PATHOLOGIC (2005) is an open world horror survival RPG set in a remote Russian town at the beginning of an outbreak of a deadly plague. Players take on the role of one of three healers - the Bachelor, the Haruspex, or the Changeling, each with different stories and gameplay mechanics. The game was remastered in 2015 as PATHOLOGIC CLASSIC HD, and a sequel / reboot was released in 2019 as PATHOLOGIC 2 - however, P2 only has one playable route, the Haruspex, and PATHOLOGIC 3 is set to be released shortly, which will be the Bachelor's route! this page will cover my thoughts on all of the games, as plot-wise, they are much the same, and i do intend to 100% every single one of these games as they come. and, be warned - rampant spoilers ahead! i'm going to be talking freely about this game, it's endings and themes and everything inbetween under the assumption that you've got some knowledge of the core basics of this game and what it's about.

there's gonna be a fair bit of yapping here so here's some links to specific sections:
initial thoughts ✸ videos & other stuff about the game
pathologic classic hd ✸ pathologic 2 ✸ pathologic 2: marble nest
pathologic 3: quarantine ✸ pathologic 3

initial thoughts:

i'd heard about this game, probably like many others, through video essays on youtube that kept trying to tell me i would hate this game if i played it. and i took that personally.

the main consensus around pathologic, namely the original game and it's remaster, seems to be: it's absolutely fantastic, if you can slog your way through it. it's unforgiving, it's hard, and it is a LOT of slow walking and reading. luckily, i'm a DISCO ELYSIUM fan, and all of these words are good things to me. and to be honest, my hot take is that the game isn't really that hard - it's just not explained very well. once i got into the groove of things, i managed completely fine. it's difficult, for sure, but manageable! it's also a remastered 2005 video game, so you just gotta know how to exploit it's inhernt jankiness and you'll be just fine. why risk your health by fighting enemies when you can just enter the nearest building to despawn them! easy!

you're gonna hear me call this game a difficult nightmare and an awful game quite a fair bit in these reviews but i mean this from the bottom of my heart: i love challenging games. i had so much enjoyment out of finishing days in pathologic classic, but god knows i had an awful time doing it- but that's what drew me to them in the first place! i love a challenge, the second i learned that there was several paths and endings, i had pretty much decided i would be 100%ing these games entirely.

Pathologic: Classic HD (2015)

steam page ✸ achievement progress: 42/42

first off, i played the classic HD version in order, following a spoiler free achievement guide just to make sure i didn't miss anything! here's how it went.


THE BACHELOR

the premise is this: you are daniil dankovsky, bachelor of medicine, a doctor and researcher from the capital who has come to the town to speak to a 150yo man who may be the key into his research - to cure death itself. the bachelor route is the recommended starting route because he is entirely a newcomer in town with no prior connections to it or it's traditions, much like the player.

first of all, my favourite thing about the bachelor's route is that when you look up guides on his run, they all say "DON'T LET HIM BE MEAN TO PEOPLE IT WILL TANK YOUR REPUTATION" and i thought, not that bad surely? and then i opened one (1) dialogue box and realised this guy is such an asshole. miserable prick. i love him.

i actually found the bachelor's run to be particularly challenging, despite it being the first one you're supposed to do, and that's simply because it throws you right into it and i had not realised how difficult time management would be, and i was terrible at reading the map. i found it very tedious to get through, but i think that's only because i already knew how the bachelor's route ends, so i had no real motivation other than just Getting It Done. but i can tell you one thing, the video essays telling you it's slow and boring to walk everywhere really do not effectively convey exactly how slow and boring it is to walk everywhere. i ended up having to walk sligtly diagonally for the end half of the game just because it makes you walk sliiiiightly faster and i needed every millisecond on my side. it was ridiculous.

