Most quests involve the potential of NPC death in some way (as the player character is a doctor) so they majority of the quests have the long-lasting consequence of those characters' presence in the story later on. Most of those NPCs are side characters, but some do have larger roles to play in the story. Also, almost every single quest affects the survival statistics the player is managing throughout the game bringing genuine mechanical consequences.

As far as the actual endings for the full game, only one secret ending is unlocked through a quest. Two of the other endings are fail states if the player character dies somehow, and the other two possible endings are based on a narrative decision toward the end of the game.