Right now, in the year of our lord 2023, Atlus is well known mainly for their RPG series, especially those in the Megami Tensei series, like Persona 5, Persona 5 Royal, Persona 5 Scramble, or Persona 5 Dancing in Starlight. It’s understandable that they put so much emphasis on the stuff that succeeds, but sometimes, you gotta miss the early 2000s, when they did more experimental stuff.
One of their strangest experiments is the Trauma Center series, which made use of a concept that had only been done by Dr. Mario: a video game about medicine. The creators have mentioned being inspired by American hospital dramas, such as ER, and it really shows.
If I could sum up Trauma Center in one brief sentence, it would be “Cooking Mama meets SMT”. This may be because I played Cooking Mama right before Trauma Center, but they do have remarkably similar gameplay. 2005’s Trauma Center: Under the Knife, as a DS game, relies almost entirely on the touch screen for its mechanics, and it honestly works really well for the most part.
There’s two gameplay types: the visual novel sections, where the story is relayed to you, and the surgery sections, which are self-explanatory. In the latter, you tackle diverse operations with the kinds of tools you’d expect from real surgery: scalpels, forceps, lasers, and miracle biogels, among others.
These surgeries usually require a lot of memorization for which tool needs to be used for which injury, but while it may sound daunting, the amount of repetition helps you get through this hurdle, and of course, muscle memory will do most of the work for you. Now, I honestly really like this idea, but it has a lot of problems in execution.
For starters, the screen resolution does not do this game any favors. You literally need surgical precision for some of the missions, and with the original DS touch screen’s resolution of 256 x 192 pixels, it is easier said than done. I played the game on my New 3DS, which has a higher resolution, but I still struggled with the precision on some of the later surgeries. Add on to that the fact that I’m left-handed, something that this game does not seem to bode well with. I have pretty slender hands, but even then, I would often find myself being unable to see where I was messing up, or if I was missing something on the screen. However, in the game’s defense, it’s not like Kid Icarus Uprising, where you could just use a different button configuration to adapt it for different lateralities- because it does not use buttons for anything besides skipping dialogue. On top of that all, there are some performance issues due to their use of 3D models instead of sprites, especially in the later parts of the game, where there’s an immense amount of lacerations and viruses on screen at all times, and it’s almost impossible to suture the cuts with precision due to the tremendous lag and the amalgamation of the VFX for the cuts.
But besides those technical issues, the game is legitimately difficult. Before you say “skill issue” like the funny little internet creature you are, I invite you to check some gameplay videos and see how easy it is to mess up. I sincerely can’t tell if it’s an intentional artistic choice, or if the devs just didn’t playtest it enough. The first quarter of the game is generally manageable. You do need to pay some attention to the patient’s vitals and the time limit, but they’re generous with that for the most part. But the worst part of the gameplay comes with the introduction of the GUILT virus. Yes, that is what it’s called, and yes, they made up some bullshit acronym to fit it.
This creation from bio-terrorists is where the main struggle comes from. The virus manifests itself in various forms, like a tiny evil shark, some yin-yang tumor generator, or others. Each variant must be dealt with in different ways, and they get harder and harder with each variant- except for Triti, which is the absolute worst thing ever and appears for the first time in the middle parts of the game. This variant is sort of puzzle-esque in that there are some ways to make it a little easier, but if you try to tackle it without a strategy, you’re going to have a bad time. It’s an infinitely-multiplying set of triangles that requires you to remove three spikes per triangle. Once you remove the spikes, you have to cut the triangle off and put it on a tray. I make it sound easy, but both the spikes and the triangles regrow at a very quick rate, so you need to be el mucho fasto. Plus, sometimes, the spikes occasionally turn into a poisonous gas fume that you have to extract immediately or you fail the surgery. There’s a way to make it easier, by using the game’s main gimmick, but I’ll explain that when I get into the story. So yeah, even with every possible advantage, I suffered a lot because of Triti. I am not exaggerating when I say that every time I did a Triti surgery, I had to take long breaks afterward because my hands were in severe pain. If I get diagnosed with Carpal Tunnel Syndrome, I’m blaming this game and suing Atlus. There’s also a one-time surgery where you have to DEFUSE A BOMB, and it’s really frustrating, because you have to keep track of several mechanisms at the same time while under a time limit. It’s bad in terms of gameplay, but hilarious in the context of the story.
But that’s just the game at its worst. There are a bunch of stupidly frustrating missions, but I generally enjoyed the normal ones where you just extract tumors or zap little viral sharks. On the positive side, a lot of the really difficult sections were nerfed in the Wii remake, Second Opinion, which I haven’t played, but I watched Game Grumps play it, and I could really tell all the changes they made right away.
Moving on, there’s the story. Your main character is the wonderfully-named Dr. Derek Stiles (GET IT? HIS INITIALS ARE DS!), an up-and-coming surgeon working in the Hope Hospital in Los Angeles. At the start of the game, he’s pretty much a newbie, but later down the line, he discovers a hidden power that gets him all the fame and bitches he so desperately needs. This power is the, I shit you not, Healing Touch, which you trigger by drawing a satanic star on your patient’s body, and it causes time to slow down to a crawl for a few seconds. It’s generally pretty helpful for some of the tougher surgeries, like the aforementioned Triti. Other than that, it’s not particularly well-explained, and its only other detail is that it drains a lot of energy from the user. Basically Witch Time for surgeons.
