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After four pretty similar games in four years, fans grew fatigued and sales continued to drop. The series needed a serious shakeup, and that shakeup arrived in the form of Trauma Team. Along with dropping the Trauma Center name, the game dropped three of the most distinctive qualities of the previous games: fighting against bioterrorism, curing multiple strains of supernatural pathogens, and the Healing Touch ability. Yet removing these elements of the formula let Trauma Team experiment with lots of new kinds of gameplay and storytelling, and it's mostly quite successful. It's the most polished game in the series, and is often considered the best.
Evidently from the title, the game shifts away from the characters of previous games, and a full team of doctors working mostly at Resurgam First Care in Portland, Maine. It's a few months after Under the Knife/Second Opinion, and years before Under the Knife 2 and New Blood. Each of the six doctors has their own linear set of missions, and you can skip around and play their missions in any order. Many are independent stories with small elements that reference other doctors' operations, but there are some huge disasters, like the collapse of a Ferris wheel or an explosion at the airport, that involve most of the game's characters. When all six narrative threads are complete, the final quarter of the game is a linear sequence of missions for all the doctors as they work together to combat a sudden viral epidemic that breaks out in Portland.
Surgery. Currently serving hundreds of years in prison for a bioterror attack on a college campus. Being a skilled surgeon, he performs operations at Resurgram First Care in exchange for a reduced sentence. Conflicted between redeeming himself and doing no further harm. Rarely shows emotion. Quite knowledgeable about butterflies and flowers.
Dr. Maria Torres
First Response. A hot-tempered, impatient EMT who tries to take care of everything herself rather than work as part of a team. Skilled at improvising surgical tools from whatever is around. Grew up in an orphanage, where she saved another orphan from a fire she started while smoking in the bathroom.
Dr. Tomoe Tachibana
Endoscopy. The estranged future heir to her clan, accompanied by her ninja butler Hanzou. Close friends with Maria. She frames a lot of her medical work as following the "path of honor,"" and has her own custom endoscope built in a traditional Japanese style.
Dr. Hank Freebird
Orthopedic Surgery. Careful and precise, with excellent bedside manner. Often mysteriously late to hospital meetings, busy with his second life as the crime-fighting superhero, "Captain Eagle." Develops a deep friendship with a patient he treats after her suicide attempt. Never shown with open eyes.
Dr. Naomi Kimishima
Forensics. Returning from Trauma Center: Second Opinion, now a medical examiner at Cumberland Institute of Forensic Medicine. Known as the "Corpse Whisperer," she always receives a phone call with the victim's last words. Collaborates with her former Delphi handler, Navel "Little Guy," who now works at the FBI.
Even with the superheroes and ninjas, this is hilariously still the most realistic Trauma game. You spend most of the game treating ordinary illnesses, albeit in really exciting ways. There's no time-slowing Healing Touch powers, and you don't fight against a cult of bioterrorists this time. There is a massive pandemic, the Rosalia Virus, but it isn't too different from the real-world Ebola, and it has nothing to do with bioterrorism.
Trauma Team drops the static portraits and visual novel style of the Trauma Center series in favor of an animated comic style, shifting from panel to panel as the story progresses. Since the story sequences aren't just people speaking one after another, and many characters can appear in a scene at the same time, the story is told a lot more organically. You can see an operating room full of doctors helping one another. You can see a field of patients being tended to in an epidemic. Characters can hug and punch each other. Even if the game tells a more ordinary story, it tells it in a much more dynamic way.
The most radical and possibly disappointing change is to the game's difficulty. Trauma Team simply isn't that hard in the first place. Vitals are quite forgiving, and you don't generally need to balance as many things to do at once as in previous games. (Except in First Response, where juggling several patients is the main challenge.) There is usually no explicit time limit, so losing vitals is one of the only ways to lose an operation outright, and often just a stabilizer injection away from being restored. There are initially only two difficulty settings unlocked, Intern and Resident, corresponding to the Easy and Medium difficulties of Trauma Center games. On Intern, you even have the option to continue after losing a mission, resulting in a "Pass" rating rather than a letter grade.
Only upon beating the game is the final Specialist difficulty unlocked, which still feels a little easier than the Hard of the previous games. And nothing in this game compares to the difficulty of the X-missions.
One doctor performs of course, a general kind of Surgery. And having used four previous games to polish the mechanics, Atlus gets these missions just right. There's a nice mix of new mechanics and refinements of old ones. One particularly dramatic operation has you extracitng a huge metal girder which has impaled the patient's liver, cutting it away sliding it out inch by inch while clearing away the massive blood pools that form arond it, all while treating lacerations and hemmorhages on the organ's edges. CR-S01 is the only surgeon in the series without the Healing Touch, but the missions are easy enough that you won't miss it.
