Re-release this: Trauma Center: Second Opinion

Despite the title, it's the first game in the series. Well, a fairly different Wii version of the original DS game.

This column is “Re-release this,” which will focus on games that aren’t easily available, or even available at all, but should be once again. Previous entries in this series can be found through this link.

Operation. A classic board game that requires a certain level of precision in order to win. You pretend to be a surgeon there, extracting body parts and also more conceptual problems like “butterflies in the stomach,” and if you touch the sides of the holes where these parts reside with your forceps (okay, they’re just tweezers) a buzzer goes off and your turn is over.

There’s not much else to the board game than that, so when it ended up releasing in video game form in 1998 for Windows, the scope of it all had to be expanded a bit, with you operating on robots, monsters, dinosaurs, all kinds of creatures that could have random stuff in their bodies you need to pull out as a test of your fine motor skills. Still, a video game based on the board game could only take you so far, given it was licensed and still aimed at kids. That’s where Atlus’ Trauma Center series would come in less than a decade later, on the Nintendo DS. The stylus could act as a pair of forceps, but it could also be a scalpel, used to suture wounds, as a guide for setting bandages, and more. And since this was Atlus, and Trauma Center wasn’t tied to any board game or directed at a specific age group, it could also be bloody and full of tumors and polyps and death and despair, with influence taken from Japanese shows as well as American medical dramas like ER and Chicago Hope.

And since this was a video game, Trauma Center could also feature a secret cult purposefully incubating manufactured diseases in children in order to be used in international terror attacks to help achieve their goal of ending medical science and therefore humanity, restoring the balance of natural selection in the process. I’d like to see Operation pull that shit off.

Trauma Center: Under the Knife released on the Nintendo DS in 2005, both in Japan and North America (Europe would have to wait until the following spring). It’s a great game that effectively uses the hardware and stylus in order to simulate the job of a surgeon, but it’s also a brutal one: there is one difficulty level, and it hates you, leaving little room for error and forcing you to replay surgeries again and again until you nail it. You’ll fail a surgery if you “Miss” too many times, meaning if you screw up in a very Operation-esque way while removing, say, glass from a patient’s skin, or even by injecting a serum of some kind into the wrong spot on a body, or at the wrong time.

Under the Knife released less than a year into the DS’ existence, so it’s pretty impressive how well it utilized the two-screen setup and stylus to create a game that clearly worked best on this system more than any other before it. And then the Wii and its specs came out, and Atlus decided that the infrared pointer and motion controls of that system could make for an even better version of Trauma Center. That’s Second Opinion, and Atlus wasn’t wrong to make the changes they did: the Wii really was the better place for Trauma Center.

Second Opinion is both its own game and not. It features basically the same story and characters as Under the Knife — a little less grim and dark, which is saying something considering the whole bit about the bioterrorist cult above — and much of the same “missions,” but it’s also been expanded and completely redrawn. Not just redrawn because the Wii was more powerful than the DS — the Wii was the pinnacle of pre-HD horsepower, capable of running at 480p on an HD set while looking wonderful through S-video on a CRT, while the DS was at its best visually with detailed 2D sprites and fully capable of enhancing 3D Nintendo 64 titles — but also to make everything more in line with Atlus’ other console game art. Plenty of the Shin Megami Tensei team at Atlus was behind Trauma Center, and you could pretty easily figure that out just from the look and sound of the Wii version of the game, never mind the dark secrets and world-in-peril stuff. Masayuki Doi, who had worked on concept art and “sub-character” design on a number of SMT and Persona titles on the Playstation and Playstation 2, took over as the lead character designer on Second Opinion from Under the Knife’s Maguro Ikehata, and stayed in that role through the rest of the series. Because of this, the DS-only sequel to Under the Knife, Under the Knife 2, looks more like Second Opinion than the game it’s actually following up on.

You play as Derek Stiles, a young surgeon who had just finished up his residency and is trying to prove his worth as a doctor. Trauma Center is set in a world where most diseases we know of as either incurable or at least featuring a high mortality rate are now treatable, which means medical technology is impressive in a sci-fi way: for instance, there’s an antiobiotic gel that you can just splash around on small lacerations on organs that not only cleans up the wound, but also helps to instantly raise a patient’s vitals. This is where the manufactured diseases come in: ones that adapt and evolve and fight back as you try to extract and defeat them. GUILT, said manufactured disease, comes in a number of strains. It’s a parasite that feeds off its host, growing tumors and polyps that’ll burst and cause vitals to rapidly drop, figuring out how to replicate itself so removing it isn’t simple. It has automated defenses, and is described quite a bit like a computer virus that’s been programmed to act a certain way in certain conditions.