i was managing pretty fine during this run until about day 9, when they introduce the army and, with them, a new obstacle in town called the flamethrowers, which are people with big fuck off flamethrowers that torch anything that might even have the vibes of infection. that includes the plague-infested rats that were constantly chasing me around town, and so i kept being baited into the line of a flamethrower and borderline torched to death and forced to restart my game. i got very good at quicksaving and quickloading before turning corners, i tell you.

maybe it's cheating, but i kind of very quickly gave up making an effort to cure myself of the plague if i did get infected. it's difficult dodging the infection; those plague clouds come out of nowhere, you have to visit infected districts occasionally, the goddamn rats, etc., however the cure items were all so much more valuable than 3 real life hours of my time that i very frequently just ended up loading earlier saves if infected.

all in all, the bachelor run took me 27 hours to get through. my ultimate ending choice was to destroy the town and save the polyhedron - recognizing this is the "wrong" choice, but knowing that it's the bachelor's ideal ending (also, after the gruelling, frustrating hours i had spent running around doing fetch quests for ungrateful assholes i actually personally found a tiiiiiiny bit of satisfaction in flattening the settlement). i did every side quest and got all of his achievements, and i enjoyed it!


THE HARUSPEX

the haruspex is artemy burakh, a surgeon and son of a local healer who has returned to town to find that his father has been murdered, and he is the primary suspect. you start the haruspex's run right after being jumped by three men; half health, high exhaustion, and abysmal reputation so bad that the people in town will attack you on sight, and the local stores will not sell anything to you to help.

right off the bat, starting with the haruspex feels like a completely different game. the first thing you do, after the self defence murders, is find out that you can take dead people's organs out and use them to barter with certain people. you get thrown instantly into the shady underworld of the town, as well as tangled up with the kids and orphans. despite all these differences, i had a much easier first day as the haruspex. i knew the map, i knew how to be prepared for day 2, and there was a lot less running around through identical buildings to figure out who the hell i'm supposed to be talking to.

cruised along pretty comfortably for the first 6 days before getting my first inevitable infection after being jailed in a small room with two unavoidable plague clouds. it was gonna happen eventually, high immunity or not. something else that's making this run exceptionally easy is that the haruspex gets to make all sorts of twyrine mixtures for immunity boosts and i was getting along VERY comfortably before this (and possibly a little complacent LMAO). the horrors perist but i stay silly.

it took me a MUCH quicker 18hrs to get through the haruspex run and that is absolutely entirely due to twyrine mixtures, a completely OP ability - making mixtures to boost immunity and health - that made this game a breeze. no reloading, no panicking about the plague. life is good and simple - i think also having that knowledge of the town map and the process each day was going to bring was also what made it so much more streamlined. plus, i was very invested in the haruspex run much more so than the bachelor's. like i said earlier, i love the lore of the town and the steppe traditions and medicine. it's one of my favourite aspects, and it is very, very heavily explored with artemy, and opens up a whole world i only saw glimpses of in the first run. the ending i chose for this run was to destroy the polyhedron and keep the inquisitor alive. i finished all side quests and got every optional achievement!


THE CHANGELING

the changeling is a young girl named clara, who is found at the bottom of a freshly dug grave on the morning of day 1. she is a mysterious character, either hated by the town or revered for her ability to harm or heal with her bare hands. rather than weapons, clara will use this ability throughout the game.

i never hear people talk about the changeling route, and while playing it, i can see why. i'm not sure if it's just fatigue from doing the third run in such a short amount of time, or if i am just better at the game now so everything seems more trivial and not so difficult, but i've found clara's route a bit too....slow? easy? i have most of the quests done and out of the way by 11am. her story IS interesting, it's fascinating to get some insight into her actions that are hinted at during the other two character's runs, but aside from that, it feels very fetch-quest-y for the same two characters.

