Pathologic 3 review – A demanding but engrossing horror

Pathologic is back and this time it doesn’t hate you with every fibre of its being! That’s not to say that Pathologic 3, set in the early 20th century, doesn’t place some serious demands on you, as you struggle to cure a plague and uncover the truth of an apparent immortal. For all its challenges, however, this psychological horror game is accessible in a way that previous entries in this open-world horror series aren’t. It eases you into its myriad mechanics while introducing you to its fantastically realised but undeniably strange town, preparing you for the tasks that await you.

As Bachelor of Medicine Daniil Dankovsky, you’ve got 12 days to deal with the sickness that’s sweeping through the Russian steppe town of Town-on-Gorkhon. You accomplish this through a combination of detective work, medical examinations and occasionally fleeing while the living embodiment of the plague tries to murder you.

Just experiencing Pathologic 3, chatting to quirky NPCs, uncovering some new lead, or discovering a strange scrap of lore is a delight, even when you know half the town’s gone to hell. Maybe especially so. Does that make me a terrible person? Probably, but Dankovsky isn’t exactly your happy-go-lucky type, which allows you to be as acerbic as you like to… well, everybody. One of Pathologic 3’s coolest touches is that, every now and again, a conversation puts you in the role of NPC, putting your own behaviour and actions under the microscope.

My biggest gripe with Pathologic 3 is that while it’s technically open world, the world is chunked into distinct zones, so travelling back and forth can be tedious. Travel also proves hazardous because, plague monsters aside, some zones turn hostile, forcing you to hold your gun on locals to get them to back off.

They don’t know you’ve only got one bullet left and are afraid to shoot them because it’ll plunge you into apathy. But with resources scarce as they are, it’s worth firing off a warning shot, just so you can rob them for whatever they’re carrying. Hippocratic oath? Never heard of it.

Matters are further complicated by the fact that you don’t experience Pathologic 3’s twelve days in order. Instead, you’re thrust forward in time, to when the plague is in full swing, one of the game’s many attempts to wrong-foot you. As handy as your medical skills might be, you’re suddenly missing four days’ worth of conversations and insights.

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The good news is you unlock the ability to switch back and forth between days, eventually using your own accumulated knowledge to your advantage. The catch is that it requires Amalgam, which is also used up when you die. The other trade-off is that you can’t carry regular resources between days, so stockpiling items is right out.

I breathed a sigh of relief when I discovered that I wasn’t going to be forced to scrounge for food or water. Instead, you have to manage Daniil’s mental state, which swings between Apathy and Mania altered with the consumption of various drugs. The latter state, for example, gives you a comically massive Sonic the Hedgehog-style speed boost but also erodes your health.

The latter’s especially handy when you’re fleeing the aforementioned plague stalker. That and the odd terrifying presence aside, Pathologic 3’s horror is of the brooding variety, as the death toll rises, panic starts to set in and you wonder if you even have the capacity to make a difference.

Resource management is critical, especially now your inventory is wiped at the end of the day. Filling your pockets with the ingredients you need to fuel your anti-plague weapon will give you a grin, but it’s not the most satisfying aspect of Pathologic 3.

What really makes Pathologic 3 so compelling to play, even when you’ve failed for the fifteenth time, and misery and death is devouring the town, is the responsibility it piles on your shoulders. Yes, there are locals who treat you with suspicion, but those in power actually trust you to undertake your task, enough to lend you a degree of authority.

That’s where Pathologic 3’s management and medical examination elements come in. As you struggle to end or at least control the plague you dole out decrees, issues and orders to your personal assistant and conduct physical examinations and more. It’s a world away from The Elder Scrolls V: Skyrim, where being the head of a guild just makes you a dogsbody.

With great power comes great smugness, but it’s tempered by the fact that more and more problems are piled upon you. You don’t have to deal with each directly, but your choices may impact the already ailing town. A misdiagnosis could be fatal to more than just the patient.

Time, you’ll soon realise, is just as precious a resource as anything you can shove in your pockets. Even with the ability to revisit days, you’ll find yourself scribbling down to-do lists. Yes, I admit it, a hospital didn’t get built because I was too ‘busy’ pottering around on lore-related sidequests.

Pathologic 3 isn’t for everyone. It’s more accessible than its predecessors, but this is not a game you can breeze through, and you’ll fail again and again and again, learning a little more each time. But between its rich narrative, its quirky (though not fully voiced) characters and the drive you’ll feel to push back the plague, it’ll have you hooked.