Pathologic 2 (Xbox Series X/S) Review

Every aspect of Pathologic 2 is designed to make the player suffer through their choices. Death is a constant presence. The town is dying from a deadly plague, and there are constant reminders both of one's own mortality and the mortality of others, which forces a confrontation on fears and anxieties about death. The protagonist Artemy is a Haruspex, which is a kind of doctor or surgeon, who has returned to his hometown. The Town on Gorkhon is infested with the Sandpest, which is transmitted through the air and can infect anyone, regardless of their age or health.

The symptoms of the Sandpest are varied and include fever, nausea, vomiting, diarrhoea, and bleeding. As the disease progresses, the infected person begins to develop pustules and ulcers all over their body. These ulcers will eventually burst, releasing a black ichor that is highly contagious. As a Haruspex, Artemy is the town's only hope for a chance for survival. The problem is there is no way to save everyone. The fatal illness always seems one step ahead of Artemy, and he must use all of his skills and cunning to both survive and find a cure.

Pathologic 2 explores the different ways that people deal with death. Some deny death, while others try to make sense of it through religion or philosophy. Artemy must find his own way to cope with the Sandpest in order to survive and help others. It's a very difficult disease to treat and there is no known cure, and the only way to survive is to boost immunity and manage the symptoms. Artemy can do this by using tinctures, finding rare ingredients, and making difficult choices.

Lockpicks are not just used to open locks, they can also be used as a stabbing weapon. There is a difference between selling and bartering - almost every NPC will be willing to barter at any moment and money is typically too rare to be relied on. Expect to constantly rummage through almost every trash bin for scraps of anything that can be used to trade because almost every step taken is a drain on Artemy.

Every doorknob and every room, no matter what the object is, the Sandpest infection is constantly looming. The stressful feeling in deciding on whether to eat and drink to keep hunger down, or to use the food for trading or to complete a quest is agonising. Running causes fatigue, but getting to places faster is crucial because everything is tied to an in-game clock. Too much fatigue means Artemy needs to rest, which also moves time forward. There is a twelve-day time limit and it's easy to have entire questlines end or fail because of the tightly connected systems.

The experience is unbelievably stressful and harrowing. Pathologic 2 revels in making gamers feel hopeless and distressed over everything falling apart. It can feel like having a bad day that continuously worsens. The only thing to do is accept a terrible fate and keep moving forward to see what happens next.

The survival mechanics are unbelievably challenging but rewarding. Resources must be managed carefully, and difficult choices taken in order to survive. There are often no easy answers, and weighing the consequences of every action is core to the Pathologic 2 experience. Combat is utterly necessary but is the ultimate risk because fighting causes injuries and depletes stamina, which feeds into time. If Artemy is lucky enough to have bullets for a gun, don't bother shooting because the gunplay is mutilated and purposefully unreliable. Ammo is best reserved for bartering.

Pathologic 2 frequently breaks the fourth wall to interact with the player. These "meta" elements can be subtle or overt, but they always serve to remind the user that they are playing a game. The entire world is presented in the form of a play; every character is an actor, and some are stagehands dressed in black. To die is to be recast, and the game itself is a meta commentary on the nature of video games and storytelling.

NPCs or townspeople will comment how nervous they feel around the player interacting with them, as if they are expecting at any given moment to be robbed or attacked. Theatrical elements such as spotlights, scene changes, and disembodied stagehands help to create a sense of immersion and to create an atmosphere of being part of a larger performance.

Visually, Pathologic 2 looks very strange. It has an old-world Eastern European flavour, and characters are very uncanny looking. During conversations, there will be uncomfortable close-ups with dramatic lighting, which is followed up with some non sequitur banter. The constant overcast and diseased look of everything and every NPC looking filthy makes Pathologic 2 get under the skin and itch. The way sound is used also seems like it was designed to cause stress.