First Response is definitely a highlight of the game, taking the idea of trying to intelligently multitask under incredible pressure and extending it over multiple patients at once, all of them being in pretty bad shape to begin with. You have only half the tools of a general surgeon - forceps, medical tape, antibiotic gel, and stabilizer - but you get other tools when the situation calls for it, such as scissors to cut away clothes or tourniquets to stop profusely bleeding limbs. Since you use whatever's around to help the patients, there are some pretty horrifying medical improvisations, like cutting a treachea open with a boxcutter and using a ballpoint pen to secure an airway. These missions are extremely high-pressure, and are a natural addition to the series.
The Orthopedic Surgery operations are the polar opposite of the First Response missions, focusing on your ability to focus and concentrate on exactly one thing at a time, doing it with precision and care. When these operations succeed at tapping into this sense of deep concentration, they are very calming and meditative to complete; the first mission, tracing along the concave outlines of thyroid tumors, is definitely fun. There's no question that they are the easiest operations, of course. However, they can be quite repetitive. And unfortunately, when you're tracing along a long outline that extends past the screen, you often find yourself fighting against the game's camera, which lurches suddenly in various directions attempting to center your scalpel or laser. Overall, the Orthopedics missions are definitely hit and miss, but the last handful are generall hits.
Endoscopy is pretty widely disliked for its clumsy controls and repetitive missions, as well as for Tomoe not being the most interesting character. Using the Wiimote, you physically grasp the endoscope with A and B and shove it forward into the patient, using the Nunchuck's control stick to better follow the curve of the patient's organs. The endoscope is armed with a full complement of surgical tools, and you press C on the Nunchuck to access the radial tools menu. You can't do anything while selecting tools, and most of the tools look just like one other tool, so that can be annoying. Finally, you press Z on the Nunchuck to use the tool you've selected, and you can manuver it around with the control stick. The controls are pretty tiring, especially when you need to keep shoving the Wiimote forward during the long, mazelike operations. But you do get plenty of practice, and finally being able to snake through the body with minimal fumbling around in menus feels pretty great, even if you only get to that point near the end of the game.
The other two categories are drastically different in terms of style and pace - the missions are dramatically longer, and play like graphic adventure games. You pore over interviews, uncover contradictions in unreliable information, and try to narrow down a final verdict. They feel like playing a different game. Many found these pretty refreshing and fun, but one particularly opinionated GameFAQs walkthrough explicitly divides the game into "Legitimate Operations" and "Filler Missions," the latter being these Diagnostics and Autopsy missions.
Forensics mysteries require collecting evidence from many areas: spotting abnormalities on the corpse and effects, finding information in interviews with witnesses, and exploring the crime scene and other locations. Each piece of evidence is represented as a card, which can be combined with other cards to form new inferences after a short and usually quite obvious multiple-choice quiz. These cards can be shown to Nozomi's contact at the FBI, "Little Guy," who will run analyses of bloodstains or chemicals found at the scene, or round up witnesses. The missions are extremely long, but the scenarios and writing are generally strong enough to justify it. You can actually lose these missions by mising enough multiple-choice inference questions, but you'd need to try really hard.
Diagnostics follows a different procedure, but the core is pretty similar. You interview the patient and spot signs of symptoms in their dialogue, then examine their abdomen and listen to their breathing and heartbeat through the Wiimote's speaker. Tests get ordered based on the symptoms you identify here, so you can look at the patient's X-rays and MRIs, trying to spot abnormalities. The game also presents you a "normal" version of the same medical image, so it becomes a simple game of spot-the-difference, though it's often quite subtle. Having collected all this information, you then proceed to the computer, where you have descriptions of several plausible diagnoses, where you can compare their descriptions with the list of symptoms you've collected. Diagnosis requries a lot more medical knowledge than solving a whodunit in Forensics, so RONI's infinite mdical database is an interesting solution to the player's presumed lack of an M.D. You can't really solve the mystery of a diagnosis in advance like you can a Forensics case, so it's a little less satisfying, but it's still fun to try to figure out what you've missed and try to narrow down the options. Plus, living patients are generally more interesting to talk to than dead ones.
One consequence of the six-doctor format is that the game has very few missions within which to introduce the doctor's play mechanics, throw in some twists, and end in an appropriately climactic final mission. This addresses the somewhat plodding, meandering pace of the middle sections of previous games, which often re-treaded a lot of the same mechanics. But because there is so litle time to re-tread old elements, you're constantly being given directions on how to address new surgical scenarios - you're rarely left to experiment and figure out a solution on your own.
