| abstract
| - Simulation game for the Nintendo DS and Nintendo Wii consoles (released in Japan as Choushittou Caduceus, "Caduceus: The Great Surgical Operation"), where you get to save the world's health, one person at a time. The year is 2018. You are Derek Stiles, a rookie doctor who has just begun his internship at Hope Hospital. Each stage/mission in the game requires you to correctly select and use a variety of surgical implements, such as the scalpel, the laser or the ultrasound, in order to cure each patient of his or her affliction. At the same time, you must avoid making too many mistakes, running out of time, or letting the patient's vitals drop below zero, any of which causes you to fail the operation and kill...your career. Despite the unusual premise, at the beginning things seem pretty mundane. You are guided by the motherly Nurse Mary and later her younger, spunkier, stricter replacement Nurse Angie in treating injuries and removing tumors, procedures made easier by the advanced medical technology at your disposal. One day, however, Derek is the only doctor available to perform an operation far more difficult than he can handle. As he frantically tries to concentrate, Derek feels time slowing down and miraculously manages to save the patient. He soon learns that he is an heir to an ability called "The Healing Touch", thought to originate from Asclepius, the ancient Greek god of medicine. Armed with his surgical skills and his Healing Touch, Derek and his motley crew of colleagues must aid Caduceus, an organization of medical experts, against a deadly new disease called GUILT, parasites that kill in various intricate ways. GUILT is a man-made plague, unleashed into the world by Delphi, a shadowy cult that regards medicine as wrongfully extending life and interfering with God's intentions for when people should die. A sequel, called Trauma Center: New Blood has been released for the Nintendo Wii. The Wii also saw an Updated Rerelease of the original game, entitled Second Opinion. Another sequel, taking place after Under the Knife, but before New Blood, was released for the Nintendo DS as Trauma Center: Under the Knife 2. There is also another sequel, Trauma Team, released for the Wii. This series has a character sheet. Put tropes related to the characters there.
* Acceptable Breaks From Reality: The game makes no attempt whatsoever to portray surgery realistically.
* Developers aimed for more realism in Trauma Team. The result was less Bullet Time and killer parasites, but more ghosts, flying superheroes, cell phone calls from dead people, and teleporting ninja butlers.
* Even still, some of Trauma Team's patients are far less traumatized than you'd expect, Alyssa in particular. Her wounds are more consistent with being slammed into a hard surface by the blast rather than being right next to the bomb when it goes off, but it's much less Nightmare Fuel inducing to keep all of her limbs attached.
* Action Girl: Maria Torres has the most frantic gameplay of any character in Trauma Team, since she has to treat multiple patients at once. Her personality fits this. Bonus points for single-handedly stopping a bus from falling and crushing two other main characters.
* All There in the Earlier Game: If you haven't played Second Opinion you wont know what Naomi and Little Guy are referencing when they are talking about not talking about their pasts. They're both ex-Delphi agents.
* Second Opinion does this to itself - the climax of the main plot is glossed over so it can launch straight into the remake contentand can be downright disappointing if one doesn't have access to Under The Knife to see the full version. It does close up some plot holes, though, such as how Delphi actually learned about Triti.
* Another Side Another Story: Trauma Team's main gameplay hook. To elaborate, several events during the game will have multiple doctors address the situation in their own storyline. A patient Gabe diagnoses will be operated on by CR-S01. An accident first attended to by Maria will have patients that get operated on by Hank. Of course, in the finale, all six work together on a massive problem.
* Second Opinion as well with Derek Stiles on one side and Nozomi Weaver on the other.
* Anti-Frustration Features: While multitasking several fiddly jobs at once is a core part of the gameplay, the games will occasionally throw you a bone. For instance, in the first game, the laser will never "break" while operating on Pempti (which require you to use it constantly and could kill a patient in the normal recharge time) and defeating Savato causes the woulds it caused to vaporize along with it.
* Arc Words: Rosalia.
* Also in Trauma Team: "Beginning..."
* Arranged Marriage: In Trauma Team, Tomoe's father nearly forces her into one in order to decide the clan succession. Luckily she manages to get out of it thanks to the timely intervention of Chief Patel & Gabe and her father's lung condition suddenly acting up.
* Art Evolution: The art style used in the games changes drastically between Under the Knife and its Wii remake, Second Opinion, and hasn't changed since.
* Trauma Team also shakes up the art style, especially during operations.
* Art Shift: Trauma Team's anime style suddenly shifts to a more intense, detailed one when Gabe trashes his office.
* Asian Rudeness
* Asskicking Pose: Surgeons in this series have a flair for the dramatic.
*
* Derek does this even in a car when they are being kidnapped and even yells out when they are trying to silently escape a prison cell
* Asteroids Monster: The GUILT Paraskevi has to be cut in half, and the halves cut into half as well, until 16 little Paraskevi are produced, each of which is small enough to be extracted safely.
* As You Know: Lampshaded repeatedly in Trauma Team as Gabe's computer gives him basic medical information.
* The Atoner: CR-S01 from Trauma Team. Subverted: He didn't do the thing he's atoning for.
* Dr. Weaver from Second Opinion helped Adam develop GUILT by keeping the "incubators" alive.
* And then in Trauma Team Alyssa accidentally takes a bomb meant for her and nearly dies
* Badass Normal: The cast of Trauma Team. Well, most of them, anyway.
* Barbie Doll Anatomy: Chest operations on female patients in the first game and Trauma Team show their uncovered breasts, but without nipples. Other games instead opt to cover the breasts with pieces of cloth.
