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The final operation of Second Opinion forced Derek and Nozomi to work together, allowing you to take control of each one alternately as you conquered different phases of the operation. New Blood takes his concept all the way and offers co-op play for the entire game. Each player chooses one of the game's two doctors, Markus Vaughn or Valerie Blaylock, and can operate at the same time, with their own full set of surgical tools and their own Healing Touch. Trauma Center games are all about multitasking, and it feels great to have someone by your side tackling part of it with you.
Dr. Markus Vaughn
A calm and collected doctor with the Healing Touch, and one of the game's playable doctors. Often lazy and surly, but dedicated to his patients. Accidentally created Stigma while conducting research under Prof. Wilkens, and dedicated to eradicating it. Born in California.
Dr. Valerie Blaylock
A younger doctor who comes to Montgomery Hospital to learn the Healing Touch from Markus, and another playable doctor. Much more personable than Markus; many characters are her old friends from medical school. Often impulsive and hotheaded.
A nurse, and a former patient of Markus'. After asking Markus to repair her malfunctioning pancreas implant, she becomes the two doctors' assistant for the rest of the game. Basically the opposite of Angie - she praises our doctors endlessly, and has little effect on the game's events as a whole.
The choice of characters is more than between their appearance and personality; they have different Healing Touch powers. Markus' power is the same as Derek's, to slow down time, but Val's is something new - it freezes the patient's vitals. Nothing can hurt the patient while the power is active, but you can't raise the vitals with stabilizer either. Additionally, the Healing Touch isn't the dark, dangerous burden that Dr. Hoffman warned Derek about; here's it's a legitimate medcial technique that seems quite common, and is studied in textbooks. It's not discouraged at all by the plot or the scoring system, so you are free to use it whenever it'll help the operation the most.
New Blood begins several years later in the middle of nowhere, at the tiny Montgomerey Memorial Hospital in Alaska. We're introduced to Markus and Val, the hospital's only surgeons, through a series of very Alaska-specific operations, including a grizzly bear attack and a hunting accident. But it quickly becomes obvious that Markus is in Alaska to hide from something at their previous hospital in California, Concordia Medical Institute. After Montgomerey's director falls ill and retires, Markus and Valerie must transfer back to Concordia, where Markus' mentor Professor Wilkens is infected with an unknown, confidential illness called Stigma. When the Professor is kidnapped and his Stigma research stolen, Markus and Val join Caduceus to prepare for a Stigma outbreak.
Even though tons of terrible things happen, the tone of New Blood is markedly lighter. Most notably, there are far fewer meditations on what it means to be a doctor, Derek and Angie's favorite subject. Markus and Val just mostly seem concerned with helping each patient, one at a time; they don't spend much time inside their own minds, so the plot is driven more by events than feelings. So the plot is a bit less emotionally involving, but you might roll your eyes less at its dialogue.
The characters are a bit less interesting than those in the previous story. The cast is fairly large and sprawling, but few are explored in depth. Because Markus and Val travel to so many hospitals and other locations in the game, the staff of each hospital remains rather forgettable by the time our doctors move to the next one. And Markus, Val and Elena aren't the strongest personalities to begin with, so the game falls pretty flat in the area of its characters.
Don't worry, the plot is still full of ridiculous and fun scenarios - but the most outlandish ones have nothing to do with bioterrorism at all! Toward the middle of the game, a poor dad can't afford an appendectomy for his son. Next door, an insufferable rich kid is complaining that his appendectomy isn't as expensive as his friend's surgery. Val gets the rich kid to pay for the poor kid's surgery, satisfying both. Immediately after this, the star of the reality show "Miracle Surgery" provokes conspiracy theories about Caduceus on air, so Markus and Val must compete against him on TV several times to reclaim Caduceus' good name.
In fact, this is easily the game with the funniest dialogue and scenarios in the series. The characters tend to be rather flat in the dramatic scenarios, but they shine at the game's more lighthearted moments.
This entry in the series follows a more consistent formula than the others, particulary due to the elimination of story-only chapters. Now, every chapter has a surgery at the end. Unfortunately, this leads to a lot of "filler" operations that don't offer much new material. Like clockwork, halfway through an innocuous conversation, some character will burst in to announce some surprise emergency requiring surgery. This causes the middle of the game to drag a bit, but once the plot picks up the pace, the game strikes a nice balance of plot and surgery in contrast to the too-long exposition in some of Derek's story.
