I've made a lot of posts here related to this game but never actually got into what this game was supposed to be. I should mention here that in order for this thread to really make any sense, you'd need at least rudimentary knowledge of the setting. I've posted a rather lengthy thread on the subject here. I am posting this for comments, suggestions and other feedback.
Title:
"What have you done to your planet?" -Anonymous keeper
Before I get into it, I should clear something up about the title. While I am well aware that the term "gaia" is thrown around left and right in fantasy works as a generic term for "earth" or the local equivalent, to the point that everything else associated with the term has been forgotten and the word has lost all meaning. That is not how it is being used here. "Gaia" in the title relates to gaia theory, the theory that life within a planetary biosphere acts to regulate conditions within it to ensure it remains inhabitable. In this respect, the entire biosphere would then qualify as one large superorganism, which is what the term "Gaia" means. In this game, Europe has been devastated by two massive waves of nuclear bombardment, including a great many "enhanced fallout" weapons. The area still sustains life, but at this point the emerging life in Europa is doing more to poison the rest of the world than maintain liveable conditions. This is how "gaia" is "wounded." This is made increasingly clear as the game goes on, with everything from animals acting in unusual manners to little bits of information getting to the player that toxins and diseases are emanating from this area. Something is clearly off here, and the player will only get hints as to what. (I intend to do more in this setting later on. The picture will come together as the series goes on, and some thing will make sense, including what a "keeper" is.)
Location and overworld:
"Yeah, it's fucked out there. The troglodytes and such will leave you alone if you don't startle them, but watch out for the leucocytes. They aren't terribly tough, but they attack anything that moves and don't even stop at what they can eat." -American Republic relief officer
The game is meant to take place in the Black Forest, specifically the outskirts of Freiburg. The area is heavily irradiated and infested with more diseases than anybody cares to count. (The tendency for acute radiation syndrome to compromise the immune system makes this a nasty combination.) The overworld is initially very small, just a square kilometre of forest that makes up the south-eastern quadrant of the map. It includes a few cabins, some animal dens and a single Russian military outpost. This area is the tutorial area, with weakling enemies being abundant and a single outpost of Russian soldiers that will warn you off and not harm you if you obey their clear and multilingual warning but will kick your ass six ways to Sunday if you attack them or come too close.
The south-western quadrant of the map is a barley farm, another Russian outpost to the north, a relief outpost to the southwest and a little forest to the northwest, and is quickly unlocked as the player exits the tutorial area. This gets them going on the main quest, throws an easy side quest their way and is still a fairly nooby area with no majorly threatening enemies. (Nothing worse than leucocytes, at least.) This area has a lot of trouble with leucocytes, which have killed a farmhand, wounded two more farmhands, the farmer and his four-year old daughter. (The farmer got the worst of it, his leg had to be amputated at the knee.) The farmer believes they are operating from a den in the northwest and wants somebody, anybody, to put them down. Say you're willing and he'll put the sword in your hands. (Not a metaphor, although he also gives you a rifle.) This quest is meant to feel like a side quest because it's out on the overworld, but it's actually mandatory. Once you do this the relief outpost will contact you with a note of thanks and the rest of the story opens up.
The north-western quadrant of the map is suburban, and mostly ruined. Here you'll find the main relief outpost for this area, and another small Russian outpost. There are a few civilians in the houses, but there are also raiders and animals throughout the area. This is the first time the player is at any serious risk of getting shot. This area is divided into four smaller sub-quadrants that are unlocked by doing missions that take place within them. Once you do those linear missions, this entire area is available along with a couple non-linear side quests.
The north-eastern quadrant of the map is forested, and contains the primary Russian military base for this area at the very northeast corner. Once again, just don't attack them or get too close and they won't hurt you. And no matter what level you are you don't stand a chance here, so keep your distance. There are also a few old shacks and a derelict relief outpost. You'll be doing a mission in the southern section of this map, then three more missions across the rest before the game is done. Then you return here one last time to finish the main questline. This area is quite important to the end of the game, but you can't go there until then.
And just to clear it up: The game's dialogue is only translated in subtitles and only if you have subtitles on. The majority of the locals speak German or English, which it is assumed the PC speaks as well. There will be subtitles for both of these in game. There are American, French, Spanish and Japanese soldiers present to reinforce Germany, so their languages will be spoken as well, although if asked most important characters speak German. There are also a large number of Russian soldiers there trying to take Freiburg over under the justification that they "earned it" by doing the majority of the clean-up. The player character can learn these languages as well, which will provide subtitles and allow communication with those who do not speak their language.
Themes:
"You got to know when to hold 'em, know when to fold 'em, know when to walk away and know when to run." -Kenny Rogers, The Gambler
The game has a number of themes running throughout it, most of which are handled invisibly to prevent them from being anvillicious.
There's karma in the game and a karma meter, but it's not visible to the player and they don't know when they're gaining karma or losing it. There's no reward for positive karma, and most positive karma actions earn you enemies, but there are considerable penalties for negative karma. The karma meter should ideally remain about neutral, with the player using good deeds to keep the public opinion of them strong and allowing them to do get their hands dirty without suffering any consequences for it. You can afford to kick a downed raider in front of his friends if you've saved somebody's life, for instance. And to a certain extent, cruel actions are rewarded by the game itself and only penalized if taken too far. The game encourages the player to be a savage bastard, but to do it in moderation and know where the line is.
EDIT:
It's important to note that karma is not morality. The karma meter represents public opinion only, it is not a representation of morality. My morals do not enter into it. I base positive and negative karma only on how I think the public will perceive your actions. This is the reason charisma influences karma build and loss. As a general rule, acts that seem unnecessary or cruel (even if they are really neither) are not accepted by the public as all context tends to get stripped out. It's entirely likely what you are doing is not only justified but serves a good purpose and the harm it may cause is insignificant compared to the good. You'll still lose karma, because human culture as a whole is stupid and narrow-minded. They often see kindness, pleasantness and law as good even though they are frequently anything but, (the latter can only be anything but) while seeing coldness, harshness and chaos as evil even though they usually serve much better purposes overall. Sometimes, good things give positive karma and sometimes negative karma. Sometimes, bad things give negative karma and sometimes positive. I just wanted to make sure that was out of the way.
There's a lot of elements that reinforce the player's humanity and most importantly their limits. The player isn't Rambo, the game shows this to them, and the game is designed to show the player their limited power. Leroy Jenkins "strategies" will get you killed time and time again, dismissing the threat of an enemy will get you wounded and conflicts with other humans often simply won't be resolved in a manner that satisfies the player. There's a sense of fear and helplessness in those encounters, because even when you begin to feel like a badass your ego gets kicked back into its hole as you get caught off guard by a bunch of gun-toting thugs and get forced into backing off. The player is human, and the game makes them play within human limits, and this just makes it all the more rewarding when you find a way to achieve your ends while still operating under these limits.
