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A step down from Dead Money, but there's still a lot to like here.

There are a ton of unique items, apparel, and weapons scattered throughout the Big Empty, not all of which are too compelling, but some of them are fun and all of them are creative. It's a good way to motivate exploration of its quite large hub world, even though that hub itself is a bit tedious to traverse despite plenty of unique art design along the way. I enjoyed discovering traces of Father Elijah from the previous DLC and finding the patient zero plant creatures that led to that one overgrown vault in the main game.

The level design within the facilities has enough to set them apart from each other but lacks the intricacy and intuitiveness that I loved about the Sierra Madre (the waypoint markers were necessary to find where you were going this time). But there are still a couple of smaller areas that provide rewarding exploration and offer up fun and clever environmental storytelling, like when you go past a bunch of empty cages in a kennel and figure the dogs must be long gone, but then you read a log that describes the dogs eating a bunch of Stealth Boys and you get that "oh fuck" sensation realizing you now have to fight through a bunch of invisible robo-dogs on your way back out.

The story and theme of Old World Blues is certainly distinctive, focusing entirely on humor and science-fiction as its two drives. The jokes can be rather hit or miss (the slow pauses during speaker changes kills the pacing of what was clearly meant to be rapid-fire back and forth dialogue at points) but there's plenty of funny material in here to be sure; the personalities in The Sink are all fun.

The sci-fi angle is almost a little too over-the-top for my liking. It's not canon-breaking necessarily, but undergoing a complete brain, spine, and heart transplant is just a bit hard to buy in this world and stretched my suspension of disbelief a touch too far. It at least gives you a motivating core objective, but then the actual quest design isn't particularly interesting — it basically boils down to a long fetch quest throughout the middle with a big list of things to gather.