Derek Stiles gets chances to prove his worth after encountering a strain of GUILT and successfully removing it from the patient. One of, but not the only reason, that he’s a talented and (eventually) trusted surgeon is that he has a rare skill called the “Healing Touch.” For Derek, the Healing Touch allows for superior concentration that makes it seem as if time has slowed to a crawl. It’s bullet time for surgeries, and you can only use it once per operation, meaning it’s not a way for you to just barrel through whatever obstacle is in your path. You have to pick the spot where you need to use the Healing Touch the most — a puzzle you can’t quite figure out so you need to move faster than GUILT can replicate, or a section where, if you don’t move fast enough, tissue will take too much damage or polyps will grow or tumors will rupture and cause bleeding, impacting a patient’s vitals faster than you can help them recover. When you’re more skilled and experienced at the game, maybe you deploy Healing Touch at the moment where it will most improve your surgery score, allowing you to achieve a rank of S in the procedure, but early on, you’re probably just using it to survive.

To enable Healing Touch, you hold down the B button the Wii Remote and the Z button on the Nunchuk, then move the two controllers in tandem to draw a star on the screen. It takes a little getting used to the delay between your movements being made and the lines of your movements showing up on the screen, but you’ll master it with experience and be able to draw that star without missing a beat in your surgery before long. In general, the game’s motion controls work well, though much worse if you’re too close to the television, since on rare occasion you do need to have the range of motion to move the controllers both forward and back, rather than just pointing. You can’t use defibrillators effectively if you’re going to punch the TV screen when you do it, so move that chair back a little bit.

There are actually two playable characters and two forms of Healing Touch. Stiles has the time slowdown, while Dr. Nozomi Weaver, a Japanese surgeon banned from practicing medicine in her home country due to her Healing Touch and now (mostly unwittingly) working for the cult (known as Delphi) to keep the children infected with GUILT from dying, has a Healing Touch that recovers vitals every time you successfully complete an action. The differences don’t mean much at first, with Weaver, who is exclusive to Second Opinion, appearing in just a handful of side-story missions that run parallel to Stiles’ own journey. But she eventually ties into the rewritten final chapter of Second Opinion, and is fully playable in the game’s post-game X Missions, which are basically a series of boss-rush challenges tougher than anything else an already difficult game had thrown at you. Being able to choose between whether you want time to slow down for you or for vitals to perpetually raise each time you successfully complete an action is going to be a real boon to your chances of completing those missions.

As for how the non-Healing Touch portions of Second Opinion play, you have a tool wheel that the analog stick on the Nunchuk lets you access at any time during an operation. Rather than having to bring the stylus to the left of the screen for every tool selection like in Under the Knife, now you can just press the analog stick in the direction that the tool you want is in on the wheel, allowing for a smooth and speedy transition between tools that’ll let you operate in a real hurry even without the use of Derek’s Healing Touch skill. There are some complicated sections where you’re in a race against the clock for more reasons than putting together a high score, and being able to switch between suction, scalpel, forceps, and antiobiotic gel instantaneously to clear up a tumor without having to move where the Wii Remote is pointing during the entire thing (other than to make the cuts and grabs, I mean) makes you feel like you’ve got surgical superpowers even when you aren’t actually utilizing them.

You’ll be removing shards of glass, healing small lacerations, stitching up large ones, draining fluids, burning away polyps with a medical laser, even transplanting a kidney at one point, and since this is a very soapy experience, you’ll even have to defuse a high-tech bomb at some point, because why not? You’ll also be fighting off GUILT, and that word was chosen for a reason. GUILT is much more alive and active than anything else you’ll face, as it’s a parasite programmed to protect itself. Each GUILT battle is basically a boss fight where you have to figure out patterns and adapt: you’ll have to burn them with the laser to stun or defeat them, find where they’re hiding inside of an organ using an ultrasound and then cut them free from there with the scalpel, remove their built-in defenses that attach organ-hardening material to organs that’ll replicate themselves if you remove them incorrectly, inject a weakening serum into a fluid-producing GUILT strain that makes any other operation on the lungs impossible… you’ll be busy in these surgeries, and it’s very easy in these missions to make a mistake that’ll either guarantee you earn a low rank of C, or fail entirely.