* Being Good Sucks: The central trope of Dr. Freebird's story in Trauma Team.
* Big Bad: Adam in Under the Knife and Second Opinion, Master Vakhushti in New Blood, and Heinrich, Reina Mayuzumi, and Patrick Mercer in Under the Knife 2. Averted in Trauma Team.
* Big Damn Heroine: Maria's juggling five near-death patients entirely on her own... cue the paramedics.
* Maria gets her own when she rides a crate of Rosalia vaccine Slim Pickens style to Resurgam.
* Body Horror: GUILT and Stigma and in Trauma Team, Naomi contracts the Rosalia virus which then absorbs the genetic disease in her DNA and "evolves". Looks like a freaking caterpillar is in her heart.
* The 'claw' on the liver, which is composed of the black bruises that cover organs.
* What makes the "claw" even more horrifing is that it then starts pulsating making it look like it is trying to crush the liver.
* How about the simple fact that the Rosalia Virus is a form of viral hemorrhagic fever gone wild that is basically eating you from the inside out, causing you to bleed uncontrollably out of every orifice (including your eyes)?
* Blatant Lies: Gabe and RONI have a lot of fun abusing a bot program's Artificial Stupidity.
* Book Dumb: Derek is really only kept around Caduceus because he's a genius surgeon, and definitely not for his skills as a doctor. Dr. Kasal even sends Angie along with him because he doesn't trust Derek in that regard (though it's rather pathetic that his nurse is a far better doctor than he is). Still, he gets better by Under the Knife 2, and is shown to be impressively competent by New Blood and Trauma Team (if only because you're not playing as him anymore).
* The first game does extensively examine this, at least. Derek's so-so bedside manner and mediocre diagnostics skills are acknowledged by other characters (he was never top of the class in med school and borrowed assignment answers) and nearly get him in very serious trouble while he's in general practice. Part of the reason he chooses to join Caduceus is because by that point he's aware his incredible surgical skills are far and away his best asset and an environment that focuses him on that exclusively will allow him to do the most good.
* Breakable Weapons: In games before Trauma Team, the tools "break" from overuse and you have to wait for a new one. Savato spins webs that have to be cut by the scalpel, but are so corrosive, the scalpel is destroyed in the process.
* Bullet Time: Derek and Markus' version of the Healing Touch slows time to a crawl from their (and in Markus's case, his partner's) perspective, allowing them to make rapid surgical maneuvers that would be impossible without it.
* Butt Monkey: Hank Freebird in Trauma Team. He (as Captain Eagle) is hated by the public, no one at the hospital understands his mindset of good and humanitarianism, and Claire, his patient for whom he truly cares, is shot in a freak mall shooting (though she got better).
* Butterfly of Death and Rebirth: The primary motif of Trauma Team, along with flowers.
* Captain Ersatz: Diagnostician Gabriel Cunningham from Trauma Team looks and acts very similar to Spike Spiegel, down to smoking damaged cigarettes. Too bad Steve Blum isn't voicing him.
* Some fans also think he looks like an anime version of House.
* Character Portrait
* Call Back: When you extract the Twisted Rosalia virus the screen briefly says DEFEAT like in the previous games when GUILT or STIGMA is extracted.
* RONI mentions adding "To hell with that" during "Moving Heart", and later, during "The Simplest Truth", where she defies direct orders, she mentions she referred to the "To hell with that" in her database.
* In one of Gabe's early cut scenes, the Chief invites him to go with her to a medical conference in Japan. Come 'Healing Warrior', when Tomoe goes back home to Japan, guess who shows up to be her support?
* When a prison guard in CR's cell collapses during the Rosalia virus outbreak, his partner would rather point his gun at CR instead of calling an ambulance. Genre Blindness aside, his reactions make some sense when you consider that at that point the outbreak was in its early stages and CR is doing time for bio-terrorism.
* Catch Phrase: Each specialty gets one:
* Surgery: The patient's life is in your hands (used in the original Trauma Center games as well.)
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* First Response: The first moments are the most critical
* Orthopedics: Work your marvel with strength and skill
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* Endoscopy: You must seek what lies within
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* Diagnosis: Your mind is the ultimate tool
* Forensics: The truth can never truly die
* Chekhov's Gun: Several in Trauma Team. One big one: whatever did happen to that girl Maria rescued all those years ago?. Actually in the last chapters it's shown that the girl Maria saved was Rosalia.
* Cheerful Child: Alyssa. Pity the girl when she takes Naomi's place when she took a bomb disguised as a teddy bear. Fortunately she survived the attack.
* Christmas Cake: Reina Mayuzumi in Under the Knife 2.
* Code Silver: All of the games so far feature some sort of break-in or hostage situation.
* Color Coded for Your Convenience: Each character/discipline in Trauma Team has an associated color: red for CR-S01 (surgery), orange for Maria Torres (first response), green for Hank Freebird (orthopedics), purple for Tomoe Tachibana (endoscopy), blue/indigo for Gabriel Cunningham (diagnostics), and silver/white/gray for Naomi Kimishima (forensics). It's pretty close to Rainbow Motif
* Contest Winner Cameo: The winner of a contest at E3 2009, Charlie Malone, was made into a patient in Trauma Team.
* Continuity Nod: A few in Trauma Team; notably, Esha notes that one patient's spinal tumors were deemed inoperable by Concordia, and Naomi remarks that she didn't expect to find someone else with the hands of a god at Resurgam if the player earns an XS rank on the stage where she assists Tomoe.
* Co-Op Multiplayer: New Blood lets two players operate together. Trauma Team does as well and attempts to balance the roles of the two players invarious ways, depending on the type of operation. Diagnostics and forensics are one player only.
