense
From a narrative perspective it makes complete sense that this would be an action taken in a remote town but it is absolutely punishing from a gameplay point of view. It’s fairly likely that you’ve settled into a rhythm by this point, just scrounging enough money to get some food or managing to complete tasks at the hospital in order to get supplies but this totally throws that out of the window by making one of the main resources (money) completely useless for dealing with one of your survival stats. It’s another punishing layer of Pathologic but when it arrives and why it happens, feel like a completely natural step for the town to take.
With food becoming much more elusive, work at the hospital becomes much more important despite the jobs themselves becoming much harder and potentially very time consuming to do. The final two jobs on Day 9 and 10 particularly stand out in their ability to completely break the game for you. On Day 9 you’re required to survive in the hospital whilst six plague clouds drift around, waiting for your shift to finish. In a further cruel twist, your relief ends up being half an hour late so you end up panicking as your shift ends but nothing actually happens to save you. Day 10’s task is relatively simple by comparison, all you need to do is cure someone of the plague. If you know how to, it’s actually one of the easiest days at the hospital but why would you know how to do this on your first playthrough? It’s incredible how the feeling of failure builds around you later in the game as things become very desperate.
The second action the inquisitor takes is to open up the Termitary, which had previously been closed to prevent industrial riots from the kin who live there but had been left locked to protect them from the Sand Pest outbreak. After speaking with the Inquisitor and updating her on the progress of your cure, you receive a mission to find Overseer Tycheek inside a newly opened Termitary and speak with him about the location of a special kind of blood that could potentially be the key to the cure. It’s discovered by your friend Rubin that the indigineous bulls that are harvested at the town’s abattoir are actually immune to the disease and there is the potential that some sort of cure could be developed from their blood.

As you approach the massive apartment complex you aren’t faced with hundreds of newly freed kinfolk pouring out of the town, escaping captivity. In fact you see nothing at all, the road up to the Termitary is completely silent, even the guards previously posted have abandoned their posts. The sense of dread from walking towards this massive brutalist structure expecting to make big progress into your work only to be faced with silence is awful.
Upon entering the facility your worst fears are confirmed. The walls are covered in blood and fluids and large brown tarpaulin are poorly covering piles of dead bodies. The music that plays in the termintary is more akin to static punctuated by the moans of the dying. The sand pest has ripped through the thousands of kinfolk who rather than being protected from the illness, have been trapped inside in a bloody epicenter of disease. It is truly one of the most awful places ever to have been designed in a video game and playing through this section at 2am in the morning was one of the most disturbing experiences I’ve with any kind of media.

The termitary itself is an absolutely enormous but highly repetitive space that is completely covered in infection. It is literally just a monochromatic series of staircases with many many locked doors across around 10 floors. Searching through this place for Overseer Tycheek isn’t just disturbing from an artistic or narrative point of view but it presents very difficult gameplay. You naturally want to be out of there as fast as possible but it’s so easy to lose your bearings and forget which identical door you’ve checked, all while the plague ticks down your infection meter.

Eventually you manage to find the small group of surviving kinfolk only to discover that Overseer Tycheek was among the dead and your questions cannot be answered. In his place, his young daughter Taya has taken over leadership of the remaining Kin. You realise that Taya is also on the list that your father gave you but other than trying to convince her to leave the town, there isn’t really anything you can do or gain from this horrible journey into the termitary.
The only benefit from the journey is that it causes you to meet Foreman Oyun, who seeks you out after hearing that you convinced the Inquisitor to open the Termitary gates. Oyun is a complex character who might be one of the most interesting in the game. He’s a member of the kin but effectively works for the ruling Oglimsky family, helping to keep them repressed through his physical power. He’s an incredibly imposing figure, around 7 foot tall, covered in muscle and it’s clear that he doesn’t hesitate to put down members of the kin who threaten their place in the town. A more predictable narrative would have him doing this on the take from Big Vlad Oglimsky, cynically benefiting from their plight, but Pathologic actually takes quite a long time to set up a series of explanations for his actions.