ALRIGHT. i'm writing this bit after finishing the changeling route and i can honestly say - yeah, this was not very enjoyable. it really was just fetch quests, which i know is kind of the basis of the whole game but there felt like there was narrative amongst all that. clara specifically is just too mysterious of a character imo and the game does not want to give too much away about her, and her route suffers for it. i was very bored. the other thing is as well, the other two characters really do rely on you toeing the moral line properly otherwise things are difficult for you. it would be easy to shoot your way out of every situation, but then your reputation will drop and everyone will be out to get you, making things much harder. unfortunately, clara's reputation is constantly dropping. like even if you do nothing but good deeds and keep your rep at 100%, the game will drain it as part of her run, so. what's the point, yknow? i will just shoot my way out of every scenario, the town will hate me anyway. she doesn't even need to shoot! she has magic hands! i don't even have to strategically conserve ammo! sure, it was interesting getting to see what she was up to while the other two ran around looking for a cure but ultimately, i did not need to have over 10hrs of boring gameplay about it. i know. i know the game is notoriously boring. i know it's a walking simulator (derogatory). but the other two routes are at least challenging, this one is not.

the changeling's route was my fastest run, clocking in at 13 hours. this is for a mixture of reasons: VERY familiar with the map plus clara has access to the map of infected and abandoned districts, meaning i could just bypass areas that would be hard to navigate. i had less issues with conserving my resources, i didn't need to go out at night and kill bandits for money - i could just break into homes, kill the residents, and steal their food. because my rep was abysmal and everyone attacked me anyway. and finally, i was getting most of her quests done by midday and just sleeping until the following day to progress the story because i had nothing else to do. i did get the one final optional achievement, as well as the achivements for each day, meaning i have officially finally 100%'d this game! the ending i chose was, of course, the changeling's ending - kept all of my bound alive and then just picked the first 7 to sacrifice because i truly do not like any of clara's bound whatsoever, they're deeply unpleasant - and did not destroy the town nor the polyhedron.

overall thoughts (so far): i'm enjoying the flow of this game. i don't mind janky games, so that doesn't bother me too much - even if i am sideways strafe walking to go 0.2s faster to stop myself from going insane over the time constraints. i like that all three of our characters are tied into this narrative and playing as the next two characters, i will presumably get to interact with them there as well. very excited for the haruspex run, though i know he's much more difficult. i do also loooove this soundtrack, like a whole lot. it's very gritty and industrial, there's some real off-putting and unsettling tracks in there. this game has a phenomonal atmosphere and does it's job at pressuring you into feeling like you don't have time for everything exceptionally well. it wormed it's way into my real life dreams as well this week, so that's quite an achievement.

i am enamoured by the story and lore of this little town. there are traditions and culture and healing practices that occur in the steppe that are only ever alluded to in the bachelor route, as an outsider, but are elaborated on much more in-depth and play a major part in the haruspex route. there's impossible geometry and some magical realism and some absurd surrealism that i think comes together so perfectly to give you that unsettling sense that something is very odd in this town and there's much more to it than you think. AND - i'm not even going into the overaching theme here of theatre, and how this is all just a play, and nothing is even real and your entire existence here is in the hands of two bored little kids at a funeral but that is way beyond the scope of my quick little reviews here. i'll link a bunch of videos that analyse the proper, true themes of this game at the end of the page.

i also want to talk about the soundtrack quickly - i have come to really, really appreciate the music in pathologic. it's incredibly industrial, grim, kind of ominously looming, almost. each track has a day version, night version, and a disease version for when that area has been infected. they all sound fantastic. one of my favourites, and likely the first you'll notice as it plays in the area the bachelor begins in, is UTROBA MAIN. most of the town's music sounds similar to this but this one specifically feels like the calm before the absolute chaos later on. but my absolute, complete favourite is the steppe's theme - STVORKI MAIN and it's night version. it's so unlike the majority of the music, this ethereal, primal, otherworldly track. you dont really get this experience on your first playthrough as the bachelor, you have absolutely no need to go into the steppe (i maybe skirted the edges a few times and heard the first few notes of this track, but never spent any time in there properly), but you do have to spend a lot of time out there as the haruspex and it does a brilliant job of making you realise there is so much more to this game you did not know about. whole different world the second time around. this ost is brilliant - you can listen to the whole thing on youtube.