Most of the other characters don’t really stand out that much, but it’s worth mentioning Angie, your assistant nurse, who’s pretty much just your average tsundere who treats you like shit at the start, but wants to pleasure you orally by the end of the game. There’s also this guy called NIGUEL (not Nigel, not Miguel), who’s just an arrogant piece of shit who thinks he’s the greatest doctor of all time. Fuck that guy and his stupid name.
As mentioned before, the antagonists are a group of bio-terrorists who created the GUILT virus, known as Delphi. They’re not represented by any particular character until the very end of the game, and this makes them a little forgettable in my opinion. I think it would’ve been cool to give them some kind of cultist vibe, with plague masks to fit the medical themes. Their motivations are also incredibly weak, but I think they’re funny enough to avoid spoiling them.
That’s a recurring issue with this game’s story, being unintentionally funny. It has zero self-awareness of its plot’s stupidity, but that’s honestly part of the charm. It just screams “self-serious 2000s drama movie”, mostly cuz it’s basically that. If you’ve seen any hospital drama show and added heavy-handed terrorism to it, you’d have this game’s plot, and I kinda love it. I often found myself excited to play more just to see how much stupider the game could get, and stupid it got.
Despite its poor writing, there are some areas where it tries to be profound and fails catastrophically. For example, there’s a patient who is suicidal, and Big Dick Derek casually fixes her depression by holding a mirror in front of her and telling her to repeat her suicidal statements. If only it was that easy. Another part that pissed me off immensely was when they took a stance against euthanasia. Okay, I get that it’s a touchy subject and not everyone is okay with it. The particular case that involves it in the game is probably not the best dilemma about euthanasia one could propose, given the existence of miracle doctors with Witch Time. I just think the way they generalize about all cases of euthanasia was the kind of shit you’d hear from American politicians. I will say, however, that they attempt to criticize the business of Big Pharma when they try to release a cure for GUILT without it being approved by commercial distributors. This is one of the few moments where it feels like the game has an actual message besides “diseases are painful”.
Visually, I don’t have a lot of issues with the game. Things are easy enough to tell apart in surgery, and some of the viruses are cute. The characters are, once again, unmemorable, BUT, their designs improve significantly in the Wiimake, where they were redesigned by Masayuki Doi, the second/third most iconic character designer in the MegaTen series (after Kazuma Kaneko and maybe Shigenori Soejima). I seriously love the redesigns in the Wii version, they make the game feel much more unique and mature in comparison to the generic “animu” style from the DS game.
Regrettably, I cannot comment much on the music. It was composed by Shoji Meguro, the same person who blew everyone’s mind with the Persona series’ OST. This game’s soundtrack is definitely not his best. It does its job. It sets the mood just fine, but it’s not good enough that you’ll be jamming out to it when you’re not playing. Fortunately, the second game has the greatest song of all time, Gentle Breeze. The rest of the sound design, and by that I mean the sound effects, is quite solid. It adds a lot of impact to your actions, especially your mistakes, so it gives the game a whole ‘nother layer of realism, with all them squishy gore sounds and whatnot.
I probably sound fairly negative about this game, but that’s because the bad outweighs the good in this case. I love the concept of a surgery game, and the early missions are really fun, but it just gets extremely stressful and difficult- and your only real reward is the poorly-written story and whatever ranking you got from the missions. It shouldn’t be hard to gather from my insinuations that the Wii version of the game is considerably better. The revised gameplay, artstyle, technical performance, difficulty, and to a lesser extent, story- all help turn this game from a gimmicky mess to something actually playable.
I strongly doubt that you’ll find any copies of this in your local GameStop (I did once), so if you want to play either version, you’re gonna have to turn to yar-har-ing. If you, for some reason, decide to play the DS version, do it with a flashcard or download it on your 3DS, because if you try to emulate it, you WILL suffer. DeSmuMe, the most well-known DS emulator, fucking sucks when trying to play games involving 3D models. If the game lags so hard on native hardware, I cannot possibly imagine how painful it would get on DeSmuMe (seriously, that emu lags even in games that barely use 3D, like Castlevania: Dawn of Sorrow or Pokémon Black/White), plus, touch screen games were not envisioned to be played with a mouse. This ain’t Super Princess Peach or Kirby Squeak Squad, you’ll be doing more than just tapping the screen. The other major DS emu, MelonDS, has better performance, but I doubt it would make the mouse controls any less awkward. Fortunately, Wii emulation is much better, so you can definitely survive if you play it on Dolphin, although you’ll need a USB sensor bar if you don’t want to awkwardly keep your actual Wii plugged in while playing (seriously, just jailbreak it at that point).
In conclusion, these are my main points about Trauma Center: Under the Knife, for the Nintendo DS:
+Fun and innovative ideas
+Unique gameplay
+Hilarious(-ly bad story)
+Decent music
+Good sound effects
-Objectively inferior to the Wii remake
-Poor resolution
-Performance issues
-Ball-busting difficulty
-May cause actual bodily harm
-Mediocre artstyle and characters
-Triti
Final score: They did surgery on a bomb/10
Nocverse 