There is a lot of solitude in the game. There are no companions, NPC interactions are limited and rarely closer than arm's reach, the player is on their own the whole way through with no crutch to lean on. The game does manage to provide a relatively shallow difficulty curve to compensate, and make sure the player is fully self-reliant, but the simple fact that there is no obvious help from the machine means you have to start thinking for yourself. You can, later, use perks to purchase aid from the machine and even fill out a HUD, but when you do so you'll often find this doesn't help you much by the time you can get it and is a complete waste. When you start the UI is limited, simple and the things the player cannot be expected to manage are all handled in a reflexive manner. (Red flashes and pulses for pain, the screen losing saturation as health falls, the characters animations changing as they are wounded, panting when tired, wince effects and laboured breathing when fatigued, that sort of thing.) The player has to be almost completely self-reliant in the game, and the easy difficulty and subtle aid at the beginning is there to teach them this.
Fear is ever present in the game, with scant relief. The location is scary, unnerving and hostile. The player is always on edge and this is rewarded by the stealth element of the game, where noticing an enemy and acting before they notice you allows you to dispatch them easily, but an enemy noticing you and acting before you notice them makes the fight brutal and terrifying. The player is going to have their eyes on the screen and watch their surroundings, especially since the most aggressive enemies in the game (leucocytes) are white and blend in with the snow.
There's a feeling of unease in abandoned buildings as there's always something inhabiting them. The player has to feel on edge when they enter, especially since there's a story to so many of these locations and the player has to be alert to notice them. There's the obvious physical threat, weird (often grotesque) imagery and the mystery behind the locations to give the player that sense. These areas are really jump-scary, but have a history that draws the player into them even knowing that. Facing these frightening, bizarre and disturbing areas is actively rewarded, and the more disturbing the area is the more rewarding it is both with more interesting stories and more gameplay bonuses.
While the player is free to make any kind of character they want, their story makes the most sense if their character is a child. The game forces the player to survive in a hostile environment that is exceedingly dangerous, teaching them things life skills like self-reliance and problem solving. While these are natural human traits, they aren't common to modern gamers as most modern games hold the player's hand a sickening amount of the time, and so their sheltered mind has to be taught these basic skills. These traits are also not common to modern children for much the same reason, they're smothered. They are way too sheltered, they never make any decisions and their every decision is dictated by adults that have their own best interests in mind rather than the child's. As a result, a child in this situation would need to learn these skills much the same way the player needs to, making the gameplay element where the player is slowly and subtly taught to fend for themselves mesh well with the story element where the child character slowly learns to fend for themselves.
Well, apparently I need to have a central idea for the game's design aesthetics. A core meaning to the game that it is supposed to embody, and I should choose that now. Thankfully, I already did that long ago, although I chose three things that are tightly knit together.
1. Humanity: This game is quite focused on teaching the player their limits. It lets them know what they can and can't do just from the way it is played. Some of it should be common sense stuff, but common sense tends to go flying out the window when games come into play and players do unbelievably stupid things and expect them to work. This can't be allowed, so early on the player must be allowed to fail. They need their video game ego bubble to burst before they can appreciate their character's weakness relative to other game protagonist and learn to work with it. This low level of relative power, that realistically available to a person, is the level that I find makes the most interesting gameplay. Basically, the player does best in this game by accepting their human limitations and learning to work within them. The message should be obvious here.
2. Self-reliance: This is a game largely about survival within a hostile environment. Teaching the player self reliance is not only important to the rest of the gameplay, but it's the best thing the player can pull from the game. The game's apparent crushing difficulty and lack of obvious aid from the computer leaves the player fending for themselves, and that's something utterly alien to most gamers. None of the normal mechanical hand-holding is there. There's no obvious HUD, no crosshair to shoot at, no ammunition counter, no minimap. The player is without the basic tools of navigation normally thrusted upon them and they have nothing obvious that wouldn't actually be there if this was really happening. There is still a certain degree of reflexive HUD present as the screen filters relate to different effects and there's audio cues as well. This is strange at first, but it's part of the immersion factor and the message of the game. The enemies in game, especially in the noob dungeon the first house represents, and unusually strong and frightening for early game enemies and the player might actually begin to assume this is a survival horror game just because the enemies are strong and they've been noticeably wounded in minor scuffles. When their character is wounded, they have to treat their wounds to survive and heal rather than relying on video game magic to make them go away. The player needs to find food, water and a safe place to rest rather than relying on video game magic to keep their character in top condition. They have to keep themselves dressed for the weather, rather than relying on video game magic to keep them warm. The message here should be obvious as well.
3. Accomplishment: This player gives the player many things they can do throughout that give a sense of accomplishment. Many of these wouldn't elicit a sense of accomplishment in other games, and it's only the human limits they are presented that makes these satisfying. It's not impressive for a player in most games to kill a dozen enemy soldiers. That's something that happens every 30 seconds in a shooter, and even in an RPG or survival horror it isn't that impressive. Here, it's damned near impossible throughout the game. It can require some ingenuity and planning, often patience and some underhanded manoeuvres. But the fact that it's hard and requires so much thought is what makes it so gratifying to pull off. You don't just feel like a badass, you actually have to be one. The message here is probably less obvious.
Basically, these three core ideals shape the player's experience. First, the player's video game ego is busted as they learn first hand they aren't superman. Then, after a few harsh lessons they have to fend for themselves and learn to survive in the area, the most basic skill of all. Then, they learn how to achieve difficult things within their human limits. These are some foreign concepts, as in most games there are huge advantages lent to the player to make them automatically superior to the AI, the game holds their hand all the way through and their accomplishments are massive and epic to make up for their insane levels of power. But in the end, the game feels a lot more rewarding to master because of the player's independence. The game taught skills other games simply can't, and did so while maintaining the player's interest with challenging gameplay, mystery, a levelling rewards system, a plethora of meaningful (and incomparable) choices, a decent plot, tense moments and scenes of pure, white-knuckle terror.
Aesthetics:
"Aesthetics should work to reinforce mechanics, and vice versa. They can't be independent, and if you design them as such the game is broken before it's even made." -Me
Overall, the game has a comic book style, specifically that typical of a mystery or horror comic. There are actually a lot of these, and although they vary pretty heavily there are some common features. It's got a decent colour palette, at least as far as the location allows, but the colours themselves are fairly dull and of low saturation to keep the game's darker emotional tone. Things can thus be told apart (especially since everything has an outline) without it feeling jarring or disrupting the mood. The game's lighting and shaders change from one location to another, and visual tweaks (like the outlines, calculated changes to saturation, brightness and so forth) serve both to help the player recognize objects they are supposed to interact with without using something as crass as a label and to reinforce the mood of an area or draw their attention away from things they aren't supposed to notice yet. (Hell, this is the whole reason leucocytes are white. To make sure they're hard to spot at a distance and increase the player's alertness as a result of their enemy not being immediately obvious. It also increases the fear factor with them, and they are supposed to be terrifying.)
There's a subtle amount of variation within the aesthetics. Outside in the snow and especially in blizzards, things have their normal comic book outline softened to emphasize the blizzard's impact of visibility. Inside and in the dark, the same thing. Any time the location would create poor visibility outlines soften and players often lose the firm, traceable shape to emphasize the poor visibility. This is meant to reinforce the helplessness of being stuck in the blinding snow or the fear of venturing into the darkness. Further, it works for gameplay and allows the perception attribute to be meaningful and rewarding to the player. Perception reduces these effects and helps the player see and distinguish things better through their opposite, hardening outlines and slightly highlighting objects through increased saturation and distancing their relative brightness from that around them. This effect is actually very small, but makes a huge difference. A player with high perception will find these easier to see, especially those that are supposed to blend in, and will notice more minute details and less obvious objects easier, a meaningful advantage that isn't always immediately definable. This is something that couldn't be gotten away with in a realistic or even semi-realistic style, and is a good way the artistic style works with the gameplay mechanics.
