Note: This review contains no direct spoilers, but it does pull the curtain on how the game works in a general sense. If you're interested in the game, I recommend against reading it and just starting your playthrough.

Reacting to all of a player’s decisions is a common goal for games, but it simply isn’t possible. Doing so would require not only creating reactions for each choice, but for each set of combinations, leading to infinite complexity. The real question is how games that use decision making as a focal point are able to fake the reactivity in a way that still gives choices impact. Telltale games typically let choices affect the player’s relationship with other characters, but not the flow of the plot itself. Bioshock Infinite’s choices don’t end up mattering at all, with director Ken Levine’s philosophy being that the real impact of decisions happens in the player’s head, not in the game itself. These could be interpreted as lazy or misleading ways to sell a game, but as mentioned before, developers have limited resources and need to ensure their effort is used economically. It’s this principle that allows a game like Pathologic 2 to exist at all, promising a town full of radiant choice and consequence from an indie team on a relatively small budget. The player’s goal is to stay alive as a doctor in a steppe town overrun by plague, and save as many people as you can. There are about thirty named characters to keep track of, and generic townspeople you can trade with or heal to manage your supplies and increase your reputation. You have to survive for about ten days, making deals and compromises along the way to make it out as best you can.

So, with the aforementioned need to compromise, where does Pathologic 2 stand on the reactivity spectrum? Oddly enough, it falls closest to Bioshock Infinite, with the vast majority of choices having no discernible impact. The game emphasizes how the plague is random and how you can’t save everyone, so the cast mostly consists of disposable characters who could die and leave the story unaffected. Ironically, this also forces the few plot-critical characters to be totally immune until the plot says so. The endings suffer a similar irony, where a theme of nuanced decisions is filtered into a binary choice so the narrative can have structure. This recurring mismatch between a focus on player choice and the limitations of a set-narrative structure might be Pathologic’s fatal flaw, especially when the plot exists more as a framework for decisions than a narrative in its own right. If a game is about tough judgement calls, but as a result can’t present any real consequences, isn’t the design an inherent failure?

It might be tempting for me to answer that with a “yes”, and use it as an example of why most games with choices keep a tight leash on their narrative structure, there’s still the mental half of the decision making process to factor in. Players recognizing the pointlessness of their decisions at the end doesn’t matter when they felt real in the moment, and with media being inherently artificial, the real pointlessness would be in trying to convince people that their actions did have consequences. For most games, I would say this interpretation is giving way too much credit, but Pathologic has a recurring theatrical motif that fully acknowledges the artificiality of the drama. The truth is that the intention was never for players to have narrative agency, but to be like an actor in a play. The script may be unchanging, but the emotions and energy brought to a role can add a different life to the same material. The changing circumstances of the player’s survival helps shift this context in this way, creating a narrative arc that is tied to the process of decision making in itself.

I’ve fluctuated between these pessimistic and optimistic viewpoints of the game, and it’s been difficult to draw the line between flaws and intelligently acknowledged limitations. Analyzing the game’s structure in a vacuum makes it easy to be on the positive side, but the dryness and repetitiveness of the actual moment-to-moment interaction puts me on the negative side. Fans will counter that the game’s not exactly supposed to be fun, I might counter that it should at least be engaging, there’s never an easy answer. In everything from the minor details to the overall structure, the line will be drawn based on how much you’re willing to entertain the game’s artistic ideals, rather than them entertaining you. While I wasn't a fan, I still respect the game immensely for committing to an artistic vision that a lot of people would never have the patience to try. It’s a game I can’t exactly recommend, and can’t even really say I like, but trying something new and broadening your horizons will always be an excellent choice.