While this is happening you are of course, frantically trying to stay alive and keep everyone in the town alive (probably with little success) and it’s in the approach to the final day that the game decides to throw another brutal curveball at you. The infection system during the rest of the game works pretty simply – if a character lives in an infected district they have a chance to become infected that night. You can give them tonics and medicine to minimise the chance but it will never get to zero and in fact I had many times when people who had almost no chance of becoming infected somehow were. Once a character is infected, each night there will be a coin flip to see if they succumb to the illness and die. You can try and stave this off, again through the use of medicine, but eventually they will die unless cured as the chances shorten each night.
On Day 10 the game simply throws all these rules out of the window and all the children on the list become heavily infected. You are visited by an actor from the town theatre who speaks with the voice of the plague and pretty much tells the player, “yes I know this isn’t fair but I don’t care”. It’s an absolute slap in the face given all the hard work you’ve put into keeping everyone alive and it was particularly brutal for me as I’d put special effort into keeping the kids safe.
At the very same time you’ll receive a message from Oyun telling you to come meet him at the Abattoir. The final day presents a brutally difficult toss up between spending your time making sure that a huge amount of people are protected from infection and actually getting answers to the questions you’ve had since Day 1. The game knows it’s breaking its own rules but really it’s doing this to keep the core theme of Pathologic there right until the end – difficult choices with no real right answer.
What takes place inside the Abattoir is probably one of the strangest and most David Lynch like sections of any game I have ever played before. Many games attempt to create dreamlike experiences but none succeed as hard as Pathologic 2 does with the Abattoir sequence. Even writing this now, I am still unsure if it actually happens in the game’s narrative or if it’s simply meant to be taken metaphorically. It’s confused, beautiful and most of all, a brilliant blend of story and gameplay.
Immediately all of your items are removed as you step into the dingey, dark underground cave system that forms the Abattoir. Shamanistic runes are scrawled across the walls and strange noises echo through the chambers that you move through. You immediately speak to an injured worm man who informs you of the living blood that flows from the rocks around you, he claims it’s the blood of their god – Mother Boddo and while you can drink it to heal yourself, if you’ve done certain events in the game you’ll know it has another use.

As I’ve stated before, a huge goal in the game is to try and develop a cure for the Sand Pest. While an out of town doctor called Danill Dankovsky, tries to create a vaccine using his knowledge of medical science, Artem’s path takes him down a much more naturalistic route. Through discussion with your father’s apprentice, Rubin, you begin to experiment by mixing infected organs that can be harvested from sick townsfolk with the herbal tonics you create. If you manage to create and administer five different tonics and go to sleep before Day 6, you’ll have a strange dream where the mother superior of the kin tells you that the earth’s living blood can cure the plague. It’s a huge revelation that’s incredibly easy to miss as the game never makes it clear that there is any reward for conducting these experiments and after having 2 or 3 of them fail (as they are supposed to) it’s easy to become disillusioned and give up. It’s a very human response and the game plays on that by keeping this critical information behind a wall of activity that literally works against you.
You discover through exploring the Abattoir that there are various fonts of Living blood that can be collected in bottles. It’s possible to get 6 bottles of living blood which means it’s possible to create 6 cures for the plague if you’re able to escape the Abattoir alive.
It’s easily the most difficult section of the game
The issue is that the kin inside have gone mad, it’s unclear why exactly, and are purposely infecting themselves with the plague as they believe that as they are one with the earth; that they are protected from the “breath of the earth”. Massive worm men attempt to kill you as you sneak around the halls of the cave system and in terms of combat, it’s easily the most difficult section of the game and most people die quite a hell of a lot (which then makes the final hours of the game even more difficult due to the stat punishments).
Upon reaching the centre of the cave system you’ll find Foreman Oyun nowhere to be seen and instead a worm man standing over a stone altar. He instructs you to perform surgery on a few odd items you’ve found whilst in the Abattoir, a fingernail and a spindle, which creates a small beating heart which you can enter into a dialogue with.

The strange dreamy conversation seems to consist of “Zurkhen’s small chamber” (the heart) telling you that the reason that the plague is so lethal is that it specifically targets those who separate themselves from the earth and invites you to return to the earth by diving into a huge abyss that lies before you. It’s incredibly strange but this invitation to discover if you are “man or beast” is as compelling as anything in the game so inevitably you throw yourself over the edge.
You awaken to find yourself inside of a new set of caves that look eerily like the inside of a body. It’s hard to tell if you’re inside of moist rock tunnels or walking through the veins and arteries as a horrible squelching sound accompanies your footsteps. It’s a really maze like environment so trying to work out where to go and why isn’t abundantly clear. The music is again almost silent meaning it’s an almost introspective experience, you’re left wondering what exactly is going on as you walk around these fleshy halls.