One new element New Blood brings to the operating table is biotechnology. You install pacemakers, repair pancreas pumps, apply myocardium patches, and modify brain implants. These provide some more variety to the operations, and every one is different. The technology is central to the plot, as well. The Humani Corporation is a biomedical research company responsible for a lot of the biotechnology, and a lot of what goes wrong with it as well. A doctor identifies the metal Culurium to be central to Stigma's reproduction, which is unfortunately present in most of Humani's products. The overall arc of these operations is from saving lives with technology, to dealing with untested experimental technology that's messing up some part of the operation, to removing harmful technology from the patient entirely.
One rather notorious new operation type introduced in this game is the skin grafting procedure, used when operating on burn victims. You use the syringe to culture new skin from the healthy part of the patient's body, then cut it into squares to place on the patient's burns. Each burn requires four squares to be covered, and the burns are all right next to one another, so it's hard to tell which burn you're covering. Until you place all four squares and seal them in with antibiotic gel, the burn could bleed at any moment, shedding the graft - and then you have to start all over with new skin. These operations are nasty and repetitive, and you can quickly run out of time just by making a few mistakes.
It was made a big deal that the game introduced brain surgeries, too, but these aren't too different from normal ones - vitals are a bit more sensitive to your errors, but that might be it. And because you start the surgery automatically looking at the exposed brain, you don't get to make the initial incision or deal with the skull, which would have been an opportunity for new mechanics. (This kind of thing would be later explored in Trauma Team, whose orthopedic operations involve drilling, chiseling, and shaping bone. Still no skulls, though.)
As Markus and Val come to prominence in the fight against Stigma at Caduceus, they find themselves kidnapped by the Kidman Family, an organized crime group interested in selling Stigma as a biological weapon on the black market. At night in their cell, Markus reveals that he was the one who discovered Stigma in his research with Prof. Wilkens, and pledges to eradicate Stigma and clean up the mess he's made. After escaping, they travel to Culuruma, where a Stigma outbreak is taking place near a Culurium mine, and the Kidman family ends up connected as well.
It's not until the last few missions that Caduceus connects the dots and reveals the organization responsible for Stigma: Parnassus. A man named Master Vakhushti originally founded a subsidiary of Humani, the biotechnology company. He had is girlfriend Cynthia spy on Caduceus to monitor Stigma research. He is given an origin story of being betrayed by his home country after trying to save it, and tries to cure his own terminal brain illness with a strain of Stigma. But his evil acts are dismissed afterwards as the effects of Stigma-induced delirium, just as Derek's patient's suicidal thoughts were dismissed as a symptom of GUILT. For how complicated his relationship is to various other shadowy organizations in the plot, Master Vakhushti really isn't that satisfying of a villain, especially only being introduced a few missions from the end. Plus, he looks like Jesus, another example of the series' often odd and half-baked references to Christianity. At least his Cardia strain of Stigma is appropriately challenging and final.
The strains of Stigma represent a mix of old and new mechanics. Some offer clear parallels to the GUILT in the previous games, such as the swimming lacerator Cheir and the final showdown in the heart with the nearly invincible Cardia, but they are still different enough to feel new. They're just as challenging as GUILT, too. The hardest and most original are Ops, which floats around and draws various nutrients to itself which damage the patient, and Brachion, who pumps toxins into the patient through a series of segmented, grapple-like arms.
This is the first Trauma Center game with full voice-acting, and its quality is... about what you'd expect from an Atlus game from around this time. It's still a pretty star-studded cast, with Troy Baker and Kimberly Brooks as Markus and Val, and plenty of others with famous credits across anime and games. The music is fairly minimal and brooding, and seems a bit serene compared to the previous games. At the briefing for the more dire operations, the previous games' "Operation Briefing" theme returns with a new arrangement.
The graphics are definitely a step up. The game is designed for widescreen mode, unlike Second Opinion. The character portraits and backgrounds are more detailed and varied, and the organs in particular are more stylized and colorful. The main surgery interface is given a different flavor in this game, now mostly opaque and colorful instead of the glassy and translucent icons of the previous game. Despite this, the interface never seems to be in the way, even when you're hunting across a large organ for Onyx.
There are a handful of optional "Challenge" missions between chapters, and they feature a sequence of anonymous patients with harder versions of the ailments featured in the previous chapter. For being optional, they are unexpectedly a highlight of the game. No one guides you through the operations, so the whole screen is reserved for gameplay. With no assistant, there are none of the often overbearing instructions of the normal operations, so you can come to your own conclusions about what must be wrong with the patient. ("Everything seems fine but vitals aren't stabilizing? I should look for tumors...") Additionally, even if you don't make it through every patient, you are still graded on your performance, so you can feel accomplished enough for what you've done rather than frustrated by what you haven't done.
The final Challenge mission is a fun throwback to the previous games. Derek and Angie, who make a surprise appearance in the last chapter, ask Markus and Val to test some simulation data on Stigma and... "other pathogens." In this challenge, you battle once again against the GUILT strains Kyriaki, Deftera, and immature Savato, and at the end you battle GUILT and Stigma at the same time.
