Joining a long cultural history of depressing and game-changing fiction, the Russian game Pathologic entered the scene in 2005 to a resounding “meh, where are the guns?” from American audiences. Described by some later on as “the single best and most important game that you’ve never played,” Pathologic‘s fatal flaw was that it got made ten years ahead of its time. Its second most fatal flaw was an atrocious English translation that made it barely understandable to aforementioned reviewers.

But now, nearly ten years later, Pathologic is back. With a Kickstarter video so vengeful that it gave me all kinds of heebie jeebies. Because what else am I supposed to feel when three stern, sweaty Russian guys are casually removing my organs over a discussion of deadly pandemics?

Described as first and foremost a stress simulator, Pathologic is not your typical empowerment journey. In a remote and obscure town ravaged by the Sand Plague, you have twelve in-game days to “defeat an invisible enemy.” You play as one of three doctors: The Changeling, a young girl who can heal with magical powers; The Haruspex, who’s partial to experimental surgeries; and The Bachelor, a more traditional practitioner. But no matter who you choose, there’s no saving everyone. In fact, you can’t save most. The clock ticks mercilessly on in Pathologic, not matter how many you manage to cure.

Though the game technically falls under the survival-horror umbrella, “survival here is about much more than staying alive.” Though combat remains an aspect of gameplay (though hopefully improved from the stab-and-pace found in the 2005 version), encounters are much more about establishing the degradation of the town than presenting a challenge to overcome. The focal point of Pathologic‘s challenge instead lies in the nebulous consequences of your actions, which have no clear trajectory. Will you try to save someone who says they don’t want to be saved? Are you willing to cut someone’s heart out in order to cure others? Will you keep the medicine for yourself? Distribute it evenly among citizens or use it as leverage for more resources? Or will you just run away from the whole thing, leaving the town to rot in your wake?

Discovering the secrets of this obscure town is another integral aspect. You must barter and scavange for resources in an increasingly desperate  atmosphere. Nothing is safe from the all-consuming plague—not even your own body. Saving lives itself becomes less straight forward as the game progresses, when you run the risk of infecting others as much as curing them. Despite your status as doctor and “hero” of the story, Pathologic is not a story about saving the world. You’ll find that damaging the town is much easier than doing it any sort of good.

As in 2005, the intangibility of your enemy remains at the core of Pathologic‘s unconventional narrative. How does one win against wide-spread hunger, thirst, and disease? Like in real life, you don’t. At best, you may lessen the epidemic’s ability to devour.

Though Pathologic was Ice-Pick Lodge’s debut game, they have since released The Void, and more recently the disorienting Knock-Knock. Though Pathologic’s concept remains as tantalizingly atypical (especially for the survival-adventure genre) as it was in 2005, delivery on that promise shouldn’t be assumed. For all its ambitions, the original game had some glaring faults (other than the lack of guns). But hopefully, with more relevant technologies readily available and years of experience under their belt, Ice-Pick Lodge will pull through with the desolate stress simulator of our dreams.