Pathologic 3 review

The Pathologic series has a reputation for being mechanically challenging, narratively dense, and positively grim. As you'd expect from games about surviving in a plague-ridden turn-of-the-century Russian steppe town, inspired by the most dour of classical Russian theatre. What I did not expect from Pathologic 3 is how often I would be laughing out loud, and how deeply I would resonate with its multi-layered protagonist, Daniil Dankovsky, Bachelor of Medicine.

Despite its place as a vastly expanded reimagining of one of the 2005 original's three plot routes, Pathologic 3 is a great starting point. While there's plenty of little references and twists for returning fans like myself to chew on, newcomers looking to recapture the spark of Disco Elysium should look here. While Daniil isn't quite so fragmented as Revachol's defective detective, he does contain multitudes. Two core pillars I identified quickly, with a third hitting like a perfectly-timed punchline.

Everybody lives!... Maybe

Core to this man is Doctor Who. Specifically, a blend of the most baffled and driven incarnations. Wrapped in several layers of narrative framing (unreliable perspective-hopping narration, perhaps some kind of theatrical play, maybe hallucinating), Dankovsky may be a continually griping, arrogant misanthrope, but he still wishes to save everyone, even if they seem to have a death-wish. But there's never enough time. Too many cases, too many places to be. Too many trolley problems to solve.

Fortunately, the nameless Town on the River Ghorkon is a mystical place, inhabited by strange, superstitious families, mystical steppe-dwelling natives and filled with impossible structures that tower above the early 1900s architecture, which would make it a lovely place to walk around if I wasn't sprinting frantically from problem to problem. Touched by the town's magic (or just telling his story badly and out of order), Pathologic 3's key mercy is that (at the cost of manually saving and loading) you can warp to any day that the town still stands on in search of a better ending.

To reach any ending, you'll have to abuse that timeline. This is one of the few games to capitalize on how much of an emotional rollercoaster time travel is, conceptually. You can repeat each day as many times as you want (with successfully completed quests staying done on return loops, reducing pressure) until you get everything perfect. For the first third of the game, I felt that everything was coming up Dankovsky.

But this is Pathologic, pisser-in-cornflakes. Not to spoil too much, but many of my very clever early decisions ended up resulting in the deaths of half of the major characters, sending me scurrying back through time to systemically unravel my own actions, and find cunning ways to cheat fate through a mountain more multi-choice dialogues, piecing together the game's unhinged visual hybrid mind-map and quest-log.

Temporal instability isn't helping Daniil's mental health, which seems like it was pretty bad even before getting trapped inside a plague-ridden madhouse of a town. As well as the constantly ticking clock, half of Pathologic 3's mechanical stress comes from balancing an ever-present gauge measuring his Apathy and Mania, which every dialogue option has the potential to throw towards either extreme.

These moods can be regulated through interacting with soothing or stressful items in the environment, or dipping into his doctor's bag. Keep him hyped up and he'll move faster, but take steady health damage. Let him slip into apathy and he'll move at a crawl, slowly bleeding the semi-limited currency you need to travel through time. A constant stress, designed more to FEEL suffocating than actually hurting you.

It's never lupus

Those mood swings tie into the second cardinal part of Dankovsky. A role I found exceptionally fun to play, mechanically and narratively; Gregory House. In order to create a stopgap vaccine to suppress the plague daily, you need to correctly diagnose several people whose plague symptoms are suppressed by a second, mystery affliction. Each day, like an episode of the TV show, there's a couple side-plot characters who you can diagnose through interviews, tests and a bit of deductive reasoning. But also, there's the Patient Of The Week.

There's always one, and they'll lie, mislead, and send you investigating, interviewing friends, family & witnesses. Picking apart their homes, eliminating false positives, narrowing down diagnoses and calling out the lies, often ending in a cathartic and sassy denouement. Pathologic 3 contains a whole series of these tightly-written mini-mysteries, which are just part of a much greater whole.

