Video games have a tense relationship with human biology. One that revolves around mostly ignoring how they work when knives or arrows or lead are introduced to them. This is necessary to keep gameplay fluid, as the months or years necessary to rehabilitate from a single bullet wound generally don’t fit the narrative of going on to diligently murder every living soul between the player and revenge/treasure/freedom. It’s a relationship that only becomes more strained if you extend it to include the many, many illnesses that can befall our fragile anatomy.
As a plot device, injury frequently brings its’ full weight to bear. One well placed bullet among the hundreds previously absorbed can spell the end for a budding partnership between grizzled soldiers, provided it happens during a cutscene. No amount of Phoenix Downs crammed into the wound left by a needlessly gigantic sword will ever bring Aerith back to life. It’s a stark contrast to crouching down behind a waist high wall for a few seconds while the red filter drains from the screen, or eating five full wheels of cheese in the middle of a fierce battle with a dragon. Somewhere in between these extremes we have the likes of Tomb Raider (2013), where Lara Croft sustains a nasty fall and is impaled right through by a piece of (almost certainly unsterilised) rebar. After a brief quick time event wherein she yanks the offending piece of rusty metal out of her torso she’s back on her feet and, fortunately, the lack of disinfectant or medical facilities don’t lead to a life threatening case of septicemia.
Disease, by contrast, often works in a more indirect fashion, framing a narrative and providing the motivation for fetch quests and entire games. In Batman: Arkham City, a blood disease spurs Batman into action. He probably would have been spurred anyway, but this really got him going. Brothers: A Tale of Two Sons revolves around the titular brothers seeking a cure for their dying father in the waters of the aptly named Tree of Life. The action in Hyper Light Drifter halts and stalls as the main character staggers and coughs up blood. He too seeks a cure. Mako poisoning removes Cloud Strife from the player’s lineup in Final Fantasy VII, which raises the stakes by leaving a pointy-haired hole in the party to be filled by a lower leveled substitute.
Examples of injury and disease causing significant impact in terms of gameplay are markedly fewer and rarely extend beyond forcing the player to walk with a limp for a few minutes, or endure 2-3 bouts of vomiting before carrying on as normal. Not without good reason, it’s tough to make having a broken limb or radiation poisoning feel impactful without being irritating to the player. It’s hard to convey the sensation of powerlessness at your body succumbing to a virulent illness, or the despair of having a limb hang limply by your side. Games like Fallout attempt to represent this by having the neon green screen of your Pip-Boy 3000 show how your stats have been impacted by radiation or addiction, but the dip in stats doesn’t do much to impart the gravity of these afflictions. Fallout does provide a reasonable estimation of the effects of damaged limbs, with aim and movement speed being crippled by damage to arms and legs. Taking too many hits to the noggin causes a nauseating blur to engulf the screen now and then until treated. This definitely amps up the tension when a Deathclaw is barreling towards you, but simply by jumping into the menu and administering a couple of stimpaks you’ll be fleeing at full speed again in no time. Literally, it pauses time when doing so.
Skyrim, Fallout’s high fantasy counterpart, borrows some of the same systems. Most diseases cause some debilitation in stats and are prayed away with ease. An exception to this rule is Sanguinare Vampiris, the disease that causes Vampirism. For the first three days in-game after contracting the disease (done by taking damage from a vampire), no symptoms are evident. If left untreated for 72 hours, it progresses to full blown Vampirism. From that point on the character ceases to recover health, stamina or magic while in sunlight. They become harder to detect while sneaking, gain resistance to diseases and poisons, and grow pale, with glowing yellow eyes and lengthy fangs. Now praying no longer provides a cure and the player must feed on blood at least once a day to prevent symptoms from worsening. Each day their weakness to fire grows, as does their resistance to frost. Extra spells centered around charming enemies, draining health and reanimating the dead are added up until the fourth day without feeding, when the vampire becomes so grotesque that they’re attacked on sight by the majority of npc’s. It’s an impressive system in that the changes are noticeable, worsen with time, and actually impact how you play the game.
Far Cry 2 also attempted to work a realistic portrayal of disease into the gameplay, with the protagonist contracting malaria at the beginning of the game. Though met with criticism for the difficulty this caused in playing the game, it definitely impressed upon the player the seriousness of the condition. Roughly every half hour in real-time, the screen would turn a pallid shade of yellow and vision blurs. Sprinting is disabled and, should the player not take a dose of medicine, the attacks continue until they eventually collapse and pass out. Towards the end of the game the medicine is less effective as symptoms worsen. It was gritty and real, but was met with criticism from players who resented the fact that it was an unavoidable aspect of the game and would frequently interrupt combat.
The issues with effectively working injury and illness to games are pretty pronounced, so maybe we can forgive the tropes of super soldiers who can recover from infinite bullet wounds or healing broken bones with a few hours of sleep. There are games that break the mould in how they deal with these subjects like Theme Hospital, Plague Inc., and the infinitely more weighty That Dragon Cancer, to name a few. There are more again that deal with mental illness, which I’ll be exploring next time. For now we’ll just have to learn to live with being in control of near immortal demigods. Which is fine, I guess.