“Are games supposed to be fun?” asks Harris Brewis, better known online as Hbomberguy, in his 2020 video essay on the original Pathologic. This question has stuck with me since first watching the video in question, as has his warning to not play the 2005 game, or it’s 2015 remaster. Thankfully, in 2019 developer Ice-Pick Lodge and publisher tinyBuild released Pathologic 2.

Pathologic 2 is a remake, remaster, and reimagining of 1/3^rd of the original Pathologic’s story. However, it is in no way less of a game. In the original, playing through all three routes would take roughly 60 hours. By the time I finished Pathologic 2, I had racked up 71 hours in the game. Yes, this number includes 2 restarts: once on the morning of day 4, and once on night 9. But this is a game where restarting is an integral part of the experience. Whether you’re reloading an earlier save, or beginning again entirely. Pathologic 2 is an endless rehearsal – that is, until it is done. But more on that later. Now, it is time to begin.

The Mechanics

Pathologic 2 is a first-person survival horror game, at its basic core. The game’s Steam page describes it as a “Narrative-driven dramatic thriller about fighting a deadly outbreak in a secluded rural town.” You have to eat, drink water, and sleep to survive. When you’re hurt, you have to use tourniquets and bandages to patch yourself up. Or you can “Pop a morphine and take a nap,” as I repeatedly put it while playing.  Resources are scarce, and always expensive. You might not always be paying in coin. More often than not you’ll be bartering with the locals – usually children – or spending your time scavenging. It is a ruthless yet satisfying gameplay loop.

Fights are brutal, quick, and easy to lose. They are not satisfying; you will want to avoid them. You’ll end up in fights anyways, especially at night. Running is an option and may be your best one, especially early on. Never take on more than one opponent if you can help it. If you play your cards right, you can get your hands on a gun within the first 3 days. That can even the playing field a bit, but in this game bringing a gun to a knife fight is not a sure bet. Especially since ammo is scarce, sells for a lot, and you’re always hurting for money.

Practicing Medicine

On the second and third day, you will add herb gathering. In many ways this is just an additional step of the foraging and bartering you’ve already been working on, but it becomes infinitely more important as time wears on. Herbs will grow around town, in the Steppe, and can be acquired by feeding blood to special roots.

Also, on days two and three, you’ll begin practicing medicine. People are getting sick, and you’re one of the (arguably) four doctors the town has. The medicine you’ve been brewing with the herbs you’ve collected can be used to diagnose patients. Eventually you’ll be able to brew painkillers and antibiotics, but those are no cure for the disease ravaging the town.

The Plague

Once the plague hits, you’ll also need to keep your friends, enemies, and loved ones alive and well. As you make your rounds, run errands, and follow dead ends, stopping by characters labeled as “In Danger” to give them tinctures to boost their immunity is key. You don’t want the people you care about catching the disease, as there’s no cure. Once infected, their likelihood of dying rises with every day they stay alive. Do what you can and pray for a miracle.

There are, technically, different difficulty levels. You can also adjust the difficulty of a multitude of different mechanics. The explanations in the settings are truly fascinating, and give a wonderful insight into the rationale behind the choices the developers made. I highly recommend going with the intended difficulty. It is punishing by design, and you will appreciate everything the game has to offer on a much keener level.

Music, Sound, and Visual Design

Opening up the game for the first time, you’ll immediately take notice of the score. Truly, I cannot say enough about the music and sound design in this game. Drums, strings, and haunting vocals pair with electronic distortion and synthetic beats. It is disconcerting, discombobulating, and an absolute bop. The music works well both as a background element, and as the focal point.

The Town Sings

Since most of the game is walking, you’ll spend a lot of time alone with your thoughts, taking in the sights and sounds of the nameless town. After a while, the music becomes a part of you. Audio cues become an extra sense to help guide you. The town and Steppe become alive with sounds. A low note alerts you to nearby danger, the buzz of flies signals nearby herbs. The timbre of the music changes and becomes distorted when you step into an infected or ashen district.

