I’ve said it before and I’ll say it again: the Nintendo DS was an amazing platform for weird, experimental games. And Trauma Center: Under the Knife (TCUtK) is certainly no exception. Like most “weird” games, I’m fairly certain I first heard about this little gem through Nintendo Power, although, admittedly, my memory’s a bit hazier on this one. Can’t have fond, bizarrely specific memories about them all, can I?
Regardless of how I found out about it, I was glad I did. At the time I really enjoyed TCUtK. Replaying it now, my enjoyment has lessened a bit, as I see flaws in the game younger me simply ignored. But still, I think it’s a game worth talking about because it was so very unique for its time, and certainly a game that could have only been produced through that wonderful, weird little system called DS.
TCUtK follows the story of one Derek Stiles (DS, stylus, get it?! Ha ha… ha… this was in the DS’s very early days…), a young, scatterbrained, slacker of a surgeon fresh out of residency. He’s well meaning, but he doesn’t really “get it” at first. But fret not, the hero grows and learns, and by the end of the game he’s the most renown surgeon in all the world.
Mechanically, the game is focused on two genres: surgery simulator and visual novel. While the latter is fairly self explanatory, I’ll mostly be focusing on the former in this analysis.
The game setup/layout is fairly simple. Split into chapters and episodes, the player progresses through the story of Derek Stiles’s journey as a surgeon. Episodes usually start with a bit of story telling, setting up why you’re performing surgery, followed by a prep screen giving details about the patient and what you the player need to do to successfully complete the operation. I particularly liked the prep screen because of the surprisingly numerous references to Scrubs and other TV medical shows (I think…) in the patients names (Dorian, Turk, Reid, Cox, and so on). I found that to be a hilarious bit of juice, as I was a big fan of Scrubs.
Once you’re through with prep, the actual gameplay can begin as the player is shown a scene of the patient’s body on the lower screen of the DS, with various surgical tools accessible on the left and right sides of the screen, all accessed through simple taps of the stylus. Since I’m on the subject, I might as well explain what those tools are right now, as these are essentially the player mechanics of the game. They are as follows (in no particular order):
- Scalpel: Fairly self explanatory. The scalpel is needed in virtually every surgery, as it is used to slice the patient open so you can actually perform surgery on them. The scalpel is used in other ways, too, depending on the tasks required of the surgery, but it’s basic function is always the same. It’s slices, it dices (but it does not make julienne fries…) by way of the player swiping the DS across the touch screen.
- Stitching needle: Again, another pretty self explanatory tool. Used to suture wounds, and close patients up after you’re done operating on them. Note that this game is hardly realistic in the way it does things, so stitching up a patient is performed by making quick zigzag patterns with the stylus.
- Syringe: The syringe is used to inject various medicines into the patient, including the ever present “all purpose” healing medicine to raise a patient’s vitals (more on that later). To use it, one needs to draw the medicine from a vial by slowly drawing up with the stylus, then by pressing the stylus on the portion needing injecting.
- Ultrasound tool: This tool acts like a radar of sorts. Tap the stylus and you can see what’s hidden beneath the flesh/organ/whatever, temporarily. Alternatively, this tool is also used to magnify areas of the body for larger operations. I found the magnifying tool to be clunky, unresponsive, and worst of all, unnecessary. The idea might have sounded fun on paper, but in play, it was just tedious.
- Laser: This tool is used to burn away tumors and other maladies in special situations. But care must be used, use the laser too much or in the wrong spot and you damage the patient. The same can be said for the scalpel, wanton slicing will just result in unnecessary injuries.
- Gel: Like the syringe medicine, this is another miraculous “cure all” medicinal gel that instantly heals smaller wounds (in other words, wounds too small to suture) by rubbing the stylus on the affected area.
- Suction: This device drops a long tube wherever you tap, but in order to drain the excess blood or other fluid, the player must slide the stylus up the tube. This was another tool that more often than not simply did not want to cooperate.
- Forceps: Pretty simple, used to grab and extract things. Just tap to grab and hold to move.
- Hand: The hand is used to rub (such as rubbing the heart to restart it). Comes into play very infrequently. Seemed like an unnecessary mechanic.
- Bandages: Used only after an operation was finished. Once sutured, and covered in gel, you roll the bandage over the stitches to officially finish a surgery. Again, felt unnecessary.
Note, that far before Breath of the Wild was ever a thought, tool durability was still a terrible game mechanic. And yes, TCUtK makes use of said terrible mechanic. Use a tool too much, and it will break. Resulting in you needing to wait for it to become available again. Tools not in use have their durability automatically refilled, as well. So, it’s just a weird balancing game in a game that really didn’t need it.
So, now that you know how it’s done, I’ll go into more of the specifics. Naturally, your patient has vitals. This is represented by a heart in the top left of the bottom screen. Vitals usually start at 99 and lower progressively as time goes on. As I mentioned before, you can inject medicine to raise vitals, but that is only a temporary solution. The only way to really stabilize them is to perform the surgery as quickly and efficiently as possible.
The longer you take to stitch up wounds, remove tumors, or whatever it is you’re doing, the more (and the faster) your patient’s vitals will drop. Naturally, dropping to zero will result in game over.