Gameplay style:
"Always be careful and know the best way to engage each foe. With animals, walk softly and carry a big stick. With monsters, try to avoid their strengths and play to their weaknesses. With humans, back off and don't get shot." -Loading screen advice
The game is an RPG in a near future/alternate history setting, and Europa is almost post-apocalyptic in its nature. There is a definite element of survival horror to it, with everything from needs and radiation to inclimate weather, disease and realistic injury. There are enemies in the game the player cannot hope to fight at any point in the game, strongholds that are (to the player) nearly impenetrable and fairly frequent, tense encounters that can go very, very bad if you apply just a little bit of stupidity. Even fights that aren't a serious threat to the player character's life can cause them injuries that can cause them issues further down the line. Encounters with other humans are often tense standoffs, where you are outnumbered, outgunned and all you can do is back off and try not to give them a reason. The rest of the time it's more about preparation, tactics and smart, well-thought out approaches than reflex and character level.
Thus, it will be hated by Call of Duty and World of Warcraft players alike.
The point playing the campaign, at least the first time around, is less to beat it and more to survive it. This is a survival story, after all. And you can survive it best by being smart, avoiding fights that you can't win and taking an approach to difficult fights that minimizes the risk to your person. The entertainment factor comes from the difficulty, fear and the thought put into the game. It requires awareness, intelligence and forethought in its gameplay in a manner most games simply don't. Beyond that, it's got a lot of backstory and unusual themes and imagery that will draw the player into exploring for its own sake, which has a strong, random and nonlinear challenge to it provided by the environment and the dangers present there. The campaign hooks you into this by putting really obvious documents and clues in front of you. The in-game journal entries especially are there to inspire a sense of mystery and give not only an intriguing story for the player to follow but also a tangible in-game reward in the form of feats and/or perks related to those stories. Some of these, like the tutorial mystery present in the first house (unscripted, but has an obvious start and hints and why the player is there to begin with) provide bonuses that help you find other documents later on, subtly reinforcing this mechanic.
This isn't just a survival horror/shooter/RPG mash-up with a complicated ruleset. It's in a complex setting the player starts knowing nothing about and will learn about and gain interest in through playing. The snow blind, the visual style, disturbing imagery and grim sense of humour are meant to help this process along. The complicated ruleset isn't even visible to the player to start with, and most of it is just there to make the combat realistic so the gameplay can run with less thought on rules, less strain on their willing suspension of disbelief and more immersion as a result. The rest of the aspects are there to unsure the player has as many options as possible, and then to guide the player into playing the game a smart way with the build they created and find an intelligent use for every tool. There is a little remainder that is for other purposes, such as just being for pure realism, (massive explosion radii) to inspire a feeling of terror in the player when it's needed (leucocytes will diligently hunt for you long after they lose contact) or to reinforce the themes of the game. (Tormenting a wounded enemy will result in crying and screams for mercy, but it'll terrify other allies and force them to keep their distance. It's a cruel action, providing a noticeable reward. Same goes for holding one hostage.)
The game is in real time, and has two different control setups for the two different viewpoints. In first person, the control scheme is that of a first person shooter. In third, it's more of a third person action game using concepts like target lock, relative movement and character accuracy. As a general rule, the first person setup is better with ranged weapons, especially at long distances. The third person setup is better up close and especially with melee weapons. You can switch between them quickly with a bound key on your keyboard. (I'll have to experiment a bit to decide the default, but right now "f" seems a good choice to me.)
Tutorial area:
"November 2nd, 10:15am. You're tired, hungry, thirsty, irradiated, half naked, covered in bruises and apparently drugged. You're lying in the snow and it looks like it's about to rain. You can't remember anything that happened in the last twelve hours, you don't remember coming here and can't even tell where "here" is. Either you were robbed last night or had one hell of a party. Possibly both." -Intro text
The player wakes up, beaten and robbed. (Explanation for their presence and lack of proper provisions.) They need to get their bearings, find some new equipment and get some practice at the game's combat before they can move on. (Probably a good idea, because the system is a bit bizarre.) There is a forest cabin ahead of them and a few noises coming from it, but it's clearly abandoned. (Broken windows, door busted in, that kind of thing. Intro to the setting.) There's a tool shed behind them. (A quick lesson in the value of observation.) They don't have a choice other than going into the house, the place is fenced in with concertina razor wire on the other side of the fence. (A common leucocyte repellent, and you're not getting over it.)
They'll find their own pack in the corner of the yard laying open with a few things left. (It really is obvious, it's black and sitting on snow.) It's obvious, and looting it should put them in a corner so they have to turn around, thus showing them the shed so they don't miss it. (What's the point of a lesson that isn't learned?) The pack includes a few toys, some clothes, none of it very good or it wouldn't still be there. (Keep the toys, especially. They all have something special to them.) The exact contents are dependent on your tag skills. You need to take the pack to continue. (You need a pack to store objects in, or your inventory space is harshly limited.) The player may choose to loot the tool shed for weapons. (It's hanging open, you can see the tools.) All they'll find is some rusty old tools, but it's something. (A first-time player will want it especially bad. They won't good enough at the game's combat to work without it.) Enter the house after that, and continue.
The house itself is clearly abandoned. There are a few dead troglodytes on the ground, with obvious bullet, club and axe wounds. (!) The player will run into at least two living troglodytes, which they will likely startle and have to fight. (Or they might circumvent this.) These enemies are fairly weak, and a player with a melee weapon (even a rusty crowbar) should be able to put them down with ease. You don't have a gun yet, (except the toys in your pack, that is) but even if you did it wouldn't do you much good in such close quarters. (That's an important note most American players will miss at first.)
The basement and attic are good places to loot and each have small obstacles in the way. There's a pair of truly ancient zombies in the basement, which are territorial and brandishing bricks at you. (Too weak and too clumsy to really be a threat.) In the attic, there's another pair of troglodytes. (Both too weak to really be a threat.) The loot in the house includes a bolt-action rifle (Mauser Karabiner 98k) and a revolver (S&W Model 19, a strange find in Germany) with a little ammunition for each, (15 7.92mm Mauser, 36 .357 Magnum) as well as a few tag-dependent random dedicated melee weapons and some basic household items that are easily weaponised. (Kitchen cutlery, a fire poker, that stuff.) There's clothing and an old motocross outfit. (It's light armour, even if it isn't very good. Strangely sports a French flag on the back.) Exit the house and you'll find a raider smoking a cigarette and standing over the body of a zombant. When the player comes out another pair of zombants comes across and the raider is caught in a standoff. (Assuming the player doesn't just charge him right off the bat. He's got his back turned, you can do that completely safely.)
The player can either watch them stare each other down and the zombants back off, or capitalize on the opportunity and kill the raider without risking getting shot. The raider carries a double-barrel shotgun, a baseball bat, a britva, flare gun and some improvised explosives. If you let the standoff run its course, he'll probably notice you. He'll threaten to shoot you, warn you not to come closer, then back away. He'll tell you to come out and leave, and not to come back. He won't shoot or otherwise harm you if you do as he says. (Get used to that.)