On the other hand, one bit of polish counteracts this problem - the Skip button is much more effective. In previous installments, the Skip button sped up the process of reading all the text, but you still had to wait for the character portraits to switch in and out. Truama Team's skip button eliminates dialogue entirely, which makes re-playing a hard operation less tedious and allows you to focus on the operation itself. This improvement gives you the option to extend the best aspects of the Challenge missions in New Blood to the entire game.
Also like New Blood, this game allows co-op on any surgical mission. But unlike playing as the roughly equal doctors Markus and Val, here your responsibilities are split and you must depend heavily on your co-op partner. There's some kind of asymmetry in every operation type. In general surgery you distribute a single set of tools beforehand, so you must coordinate your efforts depending on what tools your partner has; in First Response you divide up the first set of patients, then alternate in treating them. The other two are clumsier, more shoehorned-in kinds of co-op: in Orthopedics you switch off after every action or mistake, and in Endoscopy you alternate every 30 seconds between controlling the endoscope and merely shining the light. While it is nice to have the option of co-op, it is a bit more experimental than that of New Blood, which was clearly designed around symmetrical co-op, and it definitely works better in some game modes than others.
This is by far the best looking Trauma game. The story sequences are a welcome replacement for the static visual-novel portraits, even as some character poses are repeated all the time. Everything in gameplay is absurdly stylized - the colors are even brighter than New Blood, matching the game's recurring motifs of flowers and butterflies. Pools of blood seem to have the texture of soft, fluffy pillows; tumors look like shimmering, many-faceted gemstones. It couldn't look more different from Under the Knife.
This game is the only one, too, to make heavy use of 3D, particularly within the space of an operation. One surgical mission involves reconstructing the patient's entire ribcage, requiring you to rotate and shift between views of the left and right lung. Forensics gives you a full 3D corpse to work with in every mission. Endoscopy takes place entirely within the 3D maze that is the patient's digestive tract.
Even if the gore in the operations is incredibly stylized for those with weaker stomachs, the forensics cases are incredibly dark. One features a girl with a violent mental illness, eventually locked in her room, who tries to claw her way out until her bleeding nails cover the door. Plus, you hear each murder victim's last words on a call through the Wiimote, and they're pretty grisly as well. It's probably best not to play all of Naomi's missions in a row.
On the other hand, the Diagnostics operations are much lighter in tone, Gabe generally being surly and unprofessional with his patients and arguing with his computer assistant, RONI. One pretty notable patient is a crotchety, uncooperative politician in a wheelchair who fights with Gabe the entire time. Another diagnosis is on a patient whose ailment is a government secret, and spyware on RONI's system will alert the government of any overt diagnostic activity - so Gabe must disguise his patient interview as idle chat between friends. However, these stories often don't have happy endings - many of the diagnoses Gabe has the give the patients are quite serious, so the lighthearted fun comes to an abrupt end.
Toward the end of each story thread, the patients begin to behave more erratically, their injuries become more grisly, and you keep finding black claw-like bruises on their bodies and organs. When every story thread is complete, a new thread called "Patient Zero" is unlocked, in which these isolated incidents are revealed to be part of a deadly new epidemic called the Rosalia Virus. This thread involves different doctors for each mission, tackling different aspects of the epidemic. Maria treats an entire infected train station at once; Hank treats Rosalia bone tumors; Naomi discovers the origin of the epidemic through an autopsy of its creator and its natural host, and finds a cure. This story thread is an excellent culmination of the mechanics explored throughout the rest of the game, though some players might be disappointed that the final battle against the epidemic is a lengthy endoscopy operation. It's the closest thing this game has to the GUILT and Stigma operations of the others, and it captures what was great about them.
The final operation, however, takes place after the epidemic ends - Naomi, having battled against a terminal illness throughout the story, comes down with Rosalia, which combines with her previous illness and becomes "Twisted Rosalia." With advice from one of Gabe's old friends, strongly hinted to be Derek Stiles, CR-S01 treats Naomi with the rest of the doctors as support. After a lengthy operation across all four chambers of her heart, you defeat Rosalia and cure her terminal illness in the process.
The music is a return to the more dramatic style of the Derek Stiles games, a welcome change from the elevator music of the others. While the results aren't terribly memorable, the music is quite dynamic, with multiple characteristic themes for each doctor and level of tension. One nice musical touch is during the Orthopedics operations. The music begins quite soft and minimal, but each time you complete an action, another instrument or beat is added to the mix, growing in intensity as you put the patient back together. If you make a mistake, the rest of the instruments drop out and you start from the beginning.
One example of Atlus truly pulling out all the stops for this final entry in the series is the most gratuitous fanservice. Patient bodies on the operating table are still sacred and dehumanized, purely objects for gameplay, but two female doctors show a lot of cleavage, as does a diagnostics patient. There's a pretty beefy male diagnostic patient, as well, so there's truly something for everyone in this game.