The game also featured online leaderboards for each operation over Wi-Fi, before the demise of Nintendo Wi-Fi Connection. Scores were not split by difficulty, so those who played on Hard had the advantage, of course. As did those who cheated, which was pretty clear from the champions of the game claiming to complete operations in 0 seconds.
As betfitting an America-centric game, New Blood also takes the references to American medical dramas one step further. Not only are the generic patients named after medical characters and actors, but the game's intro sequence before the title screen is pretty clearly modeled on the intro to House.
New Blood was the last Trauma Center game released in Europe, an odd move considering Europe's sales had only increased with each installment, surpassing Japan's with New Blood. Europeans might find solace, however, in their region's box art being quite more interesting than the widely-derided North American cover.
Trauma Center: Under the Knife 2 / Medical Emergency: Caduceus 2 (救急救命 カドゥケウス2) - Nintendo DS (July 1, 2008)
Under the Knife 2 combines the satisfying touch controls and characters of the first Under the Knife with the art, atmosphere, and many mechanics of the Wii games. Overall, it's likely the most polished and varied of the Trauma Center games. Yet the game is a bit disappointing at times - many mechanics imported from the Wii version are simplified and less interesting, and significant parts of the game feel like lesser retreads. The game does have its own unique things to offer, but it takes many hours for them to be introduced.
The story begins with Derek and Angie in a fictional African nation, Costigar, researching a new fever outbreak. Derek takes on a Costigarian protegé, Dr. Adel Tulba, and brings him to the United States, where he makes the same sorts of careless mistakes Derek made throughout the beginning of his career. It's a fitting re-introduction to the world of Trauma Center and Derek's world in particular - you get to have someone more experienced walk you through some basic operations, then perform some more difficult ones when Adel fails to notice something serious about his patient.
But even though he's now in the position of a respected doctor, Derek still has a long way to go. His international reknown goes to his head, he lusts after every attractive woman he meets, and he makes some terrible mistakes while relying on his Healing Touch. Angie holds him accountable for all of this, of course. A lighthearted scene where two now-married Caduceus doctors show off their new baby comes to a screeching halt when someone suggests Derek and Angie will be the next Caduceus couple. She forcefully shuts down that idea and points out how terrible and egotistical he's been.
Early in Dr. Tulba's training in the United States, a series of infections begins to affect the survivors of GUILT, necessitating further operations to treat their Post-GUILT Syndrome, or PGS. The syndrome manifests itself in a variety of ways, but the affected organ is distinctively blackened wth toxicosis. You can't treat a toxic organ with stabilizer, so you can't raise vitals until you inject a medication to suppress the toxicosis. Toxicosis also decreases vitals fairly quickly, but it's still more of a minor annoynace than anything, since one injection doesn't take much time at all, and toxicosis only comes back every now and then.
Despite its prominence in the game's advertising, PGS is one example of the often underwhelming operational gimmicks present in this game. One operation is covered by a news broadcast, and you're warned that there will be lots of distractions and interruptions throughout the operation. But all this amounts to is an extra line of newscaster dialogue in the middle and some brief camera flashes every 10 seconds or so. Not only is this a retreading of the "Miracle Surgery" reality show missions in New Blood, it's also a pretty noncommital execution of it. The gimmick just doesn't amount to much of a difference from an otherwise ordinary operation.
PGS definitely has mixed effects on the pace of the early game. When you're operating on a lot of old patients, you begin to feel like you're in for a lengthy retread of the last game. But you also get the opportuinty to operate on a few of the more memorable GUILT patients, such as Linda Reid, the suicidal girl infected with Kyriaki, and when you meet Emilio Juarez, you finally put a name to one of the anonymous Sinners from Derek's last game.
Other mechanics are ported from the Wii games but rendered slightly less complex due to the difference in controls. In the Wii games, replacing the shattered parts of broken bones was more of a puzzle, since you had to twist the controller to align the bone fragments correctly. You had to align the synthetic veins when treating three-way aneurysms, as well. But armed with a stylus, you wouldn't be able to twist the things you pick up with forceps, so they are simply aligned correctly to begin with. In some sense, this is a welcome change - the Wii games had incredibly specific judgment of where you're allowed to place these objects, so operations go a lot smoother without this mechanic.
The structure of Under the Knife 2 is quite different from the formula set by the previous games. The game's unique collection of artificial parasites, Neo-GUILT, lay hidden for most of the game - you operate on one strain once in Chapter 2, then they lay dormant until the end, in Chapter 7. In other words, you spend almost the entire game retreading old mechanics with slight differences, and you don't encounter the original parts of the game until the very end.
