With the unconventional design of the DS, Nintendo suggested that developers would step in and use its technological opportunities to create innovative games and new play experiences. Up to this point, I would say that this prophecy has gone largely unfulfilled. There have been some neat games to be sure, but in my opinion, very few of them have really capitalized on the things that separate the DS from the competition until Trauma Center: Under the Knife came along.
While most DS selections have always-on maps, small extras, or bonus features that use the fancy doodads in Nintendo's little fliptop, Trauma Center, a game that places you in the role of a surgeon, is the first title that I truly felt could not have been pulled off on any other platform.
The DS's stylus (or better yet, a normal-sized one bought at an office store) is a substitute for a range of medical implements; by selecting one from icons located at either side of the screen, the blunt stick can become a scalpel, forceps, a syringe, needle and thread, a roll of gauze, and a few other things as well. It seemed awkward and unfamiliar at first, but within a few minutes I became submerged in the concept and started to see (and feel) a certain quality that I believe could only be achieved by the touchscreen interface.
Stepping into the role of Dr. Derek Stiles, Trauma Center: Under the Knife asked me to actually cut open a person's chest with my own hand, carefully cut away tumors, patch the patient back up, and sew him or her shut. When you boil it down, the tasks themselves aren't really any more radical or innovative than other game concepts in and of themselves, but the fact that you do it by hand and not through a standard controller delivers a tactile, tense sensation analogous to the kind of fragility and finesse that comes during intense twitch games requiring high levels of precision. But, Trauma Center takes it further since the by-hand interface and medical concept are perfectly made for each other and add a level of natural immersion otherwise not achieved.
It's just icing on the cake that the game comes with a clean, attractive presentation and a story that's actually well-written and fairly interesting—a little bit personal, a little bit political, and a little bit science-fiction. Although not packing the amount of plot found in your average role-playing game, the still-frame cutscenes were actually worth reading and enhanced the game playing nicely with solid characters and intelligence.
However, with such attention given to the characters and writing, I have to admit that I was a little bit surprised there wasn't any choice given to players about the direction of story or the dialogue between the doctors and nurses. Instead, each operation happens after a short, linear story interlude and briefing about the upcoming procedure. I can't say that it bothered me too much, but it's something that I would like to see elaborated on if there was ever a sequel since the potential is so clearly there.
My wishes aside, the only real complaint I have against the game is the extremely uneven difficulty curve and unusually high level of challenge. The first few operations are a breeze, but it's not long before hitting what seemed (at the time) to be an insurmountable wall of surgical impossibility.
The science-fiction in the game's story that I mentioned earlier comes into play when it is revealed that medical terrorists are unleashing a powerful, mutative virus called GUILT into the populace. This virus takes on the form of various tiny creatures, so Trauma Center soon becomes less about surgery and more about battling creepy-crawlies inside a body cavity.
I was somewhat disappointed not only because the game became less and less "realistic" as it went on (I found the regular surgeries interesting enough, really), but also because these GUILT levels required a surprisingly high degree of speed and manual dexterity. I eventually learned to cope, but every few missions the game turned coldly punishing. With practice and memorization most of it eventually became passable, but as of the writing of this review, I still have not been able to finish the final surgery of the story. I came close a few times, but after one entire day of attempts I still wasn't able to pull it off.
Between the frustration and stylus-induced tendinitis, I eventually had to put Trauma Center: Under the Knife aside for the sake of both my health and my sanity. Although I'm sure that real surgery takes real skill, I firmly believe that the game would have been better served by lowering the overall difficulty and reserving the steepest challenges as some kind of hardcore extra content. After all, it's hard enough to perform unassisted open-heart surgery—unassisted open-heart surgery versus a regenerating, web-spinning ball of pure evil is going a little bit too far.
Even though I'm a little bitter about the difficulty preventing me from finishing the game, I still view Trauma Center: Under the Knife as one of the most worthwhile purchases for the Nintendo DS. There's nothing else on shelves quite like it, and it's a perfect example of the sort of out-of-the-box thinking that will transform Nintendo's fliptop from an ungraded GameBoy into a true next-generation handheld machine, conceptually as well as physically.