This is at the south-eastern corner of the map, north (directly in front of them) is a road ending in a Russian military outpost they can't go near. West from there is a road with another house at the end of it. Clearly, they need to head west. Exactly what they do from there is up to them.
That house is infected with zombies, which are territorial but not aggressive. (They make obvious threat displays, swinging their weapons in your direction and such.) When you approach there will be a scene where a pack of troglodytes attacks the household. The fight is unscripted, but the zombies will win pretty easily despite being outnumbered because they're all using weapons. (Farm implements. Shovels, hoes, pitchforks.) The player can choose to attack them and loot the place or continue on their way. The player won't do too well against the zombies if they attack right off the bat, even though they aren't going to have any issue with any zombies they run into on the roads. This house is the first "stronghold" the player will run into. These areas are meant to be extremely difficult for the player to enter, usually due to a large number of enemies within them. The difference between scuffling with enemies on the road and attacking a stronghold becomes clear here if the player tries. (Numbers, equipment and morale.) It also gives the player a chance to learn about the AI with enemies that aren't very bright.
Heading north from here, the player will encounter their first leucocytes. A pair of medium-sized leucocyte cats, which are currently slaughtering a pack of zombies. (It's an easy fight, these zombies are unarmed.) Once they're done slaughtering the zombies, the elapsed time before they attack the player will be measured in nanoseconds. (If they see you, that is.) These creatures attacking the player if they detect them at all, regardless of distance or aggression factors, is a sudden and massive departure from normal enemy AI that will seem jarring and emphasize how alien the leucocytes really are. (Don't forget, the player has been in for somewhere between ten and thirty minutes by now.)
This entire 1k*1k square is the tutorial, not just the first house. The player can skip it at any time by just going on to the next area, but there's a considerable beef gate. There's a pair of frazzled bears (not leucocytes, just regular bears) that were attacked by leucocytes there and are refusing to move. (They're tired, wounded and frazzled, and they've got plenty of food.) The player needs to be deterred from this until they are comfortable enough to take on such large and imposing enemies. This gives them time to explore the current quarter of the map they are exposed to and slowly get introduced to gameplay elements through the tutorials hidden in each. These range from one house teaching how to play a minigame with an old codger willing to teach just to have some company to another house having a great view of those very bears at the farm and two convenient rifles (one laser, one ballistic) with a decent amount of ammunition. This can teach them how to snipe and help them move out of the tutorial right from the get go.
If you're wondering why the tutorial listed here is so detailed, it's because I am of the opinion that the tutorial is the most important part of a game and that a good tutorial can make a game or break it. I'm going to put as much attention on the tutorial as is reasonable practical, and everything within it is done for a purpose, because I want to teach the player how to play as well as possible without any textboxes or tooltips anywhere but the loading screen. (Controls and the intro text above on the first loading screen, simple advice and related images on every later one.) I want them to understand what they need to survive before they continue, but I also don't want to overwhelm them with a frontloaded, text-ridden piece of crap they won't remember a word from. This large, explorable tutorial area with hidden tutorial pieces and plenty of space to practice at (relatively) low risk should be good enough for that. By the time they leave the first house, an even marginally competent player should know enough to survive in the noob quarter. The enemies here are weak. There's a whopping two leucocytes, maybe half a dozen zombants and the random spawns are mostly animals. They can safely experiment here, with the only limiting factor being a very small number of renewable resources forcing them onwards to sustain their character.
Plot:
"We're in a fucking holding pattern. If we dedicate the forces to take one of their outposts, we'll create an opening that'll let them take two of ours. They can't attack us for the same reason, and all we can get outside of our bases to attack are guerrillas that only seem able to tangle with their guerrillas. This is a low-priority target, so we aren't getting any reinforcements, we can't do anything about all the critters running around or the raiders robbing the evacuated houses, and my hair's going grey just trying to make sure nobody starves or freezes to death." -AR logistical officer
I'm not going to go too deep into the game's plot, it'd be hard to avoid spoilers. Sorry, just not doing it.
EDIT:
Also, I haven't actually finished the story. I've got the key points, but I haven't connected them yet. And I won't for a while, finishing the story too early is an impediment to the game as a whole.
Wounding:
"Just because you aren't dead doesn't mean you're alright. Take care of yourself, or you won't be around very long." -Excerpt from medical skill description
Whenever you receive an injury, even a minor one, it's a significant long-term issue. Just because an animal bite, an object impact or a gunshot wound probably won't kill you (at least not right away) doesn't mean it's alright to get one.
First off, there's the local body damage. Damage to body parts in the game equates to impairment in their function. An arm with a hole in it doesn't hit as hard or hold a gun as straight, and a leg with a hole in it doesn't move as easily. Wounds to the torso and head are especially debilitating. Further, on each limb are a number of mapped locations where damage causes additional effects, usually attribute damage. This is important, as body damage heals very slowly and any major wound you receive is pretty much there to stay. The best thing you can do is avoid getting hit, but if you do get hit bandage the wound as soon as possible to avoid blood loss and then medicate it once that's no longer an issue to prevent infection. Then a steady, protein-rich diet, a reduced burden on that area and lots of rest (if you have the resources, the time, and a good place for it) will help you heal. Don't leave until you're in good condition unless you have to, wandering the forest wounded is a good way to get yourself killed. (Thankfully, rest periods are skipped completely so you don't have to watch your character take two weeks of bed rest.) The only major limiting factor on rest is maintaining your needs, and you can get enough supplies to last until you are rehabilitated. Just be careful not to overuse the rest feature, too long without any activity will cause your attributes and skills to regress. You can avoid this by taking breaks from resting for minor practice activities like mini-games.
Second, there's blood loss. Your health score is an abstract representation of blood volume. You lose a little health when hit, then your health steadily drops as you bleed out. Usually, this lasts for several minutes and for most wounds is fatal if left untreated. In fact, the most likely cause of a death for any in-game character is blood loss. This is especially true of wounds to the chest and head, which both bleed profusely and come with significant physical trauma that might impair attempts to stem the bleeding. If you are wounded, you are going to bleed and nothing can stop the bleeding entirely. Even the best possible bandaging, used with the highest possible skill and the best drugs will only reduce bleeding magnitude to 20% and duration to 25%. Further, any loss of health inflicts a penalty. Your attributes are reduced by a percentage anywhere from half to double the percentage of your health lost, your regeneration (all regeneration) is reduced by a percentage equal to one fifth the percentage of your health lost, every point of health loss is mimicked for stamina and will, once your health falls to 50% your body parts all act as if they were one state (25%) more damaged than they are, at 25% your body parts all act as if they were two states (50%) more damaged and at 0% you are dead. Health is replenished much faster and much easier than body integrity, but it's still neither fast nor easy overall. It can take several in-game days to recover health from a serious wound, and even a minor wound will take at least a couple hours. You can reduce recovery time by taking steps to reduce blood loss to begin with, and then keeping your needs maintained with plenty of extra fluids. There's also medicine to promote health regeneration, and it's much cheaper and more abundant than the equivalent for body health. It's also overall more effective.
