Do you remember the era of the doctor/hospital show? Some would say it’s not over yet, but there’s always been interest in the medical field and the daily comings and goings at a hospital. From ER to House and Scrubs, we’ve been there for it all. Healthcare is a right, not a privilege, as we see it, but the reality is that the healthcare system is broken, on a fundamental level, and many people go without healthcare simply because they can’t afford it.
Meanwhile, healthcare work is grueling, and often thankless. Though we may have recognized that healthcare workers were heroes during the pandemic, working long hours in unimaginable conditions and taking life or death risks to help everyone, that’s even now (and even then) not always the case. Burnout, turnover, and even mental health issues and suicide plague the profession.
If this doesn’t sound like the start of a video game review to you, we'd understand. If you were to get a first look at Fall of Porcupine, with its beautiful art, soft indie rock soundtrack and adorable anthropomorphic animals, you probably wouldn’t immediately think it’s an emotional, intense deep dive into the realities of working in healthcare that includes anonymous interviews from those currently in the field. But, it’s both. And for as realistic and disheartening as it can be, playing Fall of Porcupine manages to somehow also have one foot solidly in cozy game territory.
In Fall of Porcupine, you’ll play as Finley, a pigeon and junior doctor who’s on their way to their first day at St. Ursula’s, where they’ll be assisting the staff in Internal Medicine. Finley’s from the big city and not used to life in a small town, and all the drama that brings, but is excited to see what else is out there.
Though I still marvel that you can call a game with the premise of Fall of Porcupine cozy, I can certainly say after beating it that it definitely has that vibe. It’s a sort of slice of life adventure that creates that soothing sense of routine that I loved in another game, Lake, that almost convinced me to abandon my 9-5 and become a local mail carrier.
Much of the gameplay in Fall of Porcupine is simple, and repetitive. Finley goes about his same routine every day, leaving from his small apartment in the downtown area to make his way to the hospital, either walking or taking the bus, and goes about his rounds in his ward. On your commute, you'll often be doing a lot of walking through a beautiful but sometimes confusing landscape, and will meet a variety of townfolk who you may or may not strike up friendships with along the way, from a barkeeping turtle and his mom to a homeless walrus and adventuresome shop-owner alpaca.
One of Fall of Porcupine’s greatest strengths lies in its character building. While a few ancillary characters border on cliche, most are well rounded enough that you can’t exactly anticipate what they’ll say or do, making the world and the characters themselves feel more realistic. They all have their own ambitions and motivations, and regard Finley from different perspectives.
Once at the hospital, you’ll take on the same sort of routine. Say hello to the incredibly endearing hippo at the front desk, and head up to the ward to make your rounds. To start, you’ll be checking in with the ward’s senior doctor, a surly cheetah named Krokowski who starts off as the person to avoid. She doesn’t take kindly to new doctors, especially those, like you, who spend a lot of time getting to know patients and other staff members, and doesn’t have the time to correct your mistakes. To avoid spoilers I won’t say too much, but she ends up being one of my favorites by the end. There’s also Karl, a ram and extremely hardheaded but experienced nurse on the ward, and Mia, a peer and colleague who’s a sweet and motivated cow going through it all with you.
To perform your job, you’ll need to complete some social tasks with patients, like asking them about their symptoms and lifestyle. You can choose how long you interact with patients, learning more about them and their lives and making them more comfortable with you and their predicament, or take a more no-nonsense approach to impress the boss and simply treat what ails them, but either extreme can cause problems. Talk too little and you may miss something critical - talk too much, and you may end up causing problems elsewhere on the ward. I like that there wasn’t a built in bias and that you needed to do both in good balance, though I tended to opt towards more talkative in my playthrough.
Fall of Porcupine also uses some mini-games so you can diagnose, prescribe meds, and give shots to patients, among other things. Each of these games are unique enough, with a common thread: intentional difficulty. When prescribing meds, for example, you’ll find that it’s tough to near impossible to balance what patients need more of and less of, while there’s diagnosis games that involve quicktime events with insane combinations of buttons that are awkward and have to be held, or rock band-esque games that take precision but increase in difficulty based on the case.
I like the literal translation of control difficulty to illustrate the seemingly simple tasks doctors face every day and the actual amount of difficulty each step in the process takes, but at times it gets to be a little heavy handed. You’re graded on how well you treat each patient, and report back to Krokowski at the end of each shift to see how you’re measuring up. Each encounter with the patients familiarizes you with them and the town a little more, and before long, you’ll find yourself becoming more attached to the perfect vision of Porcupine - a small town where everyone knows each other and works together to better the community.
Developers Critical Rabbit do a great job of slowly building up your affections for the town and everyone in it only to break it all apart shortly thereafter. Because it turns out, as in real life, people aren’t always kind, and place blame where it doesn’t belong. And, as in real life, it also turns out that not everyone is looking out for the best interests of patients or doctors. Sometimes decisions made in offices can cause pain and even death in the hospital floors above, and Fall of Porcupine doesn’t shy away from these realities. Just like with the mini-games representing treatment, you can only do the best you can with what you have. Sometimes you will be extra tired, or understaffed. Other times you’ll have to help in situations where you don’t have a lot of knowledge, or you yourself aren’t feeling well. One thing Fall of Porcupine does masterfully is illustrate these hardships through gameplay and the narrative, in a way that makes you understand these struggles more intimately than you would have otherwise.
At times, the message is heavyhanded, both as the story unfolds and as it resolves, but overall, Fall of Porcupine is a unique combination of a cozy indie game with adorable animal characters to fall in love with and a true-to-life reflection of the struggles healthcare workers face in the industry, and I couldn’t put it down.
Fall of Porcupine is available now on PC via Steam and for Xbox Series S|X and Xbox One, PlayStation 4 and PlayStation 5 as well as Nintendo Switch.
A Steam Key was provided to us for the purposes of this review.