final thoughts: i began this game on july 12. i finishied it almost exactly a month later - today, aug 13. i spent almost 60 total hours playing it, managing to knock out two days each session. it was very tiring by the end, but i'm really glad i stuck with it. the game is frustrating, but not as hard as people make it out to be. if you just play smart and pay attention, you'll be just fine - i do also think a guide is completely necessary for both getting the full experience of everything, and for not quitting out of frustration halfway through. this game does not hold your hand and direct you nicely, which i really preferred!. the haruspex run was by far my favourite, and i appreciated being able to look into the town and it's history and lore from his perspective. i do really appreciate the bachelor run as well, i think the things going on outside of the town-on-gorkhon are equally as interesting, though it's not touched on very much. the game itself has an intentionally vague setting and time period, which i like a lot. it adds to the intrigue and mystery of the town, keeping it in that weird suspended ethereal state that it gives off.
would i recommend this game to anyone? not necessarily. i think you have to be some kind of crazy determined to get through it (only 2.7% of players on steam have the achievement for finishing the final day). if you enjoyed games such as DISCO ELYSIUM specifically for the reading, worldbuilding, and story aspect; yes, i would recommend this to you. the world is wonderful, a lot of love went into it. you should be prepared to read a lot about it though. slow walks from point A to B just to learn a little more info is what this game is all about. there are a bunch of very good video essays that cover it well, but it is a massive and involved story to discuss and you will not get the full experience without playing it yourself. don't be discouraged though! i've got some really good videos linked at the bottom. check them out & if you think it looks like something you're willing to play, absolutely do it.
did i like it? yes. i really did. it has it's faults and it is deeply frustrating, but i knew that going in. they really did not detract from the experience that much imo. i loved playing and exploring this game, i also feel very proud of my achievement of getting through it! it was an excersize in patience, that's for sure. i haven't even talked about the smaller details i really loved: the earth being alive, twyrine being the earth’s way of returning the souls of the dead, the town being built on the back of a symbolic bull, the polyhedron damaging said sentient earth-bull symbolic creature, the blood from the earth being spilled by the polyhedron being the haruspex’s cure for the plague, the way the map slowly comes together to form a picture of this as you learn more and more about it each day... there's so much to this. so much. i love it dearly, it was a fantastic experience.

i am really looking forward to playing pathologic 2! it looks beautiful and has massive quality of life upgrades, and is specifically my beloved haruspex's run. my plan is to take a week or so break from patho in general and then i'm gonna get right back into it with fresh eyeballs and motivation :)

Pathologic 2 (2019)

steam page ✸ achievement progress: 29/50

i am currently working on my playthrough! just adding to my thoughts as i go :) currently on day 8/12

Pathologic 2 is purely the Haruspex run. it starts you right in the final hours of day 12, in the theatre, surrounded by the sick and dying. looking around, you’ll see the bachelor and the changeling in there with you. you can talk to your two other healer companions and get the sense that something has gone horribly wrong, and the rush for a cure was all a lost cause. this is a doomed run, the executors and tragedians will inform you. lucky for us, this is a story, and we can tell it however we like.

exiting the theater will prompt you to head to the cathedral and make your final decision. you get to walk through the end days of the town, and it is BEAUTIFUL. the graphics update is stunning, this town has come to life so well in P2; it feels cluttered and cramped and dirty, the dead are lining the streets, the flamethrowers are spraying fire over hordes of the sick who are wailing and coughing as they wander the streets.

Heading to the cathedral, you won’t have to make a decision, thankfully - talk to the inquisitor and the general, and they’ll inform you that you’ve failed, and you will wake up on a train and P2 truly begins. this is a phenomenal introduction to this game - intriguing for a new first-time player, and exciting and full of references for someone coming from P1!

