Healing Without Permission
The Patchwork Clinic Network is an informal, illegal, and indispensable healthcare system operating throughout Commonwealth City—primarily in Stackside, the Grayline, and the Fringe.
They are surgeons, cyberware specialists, biotech engineers, street medics, and experimental practitioners who provide care the City technically guarantees, but practically fails to deliver.
They do not replace public healthcare.
They exist because public healthcare has limits.
To those they save, Patchwork clinics are sanctuaries.
To regulators, they are safety nightmares.
To the City, they are an open secret no one knows how to eliminate without killing people.
Patchwork clinics emerged during the first major augmentation crisis, when public systems were overwhelmed by a surge of illegal cyberware failures, biotech rejection, and black-market mods incompatible with city-standard medical protocols.
Public hospitals followed policy.
Patchwork medics followed need.
What began as ad-hoc triage rooms in abandoned units evolved into a decentralized network of practitioners who shared techniques, equipment, and warning signs through encrypted channels and reputation chains.
The City cracked down repeatedly.
The clinics never disappeared.
Because people kept bleeding.
The Patchwork Clinic Network has no leadership, no charter, and no central database.
It functions on trust, reputation, and favors.
Independent clinics and mobile units
Shared medical lore through secure peer networks
Informal referrals instead of records
No standardized pricing—payment is contextual
Each clinic develops its own specialties:
Illegal cyberware stabilization
Emergency augmentation removal
Biotech graft repair
Black-market synth compatibility
Anomaly physiology treatment
Save the patient first
Don’t ask where the hardware came from
Never sell out another clinic
If you cause harm, you disappear
Competence is currency.
Failure travels fast.
The Patchwork Network does not exert power overtly.
It wields necessity.
People survive who otherwise wouldn’t
Augmented workers stay functional
Illegal mods remain viable
Communities resist dependency on city systems
When clinics are threatened, neighborhoods respond.
Not with protests.
With silence, misdirection, and closed doors.
Among Stackside residents, Patchwork clinics are heroes.
They fix what official systems refuse to touch.
They don’t report people.
They don’t moralize desperation.
Among civic authorities, Patchwork clinics are a liability:
Unsafe procedures
Unregulated tech
Data black holes
Legal exposure
The City oscillates between tolerance and crackdowns.
Every crackdown ends the same way:
Public systems overload.
And the clinics quietly reopen somewhere else.
Block Councils: Strong allies. Councils protect clinics that protect their people.
Civic Systems Authority (CSA): Ideological conflict. CSA prioritizes safety metrics; Patchwork prioritizes survival.
Maintenance Corps: Quiet cooperation. Infrastructure workers often rely on Patchwork care.
The Data Ombuds: Sympathetic, but limited. Privacy laws help—sometimes.
Freeholders: Transactional overlap. Ideological alignment is inconsistent.
Players encounter the Patchwork Network when official medicine isn’t an option.
A clinic hunted after a botched but necessary procedure
A patient with illegal augments the City refuses to treat
A rogue Patchwork medic causing catastrophic harm
Experimental tech that could save lives—or doom them
A neighborhood protecting a clinic at any cost
Players may:
Receive treatment unavailable anywhere else
Act as couriers for medical supplies
Protect clinics from enforcement or rival gangs
Investigate malpractice without exposing the network
Patchwork medics respect people who understand risk.
They despise people who demand guarantees.
The Network is deeply divided.
Purists believe any care is better than none
Reformists want partial legalization and oversight
Radicals see regulation as violence by delay
Clinics that push experimentation too far are quietly isolated.
Not by the City.
By other Patchwork practitioners.
The Patchwork Clinic Network exists because Commonwealth City made a promise it cannot always keep.
When healthcare is guaranteed but conditional, someone will step in to fill the gap.
Patchwork clinics do not claim to be safe.
They claim to be necessary.
And in a City that refuses to let people die for lack of access, necessity has a way of becoming its own kind of law.