* For general surgery, the tools get divided before the mission starts.
* For the EMT missions, each player gets every other patient.
* In endoscopy, control switches from one player to another based on time.
* In orthopedic procedures, the players swap after each action.
* Curb Stomp Battle: First time players of Under The Knife will often get stuck on the ninth operation. You must get rid of a bunch of aneurysms. The first few waves are very easy, but at the end, you face five of them at the same time. It's a slightly lengthy process to get rid of one. Not to mention that while you are trying to focus on one, the others are all expanding. They will eventually pop, and will drop the patient's vitals by a huge amount. The Healing Touch barely helps in the situation, as well.
* Deadly Delivery: There's a serial murderer in Trauma Team who kills her victims by masquerading as a postal worker, then "delivering" a package containing a hidden bomb.
* Diving Save: Little Guy tackles Naomi when the bombs strapped to a suspect goes off.
* Does This Remind You of Anything?: The conflict between the Razu and Dal tribes in Under the Knife 2. The conflict between the Hutus and the Tutsis, and the bloody civil war that ensued.
* Do Well, But Not Perfect
* In some operations, saving the patient as quickly as possible will not score you enough points for an S or XS rank. You will have to allow for more problems to occur to heal them and receive extra points.
* Under The Knife 2 throws this out in favor of having a set of bonuses that you must get 2000 points from in order to get the S or XS rank. If it says to do something at least X times, there is typically exactly X of that task for you to do. In short: doing perfect WILL get you an S or XS rank... except when mailing your fission, in which you MUST do a certain number of actions in a certain amount of time without any misses before ending the mission.
* Trauma Team does away with this completely by giving each operation a strictly fixed amount of actions that will result in a Good or Cool. Dragging on an operation for longer can only lower your score. Because of this, despite operations in Trauma Team being easier to clear, they are much harder to get XS ranks on. One blogger has described Trauma Center's difficulty as Tsundere (harsh on the outside, but soft on the inside) and Trauma Team's as Deretsun (soft on the outside, but harsh on the inside).
* It is possible to sacrifice your rank in order to achieve a higher numerical score. However, the game gives rank higher precedence than score when saving your best performance. So achieving a high rank can lock you out of topping the leaderboards.
* Dressed to Heal: Played straight and subverted throughout each game.
* Notably, in Trauma Team, Tomoe wears a lab coat over her kimono.
* Dual Boss: Second Opinion features one operation in which you must operate on two strains of GUILT at once. New Blood also does this with Stigma a few times, as well as one bonus operation featuring Stigma and GUILT at the same time.
* Dub Induced Plot Hole: Japan, America, and Europe have been swapped around quite a bit, causing a lot of confusion. First, the setting of Under the Knife was changed from Japan to America and what was previously America was changed to Europe. Not so confusing at first. Then the remake Second Opinion introduces Dr. Kimishima. Originally a doctor who's stripped of her medical license in America, moves to Japan, then bargains for amnesty back in America, she now loses her medical license in Japan, moves to America, and bargains for amnesty in Europe. Then New Blood, which takes place in America in both versions, cameos Dr. Stiles, said to be from Japan in both versions. Then Trauma Team, which also takes place in America, features Dr. Kimishima as a returning playable character, despite her saying that she couldn't go back there in the English Second Opinion.
* That last hole is fixed in-game though - it's stated several times that Naomi is under a plea agreement with the feds - her sentence is suspended provided she supplies the FBI with support as needed.
* Dynamic Entry: A rather brutal example, when a school bus comes out of nowhere in Trauma Team and crashes into the middle of a crowded mall.
* In the middle of a crowded mall's THIRD FLOOR.
* Dysfunction Junction: Tomoe Tachibana, professional Yamato Nadeshiko Ninja endoscopist who has dishonored her family and has abandoned ties with her native country of Japan is the player character with the least personal issues.
* Early Installment Weirdness
* Emo Teen: Linda. In her defense, depression turns out to be an indicator of GUILT.
* Hank's suicidal patient Claire would also be one, if she wasn't over 20.
* Expy: In Trauma Team, after Alyssa nearly gets killed by a bomb and is sent to Resurgam, the bandages and hospital gown makes her look like Nanako from Persona 4.
* Family-Unfriendly Death: Averted in the rest of the series (it's your job to save these people, and the one or two plot deaths aren't particularly grisly.) However, Trauma Team has a Forensics mode, so naturally you'll be examining a few victims of its major disease. They died horribly.
* Fan Service: Usually avoided with tasteful placing of the patients bodies or a blanket in the right place. Still, Dr. Myers operation for Paraskevi definitely qualifies, what with the camera starting out right on her exposed (undetailed) breasts before zooming in on her chest cavity. She is significantly reduced in cup size and more tastefully covered in the Second Opinion version of the same operation.
* So, how are you introduced to Reina Mayuzumi? A shot that loving details every sexy curve of her body, complete with heaving cleavage shot specifically provided in its own boxout.
* If this isn't fanservice, life sucks.
* Maria's introduction has her just come out of the shower to answer a call - only in a towel.
* Let's not forget how Naomi's necklines plunge like the stock market.
* And Dr. Cunningham's second female patient wears lacy black lingerie to go with her rose-pattern black stockings.
* Final Exam Boss: The last strain of Neo-GUILT in Under the Knife 2, which draws on the six types of GUILT you've already faced in the game (thankfully, four of the original strains didn't make it in - more than a few people would annihilate their cart if they had to face Triti or Savato again). To be even able to damage the boss, you need to take each type out with the strategies you used in previous battles with the strains.
