Trauma Center: Under the Knife (DS)
Medical professions are teeming with potential for fictional dramas, especially when it comes to the life of a surgeon. Every time a patient is on the table a life is hanging in the balance, but even beyond that consistent source of tension, the emotional toll of such a job and the way it can impact the personal lives of doctors can certainly keep a medical drama fed with plenty of material. Still, even though Trauma Center: Under the Knife could have derived its drama from the realities of the profession, instead, it goes in a delightfully strange direction with designer viruses being deployed by terrorists and characters who can tap into a magical power because they might be the descendant of the Greek god Asclepius.
The game does begin as a fairly typical story about an up and coming surgeon though, early patients coming in for surgery because of grounded causes like motorcycle crashes. However, things do spin off into sci-fi territory pretty quickly, the doctors encountering a strange new virus called GUILT that is designed to specifically fight against any efforts to treat it. With multiple strains that all have different abilities, it almost seems like the perfect killer virus, a terrorist group deploying it more and more over the course of the game. However, you play as Dr. Derek Stiles, an individual with a special gift that allows him to tap into an inhuman level of concentration that essentially slows down time. Along with the help of other special individuals from the medical group Caduceus, Derek Stiles works to put an end to GUILT, his skill seemingly the only way to gain an edge against these viruses that can fight back.
Even with its sci-fi elements and god-given powers, there is still room for human drama in the plot of Trauma Center: Under the Knife. Derek begins as an all too aloof surgeon, turning up late and not taking his job seriously until he sees the results of such an approach to medicine. He quickly becomes dedicated to ensuring he will never lose a patient, his attitude tested over the course of the game as more and more unusual strains of GUILT make it seem less likely he can maintain such a success rate. Other characters will come into conflict or help Derek out over the curse of the game, his loyal nurse Angie quick to chastise him when he needs it or rally him when he’s flagging, but even she has a dramatic past of her father disappearing to feed into some character drama for her. We have encounters with a strange doctor of death who contrasts Derek’s approach to medicine, believing individuals should be given quick deaths rather than fighting to overcome painful and seemingly hopeless situations, we encounter doctors who lost faith in their effectiveness and characters so devoted to similar causes to Derek’s they’ll suffer the pain of GUILT if it means there’s a chance they can be operated on as a way to find a cure. Even though this is a game with surgery gameplay to entertain a player, a lot of thought was given to making sure the plot is something with many different scenarios despite it quickly becoming mostly about GUILT, the different ways it attacks and the way characters react to it keeping the cutscenes interesting.
The surgeries are also given plenty of thought in how to keep them varied, although this is certainly not the kind of game one would go to for an accurate surgery simulator. The DS touch screen is pretty much perfect for this kind of play though, the stylus able to act as a scalpel, suction pipe, syringe, or any other tool as needed, its deployment as easy as touching or sliding across the portion of the screen you wish to work on. Impressively, despite being a game about cutting open bodies to work on their insides, Trauma Center: Under the Knife achieves a Teen rating from the ESRB, likely because of the efforts it took to make the visuals of surgery a bit more palatable. Your patients are presented as basic forms with no real identifying features, organs and other innards are clean shapes, and when blood does appear, it’s often as a cloudy red blot rather than the messy fluid that could have made opening up a patient nauseating to some. There are still plenty of wounds that aren’t pretty to look at, but the game does a decent job of reducing the insides of a human body to an appearance focused on function rather than the sometimes grisly realities of surgery.
Trauma Center: Under the Knife makes sure you aren’t going in blind to these surgeries either. Besides an opening description of the procedure, your nurse will tell you what to do next when you’re encountering something new, even repeating it a few times after until you’ve become accustomed enough to it you no longer need the instruction. The nurse’s instructions are on the top screen as well, meaning they don’t clutter the bottom screen that is solely devoted to the operation. Before GUILT enters the picture the game makes sure simple tasks like cutting open a patient and sealing them up after have become ingrained in your approach, and while surgery may seem appropriately hard at first, soon certain steps of it become almost automatic. The game does rate your performance of every step of a surgery to encourage being precise even with your routine actions, but you only need to keep a patient alive and finish the surgery to complete a level. The patient’s health is displayed on the bottom screen and the game makes sure to warn you if its declining rapidly or is dangerously low, but no matter how bad things look, you always have a special solution you can inject to give a boost to the patient’s vitals. Doing this in the heat of the moment can be hard and sometimes, if you let a patient’s condition get out of control, you won’t really be able to keep up with the amount of vitality boosting injections they would need, so this doesn’t rob the game of its difficulty. Instead, it’s more of a band-aid for when you’re figuring something out still and need to keep yourself in the game.