There is a type of dread this game is able to instill on a level of sound alone. Nothing is quite so intense as your nightly pilgrimage to the theater. Creeping along empty streets, balancing safety with resource gathering. Multiple times, I’ve spent an entire 2-hour gaming session dying over and over attempting to make my way to the nightly pantomime. The true Pathologic 2 experience is getting stabbed in the back over herbs, right after barely surviving a different knife fight.

The Set

Just as good as the sound design is the visual design – at least in my opinion. It is not a traditionally beautiful game. Not by a longshot. But Pathologic 2 isn’t meant to take your breath away with gorgeous vistas or charming characters. What it does with its visuals is phenomenal. The vast, foggy Steppe is both welcoming and intimidating. The town is at times familiar and comforting, at others grotesque and foreboding. Exhaustion and frustration drip off the character designs, even the children – children who look older than they’re intended to be. It’s as if the actors playing them are a bit older. NPCs reuse the same handful of character models, with some small amount of variation in hair color, like they’re all played by members of the ensemble cast.

Playing The Game

There’s an intentional theatrical element to Pathologic 2, in the characters, in the world, and in the story. You begin every playthrough in the town’s theater. After a brief conversation with Mark Immortell, the director of the play, you find yourself on Day 12, the last one. The one where everyone Artemy Burakh cares about has died. The one where The Army bombs the town. The one where you failed. The bad end from the original game.

Of course, if this is the first time you’ve opened this game, you’ll undoubtedly feel confused. Frustrated, even. “But I haven’t even done anything yet,” you’ll think as you walk to the cathedral. Bodies have piled up; plague clouds choke the air. “This isn’t my fault,” you want to scream at Mark after your pleas to the General and the Inquisitor fall on uncaring ears. The world distorts, time slows. You ask for another chance. A first chance.

The Beginning

In a frustratingly genius way, Pathologic 2 has already begun to work its magic on you. The stakes and stage have been set. In less than 5 minutes you know several important things. There is a deadly, impossible plague that is, has, and will ravage the town. The odds are stacked against you. You have less than 12 days to discover and produce a cure. And yet, despite all this, you can always try again. Mark Immortell wants his play to succeed, after all.

After being thoroughly disoriented, you wake up on a train. This is where the tutorial happens. Frankly, I have never seen a better in game tutorial. Pathologic 2 uses disjointed dream vignettes to organically introduce the player to who they are, why they’re here, and how the major game mechanics work. It tells you just enough that you aren’t overwhelmed by the sheer amount of questions it raises at the same time. Despite being unsettling and cryptic, Pathologic does a good job of establishing trust between the player and the developers.

The Real Beginning

After experiencing the bad end of the original game, and a deeply strange and unsettling series of dreams, the real Pathologic experience begins. And it begins, as it always does for The Haruspex, with you bleeding out in a train station after three guys attack you for no reason. Thankfully, if you’re nice to a kid in a dog mask you can fix up your health somewhat. But overall, your day gets worse from there.

Over the next 11 days, you’ll get to know the town’s culture, quirks, and meet its major players. Every non-ensemble member will appear in a menu, labeled as either Bones, Nerves, or Blood. People who are important to the function of the town are Bones, your family is Blood, and everyone else is getting on your Nerves. Oh, and people can change categories, depending on how the story goes. But that’s more for flavor than anything else.

The Magic of the Menus

Artemy Burakh’s various menus will be your home base as you navigate Pathologic 2’s story. The map menu shows you where everything is, and it evolves to have more information the more you learn and explore. It is also just a gorgeous piece of art and a fine example of maps in games. Your inventory and status menu shows you what you’re carrying and how you’re doing. You’ll spend a lot of time there organizing what you’re carrying and staring at your meters. This is frustrating, but in an intentional, engaging way.