* Fission Mailed: Episodes 4-1 and 4-2 in Under the Knife 2.
* Somewhat averted in Trauma Team, where you'll have operations that are actually going to end in failure, but the game will still treat it as a successful operation.
* Foreshadowing: In the First 'First Response' scenario, you end up with someone who suddenly starts having convulsions after you treat her wounds. She has a black bruise mark on her neck. It could be mistaken for a sort of burn or soot marks if you're not looking at it directly. The bruise and the convulsions are BOTH symptoms of the Rosalia virus. The weirdness of it all states 'Yep, Trauma Team has a super virus of it's own'.
* Also, of all the forensics levels, the very first is the only one that doesn't involve inexplicable madness or an unknown disease that remains so well after the case is solved.
* Fun with Acronyms: GUILT stands for Gangliated Utrophin Immuno Latency Toxin, even though the GUILT are clearly parasites. In the Japanese version, Guilth doesn't stand for anything.
* Five-Man Band: The cast of Trauma Team. Subject to Alternative Character Interpretation.
* The Hero: Gabriel or CR-S01
* The Lancer: CR-S01 or Maria
* The Big Guy: Hank
* The Chick / Team Mom: Tomoe
* Action Girl: Maria (even when The Lancer)
* The Smart Guy: Gabriel (if not The Hero)
* Sixth Ranger: Naomi
* Forensic Drama: The Forensics mode in Trauma Team, naturally.
* Game Breaking Bug: Surprisingly, only one's been found so far: Mature Kyriaki can actually disappear on you if you suture the first slice too fast (or, more accurately, before Mature Kyriaki spawns).
* Genre Roulette: Trauma Team.
* Gentle Giant: Hank's defining character trait. He's The Big Guy, but he loves flowers, has a soft spot for a young patient of his, and performs operations requiring precision and caution rather than speed.
* Getting Crap Past the Radar: What? Even a Mature rated game like Company of Heroes spends less of its playtime showing blood than this Teen rated series.
* Blood is the least of it. The games show some pretty horrifying organ damage in downright gory detail. In any other game wounds this detailed would get a Mature rating at the very least.
* Is that ... Pedobear on Leslie Sears' shirt?!
* More like a generic Ridiculously Cute Critter face.
* Guide Dang It: When it comes time to deliver the final blow to Savato, a Healing Touch automatically activates. When you still can't get it, that's the cue to use your in-game Healing Touch to double the effect and freeze time completely. Gee, I hope you hadn't used that at any point in the operation beforehand...
* The operation where you're told you need to operate on five people in a space of only ten minutes, a feat that's incredibly hard (though not necessarily impossible) to do. The thing, though? If you've made it to the third patient or farther when the time limit runs out, you're told that "reinforcements" arrived and took care of the other patients, and you're given all the time in the world to complete the operation you're currently on. Unfortunately, people are liable to restart the mission before the timer runs out if they think they can't beat it, and thus can get completely stuck.
* In Trauma Team's forensics mode, searching a crime scene can sometimes become this. Have fun pixel-hunting...
* The series is full of small Guide Dang Its; for example, Deftera can be maneuvered using antibiotic gel as a wall, Triti's reproduction is reliant on the thorns on the edges of the affected area, and blood pools appear faster if there is already a pool nearby.
* Harder Than Hard: The "Extreme" difficulty for Second Opinion, New Blood, and Under The Knife 2, which only applied to the X Missions. According to the developers, Trauma Team's "Specialist" difficulty takes this Up to Eleven by elevating all operations to X Mission difficulty.
* Healing Hands: Not the usual, instant-healing kind, though.
* Heroic BSOD: Combined with a Hopeless Operation, a But Thou Must!, and a Kobayashi Mario in Trauma Center 2. All at once.
* Technically, the Heroic BSOD occurred a couple of weeks (or so) earlier, with the death of Emilio disabling Derek's Healing Touch. The Hopeless Operation, etc. occur just before someone finally presses the Heroic Ctrl-Alt-Delete to reboot Derek.
* Hospital Hottie: Multiple characters.
* Hospital Paradiso: Inverted in Under the Knife. Joining the cutting-edge medical facility Caduceus is considered to be the selfless choice for Dr. Stiles, while staying at Hope Hospital would be more in the interest of his own happiness. Played straight in Under the Knife 2, in which Dr. Stiles declines a high-paying desk job at Acropolis Pharmaceutical in favor of continuing as a surgeon at Caduceus.
* Human Popsicle: CR-S01 is kept within a refrigerated cell where the temperature is kept at zero degrees Celsius (AKA 32 degrees Fahrenheit, at which water freezes), in order to inhibit the growth of bacteria. Gabriel ironically points out that several forms of bacteria can still be grown at this temperature.
* Hundred-Percent Completion: The final Doctor Medals in Trauma Team for CR-S01, Maria, Hank, and Tomoe require getting XS ranks on every single operation. The remainder involve various tasks such as finishing an operation with only "Cool" miniranks or finishing every first response operation without losing a single patient. Mercifully, Gabe's medals are glorified scavenger hunts, and Naomi's are quizzes on various medical factoids.
* Idiosyncratic Difficulty Levels: Trauma Team's have a doctor theme: Intern, Resident, and the unlockable Specialist.
* Interface Screw: The first two Wii games both have an in the dark operation, where you have to use various sources of light in order to see what you're doing. By the end of one operation, the only thing you have is the flash of a camera, which of course only lasts for a second or so, so you have to use it and remember what you saw.
