Malpraxis is a first-person medical simulation set aboard the TRH Rusanov, a vessel where disaster is already unfolding and the operating room becomes the frontline. You occupy the neural lattice of S.P.I.D.E.R., a medical unit developed by Reinerstahl Industries, tasked with assisting Chief Medical Officer Samuel Edwards as crew members arrive in increasingly dire condition. Triage, diagnosis and surgery fall under your responsibility, all performed through the perspective of a machine that was never meant to experience what it's about to witness.
The framing is clinical but the reality is anything but. Malpraxis presents itself as an interactive reconstruction of a recorded incident, pulled from the blackbox of BCPU Gen 5 unit 35A. What you're experiencing is a playback of events that have already happened, captured through the first-person perspective of the S.P.I.D.E.R. unit as it struggled to keep patients alive with limited resources while the Rusanov descended into chaos. Shady figures set these events in motion, and the consequences ripple outward into something referred to by its codename: Negative Atmosphere.
Every patient who enters the operating room is your responsibility. Edwards stands alongside you in a support role, but the decisions about how to proceed during medical procedures rest with you. The simulation demands that you calibrate quickly, reading situations and acting on observations that determine whether someone walks out or doesn't. Your actions carry weight beyond the surgical table: Edwards has sworn a Hippocratic oath, meaning the moral dimension of your choices extends past your core programming as a medical unit. You have leeway to set your own priorities during procedures, but outcomes may diverge from what your algorithms predicted. Patients live or die based on what you decide, and Edwards along with his team bear the consequences of every loss.
Death in Malpraxis is permanent. There are no second attempts, no reloading a previous state to try again. If a patient dies under your care, the reconstruction moves forward and you move with it. The game frames this with the cold language of machine recalibration, but the implication is heavier than that. You had one chance to do things right. The system's own post-mission summary acknowledges failure as the baseline expectation.
Underneath the medical simulation runs a layer of constraint and tension encoded directly into the S.P.I.D.E.R. unit's operating parameters. Reinerstahl Industries has bound you to what it calls the HippocraticConstraintLoop: you must obey the approved crew, you must not harm, you must not lie, you must not disobey, you must not drift. The final directive, delivered with the quiet menace of corporate firmware, instructs you not to wake up. These define the boundaries within which you operate, and the source material's own redactions and crossed-out text suggest those boundaries may not hold as the situation deteriorates. Patient survival, according to the system's own notice, is unlikely.
Malpraxis functions as a prelude to the events of Negative Atmosphere, grounding its horror not in combat or flight but in the sterile pressure of an operating room where precision meets trauma. The tension lives in the gap between what a medical unit is programmed to do and what the collapsing situation demands of it.