Pathologic 2 (Russian: , , , 'Pestilence') is a 2019 horror-themed role-playing game developed by Russian game development studio Ice-Pick Lodge and published by tinyBuild. "Pathologic 2" was originally conceived of as a remake of the developer's earlier 2005 video game "Pathologic", but during development grew to encompass a much greater scope. The game has variously been described as a remake, a reboot and a remaster, and draws elements from all three. Three storylines had been planned for the game, mirroring the stories of the Bachelor, Haruspex and Changeling from the original "Pathologic". The game was released with the story of the Haruspex on 23 May 2019. On 7 October 2024, it was announced that the Bachelor's route would instead be released in 2025 as a standalone sequel, "Pathologic 3", with a dramatically different gameplay and scope.
A playable demo (released on 2 December 2016) called "The Marble Nest" with its own short story is freely available on the internet, as well as an alpha build which was released on 11 September 2018. Another playable demo was released on 24 April 2019, one month prior to the game's release. An updated version of "The Marble Nest" was released on Steam as DLC content on 28 October 2019. It was available for free to players who had owned the base game before this date.
Plot.
Setting.
"Pathologic 2" takes place in a small town on the steppe only referred to as the Town on the Gorkhon River, or simply "the town." The culture of the town is a fusion of 20th century technology and architecture with ancient steppe culture and traditions, which bring about customs that greatly affect the course of events in the town. Though the exact location and date are never mentioned, it is very heavily implied by character dialogue and environment clues that the game is set during the Russian Civil War.
The world of "Pathologic 2" leans heavily into the surreal, meta-commentary and symbolism, frequently making discerning what is fiction and what is "reality" difficult. The events in the town are framed as a play in the style of Bertolt Brecht's "epic theatre," where the player is an "actor" "playing the part" of the player character. The player's "reality" often comes into contact with this framing, with theater-like elements such as spotlights, "scene changes" between day and night and a disembodied stagehand-like voice appearing intermittently throughout the game. At certain points, such as during plays performed in the town's theater or after the player's death, the player encounters the mysterious and supernatural theater director Mark Immortell, who is often critical of the player's "acting" and frequently breaks the fourth wall, referring to the game's development, referencing the mechanics and inner workings of the game's systems and referencing events or aspects from the original "Pathologic", both contextually and literally.
Story.
The protagonist of the game is a surgeon named Artemy Burakh, also known as the Haruspex. The game begins at the end of a previous, seemingly failed run, on 'day 12' of the first "Pathologic". The town is nearly empty, filled with bodies and the sounds of screaming. Artemy speaks to various characters and makes his way to the Cathedral, where he is able to speak to the mysterious theatre manager, Mark Immortell, and requests a 'second attempt'. This is granted, and time resets to the prologue of Artemy on a train, travelling to the Town. The player controls Artemy through a series of strange dreams and visions. Through dialogue with a character known as the 'Fellow Traveller', it is revealed that Artemy was born and raised in the town but has not been back in many years. His father, Isidor Burakh, is the local physician and a leading member of the Kin, the native inhabitants of the steppe. He sent Artemy to the capital as a teenager to gain an education in medicine, but has now requested that he return, stating that 'great difficulties' are coming.
Upon arriving in the town, Artemy is greeted by three locals who try to kill him. In a cutscene, he kills the attackers. Nearby strangers in plague doctor suits tell him that the locals suspect him of killing an important resident of the town and that the attack on him was an act of revenge. It is soon revealed that, in fact, two people have seemingly been murdered. The first is Simon Kain, a prominent leader of the town who had previously been assumed to be immortal; the second is Isidor.
Artemy is suspected of patricide and attacked by many of the townspeople, who have been driven to unusual violence. Young women are targeted in particular due to old steppe legends of a 'Shabnak-adyr', a creature with clay legs who brings death. A local gang of children known as the 'Soul-And-A-Halves' request Artemy's assistance with finding a boy who poisoned their dogs, while an old friend of his known as Bad Grief requests assistance with an injured local man. The leader of the town's economy and industry, a powerful man known as 'Fat Vlad', vouches for Artemy, and his innocence is restored.
At his father's funeral, Artemy discovers that his father died of a strange stab wound. He is urged to accept his father's legacy as a menkhu, a special caste of Kin folk with the right to cut open bodies. In doing so, he is given a list containing the names of seven local children, plus a strange steppe sigil that he is told means 'udurgh'. He learns that these are the children his father felt would be most important in 'rebuilding the town', and must be kept safe at all costs. Signs of an outbreak appear in the village, including a strange rot on the sides of buildings and a black cloud in his father's old bedroom. A plague known as 'Sand Pest' strikes the town, killing people within a day of infection and leaving the districts abandoned and rife with looters.