Eventually you’ll emerge into a central chamber and are faced with an enormous sentient heart, beating extremely weakly whilst a huge needle is lodged in it. Blood trickles from the monstrous organ and the game prompts you to speak to it…

The conversation with the giant heart, known as Zurkhen’s large chamber, is one of the most ambiguous in the whole game as the heart itself barely says anything and most of the exposition is driven through Artemy’s questions rather than any sort of back and forth dialogue. Artemy immediately comes to the conclusion that the heart belongs to the town and that the needle being driven into it is the base of the Polyhedron, the mystical tower that represents the futurist technology of the townsfolk. In fact the whole diorama represents the core conflict of the town – industrialisation and the future in conflict with the supernatural and the past. The issue is that Artmey himself acknowledges that the heart is actually just echoing everything he is saying and he could well be speaking to himself. In fact, this entire sequence may well not even be happening, which would make sense as the location and conversation are so abstract that you could easily make an argument that it is actually a hallucination. Artmey eventually climbs from the abyss, sure that the town is a living creature and that the living blood which can be used as a cure for the plague flows through the town’s “veins”.
After speaking to Oyun to let him know of your discovery, he agrees to reveal who killed your father in exchange for Artemy securing a future for his people. As the inquisitor has failed to prevent the spread of the plague, the military is moved into the town to destroy it and prevent a national incident and Oyun is terrified that this will lead to the extinction of his people. If you’ve managed to convince Taya to take her people out of the town and into a remote village then Oyun will agree to meet you on the final day at the centre of the Abattoir and reveal the question that began the whole game.
The final day is a rough balancing act of trying to administer the small amount of the cure you’ve been able to make, your final job for the inquisitor and this last confrontation with Oyun. It’s possible to clear it all but I can easily imagine a situation where a player who has barely been able to keep things together is unable to complete all three tasks in the time that is left. It really is the climax of the gameplay where everything catches up to you on top of it being the climax of the narrative.
If you do decide to prioritise speaking to Oyun you have to make the journey back through the Abattoir, although this time there is no danger and no plague which again throws the reality of the experience you just had here into question. When you finally reach the centre and see the looming figure of Oyun, the game hits you with one of the most brutal narrative gut punches I think I’ve ever seen.
Oyun reveals that it wasn’t just one of the kin who killed your father but that it was actually him. Oyun caught wind of Isidor’s tutoring of the future rulers and became suspicious of his intentions. He followed him out into the depths of the steppe where he saw Isidor dig down into the ground, intentionally infect himself with the sand pest and return to the town where it would surely spread. Artmey, deep in disbelief, questions further which reveals that Oyun actually mercy killed Isidor after seeing what the plague was doing to him, hoping this may spare the town from an outbreak. The murder which has haunted the entire game was actually a case of euthanasia done in the hope that it would protect the lives of many people. Oyun is distraught with himself despite his compassionate reasons and gives his life over to Artemy to do what he wishes – you can leave him alive and forgive him, leave him alive without forgiveness or simply take an eye where an eye had been taken before, killing him.
This revelation that the outbreak of the plague was actually done on purpose throws everything you understand about the situation completely out of the window. Rather than this being a recurring issue that the generations of this town have had to deal with, the plague is actually the tool of a man playing out a machiavellian scheme. Natural parallels that you’ve been drawing between this outbreak and the previous one five years ago suddenly mean nothing and Isidors brutal sacrifice of the kins quarter of the town moves from being a desperate last ditch move to something more insidious. Isidor himself, who has been framed as a wise and generous leader throughout the game is recast as a complete and utter villain, all of the pain and suffering that you’ve experienced playing through Pathologic 2 all stems from him.
If you sleep after this revelation you’ll encounter a final dream sequence between Artemy and his father in the Abattoir where you’re able to question Isidors motives and try to make some sense of his horrific actions. Of course, much like the heart sequence, it’s completely left up to interpretation if this is actually happening or if it’s just a figment of Artmey’s imagination, desperately trying to justify what it’s heard.