You’re introduced to a couple of quality of life upgrades and mechanic tweaks in beginning:
- difficulty choices. you start a game and get three options: easy (severely handicapped for people who just want to check out the story without the survival aspect), difficult (slight handicaps for people who want a chiller time) and hard (the intended difficulty)
- sprinting! and it's very forgiving. you can go a while and it doesn't take much to do so, though it does introduce a new stat bar: stamina/thirst
- ferrymen. for a certain currency, you can effectively fast travel
- map markers on the screen. no need to flip between map and full screen to navigate - though, this is something you have to hit a button to see.

I have mixed feelings about these additions. And I will admit, it’s very hard to play P2 without comparing it to it’s predecessor, even though it’s predecessor wasn’t very good when compared to any modern game. P1 had charm that has sort of disappeared in the newer games? It’s like…P1 was difficult. unforgiving. the time limit is brutal, you are barely scraping by - but that’s what makes it a survival horror, right? These new P2 additions make it soooo much easier and less stressful. i understand the difficulty choices is more of an accessibility tool so that's forgiven, but the rest? Ehhh. insane thing to say but i felt like i wasn’t struggling enough, even when on the intended hardest difficulty. a walking simulator isn't exactly rewarding when its easy to walk. HOWEVER. the extra lore and how beautiful everything is, as well as a much more fleshed out story does make this an acceptable loss. This world feels a lot more alive than it did P1, particularly when it comes to the steppe traditions and folklore - they use their own language, they have specific traditions that artemy isn’t allowed to participate in until he proves he will be following in his fathers footsteps, they refuse to trade with you for the first few days when they still think that artemy is the cause of his father’s death. Even the regular townsfolk need to be talked to in order to find more quests or direction for the day.

Something else P2 added is a renewed journal/quest system. In the first game, quests were offered to you pretty simply; you’d get a letter, there’d be text in your journal to tell you what to do, and then when you completed the quest, it would just say that. Some quests have different outcomes, so the journal kind of would just state “This is the quest, and I can do X or Z about it”, and then “I successfully completed the quest by doing X” when it was done. P2, however, has this stunning progression tree kind of thing. It will unlock a path when you pick up a quest, and show you how many outcomes it has. The more you learn or the further you complete the quest, the more branches and connections will appear. Some things will be missed, some you will be locked out of - but it shows that! I think this is fantastic. You can see my day 1 quest journal here - yellow means i was locked out of that quest entirely, the blank circles are stuff i missed, and everything else is something i completed. I love it so much

A couple of other things to note: I do think the game has lost it’s silly whimsy a little bit in it’s pursuit of becoming a better game. It IS good, it is better - substantially - but I couldn’t help but be a little bit sad when I saw the plague clouds for the first time and they were just big masses of black spores that traverse in straight, predictable lines. They are super easy to dodge, no more randomly appearing masses of floating skulls that pop out of nowhere and chase you down. Which is goofy, I will admit. And these new clouds do fit the theme of the game better. I just miss the silliness, I think. Also! Despite the clouds being slightly less of a concern, it is much harder to avoid infection in P2. The infected districts to look incredible, they’re grimy and dirty, and just walking through them is enough to drain your immunity over time, so the longer you spend time just standing in the district, the higher your odds of catching the disease are. I also liked that touching things in infected districts (looting bins, opening doors, etc.) will also increase your infection meter as well.

i want to share a couple of comparisons to really hammer in how much the graphics add to this game. the overall odd and clunky vibe of P1 was kept intact, i feel, and just enhanced rather than completely redone.





Also. i dont know where to put this but it needs to go somewhere: the howling dog sound effect in the infected district is the same as one of the default howl options in Wolfquest: Anniversary Edition. I am not joking, once I noticed I just literally could not unhear it omfg

Alright alright. Enough about the upgrades, lets talk about the game itself.

