At first, you wonder why nobody ever did this before: make a video game set amid the tension and action of high-stakes surgery. The answer is probably because it just wasn't possible to put the player so directly and tangibly inside the surgeon's viewpoint. To pull this off, you need a stylus (or a mouse, as the concept was attempted by some old PC games fifteen years ago, but the stylus does a much better job of physically mimicking the toolset). The stylus becomes your forceps, your needle, your scalpel. Using icon palettes not unlike Photoshop, the stylus becomes a multipurpose tool as you determine the most efficient way to save your patients' lives.
Trauma Center: Under the Knife is a DS proof-of-performance title. Yes, stylus games work. Yes, the DS has inspired a new wave of games that take advantage of a machine with non-standard features and hardware. This game just could not be done on a Game Boy or a PSP. It would be miserable on the GameCube or PS2. And as a PC or web-based game, it would never stand a chance of punching through the craposphere. It's DS by definition, the only system that can deliver both the specific hardware to run it and the eager gamers to play it.
Your character in Trauma Center is Dr. Derek Stiles (whose name, you'll note, abuses the DS initials like so many other Year One DS games out there). Dr. Stiles is young and talented but lacks direction... until his superior surgical skills get him scouted by Caduceus, a sort of Black Ops hospital unit. Caduceus is dedicated to eliminating all disease and sickness from the world. Nothing is incurable to a Caduceus physician. And since Trauma Center is set in the not-so-distant future, the game can take a slightly sci-fi turn and claim that the deadly illnesses of our time - cancer, AIDS, etc - have been eradicated.
Which makes me think that Caduceus doesn't have much to do... until GUILT shows up. It stands for something, but all you need to know is how to stop it. GUILT takes the form of several different types of nasty semi-sentient pathogens in the body. Usually it's a miniature fishlike organism that swims through patients' organs like a razor blade.
Trauma Center's storyline takes Derek from removing embedded glass shards to chasing down GUILT variants. Assisting him is an entire supporting cast of doctors, nurses and researchers. Along the way, Dr. Stiles learns that he has the Healing Touch... which is presented as the somewhat mystical ability to slow down time so you can work faster. More accurately, "slowing down time" is simply how it looks from your perspective. To the other people in the operating room, it just looks like Derek is moving really quickly and efficiently.
The game has a very typical style of progression. Each new patient is a "level." The patient interface is the only gameplay that matters... you don't have to walk Derek around a hospital or check an incoming board for patients to treat. The game just throws them at you according to the linear plotline. During an operation, the body and your toolset appears on the bottom screen and the top screen is used for conversation and hints (plus more anime still frames.)
Once you get your briefing on the patient - which always follows a lengthy text conversation - the countdown begins. You're working against two timers, a general level timer and the patient's lifesigns. You can extend the vital signs by means of a stabilizing injection, and in some cases you may need to inject a patient four or five times in a row just to get the heartbeat up to a comfortable level. The needle, like the rest of your tools, is selected by clicking on icons found in columns on either side of the screen.
One thing to remember is that even though you have a scalpel and a magnifying glass and a laser and everything else, you can't go tromping off through the body. You can only perform the procedures the game expects per level. So when you're told to drain blood from a pierced lung, you can't instead head north and try your hand at brain surgery. That's not to say that you can't completely screw up the lung with some mad slashing of the scalpel... you just don't have free-roaming access. Some sort of cadaver autopsy mode would have been a fun, if ghoulish, addition. A corpse sandbox, perhaps.
Lots of levels use a kind of Dragon Ball Z approach, and I'm not referring to the anime posing and shouting that goes on. ("I'M READY TO OPERATE!" Dr. Stiles screams, his arm confidently pointing at nothing.) What I mean is that you'll excise a tumor or whatever and then, without warning, something even more hideous will be found. Like when the new DBZ baddie shows up who is always ten times as powerful as the previous DBZ baddie. This is especially fun during the GUILT levels, when you burn off a polyp only to watch in horror as the unknown GUILT organism starts knifing through formerly healthy tissue like a sawblade. And of course you and your assistants will be appropriately horrified.
The Healing Touch is activated by drawing a giant star across the screen. Then the world slows down and a timer appears to show you how much Bullet Time, er, Healing Touch Time you have remaining. You can only trigger the Touch once per level, so it's best to learn all the angles of a particular operation before you waste it right before the truly nasty stuff happens.
There is a great deal of memorization in Trauma Center. Once you learn how to perform a lobectomy, for example, you're expected to know how to do it in all successive levels. (Coat the area with the antibacterial gel, then make the incision with the scalpel, then zoom inside with the magnifying glass.) When you come across a tumor late in the game, you need to act fast and have your procedure down pat, because you're probably going to have to take out five tumors in the same time frame that the tutorial had you remove one. The fun of the game is in applying your knowledge efficiently. It's easy to panic and grab the wrong tool, or get to the suction tool too late so the area fills with blood again... and all of that costs you time. When a patient's life is on the line, you need to be perfect.
Precision is key, but I never found it to be punishing. Occasionally something would feel like the touchscreen wasn't responding properly - usually with the magnifying glass or the suction pipe - but the problem was more with my poorly drawn stylus actions than any major game fault. In the vast majority of cases, you can work fast and still get the job done. On some motions, the game instantly rates you with a "Good" or "Cool" popup, but there's no real indicators as to how or why one chest incision would be cooler than another one.
The only really annoying part of surgery is when a plotpoint occurs during the level, which forces you to click through conversation exchanges during the operation. That gets awfully old after the eighth time through a difficult case.
After each level, the game grades your performance (including all of those Cool popups, I guess) and then unlocks the case in Challenge Mode... which is where you'll go to improve your score without all the heady soap opera text flying around. There are a few non-surgical levels where you have to place puzzle pieces to duplicate a sample image, but they are too easy and hardly a welcome diversion. Like many DS games, Trauma Center could use more variety and more game modes, rather than relying on a single gimmick to sell it. Multiplayer would have been great... say, two doctors working the same patient co-operatively. "You suck out the blood and I'll do the stitching." Or a competitive mode where scoring a Cool would cause an unexpected screen-coating blood spurt on your opponent's patient.
Trauma Center is a unique game, both in interface and subject matter. It may repeat itself, but it doesn't overstay its welcome or force you into busywork levels. Challenge Mode gives you that quickie pick-up-and-play value that all good portable games need, once you've invested some time in the story. And given the stakes involved, you do feel a pleasant sense of accomplishment at the end of the game. You didn't just save a princess or reach 20 frags, you saved somebody's life. With a stylus.