* Averted in Trauma Team. When the power goes out during an operation, the level ends. You resume working on the patient in the next level after the power comes back in a cutscene.
* In Under the Knife 2, there's a few dark operations - you receive a penlight to work by, but need to aim it (it's added to your surgical tools menu). Additionally, one of these takes place in a moving vehicle, and the screen shakes back and forth periodically.
* Trauma Team has an operation where your endoscope's flashlight fails. You have to navigate by the glowing gates used as navigational aids in your HUD.
* Also occurs in-universe in Trauma Team during some orthopedic missions, when the guideline for cutting artificial bone malfunctions.
* I Surrender, Suckers: Happens with one of the Delphi members in Under the Knife 2.
* It's a Wonderful Failure: "...Derek had no business practicing medicine in the first place."
* Trauma Team has you listen to a recording of whatever doctor you were playing as giving up on medicine forever... except in the final chapter, where you get to hear Rosalia's tormented lament over all that's gone wrong.
* It's Personal: In Trauma Team's forensic mode, a bomber tries to kill Naomi by sending her a rigged teddy bear. Morality Pet Alyssa, a seven-year-old girl, innocently takes it and is blown up. Naomi is not happy about this.
* In the fourth case, when Naomi sends a guitar broken by one of the bomber's bombs to be analyzed by Little Guy, he realizes it is a musical legend's guitar valued at about $100,000. Needless to say, he also isn't amused. (And yes, he literally says the trope name.)
* Last-Minute Hookup: It's heavily implied that Derek and Angie get together in Under the Knife 2's ending, if the ending epilogue to the first game wasn't enough.
* Love Makes You Evil: Patrick Mercer in Trauma Center 2.
* Paired with an excessive amount of stupidity
* In Trauma Team, the culprit of the third case is revealed to have been this, although it was also paired with brain tumor-induced Ax Crazy.
* Locked Room Mystery: One of the stages in the Forensics mode of Trauma Team. In fact, the stage has the exact name as the trope.
* Luck-Based Mission: The GUILT Deftera, Pempti and to a lesser extent Tetarti, which include a random element in the GUILT's movement or attack.
* More specifically, if a Deftera pair starts bouncing everywhere but against each other, Pempti decides to use its tumor-inducing attack followed by the cutting one, or the Tetarti huddle together making it easy to inject the wrong one, you can say goodbye to your S rank.
* Made of Iron: Valerie's Healing Touch makes the patient into this - no matter what happens, be it colossal screwups, stab wounds, or a frustrated player shanking the crap out of them with the scalpel, for the next 30 seconds or so, their vitals will not move at all. Of course, it's possible to shank the patient with no repercussions anyway (aside from the usual vital loss that comes with the scalpel's use), as long as you're in the right mission and/or you don't hold it down for too long.
* Also, in-universe, Tomoe's father in Trauma Team. When he needs to be operated on, they can't inject him because the needle not only fails to penetrate his skin, it bends in half. They also require a katana to open an airway to insert the endoscope.
* Magic A Is Magic A: Despite their fantastic nature the games are very consistent with how Healing Touches work. A Healing Touch used subconsciously out of desperation costs the doctor nothing and can last quite a while, while an intentional one exhausts the user and last for a brief time proportional to their focus. Two different Healing Touches can be used in concert without interfering with each other. Meanwhile, two of the same Healing Touch will stack. This includes the same doctor using a desperation healing touch and an intentional one simultaneously.
* Magical Defibrillator: All over the place. The first two games feature Derek using his hands to massage patients' heart when they undergo cardiac arrest, which is more or less the right procedure, but the later games regularly shock patients undergoing cardiac arrest with a flat-line ECG back into life with them. In a particularly jarring scene in Trauma Team, CR-S01 orders his support not to touch a patient who was undergoing ventricular fibrillation (which is when you're actually supposed to use a defibrillator...), only to whip it out after the patient started going into cardiac arrest. Even worse, a huge deal is made of the fact that they can't use the defibrillator on a flatlining patient while the power is out. In the interim, CR-S01 is seen giving the patient chest compressions, which is what you're supposed to do for a flatline.
* In what might be an example of The Coconut Effect in action, Under The Knife uses a defibrillator correctly, and cardiac massage is explicitly the go-to technique to deal with a flatline. Second Opinion changes these operations to incorrectly apply the defibrillator instead.
* Meaningful Name: Derek Stiles' initials refer to the DS console, and his surname to the DS Stylus.
* Second Opinion also features a doctor named Nozomi Weaver, the first syllable of her surname being a reference to the Wii console (and the Wii-specific features of her bonus missions) and her initials to the Nintendo Wii. Neither this nor the DS example is present in the Japanese version.
* Nozomi Weaver returns to her original name, Naomi Kimishima, in Trauma Team. Being a coroner in that game, it's possible she was using an alias to operate as a surgeon in Second Opinion.
* It's stated in the games that her use of an alias was due to stigma associated with her Healing Touch. Forensic pathologists - 'medical examiners' or 'coroners' - are required to first train as general surgeons and then complete additional qualifications.
* The military transport carrying the Rosalia vaccine has the call sign "Leukocyte" - a.k.a. white blood cell.
* Mundane Made Awesome: During most of the game, you feel like you are playing Space Invaders on someone's stomach. But again that is indeed awesome. Also, the final GUILT parasite at Under the Knife is a giant spider parasite that creates a web that seems to "absorb" heartbeats. Also the parasite looks like it's on fire.
* Surgical Bullet Time.
* Awesome Center.
* It's implied that on the X missions you're pretty much operating on a zombie.
* The trailer for Trauma Team takes this and runs with it.