The GUILT are certainly the main focus of most of your surgeries, and as such, the different strains of it all have unique complications and capabilities. Rather than being something that can be simply removed or treated, when the GUILT virus is located, it tends to start behaving in strange ways. For example, one strain of guilt burrows into an organ and creates long gashes across it until you can effectively eliminate it with a medical laser, one crawls around like a worm and must be divided into smaller and smaller portions until it can be safely removed without damaging the body, and one takes on the form of triangle shaped growths that will multiply if removed incorrectly. More like parasites than viruses, their mobility and range of treatment methods certainly turns the surgery into something more game-like, the player fighting an enemy while managing a character’s health. However, this does lead to the more dynamic surgeries that make Trauma Center: Under the Knife a rather exciting experience. Repeat encounters with a certain GUILT strain will have them become more effective at avoiding your scalpel or spreading their dangerous toxins and secondary viruses, and while the game could probably vary up which ones you face a bit more than it does, there is still a good set of varied GUILT where you can remember how to counter them and handle them better for those rematches.
Besides things like the medical laser, most of your tools in Trauma Center: Under the Knife are typical surgeon fare. The scalpel is of course going to find plenty of use, and things like bandages and the needle for stitching factor into the simple treatments. Tools like one for zooming in to notice smaller issues, forceps for removing parts, gel to staunch bleeding and an ultrasound for scanning patients are all laid out so you can tap them and have them immediately ready to go, but Derek Stiles’s Healing Touch is perhaps the most unique ability in your arsenal. Once per surgery (save a poorly communicated case where it can be used twice), this mystical power can be activated by drawing a star shape, time slowing down to allow the player to quickly perform actions and potentially gain an edge when things are getting out of control against difficult types of GUILT. Most surgeries don’t require it though, but it is a nice power to have in the back pocket and one that can make certain surgeries go much more quickly if activated at the right time.
Despite making surgery engaging with its unusual viruses and making it pretty easy to work on a patient with simple and easy to access tools, there are a few little flaws in the design of Trauma Center: Under the Knife. The most felt one might have to be how difficult it is to restart a surgery. Whether you’re aiming for high scores or just realizing a patient can’t be saved, there can be a point where a Retry option on the pause menu would make gameplay go much more smoothly. The lack of one instead leads to a rather unfortunate situation where the easiest method to restart an operation is to just take your scalpel and madly hack away at the patient until they die, the Retry screen then appearing so you can try again. Considering how difficult some of the late game surgeries can get, tearing your patient to shreds can become an unfortunately common option, although this is more a fault in the menu design than the gameplay. Another small concern though is that each operation has a time limit completely independent of the patient’s vitals, something that the late game GUILT viruses can really strain with surgeries that are designed to take a long time and press up against that timer. The only place they are truly egregious in their limitation would be the optional challenges you can unlock that are meant to be ridiculously hard, but the time limit is the sort of pressure only really felt if you’re struggling with the game, making its presence more a way to block out slower or more deliberate players. Many of the surgeries are definitely designed to be the kind of difficult gameplay that is satisfying to learn and overcome, it just needs a few extra touches like easier retries to be more conducive to that style of play.
THE VERDICT: In Trauma Center: Under the Knife, the surgeries and medical drama quickly go off the rails in a good way, the game straying away from reality to make the operations a true battle with the unusually active and varied strains of the GUILT disease. With a decent story of the troubles of working against seemingly incurable diseases going on in the background, the game stays somewhat grounded despite the sci-fi elements and mystical powers featured in its play. The touch screen is perfect for a surgery simulator, the player having easy access to the tools and their use feeling natural in a way that lets the game really push what it demands of the player. While it definitely craves an easier way of retrying a surgery and it repeats a few GUILT strains too often, the game makes operating appropriately tense while also feeling uncharacteristically dynamic, the goal of keeping your patient alive balancing quickness and precision to ensure that saving a life feels appropriately satisfying.
And so, I give Trauma Center: Under the Knife for DS…
A GREAT rating. While it can definitely push a player a little too hard at times, Trauma Center: Under the Knife also benefits a lot from not pulling its punches. Surgery is a high pressure affair to be sure and translating that into a video game could have lead to it being reduced to quick and simple actions more akin to the board game Operation! than a real operation. GUILT is a pretty smart way of avoiding this, because once you think you can easily help the early patients, you are quickly thrown into a game about actively fighting against active antagonistic forces. You must learn how to attack them, the best way to balance healing the patient and hurting the GUILT, and when to make your moves to make the surgery as speedy and pain free as possible. The game makes sure you learn the steps of surgery before pulling back its instructions, but even after that support ends you have the Healing Touch to get you out of a bind if things become overwhelming, ensuring that the game can really push hard against the player. Some of this does strain elements like the time limit or the inevitable repeats of a stage, but when you’re in the thick of a surgery, the battle with the GUILT diseases can make for a thrilling bit of play, quick action that you get better and better at making victories hard fought and well earned.
Trauma Center: Under the Knife injected the right amount of ridiculousness into a game that could have been content with realistic surgeries or typical medical drama. The GUILT virus, while certainly impossible in real life, fits well into the context of a surgery-focused video game, the characters still given something to work with to have meaningful arcs and the operations themselves made into a better fit for video game interaction. Under the Knife didn’t quite hit every note perfectly though, but as the series continues to feel out the space of this take on surgery simulation, Trauma Center might be able find the sweet spot of balancing its rewarding difficulty with its unusual but accessible operations.