“What a cozy squalor, what surgical intimacies! The dirt is moral as well as material; the physiological miseries are matched by the spiritual and the intellectual.”
—from The Devils of Loudun, by Aldous Huxley
We will never escape the Steppe. The train doesn’t run from the Town-on-Gorkhon to the Capital and there’s no way to leave through the countryside. Time itself stops or bends into tangled knots within its boundaries. From the outside, Pathologic 3’s Town is something like a snow globe made for us to pick up and shake. We want to watch its inhabitants from a distance, even when looking through the eyes of its protagonist, the Bachelor of Medicine Daniil Dankovsky.
Like its predecessor, Pathologic 3 is less a traditional sequel than a reexamination of the same plot and setting that its creator Ice-Pick Lodge debuted in 2005. The events of its story take place over 12 days, within a vision of early 20th-Century Russia where a plague dubbed the ‘sand pest’ has infected a remote town in the Eurasian Steppe. The Bachelor, a student of thanatology in the unnamed Capital, arrives in the Town-on-Gorkhon on a research trip to investigate rumours of an immortal man. He is promptly engulfed in local politics, trapped by the onset of the sand pest and the supernatural mysteries of the Town’s relationship to time and death. The Bachelor is appointed leader of the Town’s medical efforts. He’s allowed to issue decrees that quell local unrest and the spread of disease.
The overarching goal of Pathologic 3 is to lead the Town through the plague intact. This involves finding patients to diagnose and using the facts of their condition to formulate a day-by-day vaccine to keep the plague at bay. It also requires solving the many problems that present themselves every morning, as petitioners arrive at the Bachelor’s headquarters, an apartment called the Stillwater, letting him know about new gossip, political developments, and murders.
Pathologic 3 wouldn't be nearly as compelling if all of the above was presented as entirely realistic, or if it explored its premise without introducing the spiritual beliefs that animate the Town-on-Gorkhon. The Bachelor, like the modern player, comes to the Steppe thinking its folk traditions are nonsense—that the arcane approaches to death and time its characters embrace are rural superstitions. The Bachelor is his own person, variably arrogant and dismissive, empathetic and humble, with changes to his personality subtly reflected in dialogue options as the 12 days progress and he witnesses more than he expected to among the people of the Town. The game’s major design trapping is introduced by way of time-shifting clocks—the Bachelor moves back and forth between the dozen days’ events, altering them to shape the future—and he encounters characters whose previously nonsensible thoughts prove to be based in a kind of fact. He arrives in the Town possessed of an urbane prejudice, looking down his nose at folk traditions outside his academic purview. He's quickly humbled at the scope of the plague's reach and the failings of his own education to meet the task at hand. As a researcher devoted to a field of medicine as unorthodox as overcoming death, his viewpoint changes, and ours does, too. It's only when he starts to take the Town's traditions seriously that he begins to accomplish anything.
We’re shown the Bachelor's change in viewpoint by the way people react to his questions about the immortal man he's come to the Town to study: Simon Kain. Though Simon's corpse is seen shrouded and awaiting burial on the second day, characters state that this doesn’t mean he’s truly dead. They don’t mean that Simon's become something as straightforwardly fantastical as a zombie or that he continues to exist in the metaphorical sense of the deceased living on in the memory of the living. They mean that time itself is more fluid than we think it is, exemplified in the Bachelor hopping between days and in a ‘game over’ style screen that displays the message “There is no death, there’s only time." There are evocations of Schrödinger throughout, but Pathologic 3 resists the pull of exact scientific or concrete philosophical explanations for its exploration of death and time, of multiple possibilities for every moment in our life and afterlife. It prefers instead to couch its narrative in a fictional brand of spirituality. Its Steppe traditions involve strict rituals for the entering of giant cathedrals devoted to clocks, of disturbing the earth for burials. Children tell tales of hollow acorns and trade in bits of stained glass that refract everyday light into strange new forms. All of these novel concepts seem, at first, like nonsense, before gradually revealing themselves as in-game spiritual inventions for handling the link between time and death.
Pathologic 3 makes our own belief systems abstract through the inventions of the Steppe and the beliefs of its prophets, scientists, and architects. Architecture is particularly important in Pathologic 3, serving as a practical kind of religion for bridging the gap between concept and experience. The Town's architects serve as priests. They grasp for the numinous not through prayer and meditation, but through the design of impossible streets that show those who walk them their future, of spidery stairways extending high up into the sky, of cathedrals to time, and of the overall construction of the Town itself. To walk the Town is to believe in what those who built it believe.