* Musical Nod: Trauma Team has several nods to music from Second Opinion, usually when Naomi is involved. They include a somber piano rendition of Second Opinion's main theme and a piano rendition of its final boss theme when you stop her heart in the last operation.
* Nice Job Breaking It, Hero: In Trauma Team, Professor Sartre not only gets infected by the Rosalia virus trying to extract a cure from Rosalia's blood, he also manages to unleash the same virus to wreak mass terror.
* Nietzsche Wannabe: Adam. Yet he also thinks that he's serving God- he even goes so far as to identify GUILT with the Seven Plagues of Revelation and proclaims he will smile as Derek and friends burn in Hell for opposing the Divine Plan.
* Nintendo Hard: It's an Atlus game, what did you expect. They finally had to cave and add an easy mode in the sequels. It'll still break your arm. It seems that many of the operations in New Blood were designed around having two players, and both Healing Touches available...
* Made worse by the fact that each game is hard in it's own way. The original favored precision (no quick gestures for stitches, you have to make sure it's very even and narrow), New Blood favored consistency (keep up a tricky operating procedure over a long mission), and Under the Knife 2 favored raw speed (such as the challenge on Bythos being that most players simply can't heal faster than the patient takes damage). Which game is the worst ends up depending on your particular playing style.
* No-Gear Level: The games occasionally throw a curveball by limiting access to one of your crucial instruments. The epitome of this is an operation in New Blood where the player is given no stabilizer and a VERY limited supply of antibiotic gel - in other words, no way to increase the patient's vitals in an operation that requires techniques that damage the vitals slightly in the process. Valerie even comments afterward she'd never appreciated the stabilizer so much.
* No Name Given: The surgeon character of Trauma Team is known throughout the game only by his prisoner number, CR-S01. Japanese materials note his actual name as Erhardt Muller.
* Non-Lethal KO: If the player fails an operation, another doctor will take over before any more damage can be done and the main character will be shown having quit their job in shame. Of course, once the plots introduce GUILT and Stigma and each game's main characters are considered the only ones capable of dealing with it, it can be assumed that failure would doom the patient. The only real aversion is the bomb, which is implied to explode if you run out of time/make a mistake. No dialog, no cutscene, just an explosion and a fade to white...
* Averted for sure in the final mission of Second Opinion: Fail there and Dr. Kasal will comment that "That's enough! Dr. Hoffmann... will be missed."
* The First Response missions in Trauma Team seem to avert this as well. In fact, you can lose multiple patients. (Up to 4 without failing, anyway, depending on the mission.)
* Normally I Would Be Dead Now: Thanks to the amazing surgical skills some of the doctors possess, patients survive:
* GUILT strains that cut open the heart (and in a few cases, take over the heart completely, leaving huge tumors/an absolutely massive main body that uses part of the heart as an eye-like structure).
* Multiple aneurysms bursting in the brain
* And in Trauma Team, eight-year old Alyssa survives an explosion from a bomb that she was holding, despite several other grown adults dying instantly after suffering the same fate.
* Nostalgia Level: Operation A-4 in New Blood, supervised by Derek and Angie, has you operating on simulated patients infected with GUILT. And in the last patient, GUILT and Stigma at the same time.
* Not Quite Dead: A rarity for this series, in Trauma Team, one of Hank's patients, a depressed girl, gets shot and loses all consciousness in his arms. He later learns that Maria was able to resuscitate her, and cannot contain his happiness.
* Not Using the G Word: Naomi clearly suffers from some aftereffect of GUILT, but it's never referred to as that. Even when Rosalia complicates the condition and mutates into something worse.
* Obligatory Swearing: Trauma Team ups the saltiness quite a bit from the previous games.
* Obstructive Bureaucrat: This series loves to subvert this trope - the government officials such as Anderson, Holden, and Tillman end up doing some badass things to save people, even at great personal cost.
* Obsolete Mentor: Derek and Caduceus itself over the course of Under the Knife 2 until the replacement organization is revealed to be corrupt and its newly minted doctors equipped with an artificial Healing Touch are all on the brink of death from GUILT.
* Oh Crap: Naomi has one of these in the episode "Crime of Passion" when she realizes the package she just received is a bomb.
* And her 7-year-old Morality Pet ran off with it when she wasn't looking...
* Ominous Latin Chanting: The music for the final GUILT, Savato and part of the final Stigma, Cardia.
* Don't forget the Ominous Pipe Organ in both of Cardia's themes and Alethia's theme (albeit not nearly as much as in Cardia's).
* One of Our Own: Happens several times.
* One-Hit Kill/Nonstandard Game Over: Time limit aside, there are occasional circumstances that will end an operation immediately regardless of other factors, including allowing Triti vapor to escape or letting Paraskevi to burrow into the heart in Under The Knife/Second Opinion and touching an active pin on a mind-control device in New Blood.
* Open-Heart Dentistry: In Episode 6 of New Blood, the trio is given a dog named Pepita that they become attached to. When Pepita is shot, saving the trio's lives in Episode 6-4, our doctors take it upon themselves to attempt to operate on it. Good thing they saw an operation being performed on a dog back at the beginning of Episode 4-2, huh?
* More than a little justified, though. The entire operation is pretty much first aid, with the exception of the defib - just removing bullets from the skin and suturing.
* And even that's heavily lampshaded: Valerie comments the defib is made for humans, which Markus handwaves by telling her to turn the voltage down. Then when the paddles are applied, they descend as normal, hesitate, then awkwardly realign themselves as though the user is guess how to get a current across a dog's heart.
