Twenty-three people died last night. I couldn't do anything about it. Even if I had known how to save them I doubt I'd have been able to succeed. In Pathologic 2–a reimagining of the original Pathologic, itself a nightmarish adventure game from another era–you play a doctor who can barely save himself, let alone the wretched lives of those he encounters. Failure is your constant companion. Some games make you work hard for success, promoting that the rewards taste greater this way. Here, you're reduced to a beggar, pleading for the merest scrap, and even then Pathologic 2 will likely deny it to you.
Right from the outset, Pathologic 2 leaves you feeling disoriented. The prologue flits from one short, cryptic scene to the next, pausing only to let you ponder whether what you just experienced–a man waking from a coffin on a train, a fistfight among stone monuments, a giant bull, you murdering three men–actually happened or if it was a dream sequence or even some kind of hallucination. Once you've reached the game proper, two things become clear. One, you have arrived in town at the summons of your father, a respected surgeon, only to find him dead and you a suspect. Two, no one can give you a straight answer about anything.
This may give the impression that Pathologic 2 is something of a murder mystery. And in a sense, it is. Your father's death is the driving narrative force behind your exploration of your childhood home town. However, as you wander the streets seeking answers from important figures and old acquaintances, you reveal more mysteries to investigate. Why is the supply train late? Why are crows suddenly circling the old cathedral? What is this game the gangs of street children are inviting you to play? What's up with the impossibly-designed structure looming over the western horizon? And most notably, what's behind the apocalyptic plague now sweeping the town?
For the most part, Pathologic 2 is content to provide little in the way of answers to such questions, preferring instead to deal in metaphors, obscure Steppe mythology and sudden leaps of dream logic. Talking to a major NPC can very often feel like two people slinging nonsequiturs at each other until dialogue options are exhausted and the plot ticks inexorably forward. The writing here is mostly good, drawing on a range of rich imagery, so this is a deliberate stylistic choice to unsettle players through confusion and obfuscation rather than the result of inadequate translation from the developer's native Russian.
This sort of scattered, dizzying feeling of events that just won't quite come into focus is illustrated by what passes for the game's quest log. As you accumulate clues, they are added to your Thoughts screen and are represented by a floating collection of nodes, each one an idea or hunch that may connect to others or may be drifting all alone. Some of them do correspond to specific locations on the town map, helpfully proffering a rare moment of explicit instruction to "Go here," but typically they're little more than reminders of leads you should try to follow up somehow, if you have the time.
The passage of time is a constant pressure that reaches its heavy, nagging hands into every aspect of your travels. It's there in the day/night cycle that sees the streets become dangerous when the sun goes down and the plague's death toll ringing out when the clock strikes midnight. And it's also in the urgency felt by leads that expire if their deadlines pass unattended, causing you to lose out on experiencing situations that only occur at certain hours. You can't be everywhere and you can't save everyone, as the loading screens are at pains to frequently remind.
It's hard enough finding the time to save yourself. Not because you've been accused of murder and it's going to be difficult to clear your name, but because Pathologic 2 is a survival simulation at heart, and one that is unusually obsessed with the physical body. You have an overall health bar that is supported by secondary hunger, thirst, exhaustion, and infection meters, and it is to the game's detriment that you spend most of your time fretting about survival instead of contemplating the more metaphysical matters of the story.
These survival mechanics might have made you feel stressed about the dire circumstances you're in–and on a deeper thematic level got you thinking about the collection of blood, nerves and bones you comprise–but the execution here is lacking. You're in a desperate situation, there's a plague that has everyone scared, there's a genuine shortage of supplies, so yes, it makes sense that you'd be forced to scavenge for scraps of food and barter with other townsfolk for some repairs to your clothes. The idea is sound. In practice, Pathologic 2 has you rummaging through every trash can, hitting up every NPC for a trade, and breaking into every home you pass in the hopes of finding a way to support the dozen or so meals you need to consume each day just to stay alive.