Third, there's infection. Infection is something that occurs at least a little for most wounds. Proper medication will greatly reduce the magnitude of an infection, but can't actually prevent one from forming. However, you have an "immune system" derived stat that by default is equal to the sum of your constitution, fortitude and metabolism scores. This value is a reduction to infections that comes after it is divided by treatment but before the percentage immunity effect. (For humans this is naturally 25%, by the way.) Infection is a slow effect that causes damage to the body part affected, your overall health and possibly your attributes. It can kill you, but for the most part it just extends recovery time.
Fourth, there's fatigue. Fatigue is an effect you get from exertion, for the most part, but it's also inflicted by damage. It's effectively a form of fake body damage, which weakens you but doesn't actually limit your abilities the way real damage does. It's not an especially huge effect in the long run, but for larger wounds (especially those left by blunt weapons) it can be a significant limiting factor for a while. Fatigue itself is a major limiter in how much a character can do in a day, as opposed to effects like stamina damage and breath that are much more short term and not as severe. Injury causes fatigue right off the bat, and use of an injured body part causes more fatigue. So your character won't be able to work as long between rests when injured and will need to rest for longer. (At the very least, the extra resting periods means the player is more likely to actually let their character heal.)
A minor injury like a bruise, twist, sprain, hairline fracture, light burn, small cut or puncture isn't serious. If it is a form of penetrative trauma there is a risk related to blood loss, but if it isn't that's not a big concern. The damage will weaken you a bit, but you won't take enough damage to be incapacitated. Infection risk is low, and although fatigue does matter here it isn't going to be a big factor. This is a wound you can walk off and keep going with. You're most likely to receive this kind of injury by accident. Stepping on a nail, falling off a porch, tripping over a root, touching a hot object, failing a skill check with tools, that kind of thing. It can be inflicted in combat as well and can be hard to avoid. Thrown objects, shot, long distance shrapnel wounds, falling debris, small-calibre gunshot wounds, animal bites, scratches and so forth tend to leave these kinds of injuries. These really aren't a big deal by themselves, but you can get a lot of them and with how slowly injuries heal they can add up, so be careful.
A more moderate injury like concussions, other organ bruising, minor penetrative organ trauma, complex fractures, skull fractures, heavy burns, larger cuts and punctures are dangerous. If they are a form of penetrative trauma, death from blood becomes a distinct possibility if untreated. Treat them early and infection won't be an issue, but if you don't treat it, it can be an issue. The damage can be a significant factor, although it's not incapacitating. These can be received in accidents, especially where gravity is involved, but combat inflicts them often. Gunshot wounds, laser blast trauma, short distance shrapnel wounds, knife wounds, unarmed strikes, large animal scratches and bites, that kind of thing. You'll pick these up a lot, just treat them as they show and give them some time to heal.
A severe injury like a depressed skull fracture, major organ trauma, penetrative brain trauma, compound fractures, severed muscles, extensive burns, large cuts and punctures is a huge issue. If it's a form of penetrative trauma, you're going to have to work hard and fast to stem the bleeding. Even then, it's unlikely you'll survive. If the blood loss doesn't kill you, this wound will get infected and likely quite severely. Frequent treating is a necessity and won't stop the infection from being life-threatening in your weakened state. It's rare for accidents to inflict this kind of wound in-game, and even combat doesn't do it much to the player. If you're a big fan of melee combat or explosives it's more likely, and you'll inflict them all the time to enemies. This is the kind of wound you expect from particularly large firearms, improvised melee weapons and close-ranged blast trauma.
A game breaking injury would be something like dismemberment, decapitation, evisceration, bisection, major crush trauma, incineration, massive penetrative brain trauma, any penetrative heart trauma and so forth. And to be frank, if this is penetrative trauma you are fucked. You'll be dead from blood loss faster than you can even begin to treat it. If it's not penetrative you'll still probably bleed to death and if by some miracle you don't infection will be nearly impossible to stop. Even beyond that, the damage is so severe it'll leave you unable to support yourself long enough to recover from such a grievous wound. It is technically possible to continue with such a wound, but it's so unlikely you're almost certainly going to be forced to revert. You're done. Melee weapons and explosives are pretty much the only weapons that can do this to you, but melee weapons can do it almost painfully easily without being as expensive, unwieldy and situational as bombs are. If somebody draws a sword, they are immediately your top priority simply because a sword leaves these kinds of wounds.
Poison:
"Unfortunately, the Geneva convention doesn't mean a goddamn thing. Especially not to raiders. We all have gas masks, and part of the relief is making sure everyone else has one. There's one in the kit we'll have for you once your background check goes through. Try not to lose it, we don't have enough to replace them." -AR relief officer
The environment here isn't friendly and it's easy to get poisoned. There aren't any poisonous creatures, but there are plenty of poison plants and a great many intelligent enemies use toxic weapons. Poisons run the gambit from unnoticeable (contact poisons on plants) to irritating (CS gas) to deadly (sarin, cyanide, arsenic) and the time they take to work varies just as heavily. Their method also varies. There are haemotoxins that damage health, irritants that inflict biological effects like pain or fatigue, sedatives that damage stamina and will, paralytics that impact your attributes and even a few toxins that do all of the above. Some take seconds to make their effects known and last for several minutes. Others may take hours to make their effects known and last for several days.
Disease:
"Most of the animals out here carry diseases, and you look like you've been tangling with a few of them. It's better you try and avoid betting bitten rather than hope they don't have anything." -AR Nurse
There are a lot of diseases out and about in Europa. The first, most obvious one is radpox but it's assumed your character had it as a child (when it's largely harmless) and is thus immune to it. There are others from real-world diseases like smallpox, typhoid and rabies to fictional ones like European plague and anaemic fever. The player can catch all of these, and the diseases are handled realistically. Some (the flu and cold, which are always available and the player can't be immune to) are minor irritants. Others, like smallpox, can be fatal untreated but treatment is highly effective against. Others still, like rabies, will almost certainly kill you if you don't treat it and can still kill you if you do. Add this on to bacterial infection on the site of wounds, and you'll be concerned every time you get injured. (And thus be taking steps to avoid injury entirely, which is the point.)
Needs:
"Sure, safety is important, but we need to eat sometime. And that means heading out there, like it or not." -Local child (translated from German)
You have three needs: food, water and rest. These things trek onwards slowly on their own, and most actions and conditions accelerate them. Depending on your level of activity, you'll need to manage them anywhere from every couple hours to once a day. You'll probably be very active, so every couple hours is more likely. That said, the timescale is 1 so that's not a big deal unless you're resting a lot to heal injuries. In which case, you'll need to get supplies for the long periods you are passing.
Radiation:
"If you don't have a Geiger counter, you're an idiot. They're cheap, they're everywhere, and nobody likes getting sick. I got a Geiger counter in a box of cereal the other day, you've got no excuse if you don't have one." -Local teen (translated from German)
Europa is badly irradiated, even after decades of cleaning. Radiation sickness is a major concern for the player, as although at lower exposure levels, acute radiation syndrome can take hours or days to become apparent and isn't a major issue, at higher exposure levels it can become obvious in minutes and absolutely ravage your mind, body and needs. There's a Geiger counter in your pack if you tag the medicine skill. Failing that, there's one in the first house, another one on the first raider and another one for sale with most merchants. You want one. Get it, listen to it. There are drugs to prevent ARS, reduce its severity and shorten its duration. Keep some of those on hand.