As with everything in Pathologic 2, the dream with Isidor reveals that not all is as it seems. He implores you to try and understand why he took the actions he did and reveals finally what the purpose of the list and his message asking you to come home really were. He claims that the uneasy bond between the townsfolk and kin had failed beyond reconciliation, the townsfolk relied on the cheap powerful labour of the kin to support the town’s economy but this was only possible through the subjugation of them. In turn the kin had no way to exist now that industrialisation had come to the steppe but would always fall back under the yolk of oppression because of their cultural respect for strength. Isidor believed wholeheartedly that a new generation could be forged that blended the best of the townsfolk and the kin, hence his tutoring of the children on the list. This eclectic list which at first makes no sense finally is revealed to not just be the future leaders of the town but people who are open to each other’s way of life, children with no pre-existing prejudices or long held traditions. Isidor accepts that his solution is brutal, that it is utterly inhumane but asks that you try to see the importance of blending these cultures together to save them both. The reason he asked you back is that you, as Artemy, are perfectly placed to appreciate both worlds and to guide the growth of the children in forging a new town for all.
With that revelation, the dream ends and the player is left to their own thoughts. The game never returns to this subject and you are left to draw your own conclusions about the morality and intentions at play. It is exactly how a fantastic narrative is crafted. A crushing blow of revelation, followed by the empty space where truly fantastic endings breathe out, letting you come to your own conclusions.

As I said earlier, your other goal on the final day of Pathologic is to speak with the Inquisitor about her final plan for the town and the ultimate goal of preventing further outbreak of the plague. After Artemy’s discovery (or hallucination) of the heart deep under the earth he speaks to the inquisitor and a plan is formulated to destroy the polyhedron, and thus release the needle that is driven into the town’s heart. The conclusion is drawn that withdrawing the needle will actually destroy the heart but in the process it will allow for a pouring out of the living blood which should mean there is enough to cure the town and save everyone who is left alive. For a pragmatist this seems an easy option however things are never that simple.
In the process of delivering the orders to bombard the tower, Artemy is approached by the remaining members of the kin who beg him not to destroy the heart and to trust that the plague will burn out on its own, claiming that Mother Boddo will spare the faithful. They claim that to lose the heart of the town would destroy its link to the supernatural that has been so evident during your time here. The dreamlike sequences, the members of the town with supernatural abilities, the strange inhuman people that live here, all of these would cease to exist as they are expressions of the heart of this alien, abnormal place.

This brings us to the final decision of Pathologic. You are asked to either deliver the orders and have the polyhedron destroyed, or allow it to stand and let the town be destroyed by plague and military intervention.
While at first this seems like a binary choice between siding with the town or the kin, the more you actually dwell on the question, the more it relates back to everything you’ve seen and experienced in the game so far. It’s not a simple question of what is best but you really need to assess your own view of this world and decide what future you think it deserves.
The kin are the oppressed people, they have borne the brunt of the plague with the majority of their people killed and now you are going to destroy the very foundations of their religion and culture in order to save the uncaring town. As the game makes clear, you are one of the kin and have benefitted immensely from the dreams and spiritual guidance that their culture has offered, there is in fact no way you’d have discovered the cure without it.
Is it ever right to make a decision that involves utterly erasing the culture of one people to save another? After all, what gives the people of the town the right to life over the people of the kin?

On the other side of the coin, your entire struggle has been to prevent the deaths of as many people as possible and sacrificing the kin and the magic of the steppe would save the lives of many thousands, including what is left of the people in Artemy’s life.
Do they deserve to live more than the kin simply because there is more of them?
Do the ends justify the means when the ends are the lives of an entire populace? The town has been hostile to Artemy ever since he arrived and he never really connected with them like he does with the kin or the children, in fact quite often throughout the game he is massively hampered by those that run the town. Do they deserve to live more than the kin simply because there is more of them?
Then there is also the issue of Isidore’s plan. Which of these options is the fulfillment of his plan and do you even want to carry out the wishes of a man who obviously holds human life in such disdain. If you were able to use the living blood from the Abattoir to protect the children on the list, it’s perfectly possible to allow the plague to burn through the town, preserving the kin and
When he asks you to save the town is he asking you to save the physical town?
Isidor’s future vision of the town. When he asks you to save the town is he asking you to save the physical town, with its people and buildings, or is he asking you to save the spirit of the town, with its unique magic and culture?
Even your role play within Pathologic factors into the decision. Have you played Artemy as a caring man who gives medicine to all those who need it or have you hoarded goods to keep yourself alive? Does this element of roleplay affect your decision in game or are you happy to answer this moral question yourself? For me, I couldn’t let the masses of the town die even though I felt an affection for the kin. Telling them I couldn’t save them was genuinely heartbreaking but I couldn’t spend 40 hours trying to save as many people as possible only to betray that at the last moment. It’s a fascinating end to the game that genuinely takes all the gameplay and narrative beats you’ve experienced and asks you to make a real moral choice outside of the game world. It’s the perfect ending to a game that is desperate to affect you outside of the actual game experience..
This brings us to the final point about Pathologic I want to talk about. There is an entirely separate layer to the game beyond the narrative and gameplay that is more in line with something like a living play, where the audience participate and actually play roles within the play itself.