* See also Open Bomb Dentistry in the first game's "Explosive Patient" operation - The reason you can defuse the bomb is because your NPC partner used to date a guy on the bomb squad.
* In the same vein as the New Blood example, Trauma Team has you perform a simple endoscopy on a cat. Which becomes not so simple when Rosalia shows up.
* Operation Game of Doom: Several of the viruses get particularly nasty if you don't remove them carefully enough, or touch something you're not supposed to while moving the parts to the surgical tray. In a more literal example, the first game has Derek actually defusing a bomb with his surgical equipment while taking care to avoid detonation.
* Previous Player Character Cameo: Derek and Angie appear in a few chapters of New Blood, and even host a post-game bonus challenge where you operate on a virtual simulation of the GUILT strains from the first game.
* Derek shows up a couple times in Trauma Team, though you never see his face or hear his name.
* Phone Call From the Dead: Naomi Kimishima has the ability to receive these in Trauma Team by making contact with the corpse (or its remains).
* Rapid Aging: This happens right at the end of the game to Reina Mayuzumi, who had been using the Alethia strain of Neo-GUILT to preserve her youth.
* Rank Inflation: Not only is there the S rank, but Second Opinion introduced the XS rank, available only on Hard and Harder Than Hard.
* Real Is Brown: The graphics designers worked hard to invert this for Trauma Team, and based the majority of their design work on the theme of vibrant colors.
* Red Oni, Blue Oni: Markus and Valerie from New Blood.
* Science Hero: The main character is part of an organization dedicated to advancing medical science enough to eradicate disease, while the bad guys are a Knight Templar organization who believe that medicine violates God's will by denying humans "the blessing of death".
* Sequel Difficulty Spike: Inverted with Trauma Team, which alleviates a lot of the pressure that made its predecessors so difficult. But don't think for a second that you're on easy street.
* Serious Business: While surgery is in fact an important and serious concept in real life, the games still manage to wring every moment for all its worth. There's a TV show revolving around live, on-screen surgeries in New Blood.
* Sexy Packaging: The Japanese packaging for Trauma Team makes great use of Maria's... assets.
* Do note that North Americans are not shafted out of this, as this art is used for the cover of the NA instruction manual as well. Sexy Instructions?
* Ship Tease: A lot for Derek and Angie during the extra content of Second Opinion. From blatant (Angie being so hysterical when Derek is infected with GUILT that Weaver flat-out asks why she hasn't said anything to him yet) to subtle (the final shot of the credits is a living room/study with a corkboard over a desk. The board has pictures of everyone at Caduceus except Derek, so it's probably his place. All his coworkers are at the edge of the board, except Angie, whose picture is front and center.)
* Shout-Out: The first game's patients are named after the actors and characters of ER, House, Scrubs, and Greys Anatomy.
* Chapter 3-8 of Second Opinion is titled "Caduceus on a Plane". The symbol of Caduceus is a caduceus: two snakes wrapped around a staff.
* Not to mention the fact that the person you have to help in chapter 7-1 of New Blood is named after Rose and Blanche from The Golden Girls.
* The opening sequence of New Blood is probably a shout out to the opening credits of House.
* Shown Their Work: The planner of the Diagnosis mode in Trauma Team put an enormous amount of effort into doing research, to the point at which staff members started consulting him when they were feeling sick.
* Sliding Scale of Shiny Versus Gritty: The surgery graphics started off somewhere in the middle and slid toward shiny in future installments. This culminates with Trauma Team, in which tumors are represented by red gems. The character designs, on the other hand, got a bit more gritty in New Blood
* Solve the Soup Cans: Both Under the Knife and Under the Knife 2 feature simple puzzles that are supposedly related to complex biological science, given to Dr. Stiles to solve for whatever reason.
* Under The Knife/Second Opinion handwaves it by saying the scientist who gives Derek the puzzle isn't interested in the solution, just his problem-solving methods and everyone else at Caduceus did the same puzzles.
* Stealth Hi Bye: Tomoe Tachibana and her butler are fond of this in Trauma Team. It's not quite a true Stealth Hi Bye, since the player can visibly see them appear and disappear even while the other characters can't, but it's close enough.
* Stop Helping Me!: Angie. Elena to a greater degree, but mostly just because she's irritatingly cheerful. Invoked intentionally in two New Blood operations.
* If you run out of time, no matter where you are in the surgery, a doctor stops you and you fail. Yes, even if you cured the patient, stitched him up, and applied antibiotic-gel, and just need to bandage him up, the doctor will stop you and you quit your job in shame.
* In-universe example: Maria Torres can't stand any one assisting her in her job unless it's absolutely necessary. And even then, she treats them as incompetent losers.
* Suicidal Gotcha Gabriel in Trauma Team does this when trying to escape to create a diversion, complete with the Spike Spiegel Bang gesture.
* Suspiciously Specific Denial: In Trauma Team, Gabe and RONI are given an order to stop examining a soldier, and spyware is installed on RONI to keep an eye on them...but then she realizes that due to Artificial Stupidity, it will only report when Gabe is engaged in blatant diagnostic activity. Cue Funny Moments as Gabe has a chat with his new buddy while idly mentioning that they are not looking for symptoms.
* Talking Is a Free Action: Whenever a character gives you advice during an operation, time stops until they are finished talking.
* There's a handful of exceptions. If any chatter is more than one "message box" long, time will almost always stop and you'll have to advance the text normally (this DOES extend the Healing Touch duration, but it's almost always a bad thing). If it's just a one-line observation (or Angie helpfully reciting, step-by-step, the procedure you're doing as you do it for the fifth time), you won't even be interrupted and the clock will keep ticking.