Time-travel and diagnosis dovetail at the Decrees board, a strategic layer providing an overview of the plague's progress and disorder in the town. Here you assign daily orders (unlocked through completing quests, creating vaccines and other successes), and try to buy time. This, in turn, unlocks more days to travel to. But no good deed goes unpunished, and even the smartest, most scientific solution to the plague has potential to backfire, at least a little.

That third, vital part of characterization, and core to Pathologic 3's humor, is being the ever-suffering straight man in charge of a theatre of lunatics. No matter what you do, no matter how well-intentioned, there will be repercussions. Sometimes tragic, but often deeply funny. Not quite a failure, but a sharp slap to remind you that best laid plans often go awry.

Pure muppetry

Case in point: Install UV lamps to disinfect building entryways and the townsfolk start angrily setting piles of furniture on fire, misguidedly believing your decree to be 'sterilize all wood'. Attempting to talk sense into the crowd will escalate into a confused, nonsensical argument dragging Daniil further and further into Mania, culminating in a sprint to the nearest playground to soothe himself on the swings and roundabouts, or slamming a morphine ampoule like a 5-Hour Energy shot just to stop his heart from exploding.

It was at this moment, I realized I—and, in turn, Daniil—was also Kermit The Frog.

Related from a distance, grim, but as an intersection of writing and mechanical feedback, it is shockingly funny. The comic writing and timing are spot-on, and consistent enough to offset the depressing subject matter. Pathologic 3 never pulls punches, but sometimes it slaps you with a clown's banana-cream pie instead, and all you can do is laugh. Or scream and flail your arms. It's not easy being green.

Neither is it easy to navigate the streets of this town when dialogue is no longer an option. While Pathologic 3 ditches most of the fiddly survival mechanics of the second game, it isn't without mechanical challenge, especially when it forces me to navigate districts of the city either overrun with plague or doctor-hating rioters. The latter is relatively easy to deal with, just exhausting - waving my pistol (loaded or otherwise) in the face of an assailant has them reconsider their attack, but it can still be a drain of health and time.

More fiddly is the plagued districts, where Dankovsky gets to directly battle the Shabnak. The mythical steppe golem - a boogeywoman in previous games, now tangible and living avatar of the plague. A survival horror stalker-monster that'll stall and menace you, and do heaps of health damage if it catches up as you try to hoof it across the fog-shrouded, Silent Hill-esque infected zones.

Thematically? Thrilling, leaning into the idea of Daniil being attuned to the mystical, despite being a man of reason. Mechanically? Busywork, especially when I figured that the optimal path requires hunting the hunter with a single-shot projectile available only once per day. Not a terrible experience, but simpler and flatter than the game's other, more narrative-led elements.

Broken fever

Of course, as with any game of this kind of genre-juggling ambition, not every one of those rough edges is intentional. While the prose is uniformly excellent, more than a few typos slipped into the final script. The English voicework is of variable quality too (with Daniil himself somehow managing to mis-pronounce 'Steppe' as both 'Steep' and 'Steppy', which is very funny), which wouldn't be so much of an issue if there were any subtitles on the (intermittent) spoken lines.

Ice-Pick Lodge have already released several patches and outlined that most of those issues (weird line-reads aside) are being worked on. but at the time of writing, they're still issues. Beyond that, some things got under my skin. Sometimes it's not very intuitive which dialogue options will spike my Apathy or Mania, and on lower-end machines, the plague-ridden areas of town can hit the framerate pretty hard.

But even with these flaws and the action mechanics not quite gelling as well as they might, it didn't dull my obsession with the game, that kept me hopping between days, wrangling timelines and obsessively trying to fix past mistakes. The feverish, emotional highs far outweighed the irritations, and I'm almost ready for a second trip through. Almost.

Seeing just one of Pathologic 3's many endings (taking over forty hours) has left me drained, emotionally and mentally. Perhaps I'll give it a few months and a round of patches more before I return to the Town-On-Gorkon. But I will return. Like Disco Elysium before it, this game has wormed under my skin, and I need to see where its many alternate plot-threads and permutations lead.