Pathologic 2 Review — You Can't Save Everyone

Pathologic 2 is a narrative-driven thriller that doesn't really care if you have a good time or not. Prepare to be eternally hungry.



Pathologic 2


Ice-Pick Lodge



Reviewed On



Survival Horror

Review copy provided by the publisher

May 31, 2019

Pathologic 2 is a narrative-driven game with a brutally difficult survival system to keep you constantly on your toes. You play as a surgeon coming back to his hometown after receiving a letter from your father imploring you to visit. The devs at Ice-Pick Lodge have been marketing the game as the “most bizarre game of 2019” and, after putting almost 30 hours into it, I have to agree.

From the jump, Pathologic makes it clear that it doesn’t really care if you live or die. After a short introductory sequence in which your character murders a few drifters, the game drops you into town and tells you to go find your father. After working your way there, you find out your father has been murdered. What follows is a tale of a town falling into despair as a plague engulfs it. You have twelve days to find a cure for the plague. Before you do that, you’ll need to find a way to get back into the town’s good graces as you start the game suspected of murdering your father. Therefore, you gain the “hated” status in each district of the town.


Pathologic 2 is a narrative-driven game with a brutally difficult survival system to keep you constantly on your toes.

District status is just one of the many bars you need to manage throughout the game. Each district has its own feeling toward you, and you can influence things with your acts and words. For instance, stealing from a house is going to bring your status down, while giving a bit extra in a barter will give your status a small boost.

Your district status will raise relatively quickly, but, in the early stages, be prepared to have tons of villagers run up and try to beat you to a pulp. This is something the game does often and in various ways. Even when you can get the town to stop attacking you on sight, the game continues to send threats at you in the form of managing your survival.

Pathologic 2 gives five different bars to manage outside of district status: Exhaustion, Hunger, Stamina, Health, and Immunity. Exhaustion is a measure of how tired you are. Every so often, you’ll need to take a rest to make sure you’re able to continue moving throughout the town. Hunger is pretty self-explanatory. If you’re hungry, you need to eat. And you’re hungry pretty much all the time. Stamina tells you for how long you can sprint. Once it depletes, you’ll need to rest for a time before you can run again.

If any of those bars zero out, your Health bar will start to drain. It also drops any time you take damage from an enemy. Immunity lets you keep track of how close you are to getting the plague.

This survival mechanic is punishingly cruel. This is a narrative game, and I’m going to talk about that aspect of it soon; however, I think it’s important to talk about the survival system first. If you do not manage your various traits properly, you will die. You will die over and over and over.

Pathologic 2 will not hold your hand. In fact, it seems to want to make things even harder on you when you’re struggling. If you die, the game will reset you to a past save point, but Health (or Exhaustion or Hunger) bar will now have a lower max value. If you try to skip that and save scum, you’ll quickly find out that isn’t possible. Even when you move to an older save, that penalized bar is there to greet you. Presumably, the penalties end at some point, but I was lucky enough to not die enough to see that.

The Hunger bar seems to deteriorate the quickest. I was constantly on the lookout for food. My entire day revolved around it. If someone had a pressing quest, it often took a backseat to me trying to trade for a piece of toast.

For some, that’s exactly what you want out of a game like this. You’ll want it to be punishing, forcing you to truly think about each step you take to maximize its effectiveness.  Others will balk at how oppressive survival is. You’ve probably seen the trailers and wanted to get a look at this odd tale. And then the game starts and you walk away out of frustration when it forces you to earn every word of dialogue.

And that’s the rub. Ice-Pick Lodge has put together a complex, interconnected web of stories for you to explore. One choice can lock out another, and choosing which characters live and die can have a massive impact on what choices are available to you. It’s incredibly compelling and feels drastically different from most other games. However, all of that kind of goes out of the window with how brutal staying alive is.

Pathologic 2 will not hold your hand. In fact, it seems to want to make things even harder on you when you’re struggling.

My schedule looked like this by the time I hit the sixth or seventh day:

  • 0:00-7:30: Go to Town Hall and pick up my funds and food for helping out at the hospital the day before. Rejoice that I finally have enough food to sleep without the risk of starving myself to death in my sleep. Maybe go take care of a quest or two if I have time.
  • 7:30-9:30: Go to the hospital (theatre) and assist with keeping as many patients alive as possible. Plan out my day based on where quests are on the map.
  • 9:30-14:30: Try to complete as many quests as I can. Likely get thrown off my rotation due to new districts getting hit with the plague. Fit in time to grab food from a shop with the funds from Town Hall and get in another meal and nap.
  • 14:30-18:30: Finish up quests if possible. Begin to panic as my Hunger meter is filling at an alarming rate and my food/money stocks are basically zero.
  • 18:30-24:00: Run amok through healthy districts trying to barter with the villagers for food to make it until the Town Hall gets restocked in the morning. Frantically look for anyone who has food and is willing to take a thimble and some marbles for it.

And that was when everything was going perfectly. Often, I only had time to finish off a quest or two because various circumstances would force me off of my plan. It really feels like, in every aspect, the game is at odds with itself. It wants to tell you a deep, engaging story, but it also requires that you work for it.

Heck, even from a technical perspective the game is fighting itself. On one hand, the art is visually striking and graphically impressive. On the other, the performance is less than optimal. Even on my relatively beefy PC (2070, Ryzen 7), Pathologic hitches and stutters much more often than you like.

Pathologic 2 was an experience that was equal parts captivating and frustrating.

So, this is the point in the review that I sum up my experience and put a rating on the game. Usually, that’s pretty easy. If a game is “7” for me, it’s probably somewhere between a “6” and an “8” for most others. However, Pathologic 2 is such a polarizing game that I don’t know how effective a score really is.

For me, this was an experience that was equal parts captivating and frustrating. I quickly lost track of how many times I exclaimed to my wife that “this game is bad!” However, I’ve also been up at 3:00 AM during the last few days playing because I had to know what was next, not for the review, but because I was deeply invested and interested in what happened next.

Pathologic 2 is a flawed theoretical masterpiece. I give all the credit to Ice-Pick Lodge for having the ambition to develop one of the most intriguing games I’ve ever played. I also am in awe of their courage to stick to their artistic vision even with the knowledge that their vision likely cost them a number of sales. That said, I don’t know if I have it in me to play another Ice-Pick Lodge game again. The experience constantly thumped me over the head with my poor planning and stupidity. If another game comes along, I think I might just stick to a YouTube playthrough.


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