Weather:
"It's cold, it's wet, and the snow is glowing blue. I wouldn't go out there in anything short of a hazmat suit." -Local codger (translated from German)
It's November in Germany. Environmental damage is a particularly pervasive kind of damage, and although there are easy ways to protect against it without having to stay inside when it gets rough it can be an issue. Environmental damage is always very weak and has fairly low penetration but it has the unique advantage of hitting every part of your body at once. You are almost never covered 100%, so the exposed parts will take its tiny amount of damage. This damage is usually well within the amount your DR can completely block, but the special effects aren't affected nearly as much and some not at all. (See my thread on damage types and calculations.) Wear a coat. Try and cover as much of your body as possible. Boots, gloves and balaclavas are commonplace and available in the first house and just about everywhere else. The raiders and soldiers are wearing them for a reason, you should too. If it starts to get warmer or if you go inside, you can take some of that (the balaclava, gloves and maybe the coat) off.
Conveniences I'm not using and why:
"Yeah, I really don't have a quote here." -Me
Fast travel:
The map is small, there's no real need for it and it discourages exploration. It also alleviates the threat posed by the environment, which is a major part of the game. It would ruin many of the more serious elements.
Quicksave:
If you can undo your mistakes instantly and without losing any progress, there's no point in making them have such a serious impact. You can save your game any time you are in a safe location, the game autosaves every time you rest and hour of uninterrupted gameplay. (If you are in combat or bleeding, it will wait until that is resolved before saving.) This is a serious game, it's way on the simulation end of the gameplay spectrum, and it's meant for hardcore gamers that like a challenge.
Creatures:
"There's a lot of critters out there to keep track of, and a lot of them could be dangerous. There are dogs, bears, troglodytes, zombies... the big ones to watch out for are zombants and leucocytes. Zombants are tough and pretty territorial but they tend to steer clear of humans. Leucocytes... I don't know what's wrong with them. They aren't tough or anything, but they're so aggressive you'd think they were all completely insane. If you see one, put it down. Don't think, don't hesitate, just kill it or it will kill you." -Local Scavenger (translated from German)
Animals:
There are regular animals in the area, such as bears and wild canids. Bears are tough, but they usually avoid you and if you do have a standoff they usually back away. Even in a fight, a single bear isn't anything the player can't handle. The only time they're a major threat is right off the bat, where the player's weapons are crap. Canids are even less of an issue. If you were unarmed and naked they still wouldn't be a challenge. The only time dogs even register as a threat is when they appear in packs. Even then, an entire pack of dogs is a pretty easy fight for the player with the equipment the first farmhouse provides. Just try not to get bitten, your wounds heal very slowly in this game and infection is an issue. However, as a general rule, dogs will not attack you unless you attack them or you're already in a bad way. And while they aren't a threat to a healthy, fresh player they are a threat to a sick, badly wounded player. However, keep in mind that wild dogs are untrained, undisciplined and cowardly. Take down one or two and the rest will back off. Especially if you identify and target their alpha, or if you are especially brutal to the ones you put down. (The game rewards mild to moderate amounts of dogkicky bastardry.)
Troglodytes:
Troglodytes are mentally regressed humans, which are a ways above animals in terms of threat but still well below regular humans. They're smarter than animals and move in packs, but they don't carry weapons and at best will grab a blunt object to throw or strike with if it's available. They're actually pretty strong physically, but the player shouldn't have an issue dealing with them. The only threat they pose is that they might cause you some minor injury that could cause you issues in more serious encounters. They have better morale than animals but if you get vicious they'll get lost.
Zombies:
Zombies are humans whose brains have been taken over by a foreign organism that normally sits in their spine and does nothing major to them. This creature takes over for parts of their brain when these parts are lost, and from this zombies are born. Zombies have a strong pack mentality and are easily subjugated by humans, but are extremely dumb. They may or may not be able to use tools. Some carry tools with them, others just grab available objects when the need arises. They often wear rudimentary clothing, even when wild, which appears to be a result of remaining human memories. This is not universal, however. It appears that their ability to use tools and desire to wear clothing are tied to what parts of their brain are still human. They don't represent a major threat as they are stupid and uncoordinated, but their morale is unusually strong and they lack some significant morale-draining factors. (For instance, they don't feel pain and don't scream or cry when wounded.) If they weren't so damned weak, their relentlessness might be enough for them to pose a threat. They might hit you with a thrown object, which is a minor injury, but it's unlikely they will be able to close to melee and if they do their attacks are always power attacks that are slow, clumsy, overhanded and easy to avoid. If they do hit you they'll do a lot of damage, but it's unlikely that will happen.
Zombants:
Zombants are mutant zombies that have not only their brain but some or all of their organs under the control of the "parasite" (really more of a symbiote) in their system. They are the result of a mutant "parasite" found only in Europa, which is considerably smarter and more robust (but slower spreading) than the regular version. They themselves are smarter and more robust as a result. They are highly resistant to environmental concerns, and although they wear less clothing, they always use weapons. Despite their high (if still slightly subhuman) intelligence, zombants appear to be completely insane. They whisper, jibber, mutter, chant, sing, talk to or even hold entire conversations with themselves, move in strange, animalistic and unpredictable patterns and tend to randomly seize and continue as if nothing happened. Strangely, they understand each-others incoherent, broken speech and random gibberish and their insanity takes an alarmingly consistent form. They aren't aggressive to humans, but they often form packs of their own and are territorial, or else they end up being used by humans as something akin to attack dogs. Zombants worship a deity called Yboim-fyc. Infrequently, zombants will use complicated weapons like firearms. They are a much more serious threat than either troglodytes or zombies, but are still not as big of a threat as humans.
Leucocytes:
Leucocytes are mutant animals with a white colouration, near-immunity to environmental conditions, a milky haze over their eyes and pink blood. (It's actually a regular red, but it looks pink due to the large number of white specks. These white flecks are clumps of white blood cells, or "leucocytes" and are the source of their name.) They are no more physically powerful than normal animals, but they move in well-coordinated packs that are often inter-species and even include species that should be natural enemies. They are extremely aggressive and attack everything that isn't a leucocyte that they happen to notice. What they lack in individual might they make up for in ferocity, coordination and unbreakable morale. They are just as much of a threat as zombants, as even though zombants are deadlier both individually and in groups, leucocytes are more aggressive and less likely to back down. They still aren't as dangerous as humans, though.
Human enemies:
"There is nothing in this world more dangerous than your fellow man." -Briefing text
I'm going to just say it straight out: humans are the deadliest enemies in this game. The weakest human might not be a match for the strongest creature, but there are very few creatures that are a serious threat to a healthy player and there are no humans that aren't. Every human from the toughest raider to the tiniest child can kill you in seconds if provoked. These are fights you're better off leaving unfought. Keep your guard up around humans, and don't give them a reason to put you down or you'll end up looking like a colander.