Throughout the game, every night you can visit the local theatre where a play is put on which either revisits some of the day’s events or foretells what is coming. This concept of the game as play, in which you are an actor, rears its head at multiple times throughout the game and really brings a strange atmosphere to the whole affair.
The theatre director, a man named Mark Immortell, through his conversations with Artemy, consistently addresses the player themselves and makes cryptic references to things like your expectations of the game or how pathologic 1 didn’t sell particularly well. Artemy is obviously absolutely bemused by this but it’s not meant for him, these are references about the game world that can only be understood between the developer and the player. Most of this plays out after you die and are sent back, it’s all done under the pretense of the scene playing out incorrectly and the actor requiring instructions from the director to get it right. This is where most of the fourth wall breaking happens and it’s fascinating.

When the plague breaks its rules and infects all of the children at once, the plague is not only breaking the rules of the plague but breaking the rules of the game and telling you the player – “we can do this, it’s just a video game after all”. It’s a use of breaking the fourth wall that I’ve never seen executed so well in a video game. Ice Pick Lodge clearly want to effect not just your player character but you the player and are happy to address you directly to do so.

It means the game is directly asking you to deal with it’s moral questions. It’s very hard to just separate your decisions off as “I am just playing a game”. In other games with morality systems, like Bioware’s Knights of the Old Republic for example, the player can do absolutely horrendous things if paying through a dark side campaign. Generally this is referred to as something quite fun to do, that being evil is actually an entertaining, cathartic experience in the safe environment of a pretend video game. Pathologic sees this a different way and challenges you directly, as the player on this subject constantly.
If you kill people to harvest their organs for your experimental tonics, you are directly challenged on this. If you found out a neighbour was writing stories or drawing pictures of himself harvesting human organs, you would be deeply disturbed so why is it necessarily any different to actually live out these actions in a video game. Is it fun and normal to draw pictures of decapitation or pull the heads off of dolls even if none of it is actually real?
This level of judgement that is inescapable is so brilliantly executed. It’s almost impossible to completely detach yourself from the decisions you make in the game, all of the difficult and consequence laden choices you are forced to make absolutely stay with you and the developers won’t let you distance yourself from them. It’s another one of the ways that Pathologic sucks you into it’s world and doesn’t let go.

This pairing of incredible emergent gameplay and a fantastic narrative that asks you to actually seriously participate in its scenario is what sets Pathologic apart from the crowd. They are not just separate factors that can be analyzed independently of one another but are actually intrinsically tied together. The hammer blows of the story can’t be delivered without the torment that the gameplay puts you through and without the narrative thrust to drive you forwards, there would be no motivation to participate in the gameplay. In fact, by separating out these articles into the body and spirit of the experience, I think I’ve actually done it a disservice as really the greatest way to experience this game would be everything all together, as one complete whole.
Much like the subject matter, I don’t think all that many people will actually take the time to read through the entirety of these two articles but if you did I implore you to play the game for yourself. Games are always better when you enter into them blind but Pathologic is so dense and so beautifully crafted that I think it is still an absolutely fantastic game even if you know the route that the story takes or have a heads up on the gameplay. There is so much I’ve not been able to touch on due to the risk of turning this write up into a short novel, which just means there is so much more for you to discover if you do decide to pick it up.
It’s been an absolute joy to play through the game and it’s been good fun writing up my thoughts. If you stuck with it all the way, I can only say thank you and I hope you’ve found this game to be as beautifully interesting and captivating as I did.