One character explains that the ‘immortal’ Simon was (is) an architect who had a “dream of building a town that would become a crucible,” and the truth of this is revealed as the Bachelor journeys back and forth through its neighbourhoods—as he becomes intimately familiar with both its physical layout and the organic composition of those who are created by and live within it. Pathologic and Pathologic 2 already centre the Town-on-Gorkhon as a sort of living organism in and of itself, a body-as-town that survives only when its various components are functioning together in harmony. Pathologic 3 puts a finer point on this same theme through a system that sees the Bachelor regularly diagnosing the ailments the Town’s people suffer. The sick crowd into his field hospital in the local theatre, and he asks them questions about their coughs, their rashes, what and how much they eat and drink and smoke. The screen shifts to close-ups of their anatomy, bare torsos and limbs on display for the Bachelor to inspect. We zoom in on cracked patches of skin, squint at bruises on arms and legs. There are always corpses, too, and sometimes the Bachelor examines the dirt under their nails and the splatters of blood staining the places in which they were murdered. As he looks deeply at individual people, something greater than their bodily composition begins to make sense. The miseries of the Town’s people grow in proportion to the misery spread by the plague and its attending human violence. There has to be an order to the mortal wreckage of the Town. Pathologic 3's view narrows to explore existential themes, raised by centering the population's bodies. Through this focus, it highlights the earthier, organic source from which every larger spiritual concern springs.
The Town-on-Gorkhon deteriorates as the days progress, rioting districts lined with barricades and plague-infested neighbourhoods heaped with the moaning sick. The upheaval escalates with the arrival of soldiers who patrol the streets near the last of the game’s days. They interrogate and kill citizens, burning their bodies in piles and positioning a giant cannon to threaten them. The Bachelor moves through time to mitigate these issues and, as he does so, he's led to plotlines that invite him to invest in something greater than the rationality that’s guided his profession so far. The Town truly becomes a crucible, for both the Bachelor and the player guiding him through the game. Pathologic 3 increases in both horror and, through the suffering that comes with that horror, the possibility of spiritual epiphany. The streets are choked with death and violence. The Bachelor spends his days peering intently at the declining bodies of endless patients. The Town tests him and shows him, in its impossible architecture and time-warping spirituality, that the bounds of reality can be rethought in different ways.
"My neighbor keeps saying this plague is a test for us all. For the sick and the healthy alike,” a nameless citizen says at one point in the game. “It's like someone is testing our nature—to see if we're truly human at heart or just growling beasts.”
The Bachelor, by the game’s end, has become intimate with the town not just as a larger body he lives within, but with its peoples’ actual bodies and minds. There are secrets and revelations in both. He finds goodness in his indefatigable assistant, Yakov Little, and the ethereal Eva Yan, who resides at the Stillwater with him. These characters become foundations for both the Bachelor and the player as the Town slips further into chaos and dread. Little reminds the Bachelor that there is merit in his devotion to medicine, no matter how futile it may seem. Eva begins as an inscrutable presence, her dialogue a mystery, until, near the game’s end, she demonstrates the Town’s ability to preserve life beyond death. This takes shape through an emotionally resonant scene that speaks, in fiction, to the pseudo-magical abilities of her home and, to the real-world player, to a half-comforting, half-harrowing way of thinking about the dead as eternally present.
When confronted at the moment just before she plans to commit suicide, Eva explains that she isn't really ever quite alive or dead in a Town where time is fluid enough to spread out like a tapestry, rather than proceed evenly toward a constant future. "Think of yourself not as a particle that either is or isn't," Eva says, "but as a wave capable of fluctuation." She exercises free will in choosing to terminate her own state of fluctuation, with the player capable of either trapping her back in 'life' as an outwardly-projected version of herself, dreamed up by the Bachelor's external perception of her, or respecting her choice to float free of reality, even if that makes her appear 'dead' through her absence.
It makes a certain sense, given how fully the linear progress of time has collapsed for the Bachelor. And it illustrates a mode of thinking that opens the Town's rituals up for consideration. They become, to the Bachelor, fragmented attempts to explain something just on the tip of reality's tongue, something beyond the realm of the rational that defeats time and, with it, death itself. The Steppe is a place to stay within and consider, because its mysteries are always just close enough to solve, if we can just manage to think through them, or at least feel their truth in a way that promises revelation.
In all of this, Pathologic 3 functions as a miniature world for the player to engage with both in the toyetic sense—there are puzzles to solve, objectives to complete—and as a sort of movable site of contemplation, or, in the firm sense of the term, ‘interactive art.’ It’s a game that encourages its protagonist to rethink his fictional world and, through his perspective and the ways in which we guide his choices, offers to do the same for us as well.
***
Reid McCarter is a writer and a co-editor of Bullet Points Monthly. His work has appeared at Kotaku, The AV Club, GQ, Kill Screen, Playboy, The Washington Post, Paste, and VICE. He is also co-editor of SHOOTER and Okay, Hero, co-hosts the Bullet Points podcast, and posts on Bluesky.