Pathologic 3 Review

Developer Ice Pick Lodge keeps returning to this same canvas, finding new ways to retell their greatest tale. If you’ve not been tuned into the Eastern European video game landscape, you may be blissfully unaware of the first-person plague doctor misadventures of Medical Bachelor Daniil Dankovsky, Haruspex, and the Changling. It’s sometime during the early 20th century. These three characters each arrive in the mysterious, mostly illiterate town-on-Gorkhon at the beginning of a twelve-day pandemic that will see it wiped out. In Pathologic, players are typically pushed towards Dankovsky for their first playthrough. The unchosen healers would still occupy your story, pursuing their own solutions to the plague in parallel but without the sage guidance of an almighty player possessing that all-important power for countering fate – the quick load. 

Bear with me here. Pathologic 3 is the same setting, characters, and story as the previous games. Where the original game aimed to tell three stories in one, the subsequent games remade one of those stories, or perspectives, each with far greater focus. This go around, prepare to be locked into the fractured psyche of the infamous snark lord, the emo-fringed Bachelor of Medicine, Danny Boykovsky. Daniil Dankovsky – easily an all-timer for characters you will love to hate, but ultimately love, and yet still hate.

The blurred lines between science and superstition make diagnosing patients difficult

By revisiting Dankovsky’s point of view here, he’s taken advantage of the medicine cabinet in an effort to incorporate the quick-load into his medical mission. Inexplicably, he can now use mechanical clocks (the save points of Pathologic 2) in districts free of plague and rioting as time manipulation nodes. Walk up to one, and it asks if you would like to ‘see the past’. From here, you can access the beginning of any one of those 12 days on the town that haven’t succumbed to an annihilation event. Before your chosen day kicks off, you’re treated to a flipping headache of a mindmap covering the day’s major events and how your myriad decisions affect them. If you want to test the butterfly effect, you can choose outcomes to alter. If you’ve not yet experienced that day before, you must first undergo an episode of your post-pandemic debrief (interrogation) that takes place some time after your visit to The Steppe. With that out of the way, the chosen day begins. You then get out of bed, have a terse exchange with the tragic housekeeper who yearns for you, and Groundhog Day your way towards a new chain of events that might ultimately get you closer towards a vaccine for this town. Or the key to immortality. Dankovsky would really like that too. 

Nothing in Pathologic 3 presents quite like other video games you’ve played, even if you’re a new or returning player. The first ten hours will have the player navigating high-risk dialogue with dozens of locals, many important and recurring, some just considered ‘pawns’ in the great intellectual chess game being played out by the town’s shadowy power brokers. An efficient player will continually reset their given day, wringing out every important dialogue interaction and quest line. A day ticks by fast, you’re the only medically accredited doctor in town, and sickness is spreading fast. You cannot be everywhere at once. You can, however, chase one thread, successfully treat a patient, and discover a few more hidden mysteries in town before restarting the day and choosing which knowledge and progress to keep or alter. 

My favourite/least favourite journal in a game

Dankovsky is the most unreliable of narrator protagonists. He will mumble about events he should be unaware of, aggressively spout Latin whenever he feels cornered, and generally talks down to everybody around him and then wonders to himself why his questlines hit dead ends. Hours upon hours of decision-heavy dialogue will have taken place. The short-term consequences will be the effects on the doctor’s binary mental state. If he gets too excited from your dialogue choices, his heart races. And so can he. High mania has Dankovsky comically darting about the streets like he’s using speed hacks. Barely anybody wants to talk to you because you’re sweating bullets and scaring them, and then you drop dead because your heart gives out in this state after too long. Alternatively, the bachelor can reach a deep state of apathy during a dialogue and decide to end it with his peashooter Debutante to the temple. A handy item to have during a pandemic like this. Ironically, he will only use it on himself. The long-term consequences of conversations, however, lead to dizzying waves of flow-on effects and mindmap clutter that you’re going to have to unweave if you want any ending that doesn’t involve flames.

Your character is a bit messed up in the head and is prone to a bit of reality breaking

By the time the player has proven they can survive a few days amidst the hostility of a lockdown, a couple of major gameplay elements are introduced. Halfway through the first week, players will open an emergency hospital and also be anointed the de facto mayor of plaguetime. Each day, players will need to diagnose the intercurrent diseases that a handful of patients possess alongside their plague diagnosis. Successfully diagnose the patients to develop a limited vaccine for that day. This makes it safer and easier to navigate the town for the day. The diagnosis procedures are an entirely involved side game, which also can have players running about town, playing as Dr House while they break into patients’ homes for further information. If all this invasiveness upsets the local rabble too much, that’s okay, you’re also in charge. Install a couple of decrees for the day, distract them with food and fireworks. Decrees also backfire; your subordinates are illiterate and driven by superstition, but that’s all part of this game’s warped sense of fun. 

Remember how good social distancing was? Will you enact it?

There is no doubt in my mind that some genius designers and writers are working at Ice Pick Lodge. Yet I have lost count of the hours spent fruitlessly chasing narrative threads that wouldn’t progress. Virtually every conversation has the pressure of seeding events across the past, present, and future. Variables such as the time of day, character schedules, and whether they’re even currently alive all carry weight. Our protagonist will reflect on this, as will you. All it takes is a choice line of dialogue to not populate in a conversation already a dozen responses deep, and you can be chasing your tail around town while wasting precious resources to no effect. But those cheeky writers will take you aside every now and again to quite literally tell you that your character is a bit messed up in the head and is prone to a bit of reality breaking. Let me run that back: often this game hides its glitches behind a veneer of vaguely self-aware sophistry and surrealism. I love this more than I hate it.

At 65 hours, I have chosen to resign the town-on-Gorkhon to its worst, inevitable fate. I diagnosed every patient. I saved almost every named character. I even tried my best to create a cure. Unfortunately, with the solutions on the table before me, I decided I could not be fucked to resolve any further time towards a better outcome. The reason: too much unintentionally broken game logic that the player is expected to doctor, unless they can patiently await the patch that fixes it. Unless your save has permanently broken logic events, which mine has a couple of. You can get lucky and find a way to bypass or cheat the game’s complex logic states, which I think might have eaten a bit of my own psyche. Add to this my growing frustration at a complete lack of subtitles, unforgiving resource management in the late game in the face of bugs, and the underdevelopment of the game’s fleeting attempts at scares, and I’m left in a fragile state not unlike my dysfunctional hero.

Start carelessly shooting rioting civilians, and Daniil will finish off the chaos with a self-administered bullet

Final Thoughts

Another captivating entry in the best series you probably shouldn’t play, Pathologic 3 is currently a compelling exploration of morality, art, and science in the most curious and complex microcosm of fictional cultures. In video games, at least. Once again, Pathologic leaves behind conventional gameplay experiences in favour of a complex conversation with the player that will, as intended, leave deep emotional impressions. The illusion of a dynamic town that responds to your every effort to cure a plague and control a quarantine is compelling when it appears to be working. Alas, those that make it to the late game are going to be plagued with diseases of the blocked quest variety that are surely to drive early adopters a bit loopy, also. 

Reviewed on PC // Review code supplied by publisher

Click here for more information on WellPlayed’s review policy and ethics