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  • Nightmare Fuel:
    • While most of the conditions and their treatments are comically absurd, the treatment for "Cubism" (a disease that gives patients a body made up of unconnected colourful shapes, like a cubist painting) is utterly bizarre. The treatment machine picks the patient up with a claw, violently shakes them over a hopper so they fall to pieces, liquidises the pieces into a brown slurry, then pumps it into the neck of a fleshy balloon-body to reconstitute them. Freaky.
    • The reactions of patients having their blood drawn in the Fluid Analysis room is rather alarming. The patient puts their arm into a hole on the machine; the attending nurse then struggles to activate the machine, and when they do it violently plunges the needle into the patient's arm, causing them to panic and try to pull their arm out, while the nurse tries to calm and reassure them. The alternate animation for the treatment has the machine apparently malfunction and repeatedly stab the patient's arm. Then there's the Fridge Horror aspect, where you realize that the machine draws five huge vials of blood, which is likely three quarters of the blood in that person's body...
    • The reactions of patients being jabbed in the Injection Room is just as frightening as the Fluid Analysis room. The patient is made to lie face down on a bed which is pulled into the machine... and then a huge needle swiftly slams down and deliver the dose of medicine directly into the base of their spine. The patient apparently screaming in pain when that happens doesn't help. If you were already afraid of shots before, seeing a patient being jabbed by a needle the (relative) length of a human arm is bound to bring cringing and nightmares.
  • Porting Disaster: Downplayed. The console version is generally well regarded, however the game was specifically designed for PCs. Due to a memory limit, Off the Grid would be the last DLC released for consoles for the foreseeable future.note 
  • That One Boss: Well, inasmuch as VIPs can be considered "bosses", anyway. But of the rival CEOs that visit your hospital, Agatha Sphere tends to be the most dreaded. While the others cause sabotage that's at least manageable (Augustus Lavender wanders around occasionally vomiting and killing plants, and Jumbo McNally frequently drops trash and sabotages machinery, all things being easily manageable by a squad of janitors), Agatha will brainwash patients and staff she comes across, which will make patients ragequit almost immediately and cause staff happiness to bottom out on the spot. This, of course, will drop your reputation, but it gets especially frustrating as she simply will not leave. Woe betide you if she wanders into a heavily-populated part of your hospital and decides to brainwash everyone she comes across.
  • That One Level: Duckworth-Upon-Bilge. You don't get money for treatments. You don't even get money for snack machines, so don't bother placing them. The only thing you get money for is completing minor random tasks. It requires that you unlearn absolutely everything. Used to pleasing your patients by building them the treatment rooms they need straight away? That's a great way to fail this level. All that matters is getting those grants until you have at least a million buckaroos. Even Tarquin Foxbridge, the Health Minister, is utterly baffled by the player's choice to play the level up to two and three star ratings.

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