The Phantom Pain's Mission 43 is designed to be painful. That's the point of it. It's almost obnoxious in this regard, particularly the final bit in the basement where you shoot men as they salute you and patriotic music plays in the background. The formulas for emotional pain are not terribly complex, and it doesn't take a genius to execute on them. Mission 43 follows one of them to the letter: forcing you to destroy something which you have a responsibility to protect. It's easy.
To that end, there is precisely one character in the Quarantine Lab whose death was not, to me, formulaic. Her name was Sadistic Lizard.
When I first unlocked the combat team and discovered that it was possible to play as characters other than Snake, my first question was, "I wonder if they bothered to make fully animated female characters?" I scrubbed through my forces in search of a female character with a decent Combat skill, and found Sadistic Lizard. She was sitting on the research team with an "A+" research skill, but had "A" combat skill as well, so I swapped her over.
Over the course of the next few days, I spent about 10 hours playing as Sadistic Lizard. That's an entire game by most standards. She did dozens of side ops, fulton'd hundreds of things, and patted D-Dog on the head more times than I can count. Her face had an Asian look to it, but her only spoken language was English. A third-generation immigrant, I figured. The neighborhood I live in has a strong Korean population, so that's what I pegged her as. Over the course of two-days, Sadistic Lizard became every bit as much of a real character to me as Ocelot or Miller. She was an integral part of my story.
At the end of Chapter 1, you receive a a package of S+ staff. My S+ combat staff was a woman named Flaming Buffalo who also happened to have the fantastic Gunman skill. With some reluctance, I shifted Sadistic Lizard back to the R&D team. She had earned it, though. Some quiet time in the lab to recover from getting shot so many in the field. I was happy to have her there.
And then mission 43 happened.
Going into mission 43, I wasn't worried about Sadistic Lizard. I was worried about Quiet. I thought they would find some way to make her responsible for the new outbreak, and that the mission was the first step on the way to me having to shoot her. As I stalked through the horror-game-esque Quarantine Lab, my overriding thought was "don't let Quiet be involved in this."
Then I saw a woman in a lab coat cowering on the floor at the foot of a staircase. I hovered my reticule over her until her code name popped up. It was Sadistic Lizard.
"Maybe she's okay. Maybe I won't have to hurt her."
That was wishful thinking, of course. Later on, you get the goggles, which you're supposedly going to use to identify who does and doesn't have the infection. Naturally, everyone is infected. The actual purpose of the goggles is not to differentiate people, it's to help you justify what you're doing. The faint glow in their throats means that you're not a monster, that their deaths are necessary.
Still, I didn't particularly care about the zombie-like soldiers I was popping was I worked my way down the station. It didn't emotionally bother me until I reached the bottom of that staircase and returned to Sadistic Lizard. Sure enough, her throat was glowing too. I had to do it.
I wish I had a screenshot of this, but I don't. This moment hit me, hard, and recording it was not a priority. I tried replaying the mission as a "Flashback" to see if the same staff would be there, but that's not the case. I suppose you're just going to have to trust me that seeing her throat glow was one of the most impactful images this game ever showed me.
After you finish Mission 43, a small diamond is added to your shoulder patch. Those diamonds are the compressed ashes of the men and women you killed in Mission 43.
Mine has a name. That sparkle on Snake's shoulder is Sadistic Lizard.