Like I mentioned above, P2 is a reimagining of the Haruspex run from P1. for the most part, it’s the same plotline and story progression, it has just been tweaked and revised to be a little more fleshed out, and give Artemy a bit more characterisation, and a better sense of belonging in the town. People remember him, old friends greet him, etc. the Kin - the native steppe dwellers where the majority of the town’s folklore and traditional medicine practices come from - get a much larger role to play in this game too. To prove yourself as a doctor, you must collect herbs and brew your own tinctures and medicine, and learn how to heal people in the town. Being one of the town’s very few doctors has become a much more involved mechanic too - to heal someone, you have to diagnose the illness and then administer the appropriate treatment. You can do this to the infected people in the streets of infected districts, too - though it’s up to you whether you want to waste valuable resources on doomed NPCs, or if you just want to give them random antibiotics to boost morale and get a little reward for keeping people’s hopes up. You still have your Bound - now “The List”, a list of mostly children left to artemy by his father who you must keep alive in order to get the good ending - except now, them getting infected is random chance, and not just based on whether you complete the story quest the day prior or not. You can also administer antibiotics to your bound to lower their chances of infection for the following day. I partially really like this approach; artemy is learning the ropes of the traditional medicine that his father used, so there’s no real guidance in the game, and it’s fun to stumble into the right mixture and recipes to heal people as you play the game. However, I do miss the concept of “the Bound”; as in, this list of people MUST be kept safe, or you will be punished at the end of the game and won’t be able to achieve the true, good ending. Anyone can die at any time in P2 and it has no effect on the end of the game. I don’t think I like this very much, I think if your childhood friends perish or the kids die due to your inaction, then there should be some repercussions, whether that’s by locking you out of the true ending, or perhaps some kind of in-game punishment other than just being locked out of their sidequests.

Speaking of characters and progression: there’s quite a few instances of sidequests and character dialogue that you can only access if you are talking to random townsfolk when you wander around. There’s also lots of random events that you’ll find by walking through certain areas that you have to go and check out for side quests - i just really like that it’s all pretty random! Better than P1’s system of randomly being given a letter and hoping you notice it in time to do the quest. It feels a lot less linear than the original game too, which is nice. The days are separated into early morning (midnight - 7:30am) and then daytime (7:30am - midnight). Some things are only available in the morning hours, and some through the day, meaning you have to time when you sleep pretty carefully or you’ll miss something. You can’t skimp out on your sleep, either - there’s a lot of important moments that happen in Artemy’s dreams that you need to see as well. It’s fun to balance! I really enjoyed this. Oh, and the pantomimes at the theater!!! The nightly performances still happen, but this time, you get to walk up to the stage and it’s a different scene every time. It’s wonderful, it’s no longer just a conversation with a zoomed in shot of your character’s face. Now it’s a scene, the stage is set up differently every night, there are other characters involved that make use of the entire theater space….UGH delightful, brilliant, I love them.

Pathologic 2: Marble Nest (2019)

steam page ✸ achievement progress: N/A

self contained dlc story for patho 2!

Pathologic 3: Quarantine (2025)

steam page ✸ achievement progress: 00/14

soon

Pathologic 3 (TBA)

steam page ✸ achievement progress: ??/??

TBA - expected 2025!


& if you think that all sounds cool, but don't wanna play it...

i don't blame you! this game is a chore LMAO but here's some of my favourite video essays, analysis and plot summaries on the game that i think do a very good job of immersing you in this world without having to play <3

PATHOLOGIC IS GENIUS, AND HERE'S WHY - hbomberguy
this is the video that introduced me to pathologic initially! it's a great in-depth video into the story & gameplay

PATHOLOGIC, FOR THOSE WHO WILL NEVER PLAY IT (ACT 1) & (ACT 2) - Codex Entry
VERY in depth play-by-play videos about the bachelor route! voice acted by various youtubers, very very good videos and jumping off point if you wanted to bypass classic patho and go straight into the second game, imo.