Even more important is your thought map. The game is broken into acts, and each act has its own web of thoughts. You’ll begin with just a handful of thoughts and collect more as you follow up on leads, talk to people, and go about your day. The more you learn, the more thoughts begin to connect. You’re weaving a web of knowledge. Not all the pieces can be found, not all of them should be. You’ll find yourself staring at the empty circles and dead ends, wondering. Did you miss something important? Something obvious? Or is it something yet to be revealed? Or maybe you lucked out of a bad situation. There’s no distinction, no obvious way to tell. However, no experience compares to seeing different corners of the story start to connect. To being able to see the truth just a moment before you know.

The Walking

Getting out of the menus, most of the game involves walking. You do a lot of walking. There’s some unavoidable fighting at times, but usually you’re just walking. Or briefly running. But mostly it’s walking. And picking herbs. And rifling through trash cans. And then you walk some more. You talk to people, and then you walk to talk to some different people. You open up your map to look at all the places you have to go, you look at the time and feel your stomach drop. How are you going to do all the walking you need to do before time runs out? And time is running out.

Despite how monotonous the walking may sound on paper; I swear to you that it’s the most engaging gameplay you’ll ever experience. My roommates don’t believe me. The walking is necessary. The walking is important. Here, in Pathologic 2, your actions matter. You are real, and you are bound by the laws of its reality. Time passes, people die, and you have to walk. You punch a man to death after he attacks you. You harvest his organs to sell or study because you are in a desperate situation.

You keep on walking. The rhythm of your steps keeps you sane. The time allows you to process. When you sleep, you dream. Your brain doesn’t get to rest, you don’t get to process. Walking is your time to process everything. The words said, what’s unsaid. Events and dreams, sights and sounds. You walk the streets of this town, and as you walk the game happens.

The Heart of It

Peel back the layers of theatre, of video game, of earthen magic, and you find Pathologic’s beating heart. It’s a story about choices. About decisions. About not having enough time. It’s about trying to understand the people in your life and the decisions they make. It’s about trying to understand anything, really. A story about dirt just as much as it is about dreams. Pathologic 2 asks you to look at small society, a town with no name, and truly consider it. You have to look these horrible, wonderful, greedy, kind, stupid, brilliant people in the eyes and decide if they’re worth saving. Despite their mistakes. Despite everything. Your answer can be no, but you have to decide. Any choice is right, so long as it is willed.

What Is Pathologic?

Pathologic 2 is not fun. It’s not beautiful. It’s not satisfying. Not how we’re used to games being. It’s not technically challenging. The most difficult thing you do is walk, maybe throw a couple punches. It’s the hardest game I’ve ever played. It is a deeply compelling narrative that invites you to participate in the story. You have to participate in this story. If you put the game down, you’ve lost. That’s why it opens on failure, a failure you can’t have if you finish the game. You are responsible for the fate of this nameless town. Yes, you. Not Artemy Burakh. You’ve stepped into the role of his actor, and you have to see the play through to curtain call. You are audience, author, and player all at once. Every video game is like this, but Pathologic 2 makes you complicit in it. Makes you aware of it.

Once you get past the initial discomfort – if you can get past it, not everyone can – you will be changed. Pathologic 2 is fun. It is beautiful. It is satisfying, in ways that truly evade description. But I will try to describe it any way. It’s fun in the way reading a dense, philosophical novel is fun. Fun in the way a joke at a funeral is the best laughter you’ll ever experience. It’s beautiful in the way traffic on a rainy day is beautiful, headlights bouncing off puddles. Umbrellas and raincoats a technicolor sidewalk sea. Pathologic 2 is satisfying in the way doing your laundry is satisfying. In the way finishing any chore is satisfying. You did it. You put in the hard work, and now it’s done. You did it.

Final Thoughts

I’ll end this review as I began it: with a quote from Harris Brewis, “It may not be the game for you, but you should at least try it.” Buy it on sale for $5 like I did. Play through just day one. Just try it, for a little bit. It’s worth it, if only to try something new. It isn’t like anything else you’ve ever played. Unless you’ve played the original, of course, since Pathologic 3 doesn’t come out until sometime in 2025. While I’m waiting, I might actually play the original. Sorry, Mr Brewis.

Pathologic 2 is available on PlayStation, Xbox, and PC via Steam and retails for $34.99.