* Temporal Paradox: Done accidentally in Trauma Team.
* To elaborate, the first Surgery mission is a direct follow up of the second Diagnostic mission. Keep this in mind. At the end of the first Surgery mission it branches out to the third Orthopedics mission which then leads to the third Diagnostic mission. However, by the time you choose that last one, you'll notice that the intro of that mission literally states that the first Surgery mission didn't take place yet. So, in the end, it's most likely that the writers of the game accidentally put the writing tense in the wrong order in the third Diagnostic mission.
* Thanking the Viewer: Done quite well in Trauma Team, when post-credit Gabe speaks directly to the player, after which you are treated to a message from all doctors thanking you.
* Theme Naming: Caduceus, Delphi, and the Chiral Test for detecting GUILT all stem from Greek Mythology. The names of the seven GUILT strains are based on the Greek names for the days of the week.
* Under the Knife 2 introduces the Neo-GUILT, named for four Greek-derived concepts from Gnosticism: Nous (Intellect), Bythos (Depth), Sige (Silence) and Aletheia (Truth).
* New Blood used more Greek, this time from different parts of the body.
* And then there are patients whose names are a mix and match of the characters and actors of House, Scrubs and ER.
* Patients in the second game use names from Greys Anatomy, another medical drama. Also, some doctors borrow one of their names from these four series. Examples: you have Derek Stiles vs. Derek Sheppard, Dr. Robert Chase from House and Dr. Tyler Chase from Trauma Center are both blond, and to some extent Adel is a Spear Counterpart to Adelle from Grey's Anatomy.
* Timed Mission: Every mission, as it were. That is, until Trauma Team, which drops the timer for the vast majority of the missions.
* Time Stands Still: At the end of Under the Knife, you automatically use your Bullet Time healing touch. If you use it again, time freezes. Completely.
* Too Awesome to Use: Your Healing Touch can certainly save you... but what if you need it later? Made worse if you started with the first game, which penalized your score for using it on most operations; later games practically expected you to use it, but then would happily return to final bosses that required you to save your healing touch till the end of the battle.
* Toplessness From the Back: Tomoe bathing in her very first cutscene. Maria Torres is an even better example. Watch her first cutscene, right after she steps out of the shower.
* Twenty Minutes Into the Future: All of our most dreaded diseases (AIDS, cancer...) are all but gone. Then GUILT shows up...
* But of course. We have antibiotic gel!
* And yet they all seem to be there for Trauma Team, particularly in Diagnosis. Searching for a cure to them even motivates the events that start the viral outbreak.
* Understatement: In CR-S01's bio, it mentions that he was involved in the Cumberland College incident that killed several people. By several, they mean everyone on campus.
* Unexpected Gameplay Change: The games like to throw in at least one mission that has nothing to do with operating, such as defusing a bomb.
* Using a scalpel, forceps and laser. It's just like operating, only the patient's a mechanical device that can kill you if you mess up!
* New Blood has you using forceps to crack a freaking toy lock.
* In Under the Knife 2, it's a mechanical door lock instead - this has the advantage that locks won't kill you, but the alarm goes off if you mess up at all. Though it's implied by the Game Over screen, that if you fail that one you're as good as dead.
* Trauma Team continues the tradition by having you search through rubble for survivors of a bus crash. With an endoscope.
* Unwitting Pawn: Derek in Under the Knife 2. By both Mayuzumi and Mercer.
* The Vamp: Reina. Technically she's The Dragon, but given all the horrible things she does to Derek and the fact that she carries the final strain of Neo-GUILT, she might as well be the Big Bad.
* Variable Mix: This occurs during Hank Freebird's operations in Trauma Team. The operations start with a base soundtrack that adds more instrumentation with each successful series of combos you perform. A single screw up causes the last set of added instruments to immediately drop out.
* Virus Misnomer: The GUILT virus, in which the T stands for "Toxin", is often referred to as a tumour. It's pretty clearly a parasite.
* It's not said very clearly, but GUILT is a toxin which causes part of the victim's tissue to mutate into a parasite that starts tearing the rest apart. Also, Deftera looked more like a tumor in Under The Knife than it did in the remake.
* Voice Grunting: The first game features a few voice clips from the characters who assist you in operations. The remake Second Opinion also adds some for the playable characters. Under the Knife 2 goes all out with over one hundred short voice clips from the whole cast, including such gems as I DISAGREE and everyone saying Dr. Stiles's name in various ways. New Blood and Trauma Team just use full voice acting.
* Where Are They Now? Epilogue: Done twice in Trauma Team. The first is during the epilogue where Tomoe gives Naomi who was recently cured from Twisted Rosalia a quick rundown on how each playable character is doing. Then after that,you get the secret voice recordings.
* Who Will Take the Kids?: Played straight in Trauma Team after Alyssa is nearly killed by a bomb and orphaned
* You All Look Familiar: Averted for the most part, but played to absurd lengths with the Delphi members in Under the Knife 2.
* You ALL Share My Story: The stories in Trauma Team are all connected, and late in the game, all six doctors come together to fight the epidemic CR-S01 allegedly released before he lost his memories.
* You Are Not Alone: Chief Patel's message to Maria.
* You Did Everything You Could
* Your Days Are Numbered: In the upcoming Trauma Team, it's revealed that after Second Opinion, Naomi Kimishima was diagnosed with an incurable disease and is living on borrowed time.
* Antibiotic gel?
* The epilogue of Trauma Team reveals that the Rosalia Virus (probably) negated the disease.
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