Novotnus: My interpretation:
The best ending happens when you "defeat" Queen of Maggots, who's the ultimate parasite feeding on people's depression, desperation and death.
1. Liz - Queen wants you to hate people, to treat Liz as nothing more than annoyance. When you listen to her and care - you do the opposite to what she wants from you.
2. Crow's riddle - that one is simple: Queen wants you to fail, so you must win.
3. Breakdown - Queen is \ feeds on Susan's depression. Breakdown, despair and tears feed her. Avoid them and the old hag will starve.
4. Mask - that one is simple, you can't let Mitzi die if you want to keep her alive until the end : )
5. Candle - once again, you don't do what Queen wants from you; by refusing to blow the candle you prove that you don't need the Queen, that you break the ties with her and refuse to follow her rules. You come back from the Otherworld in an act of pure will and personal strenght.
When Queen's grasp over Susan is loosen, the miracle can happen.

Gaunathor: Looks like I have my work cut out for me. I only managed to get the normal best ending during my first play through.

Of this list, I only managed to do 2 (all too easy) and 4 (only logical). 1 I almost managed. I just I forgot the end of the missing patient story. Regarding 3, well, it is hard enough for me to prevent my own breakdowns, let alone somebody else's. I still felt terrible afterwards. Yet another failure on my part.

Gaunathor: As for 5, I couldn't conceive of the possibility that refusal is a valid option. I'm just too used to always getting told what to do, instead of making my own decisions.

Gaunathor: Well, I'm not quite ready yet for my next play through, but I'm going to do it soon. Probably once autumn starts (it's my favourite season, after all). No promises regarding the "key" though. ;)

Now, if you'll excuse me, I got a pizza to make.

Novotnus: The game is cheating you here - if the shadow hits you, you will fail no matter what.

Novotnus: And, as a smoker, I remembered Liz' story pretty well :)

Novotnus: And I'm not pressing you about the 'key' :) I guess it must take time.

Austrobogulator: I barely realised the shadow was a thing...I feel like there's so many things I missed out on during the game. I sort of want to play through it again. Also, just a question, does 48+197 mean something?

Novotnus: If it has any meaning, I wasn't able to find it during like four or five playthroughs :)
I think I tried every option for every choice... well, not every - I couldn't bring myself to let Dr. X live :)

Austrobogulator: >_> This game is heaps deeper than I thought. I didn't even realise you could let him live.