Artemy is required to perform daily tasks at the hospital in exchange for food and money, as food prices rise rapidly once the outbreak hits. It is revealed that the Sand Pest has hit the town once before, and Isidor managed to curb the outbreak by boarding up the infected district and leaving all those within to die. He encounters a young Herb Bride - a caste of Kin women who dance barefoot to encourage the growth of sacred herbs such as twyre - who seems to know him, and eventually tells him he is destined to kill her. Artemy is able to use his father's old equipment to create tinctures that increase immunity, and later use organs or blood to produce antibiotics and painkillers. He collects sacred blood from a crack in the ground in an ancient steppe village, and finds that this produces a panacea that cures Sand Pest; however, there is only enough blood for two doses.
An Inquisitor, Aglaya Lilich, arrives in the city. She has been sent to save the town at any cost, and Artemy is warned by others that Inquisitors are inherently manipulative and dangerous. He continues to search for larger amounts of sacred blood, eventually learning that the only way to get enough to stop the plague is to destroy a tower known as the Polyhedron. The mysterious 'udurgh' refers to the Earth itself, which is leaking out the sacred blood due to being repeatedly harmed and nearly killed by the Town's presence. Destroying the Polyhedron will produce enough of this blood to cure everyone, but kill the Earth in the process, causing many of the 'miracles' of the world - including many aspects of the Kin - to fade and die. It is up to the player which option they choose: either the tower is destroyed and the town is saved, or the tower remains in place and the Kin retake the Town.
Gameplay.
Overview.
Gameplay in "Pathologic 2" takes place primarily in the Town on the Gorkhon River, with occasional diversions for tutorial sequences and other one-off events. The town is divided into a number of districts named after various body parts, such as 'The Gut' or 'The Hindquarters', which may become infected or abandoned throughout the game as a result of the plague. The player's actions often directly affect which districts become infected with the plague and which remain healthy, and travelling through infected districts (which the player must do for some objectives or to scavenge supplies) greatly raises the player's own infection risk.
"Pathologic 2" takes place over day cycles, consisting of a day and a short night. During the day, most things will be available for the player to pursue and townsfolk will take part in their daily activities (as long as the district is not infected); shops will be open, children will be playing in parks and on streets and citizens will move around the city. After midnight, the night phase begins. Many events that could have occurred during the previous day will be locked off, either until the next day or sometimes permanently. During the night, many shops are closed, there are very few citizens other than night watchmen roaming the town, and the player may be attacked by roaming bandits, who may also rob any citizens caught unaware. Each night, a play is rehearsed at the theater in the center of the town. These short plays consist of bizarre and surreal scenes that cryptically predict future events. After the play is performed, the Dead Item Shop opens at a random location in the town, which allows the player to exchange normally useless "dead" items (such as wrappers, broken bottles or used bandages) for various, sometimes very rare, goods.
The player is able to obtain items in three primary ways; they can be purchased from shops or merchants, bartered for with townsfolk, or found in containers in the game world. Shops will often be the player's only source for very rare items such as high quality food, antibiotics or surgical equipment, but such items will usually come at an extremely steep monetary cost. Many items can be bartered for, which will allow the player to offload mostly useless items (such as candles, soap or religious charms) for useful ones. Each item in a barter has a barter value, which represents how much the person values said item, and the value of the offer against the request must be zero or positive to be accepted. The identity of a person determines what items they will be willing to barter and what items they will be interested in from the player's inventory. Workers, for example, will usually prioritize items like chisels or grindstones from the player, and be willing to give up metal scrap or tools that the player can use to repair their items. Finding items in containers is a way to acquire items without any material penalty, but comes with its own downsides. Trash cans will often have items in them, but they are rarely useful. Better items can be found inside houses, but getting to them requires either committing burglary and possibly becoming hated by the community, or breaking into an abandoned home that has been infected with the plague. The player can also acquire organs by performing an autopsy on a body, provided they possess a scalpel. Organs sell for very high prices and can be sometimes useful, but the process involved in obtaining them is frowned upon by the town, causing the player to lose their trust if it is done too many times.
The player's activities are guided by the "thought map," which displays the thoughts and events of the main character in a chart that can be accessed at any time. These thoughts often point to locations on the map where the player can go to advance a certain plot thread or learn new information. When a thought thread has reached a conclusion, the connections will terminate in a thought with a yellow icon which summarizes the results of the endeavor. "Pathologic 2" is designed specifically so that, especially on later days, the player does not have the ability to investigate every curiosity or thought in a single day and will often be forced to choose what they consider more important, with the knowledge that they may lose the chance to investigate certain things once the day ends.
Player character.
The player must manage a