Though the game's difficulty was clealry not a focus, there are additional challenges unlocked at the end of the game in the form of Doctor Medals. There are eight per doctor, introduced only as vague riddles in the doctor's voice. Each one has particular criteria to satisfy in one operation or all of them, though it's only described in detail beyond the riddle once you've achieved it. Some can be achieved simply by playing well, but others are quite specific and unlikely to be found without specifically looking for it. One medal requires you to complete every First Response mission without losing a single patient. The Forensics missions have "Medal Exam" books hidden in the investigation locations, and quiz you on often obscure medical facts related to autopsy.
Even with all the new life Trauma Team breathed into the series, the slight uptick in sales wasn't enough - as of writing, six years have passed without any word on a new game. Nothing feels terribly final about the ending to the game, but the polish and care put into it make it a fitting farewell to Trauma fans.
Surgery isn't the most common inspiration for a game, but Trauma Center was not the first series to explore it, nor was it the last. There are two notable series of games that explore the same subjects, although their execution and tone couldn't possibly be further away from Trauma Center.
The Software Toolworks, better known for Mavis Beacon Teaches Typing! and many educational Mario games, first experimented with surgery games for early PCs. Life & Death is pretty stunning in its realism, especially for a game released almost two decades before Trauma Center. As a abdominal surgeon at Toolworks General, you see patients one at a time, feeling various parts of their abdomen to see where it hurts, ordering and examining X-rays if appropriate, then deciding how to proceed. It's a bit like the Diagnostics missions of Trauma Team, but without the writing that made it so appealing. If you make a mistake in diagnosis, you get hauled into medical school and a professor tells you what symptoms you missed, and what to do next time, so you do a lot of learning by trial and error. Only a few combinations of symptoms in the game require surgery.
Operations are far longer and more difficult than those of Trauma Center, though there are only a handful of different kinds, such as an appendectomy and an aortic aneurysm. You're presented with the patient's abdomen, several drawers full of unnamed tools and many syringes labeled only with a single letter, and given little direction from there. Selecting the wrong tools prompts your assistants to give you a few hints as to what to do, but they're not terribly clear. You also need to watch the patient's EKG and blood pressure, and treat them with certain medicines if they don't behave the way they should. You learn the surgical procedure almost entirely through trial and error, unfortunately for your patients.
You also get to choose a team of assistants during your operations. In the Staff Room, you can view records of their individual specialties, as well as any relevant history they have with the other assistants. Just like any American medical drama, there's plenty of drama between them - the records also describe which ones have broken up or otherwise had a falling out, so you shouldn't put them together in the operating room.
The game ships with a detailed 24-page manual, "A Brief, Bloody History of Surgery." No gameplay is described - it's a purely nonfiction volume, complete with a bibliography. It doesn't tell you anything about how to perform the in-game surgeries.
A sequel followed two years later, Life & Death II: The Brain, focusing on neurosurgery.
Surgeon Simulator 2013 takes the QWOP or Octodad approach to the delicate act of performing surgery. The game's humor revolves around the extreme difficulty of getting the deliberately clumsy controls to do anything useful. They are directly inspired by the arm controls of Jurassic Park: Trespasser - each finger is bound to one key, and you can rotate and move the wrist with the mouse. You are offered a wide variety of brutal and inappropriate tools with which to get the job done, so it's quite a feat for the patient to survive any operation you perform.
The game was born as an entry for the 2013 Global Game Jam, developed in 48 hours with a single open heart surgery scenario, but proved quite popular and continued development. There's plenty of DLC available, including operations on Team Fortress 2 characters and Donald Trump.
Sometime in 2010, Instavision and Fat Dragon Films collaborated on a pilot for a potential Trauma Team live action television show. Pitched as "Grey's Anatomy meets The A-Team, it stars four "medical vigilantes" who form a renegade clinic. While it was not picked up, a rough cut of this pilot was posted publicly on Youtube in 2016. Other than taking the vaguest concept from the video game, it really has nothing to do with it, at least as far as the pilot goes - none of the characters, nothing with the Rosalia Virus, or anything. It's questionable as to whether this would've worked in a live action setting anywa, given the flair of anime-style dramatics of the games. As it stands, there's not much that made this stand out from the numerous other medical dramas out there, except for some even worse than usual writing.
Under the Knife was the only Trauma Center game directed by Kazuya Niinou, its original creator. He later went on to create the Etrian Odyssey dungeon-crawling RPG series for the DS and 3DS. There are plenty of cameos throughout the series, particularly in the Medic playable character class, which has the abilities "Caduceus" and "H. Touch." Many character designs are clear references to Trauma characters, as well.
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