Hey man, really insightful comment. It's true that the game was designed to be linear, but also features perma-death in some way, which is not always a good combination. This is actually why I don't really think adding multiple endings would benefit the game, because I don't want people to feel forced to repeat the same content if they're not satisfied with how it ended.
The pills thing is interesting because originally I wanted it to be a gameplay device (How many pills you take or following your prescription would influence things in the game, etc) but ultimately it just became a plot/narrative device. That's why the game kinds of "lies" to the player about their usefulness I think, because it might be presented too much like something that will influence gameplay.