Pathologic 3
Review
This Game Is Sick
by Quinn Levandoski
reviewed on PC
Jumping In
It's rare for me to jump into a modern game franchise without having played any of the previous titles, but I think it's important to frame my opinions on Pathologic 3, as I've never played one of these games before. I've heard the name and was vaguely aware that they dealt with addressing illness, but beyond that, I went into Ice-Pick Lodge's brain-bending adventure free from preconceptions. I'm sure that comes with both pros and cons, but I've heard chit-chat here and there about the game eliciting pretty strong reactions for how it does and doesn't carry on traditions from its forbearers. Well, taken on its own accord, Pathologic 3 is a grim, often depressing, sometimes frustrating whirlwind of an adventure that ends up being a solid way to spend time - and travel through it.
Continuing in that regard, I was initially concerned I might have some catching up to do with the story so far, but that didn't seem to be the case. I can't speak to whether there are any returning characters or story references from games past, but if there are, it didn't stop me from feeling like I got a full experience here. If you've also never played a Pathologic game, fret not about jumping into number three.
The narrative itself starts off relatively simple. At first. The player character is Daniil Dankovsky, a doctor in a vaguely 19th-century setting obsessed with finding the secrets to overcome - or at least better understand - death. Convinced that truths beyond the understanding of science exist in the countryside, he travels far into the Eastern Steppe to a small, odd, sometimes charming, and sometimes terrifying little town where reports swirl about an immortal man.
Of course, as the name Pathalogic implies, townspeople aren't destined to stay healthy very long. In fact, it becomes immediately clear minutes into the game that something's off here. The kids speak like philosophers, but also have a weird obsession with death and killing. Townspeople - including strange women wearing nothing but tiny scraps of torn cloth - speak in strange terms that sound super culty. About life, about death, about sex, and just about everything in between. More concretely troubling is that - according to them - a killer arrived at the same time as Daniil and went on a murdering spree almost instantly. If nothing else, Pathologic 3 gets credit for going straight to bat-shit crazy without wasting any time.
Out Of My Mind
Before the proper troubles are introduced in full, players get to experience one of the unique gimmicks (and I don't use that term negatively). Daniil may be an educated doctor - and he won't let anyone else forget it - but he's far from mentally stable in a traditional sense. His mental state is represented atop the screen by a spectrum from apathetic to manic, each with its own perils and perks. While encounters and experience will naturally shift his state of mind, the wonder (and horror) of drugs can be used to change how he feels as well. Many chemicals and natural medicines are labelled as addictive, meaning they get less effective each time they're used. The crafting of medicine, including its effects on Daniil himself, is one of many layers of stress that pile up as things get rolling. It's mostly fun, and it feels like Daniil's mind requires too much babysitting. Which I suppose is just life.
But Daniil isn't just here to take on some run-of-the-mill colds and injuries. Instead, a mysterious plague seems to be encroaching on town, and the good doctor has exactly 12 days to take care of business. Though the town is shown to be one of meagre means from the start, everything starts to break down incredibly quickly, and things get really depressing, really fast. Players do what they can to help people, but some people simply can't be saved, and as resources and time run thin, there are choices to be made about who to save and who isn't quite so lucky.
How Can I Help You?
Playing doctor isn't just a matter of clicking through some dialogue. In fact, the entire patient-diagnosis system is a big part of the actual gameplay. It's a multi-pronged system that includes dialogue but also requires physical examinations and actually going about town to investigate them and their surroundings. Moreover, this is complicated by the fact that, sometimes, people just lie. They'll lie about what they've been doing, how they've been feeling, their symptoms, and more. It's a wildly clever and usually very fun system that encourages - nay, requires - good detective work, and succeeding in putting the pieces together feels great.
Dealing with sick people and an encroaching plague means that time is of the essence, but Daniil has a huge ace up his sleeve. Though he's only got 12 days to fix what's going on, he can engage in some casual time-travel, letting him go back and do things he didn't do, undo things he did, make different decisions, and uncover secrets. To be honest, it's a lot. It's a lot in a mostly good way, but it's a lot, and with everything else going on mechanically and narratively, it's sometimes a bit overwhelming, especially when you're forced to do some tedious running around because of a mistake you didn't know you were making.
Having to go back in time to let someone die that you had previously saved is a real gut punch. The whole game is a gut punch because people dying is necessary. There will be lots of pain, whether you, as the player, are the cause or whether you're a helpless observer. You can't just be really good at the game and save everyone - progress takes sacrifice, and there will be blood both because of your decisions and despite your best efforts.
Overall, Pathologic 3 is a thoughtful, stressful, exciting, and depressing adventure that is well worth playing through, though it's probably not one I'll want to revisit again in the future. That's not really a bad thing, though. The beauty really is in the journey here, not the destination. Though some mechanics can feel a bit too unforgiving or tedious, they're at least all interesting.
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8.0
fun score
Pros
Engaging patient diagnosis system, unique mental state spectrum, time travel mechanics and narrative that generally work well
Cons
Some of the mechanics can feel tedious or overly punishing, and traversal is sometimes a chore.