Raiders:
Raiders are looters than have been frequent in Europe since the last bombing. For the most part, they're just looters. They don't usually attack or rob people because it's not worth the risk. They won't shoot you if you don't do anything stupid, and other than a few tense standoffs you shouldn't have any issues with them that you don't want. Raiders don't tend to be well equipped but they are fairly coordinated and very tough. They'll have good ability scores and they're damned good shots. The only difference between a hostile raider and a friendly scavenger is their aggression. A scavenger is unaggressive, cautious and fairly submissive. They won't fight you for a claim and they will often go out of their way to avoid tangling with you. A raider is aggressive, territorial and assertive. They won't kill you for no reason, but you are not getting to their claims without a fight and they won't hesitate to put you down if you make a move on them. If you must fight them, play to your advantages. With ranged weapons it's best to stay in cover and try to avoid being precisely located. With melee weapons move fast and try to avoid their line of fire. Raiders use shotguns and pistols a lot, so body armour is a good idea, but in every group of raiders at least one has a rifle or carbine. If you can, put down the rifleman first. You are almost certain to get shot in a fight like this. Treating a gunshot wound isn't hard, bullets are not especially incapacitating, but it is still a serious injury that you'll be feeling for a while. Untreated you'll probably bleed to death, and improperly treated you might develop an infection that is potentially fatal. If you end up in a melee be sure not to get hit. An axe or sword wound can stop you dead, is much harder to treat than a gunshot wound, and is likely to kill you anyway through infection even if you can stop the (always very heavy) bleeding.
Soldiers:
Compared to raiders, soldiers are much better equipped and better coordinated, but they aren't nearly as tough. If that was all their was to it, they'd be evenly matched, but it's not and they're not. Soldiers come in bigger groups, have better morale and oftentimes support of one form or another. Soldiers are by far the deadliest enemies in the game as a result of these things, even if they are low levelled and individually weak. This is especially true of the Russian soldiers, who are conscripted and not very well trained but wear decent armour, are very well armed and have a great deal of support. Just don't pick a fight with them and they'll leave you alone.
Weapons:
"Try and save your gun for when you need it. Weapons are hard to fix out here, ammo's expensive and gunfire draws leucocytes." -Local hunter (translated from German)
There are weapons of all forms in the game, ranging from simple tools to swords and guns.
Ammunition is expensive and not overly abundant, your weapon requires maintenance and discharging firearms draws a lot of attention, so using guns isn't always an option. Further, firearms are extremely unwieldy in close quarters and have poor stopping power compared to other weapons. That said, guns are still the most practical option in combat, especially in serious combat against other humans.
Energy weapons such as lasers are available and in clear weather have extremely long range with perfect accuracy and good stopping power. They aren't very reliable and the lethality of the wounds they leave is greatly sub-par. All the issues with guns count at least double with lasers, their fire rate is poor and they tend not to last in the field. They're as situational as weapons get.
Explosives are a good option overall, or at least they would be if they weren't so situational. Their range usually isn't stellar, and their blast radius is usually greater than their range, so make sure there's something solid between you and the explosion or you'll be catching shrapnel. Also, don't rely on shrapnel to penetrate armour. Most modern armour is out of Kevlar, which doesn't work on shrapnel at all, but they frequently include a small amount of chainmail to protect against it.
Melee weapons aren't always usable due to issues with distance, but when they are they are very effective. Their penetration isn't always good, but there's no complaints about their stopping power. You have three major choices, which are simple weapons, martial weapons and exotic weapons. Simple weapons are mostly improvised, provide the most skill and attribute progression, are the cheapest, the most common, the easiest to repair and don't require a very high skill to use effectively or take feats in, but they are also the least powerful and the most unwieldy, making their efficacy rather sharply limited. Exotic weapons are entirely dedicated, provide the least skill and attribute progression, are the most expensive, the least common, the hardest to repair and require a lot of skill to use effectively or take feats in, but are also the most powerful and the least unwieldy, making them almost shockingly effective. Martial weapons are somewhere in between. Examples of simple weapons include most axes, knives, spears and clubs. Examples of martial weapons include most swords, hammers, maces, sickles and scythes as well as the larger and more sophisticated versions of simple weapons. Exotic weapons only include larger and more sophisticated versions of martial weapons. This concept exists for other weapon types as well, but it's not as clear cut for other weapon types as there are usually solid drawbacks for exotic guns, energy weapons and explosives.
Hand to hand weapons are a step past simple. The skill they use starts high and progresses fast, they have exceedingly low requirements to take feats in and they get excellent penetration, the only issues they have are a significant lack of power and severe lack of reach. Brass knuckles don't compare to a club, and a katar isn't as good as a sword. Great if you're training, they don't require much effort to maintain (if any) and they're not bad as long as your enemy isn't wielding a regular melee weapon and you don't need to worry about their terrible reach.
Apparel and armour:
"You've got a lot of danger out here. You're going to want more between you and danger than your skin." -Local armorer (translated from German)
There are three weight classes of clothing and three weight classes of armour. Clothing has one skill, while each weight of armour has an independent skill. Lighter apparel skills progress faster, and light armour is more practical most of the time due to reduced weight and restriction, but heavy armour stops weapons with higher penetration and does more to reduce damage from those it doesn't stop as long as they don't exceed it too much. Heavier apparel also provides more protection against environmental damage types. Really, this is pretty straightforward, except for the different material types.
Ballistic apparel is focused on a few select damage types, it's fairly lightweight, has inlaid plates over the chest that provide substantially increased protection and has chainmail between the layers of Kevlar to halt shrapnel. However, it isn't very durable and never provides bonus damage reduction. It's only really useful against puncturing and electric damage, against other damage types it provides sharply limited protection.
Fabric apparel is pretty general and overall effective. It's very lightweight, and although it has no strong points it has no weak points either. It's not weak against any damage type, it's rather durable and it gets double damage reduction against all damage types. This is a solid all-around choice, but it lacks any serious strengths.
Padded apparel is a fairly single-minded form of armour that is really only effective against bludgeon and concussive damage and ineffective elsewhere. It's strong against bludgeon and concussive, cold and electricity. It gets double damage reduction against bludgeon and concussive as well, but it is weak against incision, and gets half DR against penetrative damage types. It's a common type of apparel, most working clothing is padded, but padded armour any heavier than light is uncommon.
Metal apparel is extremely effective, if a bit impractical. It's heavy, has well-placed strong points and high DD. (Admittedly, not as high as ballistic.) It is extremely durable, it gets double damage reduction against all damage types and is very strong against incisive damage, which is a very common damage type. It's unfortunately expensive and hard to get repaired.
Ceramic apparel is the best example of "awesome, but impractical" I can think of. It provides stellar DD, triple DR and has no weaknesses. It's strong against every damage type and isn't even heavy... but it's extremely fragile and literally impossible to repair. It will not hold up to enemy weapons for very long, and you can't put it back together like you can other armour types.
Plastic apparel is cheap, common and easy to maintain. It's also lightweight, but unfortunately that's where the praise ends. It's stronger than most armour types against puncture, bludgeon and concussive damage and has double DR against all kinetic damage types, but it's weak against incisive damage, thermal damage and corrosive damage. It's also fragile, so it won't hold up under pressure. That motocross gear you get at the beginning is a good example of light plastic armour.