As Caduceus responds to the threat of PGS, new threats present themselves to Caduceus. New and stronger strains of GUILT start to appear, and cryptic letters targeting the victims show that Delphi is active once more. A woman named Reina Mayuzumi with a pharmaceutical company, Acropolis, takes an interest in Derek and his Healing Touch. Soon, a man named Patrick Mercer, the head of the company Hands of Asculepius, begins to apparently train doctors to use the Healing Touch, and its doctors begin to overtake Caduceus in the fight against GUILT.
While Dr. Hoffman's warning about the burden of the Healing Touch just seemed like an old man's wisdom in Derek's first story, here it is proven with tragic consequences. When GUILT breaks out at Elysium, Derek must treat several patients in a row, including two important characters introduced in this game. Each of the two asks Derek to treat the other first. Derek, confident that his Healing Touch will allow him to treat them all if anything goes wrong, but he's unable to save one patient who is close to him.
Derek is devastated, and Angie blames him for his reliance on his Healing Touch. In his grief, he loses the Healing Touch and is sent back to Hope Hospital to learn how to function without it. This arc culminates in Angie's father contracting PGS, which manifests as a series of dangerous, blinking tumors that must be excised between blinks. The final tumor flashes far too quickly to be treated without the Healing Touch, and Derek, lacking the confidence, aborts the operation and sews him back up. Only after remembering his childhood helplessness at the doctors' inability to cure his father can he open Angie's father back up and cure the tumor with a regained Healing Touch.
After Derek sorts out all of his issues, the plot returns to the war on bioterror. It is revealed that all the vaguely-threatening new characters are part of a vast conspiracy, necessitating tons of last-minute exposition, just like in New Blood. You fight against Delphi once again, who kidnap Derek and Angie and threatens to incubate new GUILT inside Angie. They kidnap Reina Mayuzumi as well, so it seems like Delphi are once again behind everything. Caduceus raids their new headquarters, and you operate on their new leader, as well as his children, whom he'd been experimenting on.
But in the final chapter, you get to the bottom of it. Acropolis, with Mayuzumi at the head, created four strains of Neo-GUILT while researhing GUILT treatments, and discovered their potential to induce new abilities in people who are infected. A tennis star is found using the Bythos strain to improve her strength and speed, and Patrick Mercer uses the Nous strain to grant the Healing Touch to the doctors at Hands of Asculepius. But despite all the medical miracles it can work, it can't revive Patrick's wife from her coma. That doesn't stop him from trying, of course, so Derek must operate on her to save her.
The final battle is appropriately climactic, and definitely a highlight of the game. As before, the final strain is found within the main villain, and you must operate and save their life. There was a kind of dissonance before in choosing to save the villain's life, and it seemed like it was mostly out of Derek, Markus, and Val's instincts as real doctors. But in this case, Reina Mayuzumi is connected to a series of massive water tanks containing GUILT mist, such that if her heart stops, the mist will be released and kill everyone. Now there's a reason to operate beyond just the goodness of your heart!
The graphics are, understandably, a bit of an awkward middle ground between the first DS game and the Wii games. The organs and other operation graphics made a relatively graceful transition to the smaller platform, even if the palette is rather dull. However, the downscaling of the character portraits is pretty severe. Derek in particular seems to have suffered the most damage in the transition, having already grown emaciated in Second Opinion.
The soundtrack incorporates a lot of jazzy piano, which wasn't really present in the other games. Unfortunately, the overall composition takes a step further in the direction that New Blood began - it's all pretty serene and even cheerful. Some reviews even call it "elevator music."
Despite the minor steps back in some of the ported mechanics, this is still a very complete package of a Trauma Center game. It manages to work in almost every mechanic from the two Wii games with a similar length and replay value, and repeats itself considerably less than Derek and Angie's first adventure. The operations are still fun and challenging, and the two new families of GUILT are exciting for those who played the other games. The plot is excellent and poweful as well, even if the villains can be infuriating and Derek can be clueless. It's probably not the best starting point for the series, since it builds so much on the plot of the first, but it serves as an excellent summary of the series to those who may have skipped Second Opinion and New Blood.
Dr. Adel Tulba
A young doctor from Costigar who becomes Derek's protege at Caduceus. Talented but careless. His envy of Derek's Healing Touch leads him to join Hands of Asculepius.
Emilio's personal nurse. Having received the same training as Angie, she eventually comes to assist Derek for a few operations. Receives a lot of attention from Derek, to Angie's chagrin.
The CEO of Hands of Asculepius, and Heather's father. His wife is in a coma, and he is convinced that GUILT has powers to bring her back to consciousness.
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