I offhand pitched the idea of a tabletop RPG (TTRPG) adaptation of Pathologic by @IcePickLodge , and I can’t stop thinking about it, so let’s draw out that idea!
For the uninitiated, Pathologic and Pathologic 2 are survival horror RPGs that deliberately twist and critique tropes of theater and computer RPGs, while telling you as much to your face.
If you’re interested, check out the reviews of these games by @Lord_Mandalore, @hbomberguy, and SulMatul on YouTube.
So I’ve been working on a TTRPG system called BOLT, a d10+d4 game that prioritizes chaos, fast and lethal combat, and a reliance on knowledge skills. For more info, go here: https://twitter.com/ajeypandey/status/1230828397611438082?s=21
This is the game where everything one-shots you, and there’s a skill dedicated to Endure the pain and keep standing, but each time you do this, you’re forced to literally use smaller dice for all your skill checks.
This is also the game where you gain XP by meeting character-specific Incentives like 
“Did I act recklessly to save lives?”
“Did I demonstrate my superiority?”
”Did I rationalize an unforgivable action?”
So how would I adapt this system to Pathologic? Well, first, BOLT has two health tracks: Vitality and Tenacity. Run either one to zero, and you mark a Wound on your character, which makes you roll smaller dice for everything. Three Wounds, and your character dies...
I would add a few more health tracks: Hunger, Thirst, Infection, which would tick down as your character makes skill checks. If any of *these* meters hit zero, they *also* make you mark Wounds on your character!
Immunity? Well, that would be a “skill” check to fight off the plague. Your character would be expected to fail without extraordinary effort AND luck.
And each time your character dies, they are weakened. Their health tracks shrink, they lose ranks in skills, they lose ranks in base attributes, they lose entire Feats, they may even be pushed to change an Incentive.
But only in death can a character gain XP through Incentives. Only through death can your character grow, despite their encroaching demise.
Which brings us to character creation!
There would be options to play Roles as Doctors (Physician, Butcher, Saint...) and as non-Doctors (Soldier, Clairvoyant, Scoundrel...)
Each Role would be constructed from simple pieces.
Pick this set of skills, or the other.
Pick this tree of Feats, or the other.
Pick two Incentives from this list alone.
Each player would also select three Bound, who also have simplistic archetypes: Orphan, Leader, Exile, Architect... 

In effect, each player would start with little more than a bare character sheet and a few names. Simple, cookie-cutter characters—intentionally so.
But through the process of dying, weakening, spending XP, and changing Incentives, characters would become more nuanced. As the player adds narrative depth to their character, the death mechanic would add narrative depth to their character sheet.
Instead of having a conversation with a theater director upon character death, players would have a conversation with their Game Master, drawing backstory and motivation for their characters, for their Bound.
”Why do you think your character came to this town?”
”What made your character become a Doctor?”
”How did your character first meet this Bound?”
And as the game carries on, as player and player-character bleed closer together, the questions upon death would start to deliberately draw out the separation between the two.
“What would you have done, if you were in your character’s situation?”
”If you had failed your Bound in the way your character did, could you forgive yourself?”
“What would you say to your character to try to give them hope?
In the same way that the Pathologic games use the artificiality of theater and video games to shine a light back on the player, I’d want to use the artificiality of tabletop RPGs to do the same.
So uh...yeah! That’s the pitch! Let me know what you think!

If folks think this idea has legs, I might try and flesh it out more...
You can follow @AjeyPandey.
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