Bless Atlus for including this character and this dialogue in a game about surgery. Image credit: Let’s Play

All of these surgeries occur with the kind of drama you’d expect from a soap opera or popular prime time medical show, and while it can certainly be a little over the top, that’s the fun of it. Surgeries are performed in a first-person simulation style, while the rest of the game happens in a more visual novel form. The artwork is really something in Second Opinion, and it’s clear a lot of thought and skill was put into drawing these portraits you’ll be seeing, in order to imbue them with the life that the relative lack of voice acting could not. There are voice clips, yes, but this is a visual game.

The game’s difficulty adds to the narrative tension and gives all of it weight, too. When Second Opinion tells you something is going to be difficult and require precision, it’s not just saying so — the story and adventure bits exist in service to the more action-oriented simulation bits, and very successfully, too. The good news is that this game is easier than Under the Knife, and quite a bit more fair, too. Failure states have been changed from too many “Miss” actions to either running out of time or causing a patient’s vitals to drop to zero. While you might think, in a vacuum, that makes the game too easy, don’t worry: plenty of surgeries are setup so that vitals will drop precipitously and be nearly impossible to raise again unless you successfully perform roughly a dozen actions in a row to get them back up. Like the early GUILT strain that emerges from an organ by causing a series of massive lacerations within it, and then goes back into hiding to prepare to do so again: you need to stitch each of those lacerations up before their existence causes vitals to plummet, raise vitals to protect against the next wave of them auto-killing the patient, find the GUILT using the ultrasound, extract it with the scalpel, and then burn it with the laser… before it all happens again. That’s just what you have to do, regardless of difficulty level.

What changing the difficulty does, for the most part, is make it easier to recover a patient’s vitals. The serum you inject to do this will bring up the vitality bar by more the easier the difficulty you’re playing on. You don’t get to use the Healing Touch more often, nor does it last longer, and GUILT will remain fairly aggressive despite any changes to the challenge. It’s no small thing, though, and being able to jump vitals by twice as much with one injection could be the difference between winning or losing while you’re learning the ropes. Or even stuck late-game.

You can switch the difficulty at any time, too, so feel free to challenge yourself and scale it back when necessary. Completing a stage on one difficulty opens up the next stage on every other difficulty, so you can bounce between Easy, Normal, and Hard at will on the stage select screen. Your rank on a stage only counts for the difficulty on which you completed it, though, so to fully master Second Opinion, you’d need to achieve an S-rank on every Easy and Normal iteration of the procedures, and a rank of XS on the Hard missions. It’ll, uh, take time before you can earn an XS, but that’s the fun of it, and a reason to return to a visual novel medical simulation game that, on the surface, takes just about eight hours to complete the narrative of. Luckily, the game does tell you what you missed out on during your surgery as it breaks down your score, so you can know what you should do — or not do — on repeat plays to improve your rank.

Really, the only issue with Second Opinion is the same problem the rest of the series has: they’ve vanished, both in terms of re-releases and new entries. From 2005 through 2010, Atlus released Under the Knife, Second Opinion, New Blood, Under the Knife 2, and Trauma Team. And since then, there’s been nothing. Granted, the precision necessary to play those games hasn’t always existed on other platforms, but the Wii U was capable of using the Wii Remote and a stylus, so something could have been figured out there for not just porting over Wii games, but also the DS ones, or even with creating something new. The Switch has a touch screen that’s probably not going to be precise enough for what the DS games were like, no, but the Joy Cons are capable of motion when detached from the Switch and can be used as pointers, so another two-controller scheme like that used for the Wii games is entirely possible. And yet, Trauma Team has lain dormant for going on 13 years now.

Sega owns Atlus now, so it’s not like there’s a lack of funding or staffing to get anything like this done. And more niche releases than this have been given a second life in the present, too, so you can’t even really say that the games didn’t perform well enough to justify a re-release. Hell, considering Atlus made five of the things over six years, you’d have to imagine they were doing well enough at retail, otherwise they would have focused their efforts on something else instead. And plus, now they could be re-released digitally if cost and profit really were a concern there.

Sadly, it just seems like these have been sort of lost to the platforms they released on, as too often happens. That could always change over time, especially since Atlus isn’t shy about re-releasing old games and reviving old franchises, but then again we’re this far into the life of the Switch with nothing on that front to show for it. It would be a shame to not see them re-released in some form, as there’s still nothing quite like these games out there, and they more than deserve a second chance.

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