Vitals also drop if you screw up your tasks. But that isn’t the only punishment. If you don’t use the tools properly, or if you’re too janky in your movements, you will get a “miss.” Misses hurt the patient’s vitals, and they affect the second way the game determines your success.
Shown on the top screen is a “Miss Limit,” displayed by a set of small boxes, or blocks. With each miss, a block on the Miss Limit disappears. Once you use up all your misses. It’s game over for you.
Two ways to get a game over is just too simple! Of course there’s a third way to fail! I’m sure if you’ve even remotely been looking at the images, you’d have noticed that lovely little timer up on the top screen. Yes, each surgery is set to a time limit. Usually the time is set between five and ten minutes. And usually five minutes is more than enough for the task at hand. But later in the game, they throw some extremely unreasonable scenarios at you, and I’ve often found myself failing and frustrated due to the unreasonable tasks and near impossible time limits set.
I believe there is a way the devs tried to offset all this difficulty, though.
Naturally, Derek Stiles isn’t just any doctor. Since this is a very Japanese/anime style video game, Derek discovers he has a super power of sorts: extreme concentration. Basically, the player can slow time. Once, per surgery. This is done by drawing a star on the lower screen (because DS mechanics). This slows everything on screen down (except you), allowing you to work at a much faster speed, for a brief time.
Even with this “magic” ability, though, the game can often feel unfair and unbalanced in the speed required of the player to perform certain tasks, especially since it can only be used once per surgery (note: I may be biased in this matter due to my own physical limitations. Arthritis in the hands and wrists can put a great strain on me when playing games like this).
Now, to the crux of the matter. All of this. Vitals, misses, time. It’s all got to do with one thing: your overall surgery score… Yup. The game gives you a score and rank (C, B, A, S, you know, basic game rank stuff) on each surgery you perform. What this means for the overall game is… nothing. Scores in no way affect anything in gameplay or story. So it all seems… extremely poorly designed to have three ways of failing and judging, for something as unimportant as an arbitrary number and letter.
But enough of my soap-boxing. Let’s get on with other aspects of the game that I’d like to discuss.
I’ve said that the game can get unreasonably difficult later on, and I stand by that. But that fact makes the first half of the game all the more a shame, because starting out, TCUtK does a very good job of setting a good pace, and gradually teaches you how to use the tools at hand. For instance, the very first surgery is a motorcycle crash victim with a few shards of glass in his arm. Not many tools needed, simple procedure, easy. The next gets a little more difficult, and so on.
Something else I must complain about note, is that your surgeries are always accompanied by an assistant (nurse). And they never shut up. Their original purpose is well meaning, and for the uninitiated, someone who might be playing for the first time, their presence is almost absolutely necessary, as they explain the tasks you need to perform and what tools you need to use to do it.
While some of this information is simply displayed up top for you to view at your leisure, more often than not, it will be delivered as a “call.” which completely pauses the action on the lower screen, forcing you to tap the call button to scroll through the text until they’ve said their fill. Halting the action, constantly, is an irritant I could have done without… I know the devs wanted to pack as much story and emotion into the game as possible, and this was before voice acting was super prevalent in games, and whatnot, but still… This was not a good way of doing it.
Of course, once you get the hang of procedures and how to use the tools and whatnot, surely regular surgeries would get boring, right? Well thank goodness this is a wacky video game world!
Once you’re into the flow of the game, the game introduces you to GUILT (Gangliated Utrophin Immuno Latency Toxin). In other words, a fictional, man made disease created by a group of death obsessed bio-terrorists called Delphi.
Operations to cure a GUILT patient are much more complicated (and frankly, bizarre), making use of many more tools and usually requiring more speed than normal operations.
GUILT has seven forms, and you’ll pretty much be spending the rest of the game combating these very, very different forms of the disease (or at least attempting to figure out how to cure it).
Stepping back and looking at this from a design standpoint, TCUtK is a video game. The surgeries are nothing more than time and precision based puzzles. The GUILT viruses are simply the devs way of trying to create the most abstract and challenging puzzles in the game. But because they are so challenging, and because you spend most of the game fighting nothing but GUILT, it gets pretty old, pretty fast. Especially in one chapter, where you have to perform the same surgery five times in under ten minutes… I hated that one…
Of course, there are brief respites. The game does try to switch it up on rare occasion, giving you rare non-GUILT surgeries, literal puzzles (to be solved to find cures for GUILT) and even throwing a (very poorly designed) bomb disposal episode your way. But even so, lots and lots and lots of GUILT. Particularly the first strain. You’ll see that one more than any other.
Thankfully, repetitive as it may get at times, the game doesn’t really overstay its welcome. It’s not terribly long, clocking in somewhere around five to seven hours, depending on skill level.
And despite all my complaints now, I really did enjoy this game, once upon a time. My tastes simply have refined, I can see flaws the younger me blissfully ignored. And even now, I can still find the fun. I can see the innovation behind the original idea, and the bravery to try something that was, at the time, so bizarrely unique. And for that, I give Atlas kudos. I wish more non-indie studios were willing to take more risks these days, like they did back in the day. But at the very least, I’ve still got my fond memories of days gone by.