Medicine:
"Whether you're bandaging a scrape or stitching your quadriceps back together, it'll help to know what you're doing." -Excerpt from the medicine skill description
There are a number of simple medical implements the player may use throughout the game. These are stored in your inventory and tracked separately, and are all used for different tasks. The military first aid kit at the beginning gives a small supply of each and separate inventory space to store them in so they aren't in your pack. Medicine is a natural skill, and one I heartily recommend every player tag because the number of doctors in the game is sharply limited. There are literally three doctors on the map, and only one is available early on. (And he's not actually a doctor, he's a retired biomedical engineer with limited medical training.) It has a small effect on basic medicine, like adrenalin shots and bandaging, but it's most important in the surgery minigame where it makes it so much easier. (Performing surgery reduces damage penalties and speeds the healing of an injury.) Surgery cannot be performed in combat, but there aren't any major requirements for the basic field surgery you can perform in-game.
Bandaging:
Gauze and sterilized padding, used to cover and keep pressure on a wound. These take a short period to apply, but aren't part of the surgery minigame and thus can be performed in combat as long as you have the time. It reduces bleeding magnitude, but not duration. By default, it divides it by 1+(0.01*medicine, up to a medicine of 100) but there are better bandages available later that have a higher cap, and there are perks that multiply the whole formula. (Maximum of x2)
Adrenalin:
A simple shot that can be taken at any time. It increases the character's adrenal state by 1 once it takes effect. This increases their effective strength by 0.1*Strength, allowing them to move faster, attack faster and deal more damage, but its intended purpose is different. It reduces the impact of hypovolemic shock by 0.05*Base. It's also a divisor for fatigue, pain and will damage, and a multiplier for the "threshold" effects for these three things and the reduction effect on the latter two. Under normal circumstances, adrenal state is 2. It's 3 when particularly active, in low-threat combat or when spooked. It's 4 in most combat, or when afraid. It's 5 in life or death situations, 10 when berserk. 10 is the cap. The adrenal shot's default one minute onset time is divided by 1+0.01*medicine, up to a medicine of 100, and its duration is increased 0.1% per point of medicine, up to 150. The animation takes 60s/Dex/(1+0.01*Medicine, no cap) rounded to the nearest 0.6s.
Disinfectant:
A cloth wipe with a disinfectant chemical soaked into it. A follow up to running water to clean a wound, ineffective if not proceeded with running water. A simple item with a simple purpose that doesn't take long and isn't part of the surgery minigame. It divides the magnitude of the infection by 2+Quality+0.01*Medicine, up to 150, with the quality mod ranging from 0 to 1.5. Efficacy is doubled if preceded by cleaning the wound with water, (done from any source of running water) which also divides it by 0.5+Quality+0.01*medicine, up to 150, with quality ranging from -0.5 to +0.5 and being dependent on how clean the water is. There's a perk chain that if taken all the way up can double both, making your maximum divisor 50. Remember, the goal isn't to get it to 0, that's impossible. Just get it below your "immune system" derived stat, which for an average starting character is 30. Starting values are dice-based, and range from one to one hundred d10 dice. (1d10 averages 5.5, 100d10 averages 550.) This is dependent on both the size of the wound and the weapon that left it.
Painkillers:
There are two kinds here. Pills are slow, but long lasting and not impacted by medicine in the slightest. (These include aspirin and codeine, the latter is weak but common and the latter is powerful but rare.) Injections are fast, short lived and medicine is important in their usage. (Morphine and heroin.) Aspirin usually takes twenty minutes to take effect and lasts four hours, and codeine takes ten minutes and lasts the same time. Aspirin provides +5 pain reduction, 1.1x threshold and +5% immunity, (each extra adds +5/+0.1x/+5% up to 5 doses, a maximum of +25/1.5x/+25%) codeine provides +10 pain reduction, 1.2x threshold and +15% immunity. (Each dose adds +10/+0.1x/+5% up to four doses, a maximum of +40/1.5x/+40%) Morphine takes one minute to take effect (same division for skill as adrenalin and all other shots) and lasts fifteen minutes (same increase as other shots) and provides +25 pain reduction, 1.5x threshold and +30% immunity. Heroin gives +25, 1x threshold and +10% immunity. The two do not stack, heroin just counts as a dose of morphine if you have morphine in your system. Each extra dose of either adds +25/+0.5x/+10% up to three total doses. (+75/2.5x/+50% for morphine, +75/2x/+30% for heroin) The player can make their own painkillers using the chemistry skill, which range from questionable to mediocre in power but are very cheap to make.
Antibiotics:
These are just ingestible, so the skill doesn't matter to them at all. These permanently reduce all infection effects in your body by a set value. Normal antibiotics (penicillin variants) reduce it by 5 and there are some fancy new antibiotics (which are basically super-powered penicillin variants) that reduce it by 10. These work over the course of ten in-game hours. The two antibiotics and user-made antibiotics stack, but multiple doses of a single one only increases duration and has diminishing effect there. (+4 hours second dose, +2 hours third dose. Nothing beyond that.) Really, why bother? You're probably using them before a rest cycle anyway, it's just as convenient to take them every 10 rest hours like you're supposed to.
Coagulants and haemostatics:
These are topically-applied (coagulant) or ingestible (haemostatic) drugs. Coagulants are cheap, fast-acting, powerful and medicine dependent but have to be applied to each individual wound and don't last long or work on new wounds. Haemostatics are systemic, long-lasting, medicine-independent and automatically apply to all wounds, but are weaker, more expensive and take time to kick in. There's only one coagulant in-game, and it's a gel. It multiplies the rate at which bleeding is reduced by fortitude by 2+0.02*medicine, up to 100 medicine, and halves the maximum bleed time right off the bat. Haemostatics simply halve the bleed time, and have no other effect. The player can make their own, although their efficacy varies and is never as much as the industrially-produced ones. (Still, a cheap extra source of coagulants and haemostatics is a nice bonus.)
Orthotics:
Orthotics are devices used to somewhat reduce the penalty of a limb being severely injured (a maimed limb is now treated as crippled, crippled as wounded, wounded limbs are unaffected) and reduce self-injury and extra fatigue build-up. The reduction of self-injury is a percentage equal to 50+1/5 medicine. (Up to a maximum of 75% at 125 medicine.) The reduction to extra fatigue build-up is also a percentage equal to 25+1/5 with a maximum of 50% at 125 medicine. Orthotics are cheap and available, but their use is limited to a single body part. (You purchase orthotics in kits, but find them individually.)
Regeneratives:
Regeneratives are medicines that promote natural regeneration of at least one form. These come in three varieties and two levels of relative power each. Body regeneratives promote the healing of tissue and bone, speeding the recovery of limb integrity by 50% for the basic version and 100% for the more advanced version. Blood regeneratives promote the generation of blood, speeding the recovery of health by 100% for the basic version and 200% for the more advanced version. Energy regeneratives speed the healing of fatigue and regeneration of stamina by 200% for the basic version and 400% for the more advanced version. They all take one hour to kick in, and last twelve hours.
That's all that comes to mind right now. As always, I'm sure there's more I'm forgetting.
EDIT:
Since I've mentioned him a few times: The "Local Codger" from the weather quote, the "Old Man" who teaches the gambling minigames and the retired biomedical engineer are all one and the same. He's also the legal owner of the abandoned house you start the game outside, although he inherited it from his parents and has never lived there. (He's quite clear on this, he's also quite clear on what happened to his parents and might quilt-trip the player a bit.)
